Patients living with type 2 diabetes are typically treated with medications for optimal glucose control and urged to get more exercise, but their health often deteriorates, leading to higher risk of stroke and heart attack.
Dr. Roberto Mota Alvidrez, an assistant professor of Pharmaceutical Sciences in The University of New Mexico College of Pharmacy, wanted to see whether a structured exercise program for diabetic patients could improve their blood sugar control and reduce their burden of cardiovascular disease.
Mota Alvidrez, who is also a KL 2 Scholar in the UNM Clinical & Translational Science Center, is the principal investigator (PI) of a study that recruited sedentary Hispanic patients diagnosed with type 2 diabetes. They committed to a six-month course of supervised hour-long workouts twice a week in the Exercise Physiology Laboratory at UNM's Johnson Center.
"It's a big commitment, but they're incredibly happy and they actually don't want to leave the study when it's concluded. They get compensated, they're getting tailored exercise, and they're getting health monitoring for different things."
– Roberto Mota Alvidrez
Mota Alvidrez, who partnered with co-PIs Flavio de Castro Magalhães, Ph.D., an assistant professor of Exercise Science in the UNM College of Education and Human Sciences, Department of Health, Exercise and Sports Sciences, and Gretchen Ray, an associate professor of Pharmacy Practice & Administrative Sciences, said the study is unique in focusing recruitment on Hispanic patients, who generally face a higher burden of diabetes.
Most of the 50 or so patients recruited so far have been from the Albuquerque metro area, but a parallel study is being conducted at a medical center in the Mexican city of Ciudad Juarez, just across the border from El Paso, Texas, he said.
Ray, who has a clinical pharmacy practice at the UNM North Valley clinic, identifies patients who might be interested in participating in the study, Mota Alvidrez said. Magalhães and his Exercise Science team develop and supervise the exercise regimens.
Because the patients range in age from 30 to 78, the exercise sessions are individually tailored to accommodate their abilities. "What that means is that, for example, if we have patients that are 70 years of age, we won't have them do a lot of weightlifting," he said. "The first phase is acclimation, then there's an acute phase, which is identifying the best resistance training protocol."
The study is randomized, meaning some participants are simply asked to continue with their usual sedentary lifestyle, Mota Alvidrez said. Blood samples and other physiological data are collected from both groups at the beginning and the end of the study for comparison.
The study includes a couple of endpoints, he said. "The first one is we're looking at is glucose control, because we're trying to find a linear correlation between a marker that identifies inflammation and also glucose control. If a patient has uncontrolled diabetes and has inflammation, this marker goes up, and vice versa."
The researchers believe the novel biomarker being investigated can be correlated with hemoglobin A1C – which measures a person's average blood glucose levels over the preceding three months. The study gauges improvements in A1C related to the exercise program, but also looks at whether patients have any risk associated with vascular disease, such as their cholesterol and triglyceride levels.
Participants also undergo a body composition analysis, which measures the ratio of lean muscle mass to fat. This is particularly meaningful due to the high potential of progressive resistance exercise training in individuals living with type 2 diabetes to inhibit muscle mass loss from patients taking the new class of GLP-1 medications.
"In a lot of these patients, we can do a 10-year prognosis for cardiovascular disease, and so we want to see how much that changes from baseline to the follow-up," Mota Alvidrez said.
Although the study so far has done a good job of retaining participants, Mota Alvidrez said he would like to see more men taking part, especially because they have a higher risk of diabetic complications than premenopausal women, but recruitment efforts have been disappointing. He chalks that up to the fact that many Hispanic men work long hours in demanding jobs and aren't able to take time off to attend exercise sessions.
"Our next step is actually bringing in or being able to retain and convince males that are 30 to 50 years of age to participate," he said. "They are very underrepresented, especially for clinical trials."
