[Specific factors of diabetes in the rehabilitation of coronary patients].
This prospective controlled trial included two groups of subjects with coronary artery disease: one of 33 patients with non-insulin-dependent diabetes mellitus (6 females and 27 males, mean age 57 +/- 9 years, left ventricular ejection fraction of 56 +/- 14%) and the control group of 33 subjects without diabetes (3 females and 33 males, mean age of 57 +/- 11 years, LVEF of 58 +/- 11%). Before training heart rate was faster for patients with diabetes at rest (72 +/- 11 vs 66 +/- 81 bpm, p = 0.03) and at the end of the stress test (127 +/- 15 versus 118 +/- 18 bpm, p = 0.03). After rehabilitation, resting heart rate and peak heart rate were similar. However cardiovascular capacities improvement was better in subjects without diabetes mellitus, especially concerning peak VO2 (28.98 +/- 8.88 versus 22.78 +/- 6.28 mL/min/kg, p < 0.01) and mechanical power (138 +/- 48 versus 118 +/- 23 watts, p < 0.01). Two groups were retrospectively distinguished among diabetic patients: one group of 17 patients showing a VO2 improvement superior to 5% and a second group non improved (VO2 < 5%). For the second group the two selective factors were higher fasting glycemia (1.83 +/- 0.75 versus 1.31 +/- 0.38 g/L, p = 0.01) and higher hemoglobin A1C (8.05 +/- 2.04 vs 6.62 +/- 1.03%, p = 0.02). Heart rate variability was not significantly different for these two groups: changes in autonomic nervous system cannot explain resistance of diabetic subjects to training. On the other hand, principal aim must be the equilibrium of glycemia in the management of diabetes.
Lucas
B
B
Unité de réadaptation cardiovasculaire, CHU de Dijon.
Casillas
J M
JM
Vergès
B
B
Cottin
Y
Y
Patois-Vergès
B
B
Wolf
J E
JE
Louis
P
P
D000368:Aged; D003924:Diabetes Mellitus, Type 2 / Q000150:complications* / Q000503:physiopathology; D005080:Exercise Test; D005260:Female; D006339:Heart Rate / Q000502:physiology*; D006801:Humans; D007003:Hypoglycemia / Q000150:complications; D008297:Male; D008875:Middle Aged; D010101:Oxygen Consumption; D011446:Prospective Studies; D016896:Treatment Outcome; D018487:Ventricular Dysfunction, Left / Q000534:rehabilitation*