Effects of Aerobic Exercise in Patients With Pre-diabetes
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ClinicalTrials.gov Identifier: NCT01860599 |
Recruitment Status
:
Completed
First Posted
: May 23, 2013
Last Update Posted
: July 17, 2014
|
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Condition or disease | Intervention/treatment | Phase |
---|---|---|
Prediabetes | Behavioral: Exercise Behavioral: Without exercise | Not Applicable |
- To refine a non-invasive test for endothelial dysfunction. The investigators will examine the flow response to sheer-stress induced by the relief of pressure exerted with a blood pressure cuff on the brachial artery, measuring flow responses with Doppler. This is a measure of local nitric oxide production from endothelial cells which is known to be impaired in diabetics, normal in non-diabetics, but unknown in prediabetics.
- To measure in the same individuals indicators of glucose metabolism abnormalities including fasting blood glucose, HbA1C, insulin sensitivity by homeostasis model assessment-estimated insulin resistance (HOMA-IR) and insulin levels.
- To measure Endothelial Progenitor Cell (EPC) count, viability, gene expression of key genes such as endothelial nitric oxide synthase (eNOS), von-Willebrand's Factor (vWF) and adhesion molecules such platelet-endothelial cell adhesion molecule-1 (PECAM-1 or CD31), cadherin such as Vascular-Endothelial cadherin (VE-cadherin)or CD (cell surface marker)-144, growth factors such as vascular-endothelial growth factor (VEGF)and Insulin like growth factor (IGF-1)in the EPCs from pre-diabetes subjects pre and post exercise.
- Correlate the glucose metabolism abnormalities with potential causative factors of endothelial dysfunction by studying EPC functions such as migration and tube formation and susceptibility to apoptosis in moderate hyperglycemia. Apoptosis assay will be done by Flow Cytometry analysis using Annexin V- Propidium-iodide dye.
- Subjects will be randomized to the intervention (structured exercise) or continuation of their usual life style (non-exercise, sedentary)group.
In both arms of the study, subjects will be encouraged to adhere to the standard dietary advice that all pre-diabetic patients receive as part of their standards of care, irrespective of design arm they will be in.
The investigators expect exercise to improve flow-mediated vasodilatation, EPC colony count and function, along with better key gene expressions noted by Real Time-qualitative polymerase chain reaction (PCR).
- Assess the effects of the intervention comparing them to the findings in each individual, in a paired manner.
- After a washout period, individuals will be crossed over to see whether the effects of the intervention are reversed and to demonstrate that the difference between controls and intervention subjects was due to the aerobic exercise intervention, and not due to random differences
Study Type : | Interventional (Clinical Trial) |
Estimated Enrollment : | 30 participants |
Allocation: | Randomized |
Intervention Model: | Crossover Assignment |
Masking: | Single (Outcomes Assessor) |
Primary Purpose: | Prevention |
Official Title: | The Effect of Controlled Aerobic Exercise on Endothelial Dysfunction and Vascular Reactivity in Patients With Pre-diabetes: A Crossover Pilot Study |
Study Start Date : | March 2010 |
Actual Primary Completion Date : | May 2013 |
Actual Study Completion Date : | May 2013 |
Arm | Intervention/treatment |
---|---|
Prediabetes with exercise
150 minutes of moderate exercise per week
|
Behavioral: Exercise
150 minutes of moderate exercise per week
|
Prediabetes without exercise
Pre-study activity level (i.e. no exercise)
|
Behavioral: Without exercise
Pre-study activity level (i.e. no exercise)
|
- Measures of Endothelial Function by studying number, function and gene expression of endothelial progenitor cells (identified as CD34+ cells) [ Time Frame: 16 weeks per patient ]A. Number of viable CD34 +ve cells at Day-0 and viability assay. B. Colony Formation count assay at Day-5, pre and post exercise. C. We will test CD34+ cell migration, adhesion and tube formation properties. D. Gene expression in CD34+ cells of critical endothelial function and inflammatory genes will be measured: eNOS, vWF and PECAM1, VE-cadherin, VEGF-A, Superoxide dismutase (SOD)-1, 2 and 3, Catalase, Interleukin (IL)-6, Tumor Necrosis Factor (TNF alpha), P53, P21, PUMA, Bcl2 [Apoptosis genes] will also be noted
- Measures of Vacular Reactivity [ Time Frame: 16 weeks ]A) Measure Brachial reactivity through shear-stress using flow mediated dilatation (FMD) B). Measure Arterial Stiffness measure pre and post exercise. C) Measure Carotid Intima Media Thickness will be measured at each time point
- Measures of Insulin Sensitivity by measuring inflammatory molecules as a surrogate of insulin resistance [ Time Frame: 16 weeks ]
We will measure:
A. plasma measurements of cytokines, including C - reactive protein, E-selectin, IL-6, IL-10, thrombin, leptin, adiponectin, fasting glucose, fasting insulin and fasting lipid profile from subjects are expected to reflect endothelial inflammation.
B. Insulin sensitivity will be evaluated at baseline and weeks 6, 10 and16 using the HOMA ratio, calculated from individual serum measures (fasting glucose* insulin/405) C.Adiposity will be measured at baseline and at weeks 6, 10, and 16 using the Tanita Body Composition Analyzer scale, measured as percentage body fat D. Resting energy expenditure as measures of indirect calorimetry for basal metabolic rate measures (BMR).

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Ages Eligible for Study: | 20 Years to 70 Years (Adult, Senior) |
Sexes Eligible for Study: | All |
Accepts Healthy Volunteers: | No |
Inclusion Criteria:
-
Prediabetic
- Impaired fasting glucose (100-125mg/dl)
- Impaired glucose tolerance (2' post between 140-199mg/dl)
- HbA1C 5.7-6.4 mg/d (inclusive)
- Exercise Naive
- BMI between 20-39.9
- Nutritional Counseling prior to participation with CDE/RD
- Willing to wear activity monitor
- Willing to keep a dietary log
Exclusion Criteria:
- Pace maker or other implanted device that might have interference with Tanita scale
- Any contraindication to moderate exercise
- Previous coronary disease or cerebrovascular event active or clinically significant coronary vascular disease, or peripheral vascular disease
- Diabetes
- Uncontrolled hypertension (SBP > 140 or DBP > 90 on 3 separate occasions) ACE's or ARB's
- Premature familial CAD (Father < 55years____ Mother <65years)
- HDL < 40mg/dl
- Triglycerides >400mg/dl
- Any new lipid lowering medication started in the past 6 months
-
Framingham Risk Score two or more
- Smoking
- Hypertension (B/P > 140/90 or on antihypertensives)
- HDL < 40mg/dl
- Age men >45years or women >55years
- Low hematocrit ( or hemoglobinopathies that may impair exercise tolerance) or abnormal CBC
- Uncontrolled hypo/hyperthyroidism
- Active smoking
- Liver disease ( alt or AST> 2.5's UNL)
- Moderate or Severe Kidney disease, current or history
- Pancreatitis, current or history
- Any medication started in the last 3 months
- Active non healing wounds
- Recent Surgery in the last 3 months
- Anti-inflammatory disease, current or history
- Regular use of anti-inflammatory drugs
- CA
- Alcoholism
- Women who are pregnant or intending to become pregnant
- Oral or Injectable antidiabetic medication
- Post menopausal women on hormone replacement
- Any steroid medication (oral, inhaled, injected or nasal)

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.
Please refer to this study by its ClinicalTrials.gov identifier (NCT number): NCT01860599
United States, Massachusetts | |
Baystate Medical Center | |
Springfield, Massachusetts, United States, 01199 |
Principal Investigator: | Sabyasachi Sen, MD, PhD | Baystate Medical Center |
Responsible Party: | Sabyasachi Sen, MD, Assistant Professor Endocrinology, Baystate Medical Center |
ClinicalTrials.gov Identifier: | NCT01860599 History of Changes |
Other Study ID Numbers: |
IRB132171 |
First Posted: | May 23, 2013 Key Record Dates |
Last Update Posted: | July 17, 2014 |
Last Verified: | July 2014 |
Keywords provided by Sabyasachi Sen, MD, Baystate Medical Center:
prediabetes EPC's vascular reactivity |
Additional relevant MeSH terms:
Prediabetic State Glucose Intolerance Diabetes Mellitus Glucose Metabolism Disorders |
Metabolic Diseases Endocrine System Diseases Hyperglycemia |