Reduced endothelial activation after exercise is associated with improved HbA1c in patients with type 2 diabetes and coronary artery disease

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Abstract

Objective:

We have previously reported insignificant changes in HbA1c after exercise in patients with both type 2 diabetes and coronary artery disease. In this study, we investigated the effect of exercise on endothelial function and possible associations between changes in endothelial function and HbA1c.

Methods:

Patients with type 2 diabetes and coronary artery disease (n = 137) were randomised to 12 months exercise or standard follow-up. Endothelial function was assessed by circulating biomarkers (E-selectin, intercellular adhesion molecule-1, vascular cell adhesion molecule-1, von Willebrand factor, tissue plasminogen activator antigen, asymmetric dimethylarginine and L-arginine/asymmetric dimethylarginine ratio). Differences between the randomised groups were analysed by analysis of covariance and correlations by Spearman’s rho or Pearson’s correlation.

Results:

No effect of exercise on endothelial function was demonstrated. The changes in HbA1c in the exercise group correlated with changes in E-selectin (r = 0.56, p < 0.001), intercellular adhesion molecule-1 (r = 0.27, p = 0.052), vascular cell adhesion molecule-1 (r = 0.32, p = 0.022) and tissue plasminogen activator antigen (r = 0.35, p = 0.011). HbA1c decreased significantly more in patients with versus without a concomitant reduction in E-selectin (p = 0.002), intercellular adhesion molecule-1 (p = 0.011), vascular cell adhesion molecule-1 (p = 0.028) and tissue plasminogen activator antigen (p = 0.009).

Conclusion:

Exercise did not affect biomarkers of endothelial function in patients with both type 2 diabetes and coronary artery disease. However, changes in biomarkers of endothelial activation correlated with changes in HbA1c, and reduced endothelial activation was associated with improved HbA1c after exercise.

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