Beneficial Effects of Combined Treatment With Rosiglitazone and Exercise on Cardiovascular Risk Factors in Patients With Type 2 Diabetes

Abstract

Physical activity attenuates metabolic and cardiovascular maladaptations in diabetes by improving glycemic control, insulin resistance, cardiorespiratory fitness, and adipocytokines levels (adiponectin, resistin, tumor necrosis factor [TNF]-α, and interleukin [IL]-6) (1,2). Likewise, thiazolidinediones favorably influence the above indexes (3,4). We hypothesized that the combination of exercise training and rosiglitazone, a thiazolidinedione, would confer additional benefits in the metabolic and cardiovascular profiles of diabetic patients, exceeding those of each treatment alone. A total of 100 Caucasian, overweight/obese (BMI> 25 kg/m2) patients with type 2 diabetes consented to participate. They were treated with half-maximal doses of metformin (1,700 mg) and gliclazide (180 mg) for at least 6 months, with poor glycemic control eventually occurring (A1C > 7%). Smokers and patients receiving lipid-lowering medications, insulin, or thiazolidinediones were rejected. Those with vascular complications, life-threatening diseases, orthopedic problems, and heart, liver, or renal impairment were also excluded. After baseline examination, participants were randomized to one of the following age- and sex-matched groups: 1 ) the control group ( n = 25); 2 ) the exercise group ( n = 25), who underwent 8 months’ exercise training; 3 ) the rosiglitazone group ( n = 25), who had adjunctive therapy with 8 mg/day rosiglitazone; and 4 ) the rosiglitazone plus exercise (RSG + EX) group ( n = 25), who participated in the 8-month exercise program (as in the exercise group) while simultaneously receiving treatment with 8 mg/day rosiglitazone. The prescription of the exercise program was based on initial ergocycle testing results. Afterward, its workload was gradually increased until patients achieved 50–80% V o2max during 45–60 min sessions four times a week (5). After the fourth week, the intensity and duration of each session remained constant. …