Evaluación de un programa de ejercicio físico supervisado en pacientes sedentarios mayores de 65 años con diabetes mellitus tipo 2 / Evaluation of a supervised physical exercise program in sedentary patients over 65 years with type 2 diabetes mellitus

OBJETIVO: Analizar si un programa de ejercicio físico (EF) modifica la hemoglobina glucosilada (HbA1c), la presión arterial (PA), el índice de masa corporal (IMC), la lipidemia, el riesgo cardiovascular (RCV), el estado de salud autopercibido (ESA) y el gasto farmacéutico (GF). DISEÑO: Ensayo clínico aleatorizado controlado, simple ciego. Intervención: programa de EF aeróbico supervisado. Análisis por intención de tratar. Emplazamiento: Atención primaria: 2 zonas de salud rurales. Área Salud Navalmoral, Cáceres, Servicio Extremeño de Salud. PARTICIPANTES: Cien diabéticos tipo 2, de 65-80 años, sedentarios; 50% grupo control (GC), 50% grupo intervención (GI). Abandonos: 12%. Intervención: EF aeróbico supervisado: 50 min, 2 días/semana, 3 meses. MEDICIONES PRINCIPALES: : HbA1c, PA, IMC, lipidemia, RCV, ESA, GF, complicaciones durante EF. RESULTADOS: Diferencias postintervención entre grupos en HbA1c, PA, IMC, colesterol y ESA. En GI disminución de HbA1c: 0,2 ± 0,4% (IC del 95%, 0,1 a 0,3); PA sistólica: 8,5 ± 11,8 mmHg (IC del 95%, 5,1 a 11,9); IMC: 0,5 ± 1 (IC del 95%, 0,2 a 0,8); colesterol: 14 ± 28,2 mg/dl (IC del 95%, 5,9 a 22,2); LDL: 18,3 ± 28,2 mg/dl (IC del 95%, 10,2 a 26,3), RCV: 6,7 ± 7,7% (IC del 95%, 4,5 a 8,9), GF: 3,9 ± 10,2 Euros (IC del 95%, 0,9 a 6,8) y aumento del ESA: 4,7 ± 5,7 (IC del 95%, 3 a 6,3). CONCLUSIONES: En diabéticos mayores de 65 años un programa de EF aeróbico supervisado de fácil ejecución mejora la HbA1c, la PA, la colesterolemia, el RCV, el GF y el ESA

OBJECTIVE: To analyze whether an exercise program can modify glycated hemoglobin (HbA1c), blood pressure (BP), body mass index (BMI), lipids, cardiovascular risk profile (CVR), self-perceived health status (SHS), and pharmaceutical expenditure (PE). DESIGN: A randomized, single blind, controlled trial. Intervention: program of supervised aerobic physical exercise. Analysis by intention to treat. LOCATION: Primary Care: 2 rural health areas. Health Area of Navalmoral. Cáceres. Extremadura. Spain. PARTICIPANTS: 100 type 2 diabetic patients, aged 65 to 80 years, sedentary. Distribution: 50% control group (CG) and 50% intervention group (IG). Abandoned 12%. Intervention: monitored aerobic exercise: 40 minutes, 2 days/week, 3 months. Key measures: HbA1c, BP, BMI, lipid, CVR, SHS, PE.complications during exercise. RESULTS: There were post-intervention differences between groups in HbA1c, BP, BMI, cholesterol and SHS. In the IG, there was a significant decrease in; HbA1c: 0.2 ± 0.4% (95% CI: 0.1 to 0.3), systolic BP: 11.8 ± 8.5 mmHg (95% CI: 5.1 to 11.9), BMI: 0.5 ± 1 (95% CI: 0.2 to 0.8), total cholesterol: 14 ± 28.2 mg/dl (95% CI: 5.9 to 22.2), LDL: 18.3 ± 28.2 mg/dl 95% CI: 10.2 to 26.3), CVR: 6.7 ± 7.7% (95% CI: 4.5 to 8.9), PE: 3.9 ± 10.2 Euros (95% CI: 0.9 to 6.8), and an increase in SHS; 4.7 ± 5.7 (95% CI: 3 to 6.3). CONCLUSIONS: In diabetics over 65 years, a program of monitored aerobic exercise, of easy implementation, improves HbA1c, BP, cholesterol, CVR, PE, and SHS

[Evaluation of a supervised physical exercise program in sedentary patients over 65 years with type 2 diabetes mellitus]. / Evaluación de un programa de ejercicio físico supervisado en pacientes sedentarios mayores de 65 años con diabetes mellitus tipo 2.

OBJECTIVE: To analyze whether an exercise program can modify glycated hemoglobin (HbA1c), blood pressure (BP), body mass index (BMI), lipids, cardiovascular risk profile (CVR), self-perceived health status (SHS), and pharmaceutical expenditure (PE). DESIGN: A randomized, single blind, controlled trial. INTERVENTION: program of supervised aerobic physical exercise. Analysis by intention to treat. LOCATION: Primary Care: 2 rural health areas. Health Area of Navalmoral. Cáceres. Extremadura. Spain. PARTICIPANTS: 100 type 2 diabetic patients, aged 65 to 80 years, sedentary. Distribution: 50% control group (CG) and 50% intervention group (IG). Abandoned 12%. INTERVENTION: monitored aerobic exercise: 40minutes, 2 days/week, 3 months. KEY MEASURES: HbA1c, BP, BMI, lipid, CVR, SHS, PE. Complications during exercise. RESULTS: There were post-intervention differences between groups in HbA1c, BP, BMI, cholesterol and SHS. In the IG, there was a significant decrease in; HbA1c: 0.2±0.4% (95% CI: 0.1 to 0.3), systolic BP: 11.8±8.5mmHg (95% CI: 5.1 to 11.9), BMI: 0.5±1 (95% CI: 0.2 to 0.8), total cholesterol: 14±28.2mg/dl (95% CI: 5.9 to 22.2), LDL: 18.3±28.2mg/dl 95% CI: 10.2 to 26.3), CVR: 6.7±7.7% (95% CI: 4.5 to 8.9), PE: 3.9±10.2 € (95% CI: 0.9 to 6.8), and an increase in SHS; 4.7±5.7 (95% CI: 3 to 6.3). CONCLUSIONS: In diabetics over 65 years, a program of monitored aerobic exercise, of easy implementation, improves HbA1c, BP, cholesterol, CVR, PE, and SHS.

A new tool to assess retinal vessel caliber. Reliability and validity of measures and their relationship with cardiovascular risk.

OBJECTIVE: To analyze the reliability and validity of a semiautomated tool for assessing retinal vessel caliber and to describe the relationship of measures taken to cardiovascular risk and target organ damage. METHODS: A total of 210 patients aged 34-75 years were selected with retinography. Retinal photographs were digitized, and superior and inferior temporal vessels were measured in an area 0.5-1 disk diameter from the optic disc with semiautomated software [arteriole/venule index (AVIx) calculator]. AVIx was also estimated. Vascular damage was assessed using carotid intima-media thickness and pulse wave velocity, cardiac damage using Cornell voltage-duration product, renal damage using the glomerular filtration rate and microalbuminuria, and cardiovascular risk with the Framingham score. RESULTS: Interobserver intraclass correlation coefficient (ICC) ranged from 0.96 [95% confidence interval (CI) 0.94-0.97] to 0.99 (95% CI 0.98-0.99), and intraobserver ICC ranged from 0.97 (95% CI 0.94-0.98) to 0.99 (95% CI 0.99-0.99). In the Bland-Altman plot, the limit of interobserver agreement was -0.009 (0.066 to -0.086) in right AVIx and -0.001 (0.083 to -0.085) in left AVIx, whereas the limit of intraobserver agreement for overall AVIx was -0.005 (-0.057 to -0.047). Cardiovascular risk and albumin-creatinine ratio were higher in the first tertile of AVIx as compared with the other two (P < 0.05). In multiple regression, AVIx and venule caliber, but not artery caliber, behaved as predictors of cardiovascular risk and microalbuminuria. CONCLUSION: This tool showed a high intraobserver and interobserver reliability, and results of the validity analysis agree with those from large studies in estimation of cardiovascular risk and evaluation of target organ damage.

Relationship between ambulatory arterial stiffness index and subclinical target organ damage in hypertensive patients.

Increased arterial stiffness has been shown to predict cardiovascular risk in hypertensive patients. Our objective was to evaluate the relationship between the ambulatory arterial stiffness index (AASI) and subclinical organ damage (SOD). The design was a cross-sectional study. Subjects included 554 hypertensive patients with and without drug treatment (mean age 57±12 years, 60.6% men). The AASI was defined as 1 minus the regression slope of diastolic over systolic blood pressure (BP) readings obtained from 24-h recordings. Renal damage was evaluated on the basis of glomerular filtration rate (GFR) and microalbuminuria; vascular damage was measured by carotid intima-media thickness (IMT) and ankle/brachial index (ABI); and cardiac damage was evaluated on the basis of the Cornell voltage-duration product (VDP) and left ventricular mass index. The mean AASI was 0.38±0.07 (0.39±0.07 in treated patients and 0.37±0.06 in nontreated subjects). The AASI showed a positive correlation with IMT (r=0.417, P<0.001) and Cornell VDP (r=0.188, P<0.001), and a negative correlation with GFR (r=-0.205, P=0.001) and the ABI. The variables associated with the presence of SOD were AASI (odds ratio (OR)=3.89) and smoking (OR=1.55). The variables associated with IMT were smoking and waist circumference, whereas those associated with GFR were AASI, body mass index and waist circumference. In turn, smoking, total cholesterol and glycosylated hemoglobin A1c were associated with the ABI. Increased AASI implies a greater presence of SOD in primary hypertensive patients with or without BP-lowering drug treatment.