Tip 2 Diyabet Hastalarında Egzersizin Koroner Akım Rezervi ve Biyokimyasal Parametrelere Etkisi

Abstract

Öz (tr) Diyabetik hastalarda en önemli mortalite ve morbidite nedenleri koroner, periferik ve serebrovasküler hastalıklarıdır. Çalışmamızın amacı, iskemi semtomları olmayan tip 2 diyabetli hastalarında transtorasik ekokardiyografi ile epikardiyal koroner arterlerdeki ve mikrovasküler dolaşımdaki disfonksiyonu noninvaziv olarak belirlemek ve 8 haftalık düzenli aerobic egzersizden sonra koroner akım rezervinde artış ile birlikte endotel fonksiyonlarında, glisemik kontrolde ve insülin direncinde iyileşmeyi göstermekti . Çalışmaya İstanbul Tıp Fakültesi Diyabet Anabilim Dalı'nda tip 2 diyabet tanısı almış, diyabet nedeniyle en az üç yıldır takipte olan, iskemik semptomu olmayan 40 hasta ve 20 sağlıklı birey katılmıştır. Egzersiz programına alınan diyabetik hastaların egzersiz öncesi bazal değerleri ile düzenli egzersiz yapmayan diyabetli hastaların bazal değerleri karşılaştırıldı. Fiziksel aktivite diyabetik hastalarda insülin duyarlılığını arttırır ve glukoz metabolizması üzerinde birçok olumlu etkiye sahiptir. Egzersiz obezite ve viseral yağ dokusunu azaltmanın en önemli yoludur. Düzenli egzersizin diyabetin başlamasını erteleyebileceğine ve hatta önleyebileceğine işaret eden kanıtlar vardır.

Keywords

• egzersiz
• koroner akım rezervi
• tip iki diyabetes mellitus

Effects of Exercise On Coronary Flow Reserve And Biochemical Parameters in Patients With Type 2 Diabetes Mellitus

Abstract

The most important mortality and morbidity causes in diabetic patients are coronary, peripheral and cerebral diseases. The aim of our study was to noninvasively determine dysfunction in epicardial coronary arteries and microvascular circulation with measurement of coronary flow reserve using transthoracic echocardiography in patients with type 2 diabetes despite absence of ischemic symptoms, and to demonstrate the amelioration in endothelial functions, glycemic control and insulin resistance along with increase in coronary flow reserve after 8 weeks of regular exercise. 40 patients diagnosed with type 2 diabetes in Istanbul Facuty of Medicine, Department of Diabetes, who were on follow-up for at least three years due to diabetes, without ischemic symptoms and 20 healthy subjects took part in study. Basal values before exercise of diabetic patients who were included in the exercise program were compared with basal values of diabetic patients who did not exercise regularly. To summarize, regular exercise and physical activity are highly important in diabetic patients for primary and secondary protection against cardiovascular incidents. Physical activity increases insulin sensitivity in diabetic patients, and has many positive effects on glucose metabolism. It is the important way to decrease obesity and visceral fat tissue. There is evidence pointing out that regular exercise can defer or even prevent initiation of diabetes.

Keywords

• exercise
• coronary flow rezerve
• type 2 diabetes mellitus

References

1. 1. Gu K, Cowie C, Harris M. Diabetes and decline in heart disease mortality in US adults. JAMA 1999; 281: 1291- 1297.
2. 2. King H, Aubert RE, Herman WH. Global burden of diabetes, prevalance, numerical estimates and projections. Diabetes Care 1999; 21: 1414-1431.
3. 3. Stamler J, Vaccaro O, Neaton JD, Wentworth D. Diabetes, other risk factors, and 12- yr cardiovascular mortality for men screened in the multiple risk factor intervention trial. Daibetes Care 1993; 16: 434-444.
4. 4. Haffner SM, Stern MP, Hazuda HP, Mitchell BD, Patterson JK. Cardiovascular risk factors in confirmed prediabetic inviduals: does the clock for coronary heart disease start tcking before the onset of clinical diabetes JAMA 1990; 263: 2893-2898.
5. 5. Biondi-Zoccai GG, Abbate A, Liuzzo G, Biasucci LM. Atherothrombosis, inflammation, and dia- betes. J Am Coll Cardiol 2003; 41:1071-1077.
6. 6. Willerson JT, Ridker PM. Inflammation as cardiovascular risk factor. Circulation 2004; 109 Suppl 1: II2-10.
7. 7. Arcaro G, Cretti A, Balzano S, Lechi A, Muggeo M, Bonora E, Bonadonna RC. Insulin causes endothelial dysfunction in humans: sites and mechanisms. Circulation 2002; 105: 576-582.
8. 8. Festa A, Agostino Jr, Howard G, Mykkänen L, Tracy RP, Haffner SM. Chronic subclinical inflammation as part of the resistance syndrome: the Insulin Resistance Atherosclerosis Study (IRAS). Circulation 2000; 102: 42-7.

9. 9. Ross R. Atherosclerosis an inflammatory disease. N Engl J Med 1999; 344: 115-26.
10. 10. Rigo F. Coronary flow reserve in stress-echo lab. From pathophysiologic toy to diagnostic tool.Cardiovasc Ultrasound 2005; 3:8.
11. 11. Fein FS. Diabetic cardiomyopathy. Diabetes Care 1990; 13: 1169-79.
12. 12. Ren J, Davidoff AJ. Diabetes rapidly induces contractile dysfunctions in isolated ventricular myocytes. Am J Physiol Heart Circ Physiol 1997; 272: H148-58.
13. 13. Duan J, Zhang HY, Adkins SD, Ren BH, Norby FL, Zhang X, Benoit JN, Epstein PN, Ren J. Impaired cardiac contractile function and IGF- 1 Response in myocytes from calmodulin dia- betic mice: role of Akt and RhoA. Am J Physiol Endocrinol Metab 2003; 284: E366-76.
14. 14. Nojima H, Watanabe H, Yamane K, Kitahara Y, Sekikawa K, Yamamoto H, Yokoyama A, Inamizu T, Asahara T, Kohno N; Hiroshima University Health Promotion Study Group. Effect of aerobic exercise training on oxidative stress in patients with type 2 diabetes mellitus. Metabolism 2008; 57: 170-176.
15. 15. Giugliano D, Ceriello A, Paolisso G. Oxidative stress and diabetic vascular complications. Diabetes Care 1996; 19: 257-67.
16. 16. Baynes JW. Role of oxidative stress indevelopment of complications in diabetes. Diabetes 1991; 40: 405-12.
17. 17. Vanninen E, Uusitupa M, Siitonen O, Laitinen J, Lansimies E. Habitual physical activity, aerobic capacity and metabolic control in patients with newly-diagnosed type 2 (non-insulin dependent) diabetes mellitus: effect of 1-year diet and exercise intervention. Diabetologia 1992; 35: 340-6.
18. 18. Bassuk SS, Manson JE. Epidemiological evidence for the role of physical activity in reducing risk of type 2 diabetes and cardiovascular disease. J Appl Physiol 2005; 99:1193-204.
19. 19. Davies KJ, Quintanilha AT,Brooks GA, Packer L. Free radicals and tissue damage produced by exercise. Biochem Biophys Res Commun 1982; 107: 1198-205.
20. 20. Viguie CA, Frei B, Shigenaga MK, Ames BN, Packer L, Brooks GA. Antioxidant status and indexes of oxidative stress during consecutive days of exercise. J Appl Physiol 1993; 75:566- 72.
21. 21. Albright A, Franz M, Hornsby G, Kriska A, Marrero D, Ullrich I, Verity LS. American College of Sports Medicine position stand. Exercise and type 2 diabetes. Med Sci Sports Exerc 2000; 32: 1345-60. 22. SigalRJ,KennyGP,WassermanDH, Castaneda- Sceppa C. Physical activity/exercise and type 2 diabetes. Diabetes Care 2004; 27:2518-39.
22. 23. Nojimaa H, Watanabea H, Kiminori Y, Yoshihiro K, Kiyokazu S. Effect of aerobic exercise train- ing on oxidative stress in patients with type 2 diabetes mellitus. Metabolism 2008; 57: 170- 176.
23. 24. Ji LL. Antioxidants and oxidative stress in exer- cise. Proc Soc Exp Biol Med 1999; 222: 283- 92.
24. 25. Devlin JT, Hirshman M, Horton ED, Horton ES. Enhanced peripheral and splanchnic insulin sensitivity in NIDDM men after single bout of exercise. Diabetes 1987; 36: 434-9.
25. 26. Urakawa H, Katsuki A, Sumida Y, Gabazza EC, Murashima S, Morioka K, Maruyama N, Kitagawa N, Tanaka T, Hori Y, Nakatani K, Yano Y, Adachi Y. Oxidative stress is associated with adiposity and insulin resistance in men. J Clin Endocrinol Metab 2003; 88: 4673-6.
26. 27. Yokoyama I, Ohtake T, Momomura S, Nishikawa J, Sasaki Y, Omata M. Reduced coronary flow reserve in hypercholesterolemic patients without overt coronary stenosis. Circulation 1996; 94: 3232-8.
27. 28. Nemes A, Lengyel C, Forster T, Várkonyi TT, Takács R, Nagy I, Kempler P, Lonovics J, Csanády M. Coronary flow reserve, insulin resistance and blood pressure response to standing in patients with normoglycaemia: is there a relationship? Diabet Med 2005; 22: 1614-1618.
28. 29. Paranicas M, O’grady MJ, Welty TK, Robbins DC, Fabsitz RR,HowardBV,Lee ET.Relationship of impaired glucose tolerance to left ventricular structure and function. Am Heart J 2001; 141: 992-8.
29. 30. Sung J, Ouyang P, Bacher AC, Turner KL, DeRegis JR, Hees PS, Silber HA, Shapiro EP, Stewart KJ. Peripheral endothelium-depen- dent flow-mediated vasodilatation is associated with left ventricular mass in older persons with hypertension. Am Heart J 2002; 144: 39- 44.
30. 31. Davis CL, Kapuku G, Snieder H, Kumar M, Treiber FA. İnsülin resistance syndrome and lef ventricular mass in healthy young people. Am J Med 2008; 324: 72-75.
31. 32. Festa A, D’Agostino R Jr, Howard G, Mykkänen L, Tracy RP, Haffner SM. Chronic inflammation as port of the insülin resistance syndrome: Insülin Resistance Atherosclerosis Study (IRAS). Circulation 2000; 102: 42-47. 33. Folsom AR. Epidemiology of fibrinogen. Eur Heart J 1995; 16: 21-24.
32. 34. Stratton JR, Chandler WL, Schwartz RS, Cerqueira MD, Levy WC, Kahn SE, Larson VG, Cain KC, Beard JC, Abrass IB. Effects of physical conditioning on fibrinolytic variables in young and healthy adults. Circulation 1991; 83: 1692-1697.
33. 35. Geus EJ, Kluft C, de-Bart AC, van Doornen LJ. Effects of exercise training on plasminogen activator inhibitor activitiy. Med Sci Sports Exerc 1992; 24: 1210-1219
34. 36. Krug LM, Haire-Joshu D, Heady SA. Exercise habits and exercise relapse in persons with non–insulin-dependent diabetes mellitus. Diabetes Educ 1991; 17: 185-8.
35. 37. Dunstan DW, Mori TA, Puddey IB, Beilin LJ, Burke V, Morton AR, Stanton KG. A rando- mised, controlled study of the effects of aero- bic exercise and dietary fish on coagulation and fibrinolytic factors intype 2 diabetics. Thromb Haemost 1999; 81: 367-72. 38. Cortigiani L, Bombardini T, Corbisiero A, Mazzoni A, Bovenzi F, Picano E. The additive prognostic value of end-systolic pressure-vol- ume relation in patients with diabetes mellitus having negative dobutamine stress echocar- diography by wall motion criteria. Heart 2009; 95: 1429-35.
36. 39. Sixt S, Beer S, Blüher M, Korf N. Long but not short-term multifactorial intervention with fo- cus on exercise training improves coronaryen- dothelial dysfunction in diabetes mellitus type 2 and coronary artery disease.
37. 40. Eur Heart J 2010; 31: 112-119 Hu G, Lindstrom J, Zinman B. Fuel homeosta- sis. In: Ruderman N, Devlin JT, editors. The healts professional’s guide to diabetes and ex- ercise. Amercican Diabetes Association 1995 pp. 29-47.