PMID- 32007295 OWN - NLM STAT- MEDLINE DCOM- 20200707 LR - 20221207 IS - 1942-5546 (Electronic) IS - 0025-6196 (Linking) VI - 95 IP - 3 DP - 2020 Mar TI - Dose-Response Effects of Exercise on Glucose-Lowering Medications for Type 2 Diabetes: A Secondary Analysis of a Randomized Clinical Trial. PG - 488-503 LID - S0025-6196(19)30798-0 [pii] LID - 10.1016/j.mayocp.2019.09.005 [doi] AB - OBJECTIVE: To investigate whether a dose-response relationship exists between volume of exercise and discontinuation of glucose-lowering medication treatment in patients with type 2 diabetes. PATIENTS AND METHODS: Secondary analyses of a randomized controlled exercise-based lifestyle intervention trial (April 29, 2015 to August 17, 2016). Patients with non-insulin-dependent type 2 diabetes were randomly assigned to an intensive lifestyle intervention (U-TURN) or standard-care group. Both groups received lifestyle advice and objective target-driven medical regulation. Additionally, the U-TURN group received supervised exercise and individualized dietary counseling. Of the 98 randomly assigned participants, 92 were included in the analysis (U-TURN, n=61, standard care, n=31). Participants in the U-TURN group were stratified into tertiles based on accumulated volumes of exercise completed during the 1-year intervention. RESULTS: Median exercise levels of 178 (interquartile range [IQR], 121-213; lower tertile), 296 (IQR, 261-310; intermediate tertile), and 380 minutes per week (IQR, 355-446; upper tertile) were associated with higher odds of discontinuing treatment with glucose-lowering medication, with corresponding odds ratios of 12.1 (95% CI, 1.2-119; number needed to treat: 4), 30.2 (95% CI, 2.9-318.5; 3), and 34.4 (95% CI, 4.1-290.1; 2), respectively, when comparing with standard care. Cardiovascular risk factors such as glycated hemoglobin A(1c) levels, fitness, 2-hour glucose levels, and triglyceride levels were improved significantly in the intermediate and upper tertiles, but not the lower tertile, compared with the standard-care group. CONCLUSION: Exercise volume is associated with discontinuation of glucose-lowering medication treatment in a dose-dependent manner, as are important cardiovascular risk factors in well-treated participants with type 2 diabetes and disease duration less than 10 years. Further studies are needed to support these findings. STUDY REGISTRATION: ClinicalTrials.gov registration (NCT02417012). CI - Copyright (c) 2019 Mayo Foundation for Medical Education and Research. Published by Elsevier Inc. All rights reserved. FAU - MacDonald, Christopher S AU - MacDonald CS AD - Centre of Inflammation and Metabolism and the Centre for Physical Activity Research, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark; CopenRehab, Department of Public Health, University of Copenhagen, Copenhagen, Denmark. Electronic address: chmd@sund.ku.dk. FAU - Johansen, Mette Y AU - Johansen MY AD - Centre of Inflammation and Metabolism and the Centre for Physical Activity Research, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark. FAU - Nielsen, Sabrina M AU - Nielsen SM AD - Research Unit of Rheumatology, Department of Clinical Research, University of Southern Denmark, Odense University Hospital; Musculoskeletal Statistics Unit, The Parker Institute, Bispebjerg and Frederiksberg Hospital, Denmark. FAU - Christensen, Robin AU - Christensen R AD - Research Unit of Rheumatology, Department of Clinical Research, University of Southern Denmark, Odense University Hospital; Musculoskeletal Statistics Unit, The Parker Institute, Bispebjerg and Frederiksberg Hospital, Denmark. FAU - Hansen, Katrine B AU - Hansen KB AD - Centre of Inflammation and Metabolism and the Centre for Physical Activity Research, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark. FAU - Langberg, Henning AU - Langberg H AD - CopenRehab, Department of Public Health, University of Copenhagen, Copenhagen, Denmark. FAU - Vaag, Allan A AU - Vaag AA AD - AstraZeneca, Early Clinical Development, Cardiovascular, Renal and Metabolic Research, Molndal, Sweden. FAU - Karstoft, Kristian AU - Karstoft K AD - Centre of Inflammation and Metabolism and the Centre for Physical Activity Research, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark. FAU - Lieberman, Daniel E AU - Lieberman DE AD - Department of Human Evolutionary Biology, Harvard University, Cambridge, MA. FAU - Pedersen, Bente K AU - Pedersen BK AD - Centre of Inflammation and Metabolism and the Centre for Physical Activity Research, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark. FAU - Ried-Larsen, Mathias AU - Ried-Larsen M AD - Centre of Inflammation and Metabolism and the Centre for Physical Activity Research, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark. LA - eng SI - ClinicalTrials.gov/NCT02417012 PT - Journal Article PT - Randomized Controlled Trial PT - Research Support, Non-U.S. Gov't DEP - 20200130 PL - England TA - Mayo Clin Proc JT - Mayo Clinic proceedings JID - 0405543 RN - 0 (Biomarkers) RN - 0 (Blood Glucose) RN - 0 (Glycated Hemoglobin A) RN - 0 (Hypoglycemic Agents) SB - IM MH - Biomarkers/blood MH - Blood Glucose/analysis MH - Diabetes Mellitus, Type 2/drug therapy/*therapy MH - *Exercise MH - Female MH - Glycated Hemoglobin/analysis MH - Humans MH - Hypoglycemic Agents/*administration & dosage MH - Life Style MH - Male MH - Middle Aged MH - Physical Fitness EDAT- 2020/02/03 06:00 MHDA- 2020/07/08 06:00 CRDT- 2020/02/03 06:00 PHST- 2019/06/14 00:00 [received] PHST- 2019/08/23 00:00 [revised] PHST- 2019/09/03 00:00 [accepted] PHST- 2020/02/03 06:00 [pubmed] PHST- 2020/07/08 06:00 [medline] PHST- 2020/02/03 06:00 [entrez] AID - S0025-6196(19)30798-0 [pii] AID - 10.1016/j.mayocp.2019.09.005 [doi] PST - ppublish SO - Mayo Clin Proc. 2020 Mar;95(3):488-503. doi: 10.1016/j.mayocp.2019.09.005. Epub 2020 Jan 30.