Prevention of heart failure in type 2 diabetes by exercise intervention
Cardiac dysfunction is highly prevalent in type 2 diabetes (T2DM), leading to adverse cardiac events and premature death. In the last few years the global longitudinal strain (GLS, which can be assessed during echocardiography) was found to predict this diabetes-induced heart failure (DIHF) years ahead in T2DM patients. We have now recently shown that GLS indeed is disturbed even in well-controlled and symptom-free T2DM patients: a disturbed GLS is thus highly prevalent. As a result, prevention of DIHF should be a top priority in these patients. We and others discovered that exercise intervention may be effective to improve GLS in some, but not all, T2DM patients. Therefore, there is potency of exercise intervention to improve GLS and hereby to prevent DIHF. However, two key aspects should be studied in greater detail to maximize the benefits of exercise intervention on GLS in T2DM patients, and pave the way for maximal prevention of DIHF: 1. the impact of exercise volume and intensity remains to be assessed, and 2. it remains to be determined which patient-related factors predict improvements in GLS as result of exercise intervention. An animal (WP1) and human (WP2) study will be executed to examine the impact of different exercise volumes and intensities on GLS and the underlying contributing molecular changes. In another study, it will also be examined which patient- specific factors predict changes in GLS as result of exercise intervention (WP3).