DC20-0129_Proof.pdf (1.82 MB)
Download file

Effects of low-energy diet or exercise on cardiovascular function in working-age adults with type 2 diabetes: a prospective, randomized, open-label, blinded endpoint trial

Download (1.82 MB)
journal contribution
posted on 08.04.2020, 11:55 by Gaurav Gulsin, Daniel Swarbrick, Lavanya Athithan, Brady Emer, Joseph Henson, Emma Baldry, Stavroula Argyridou, Nishal Jaicim, Gareth Squire, Yvette Walters, Anna-Marie Marsh, McAdam John, Kelly Parke, John Biglands, Tom Yates, Kamlesh Khunti, Melanie Davies, Gerry McCann

OBJECTIVE To confirm the presence of subclinical cardiovascular dysfunction in working-age adults with type 2 diabetes (T2D) and determine whether this is improved by a low-energy meal replacement diet (MRP) or exercise training.

RESEARCH DESIGN AND METHODS This article reports on a prospective, randomized, open-label, blinded end point trial with nested case-control study. Asymptomatic younger adults with T2D were randomized 1:1:1 to a 12-week intervention of 1) routine care, 2) supervised aerobic exercise training, or 3) a low-energy (∼810 kcal/day) MRP. Participants underwent echocardiography, cardiopulmonary exercise testing, and cardiac magnetic resonance (CMR) at baseline and 12 weeks. The primary outcome was change in left ventricular (LV) peak early diastolic strain rate (PEDSR) as measured by CMR. Healthy volunteers were enrolled for baseline case-control comparison.

RESULTS Eighty-seven participants with T2D (age 51 ± 7 years, HbA1c 7.3 ± 1.1%) and 36 matched control participants were included. At baseline, those with T2D had evidence of diastolic dysfunction (PEDSR 1.01 ± 0.19 vs. 1.10 ± 0.16 s−1, P = 0.02) compared with control participants. Seventy-six participants with T2D completed the trial (30 routine care, 22 exercise, and 24 MRP). The MRP arm lost 13 kg in weight and had improved blood pressure, glycemia, LV mass/volume, and aortic stiffness. The exercise arm had negligible weight loss but increased exercise capacity. PEDSR increased in the exercise arm versus routine care (β = 0.132, P = 0.002) but did not improve with the MRP (β = 0.016, P = 0.731).

CONCLUSIONS In asymptomatic working-age adults with T2D, exercise training improved diastolic function. Despite beneficial effects of weight loss on glycemic control, concentric LV remodeling, and aortic stiffness, a low-energy MRP did not improve diastolic function.


G.S.G is funded by the British Heart Foundation through a Clinical Research Training Fellowship (FS/16/47/32190). This study was funded by the NIHR Research Trainees Coordinating Centre through a career development fellowship to G.P.M. (CDF 2014-07-045).



Diabetes Care 2020 Mar; dc200129. https://doi.org/10.2337/dc20-0129


AM (Accepted Manuscript)

Published in

Diabetes Care




American Diabetes Association



Acceptance date


Copyright date


Available date


Publisher version




Usage metrics