title: Influence of glycemic control on gain in VO2 peak, in patients with type 2 diabetes enrolled in cardiac rehabilitation after an acute coronary syndrome. The prospective DARE study.
abstract: BACKGROUND
  Gain in VO2 peak after cardiac rehabilitation (CR) following an acute coronary syndrome (ACS), is associated with reduced mortality and morbidity. We have previously shown in CR, that gain in VO2 peak is reduced in Type 2 diabetic patients and that response to CR is impaired by hyperglycemia.
  
  
  METHODS
  We set up a prospective multicenter study (DARE) whose primary objective was to determine whether good glycemic control during CR may improve the gain in VO2 peak. Sixty four type 2 diabetic patients, referred to CR after a recent ACS, were randomized to insulin intensive therapy or a control group with continuation of the pre-CR antidiabetic treatment. The primary objective was to study the effect of glycemic control during CR on the improvement of peak VO2 by comparing first the 2 treatment groups (insulin intensive vs. control) and second, 2 pre-specified glycemic control groups according to the final fructosamine level (below and above the median).
  
  
  RESULTS
  At the end of the CR program, the gain in VO2 peak and the final fructosamine level (assessing glycemic level during CR) were not different between the 2 treatment groups. However, patients who had final fructosamine level below the median value, assessing good glycemic control during CR, showed significantly higher gain in VO2 peak (3.5 ± 2.4 vs. 1.7 ± 2.4 ml/kg/min,p = 0.014) and ventilatory threshold (2.7 ± 2.5 vs. 1.2 ± 1.9 ml/kg/min,p = 0.04) and a higher proportion of good CR-responders (relative gain in VO2 peak ≥ 16 %): 66 % vs. 36 %, p = 0.011. In multivariate analysis, gain in VO2 peak was associated with final fructosamine level (p = 0.010) but not with age, gender, duration of diabetes, type of ACS, insulin treatment or basal fructosamine.
  
  
  CONCLUSIONS
  The DARE study shows that, in type 2 diabetes, good glycemic control during CR is an independent factor associated with gain in VO2 peak. This emphasizes the need for good glycemic control in CR for type 2 diabetic patients.
  
  
  BACKGROUND
  Trial registered as NCT00354237 (19 July 2006).
authors.affiliation: Service endocrinologie, diabétologie, CHU Le Bocage, 21000, Dijon, France. bruno.verges@chu-dijon.fr.
authors.forename: Bruno
authors.initials: B
authors.lastname: Vergès
authors.affiliation: Unité de réadaptation cardiaque, Clinique Les Rosiers, Dijon, France. benedicteverges@gmail.com.
authors.forename: Bénédicte
authors.initials: B
authors.lastname: Patois-Vergès
authors.affiliation: Service réadaptation cardiaque, Hôpital Corentin Celton, Issy les Moulineaux, France. marie-christine.iliou@ccl.aphp.fr.
authors.forename: Marie-Christine
authors.initials: MC
authors.lastname: Iliou
authors.affiliation: Service endocrinologie, diabétologie, CHU Le Bocage, 21000, Dijon, France. isabelle.simoneau@chu-dijon.fr.
authors.forename: Isabelle
authors.initials: I
authors.lastname: Simoneau-Robin
authors.affiliation: Unité de réadaptation cardiaque, Clinique du Lavarin, Avignon, France. jhbertrand@wanadoo.fr.
authors.forename: Jean-Henri
authors.initials: JH
authors.lastname: Bertrand
authors.affiliation: Unité de réadaptation cardiaque, Clinique du Lavarin, Avignon, France. jeanmichelfeige@yahoo.fr.
authors.forename: Jean-Michel
authors.initials: JM
authors.lastname: Feige
authors.affiliation: Service réadaptation cardiaque, Hôpital du Haut Lévêque, Pessac, France. herve.douard@chu-bordeaux.fr.
authors.forename: Hervé
authors.initials: H
authors.lastname: Douard
authors.affiliation: Service endocrinologie, diabétologie, Hôpital du Haut Lévêque, Pessac, France. bogdan.catargi@chu-bordeaux.fr.
authors.forename: Bogdan
authors.initials: B
authors.lastname: Catargi
authors.affiliation: URCA, Bordeaux, France. dr.mfischbach@bordeauxnord.com.
authors.forename: Michel
authors.initials: M
authors.lastname: Fischbach
mesh_terms: D054058:Acute Coronary Syndrome / Q000150:complications / Q000534:rehabilitation*; D000368:Aged; D001786:Blood Glucose / Q000378:metabolism; D003924:Diabetes Mellitus, Type 2 / Q000150:complications / Q000188:drug therapy* / Q000378:metabolism; D005081:Exercise Therapy / Q000379:methods*; D005260:Female; D019270:Fructosamine / Q000378:metabolism; D006442:Glycated Hemoglobin / Q000378:metabolism; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use*; D061267:Insulin Aspart / Q000627:therapeutic use*; D000069036:Insulin Glargine / Q000627:therapeutic use*; D008297:Male; D008687:Metformin / Q000627:therapeutic use; D008875:Middle Aged; D010101:Oxygen Consumption; D011659:Pulmonary Gas Exchange; D012123:Pulmonary Ventilation; D016896:Treatment Outcome
chemical_list: D001786:Blood Glucose; D019270:Fructosamine; D006442:Glycated Hemoglobin; D007004:Hypoglycemic Agents; D061267:Insulin Aspart; D000069036:Insulin Glargine; D008687:Metformin; C517652:hemoglobin A1c protein, human