Several studies in diabetic patients revealed the effects of lifestyle modification or physical exercise on endothelial function.
In insulin-resistant subjects, lifestyle modification with exercise and weight reduction over six months improved endothelial function (Hamdy et al. 2003). Interestingly, the relationship between percentage weight reduction and improved FMD was linear. A similar result was seen in patients with type 2 diabetes (Maiorana et al. 2001). Likewise, in patients with type 1 diabetes, FMD could be improved by four months of bicycle exercise (Fuchsjager-Mayrl et al. 2002). However, the positive training effect on endothelial function was not maintained after cessation of regular exercise (Figure 15.5). In all studies, GTN-mediated dilation was unaffected by exercise.
Another interesting study assessing FMD in 75 children with type 1 diabetes revealed that even children with diabetes have impaired endothelial function compared to healthy controls (Jarvisalo et al. 2004).
As this method is also predominantly assessing endothelial function, the relevance of data generated is comparable to vascular function testing with strain gauge plethysmography, with the limitation that vascular responses cannot be tested in response to vasoactive agents.
On the other hand, the non-invasive and less time consuming nature of this method makes it easier to perform studies in larger cohorts.
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