Design, setting and participants
ischemia, diabetic foot ulceration, type 2 diabetes, autonomic neuropathy
AUTONOMIC NEUROPATHY, ISCHEMIA, PERIPHERAL VASCULAR DISEASE, TYPE 2 DIABETES, PROLIFERATIVE RETINOPATHY
The clinical DIAfit program is a nationwide Swiss lifestyle based real-life clinical group intervention program (Local diabetologist or general practitioners referred their patients to the closest clinical program centre. Inclusion criteria for patient to be enrolled in the clinical DIAfit program were age ≥18 years and a diagnosis of type 2 diabetes for ≥3 months. Exclusion criteria for clinical referrals were active diabetic foot ulceration; ischemia during a cycle ergometry exercise test or state III peripheral vascular disease; untreated proliferative retinopathy and autonomic neuropathy with unstable BP during the exercise test. In order to increase external validity, all patients referred to the clinical program were eligible to participate in the study. All 185 eligible and participating patients that were referred to the clinical program between 2011 and 2012 from the 11 DIAfit treatment centres were invited to participate in the study.All patients underwent the same medical visit by physicians collaborating in the DIAfit program. As part of the clinical routine, patients had a fasting blood analysis and a cycle ergometry according to a standardized protocol at the beginning and the end. For the study, they underwent additional physical fitness tests and filled out questionnaires at both time points. During the centralized clinical training all centres were instructed how to perform all physical fitness tests and medical exams according to standard operating procedures. Baseline data of this study have been previously reported (