Impact of modified glucose target and exercise interventions on vascular risk factors

Potent glucose-lowering medications other than metformin may impede weight loss in type 2 diabetes (T2D). Supervised exercise programs improve glycemic control without significantly enhancing weight loss; their impact on fitness and blood pressure in T2D remains unclear. In this pilot study, 42 type 2 diabetes patients were randomized to (i) liberalized (10mmol/l) OR strict (7mol/l) preprandial glucose thresholds for adjustment of medication other than metformin and (ii) dietary counseling with OR without supervised exercise (2×2 factorial design). Weight (−1.2% versus −0.3%, p=0.38) and hemoglobin A1C changes (−0.8% versus 0%, p=0.37) were similar for glucose threshold-defined groups. Dietary counseling with supervised exercise participants had greater improvement in mean arterial pressure than those not randomized to an exercise program (−3.3% versus 1.1%, p=0.02). Overall weight (−1.5% versus 0%, p=0.06) and fitness changes (5.4% versus 1.5%, p=0.18) were not significantly different between these groups, but weight (−1.6% versus 0%, p=0.03) and fitness changes (21.3% versus 1.5%, p=0.03) were significantly greater among those who attended ≥75% of exercise classes. Liberalizing preprandial thresholds neither enhances weight loss nor compromises hemoglobin A1C. T2D patients who consistently participate in supervised exercise programs may experience modest weight loss and significant improvements in fitness and blood pressure.