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Title: Reducing sedentary time and fat mass may improve glucose tolerance and insulin sensitivity in adults surviving 6 months after stroke : a phase I pilot study
Authors: Borschmann, KN
Ekinci, EI
Iuliano, S
Churilov, L
Pang, MYC 
Bernhardt, J
Issue Date: 1-Jun-2017
Source: European stroke journal, 1 June 2017, v. 2, no. 2, p. 144-153
Abstract: Introduction: Deranged glycaemic control is common post-stroke, increasing risks of recurrent stroke and development of diabetes. The aim of the study is to examine glucose metabolism in relation to body composition, physical activity and sedentary time post-stroke.
Patients and methods: Observational study: Non-diabetic adults, unable to walk independently, were recruited within 2 weeks of first stroke. Primary outcome: 2-h glucose level (mmol/l, oral glucose tolerance test), assessed at baseline and 6 months. Homeostasis Model Assessment of Insulin Sensitivity, total body fat and lean mass (dual energy X-ray absorptiometry), sedentary time (lying or sitting), standing and walking (PAL2 accelerometer) were assessed at baseline, 1, 3 and 6 months. Generalised estimating equations were used to examine change over time and associations between outcome measures.
Results: Thirty-six participants (69.5 years (standard deviation 11.7), 13 (36.1%) female, moderate stroke severity (National Institute of Health Stroke Scale 11.5 (interquartile range 9.75, 16)). Within 6 months, adjusting for age and National Institute of Health Stroke Scale, every month 2-h glucose reduced by 4.5% (p < 0.001), Homeostasis Model Assessment of Insulin Sensitivity improved 3% (p = 0.04) and fat mass decreased 490 g (95% confidence interval 325, 655; p = 0.01). For every extra kilogram of body fat, 2-h glucose increased by 1.02 mmol/L (95% confidence interval 1.01, 1.02; p = 0.001); Homeostasis Model Assessment of Insulin Sensitivity reduced by 0.98% (95% confidence interval 0.97, 0.99; p = 0.001). Time spent sedentary reduced from 98.5% of measurement period (interquartile range 94.3, 99.8) to 74.3% (interquartile range 65.5, 88.6), by 2.8% monthly (95% confidence interval 1.8, 3.9, p < 0.001). For every additional 5% sedentary time, 2-h glucose increased by 1.05 mmol/L (95% confidence interval 1.04, 1.07; p < 0.001).
Keywords: Stroke
Glycaemic control
Physical activity
Body composition
Publisher: SAGE Publications
Journal: European stroke journal 
ISSN: 2396-9873
EISSN: 2396-9881
DOI: 10.1177/2396987317694469
Rights: This is the accepted version of the publication Borschmann KN, Ekinci EI, Iuliano S, Churilov L, Pang MY, Bernhardt J. Reducing sedentary time and fat mass may improve glucose tolerance and insulin sensitivity in adults surviving 6 months after stroke: A phase I pilot study. European Stroke Journal (Volume: 2 issue: 2) pp. 144-153. Copyright © 2017 (European Stroke Organisation). DOI: 10.1177/2396987317694469.
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