240: Significant improvement of VO2 peak, after myocardial infarction, in type 2 diabetes when glycemic level is well controlled during cardiac rehabilitation. The DARE Study

Abstract

It is well known that gain in VO2 peak, after cardiac rehabilitation (CR), is associated with reduced mortality and morbidity. We have previously shown that the VO2 peak improvement in CR, after myocardial infarction (MI), is significantly lower in Type 2 diabetic (T2D) patients and that response to CR seems to be impaired by poor glycemic control. Thus, we set up a prospective multicenter study (DARE Study) in order to determine whether good glycemic control during CR may improve the gain in VO2 peak. Fifty six T2D patients referred to CR after MI were randomized in an intensive treatment group (basal-bolus insulin) or in a control group (usual treatment). Fructosamine at the end of the CR program was used to assess mean glycemic level during the CR period. For the whole diabetic population studied, mean gain in VO2 peak after CR was 2.7±2.4 ml/kg/min. Gain in VO2 Peak after CR was negatively correlated with basal (r=-0.32, p<0.05) and final fructosamine (r=-0.36, p=0.01) and with basal (r=−0.36, p<0.05) and final HbA1c (r=-0.34, p<0.05). At the end of the CR program, the gain in VO2 peak and the reduction in mean fructosamine were not significantly different between the 2 treatment groups. But, patients with final fructosamine below the median value showed significantly higher gain in VO2 peak (3.5±2.5 vs.1.7±2.4 ml/kg/min, p=0.014). In multivariate analysis gain in VO2 peak was associated with final fructosamine (p=0.019) but not with age, gender, duration of diabetes, MI location, insulin treatment or basal fructosamine. In conclusion, the DARE study shows that fructosamine at the end of the CR-program is an important determinant of gain in VO2 peak in T2D patients and that good glycemic control in CR is associated with significantly better gain in VO2 peak, independent of the treatment used (insulin or not). These data indicate that good glycemic control of type 2 diabetes in CR, after MI, is mandatory in order to get optimal gain in VO2 peak.