Diabetes may compromise long-term outcomes in older people undergoing cardiac rehabilitation
medwireNews: Older people with and without diabetes experience similar short-term improvements in exercise capacity following cardiac rehabilitation (CR), but those with diabetes fare worse after 1 year, EU-CaRE study results suggest.
Matthias Wilhelm (University of Bern, Switzerland) and co-researchers analyzed data from 1630 European patients aged 65 years and older who participated in a CR program following chronic coronary artery disease, a recent acute coronary syndrome, or receipt of surgical or percutaneous treatment for valvular heart disease. A total of 26.4% of participants had diabetes at baseline.
As reported in Cardiovascular Diabetology, exercise capacity – measured by peak oxygen uptake (VO2 peak) – improved to a comparable degree in both groups from baseline to the end of CR (3 weeks–3 months depending on center), with an improvement from approximately 14 to 16 mL/kg per min among people with diabetes and from approximately 16 to 18 mL/kg per min among those without.
However, individuals with diabetes experienced a significant 0.6 mL/kg per min smaller improvement in VO2 peak from baseline to the 1-year follow-up than those without. Average VO2 peak measurements at 1 year were approximately 16 mL/kg per min in the diabetes group and 19 mL/kg per min in the no diabetes group.
People with diabetes also had higher rates of some hard cardiovascular outcomes, including cardiac mortality, than those without at the 1-year follow-up.
Wilhelm and team say that the inferior outcomes at 1 year among people with diabetes were “possibly related to disease progression.” They note that glycated hemoglobin was 12.9 mmol/mol (3.3%) higher among patients with versus without diabetes after adjustment for age, sex, BMI, intervention type, comorbidities, and cardiovascular risk factors.
From the end of CR to the 1-year follow-up, HbA1c increased by a median of 1.1 mmol/mol (2.3%) in the diabetes group but remained stable in the no diabetes group. Exercise capacity and number of CR sessions attended were not significantly associated with glycemic control, but bodyweight was, with each kg in weight gained between baseline and the 1-year follow-up associated with an additional 0.4 mmol/mol (2.2%) increase in HbA1c.
This result “highlights the importance of weight loss of obese [diabetes] patients during CR,” say the study authors.
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