Diabetes Care：腹型肥胖减少可预测2型糖尿病患者运动锻炼疗效

为了探讨2型糖尿病个体在运动锻炼后身体组成和适能变化与血红蛋白A_1C（HbA_1C）变化的关系。来自加拿大马尼托巴省儿童健康保健研究所的Timothy S Church教授及其团队进行了一项研究，该研究发现在2型糖尿病患者，中心性肥胖的减少和适能的增加，是HbA_1C对运动锻炼反应发生变化最显著地预测因子。该研究结果在线发表在5月13日的《糖尿病治疗》（Diabetes Care）杂志上。

该研究中，201例受试者被随机分到有氧锻炼、抗阻锻炼、或者联合锻炼9个月。评估基线和随访期间的HbA_1C、腰围、总和躯干脂肪含量、四肢脂肪含量、瘦体重、等速腿部肌肉力量、峰耗氧量、以及估算METs。在跨身体组成和适能变化的四分位数中评估HbA_1C的变化。

该研究结果表明，HbA_1C的变化与体重（r＝0.13,P＝0.052）、腰围（r＝0.17,P＝0.013）、躯干脂肪含量（r＝0.19,P＝0.005）、以及估算METs（r＝－0.16,P＝0.023）变化相关。在跨腰围（P=0.011）、躯干脂肪含量（P=0.020）、以及估算METs（P＝0.011）四分位数中，HbA_1C有变化的趋势。在锻炼后，估算METs增加和躯干脂肪含量减少的受试者HbA_1C减少的几率更高（3.48,1.46–8.31）。最终，估算METs增加和腰围减少的受试者与那些没有适能和中心性肥胖改善的受试者相比，出现HbA_1C和2型糖尿病用药减少的可能性增加2.81（1.13–6.98）倍。

该研究发现，在2型糖尿病患者，中心性肥胖的减少和适能的增加，是HbA_1C对运动锻炼反应发生变化最显著地预测因子。

Changes in Body Fat Distribution and Fitness Are Associated With Changes in Hemoglobin A1c After 9 Months of Exercise Training: Results From the HART-D Study.
Abstract
OBJECTIVETo investigate the associations between changes in body composition and fitness after exercise training and changes in hemoglobin A1c (HbA1c) in individuals with type 2 diabetes.RESEARCH DESIGN AND METHODSParticipants (n = 201) were randomized to aerobic, resistance, or combined training for 9 months. HbA1c, waist circumference, total and trunk fat mass, appendicular fat mass, lean body mass, isokinetic leg muscle strength, peak O2 uptake, and estimated METs were assessed at baseline and follow-up. Change in HbA1c was evaluated across quartiles of change in body composition and fitness.RESULTSChange in HbA1c was associated with changes in body weight (r = 0.13, P = 0.052), waist circumference (r = 0.17, P = 0.013), trunk fat mass (r = 0.19, P = 0.005), and estimated METs (r = -0.16, P = 0.023). There was a trend in change in HbA1c across quartiles of waist circumference (P = 0.011), trunk fat mass (P = 0.020), and estimated METs (P = 0.011). Participants with increased estimated METs and reduced trunk fat mass had greater odds of having reduced HbA1c after training (3.48, 1.46-8.31). Finally, participants with increased estimated METs and reduced waist circumference were 2.81 (1.13-6.98) times more likely to have reduced HbA1c and type 2 diabetes medication use than those who without improved fitness and central adiposity.CONCLUSIONSIn patients with type 2 diabetes, a reduction in central adiposity and increase in fitness were the most prominent predictors of the change in HbA1c in response to exercise training.