Glucose effectiveness, but not insulin sensitivity, is improved after short-term interval training in individuals with type 2 diabetes mellitus: a controlled, randomised, crossover trial

• Published in: Diabetologia Vol. 60; no. 12; pp. 2432 - 2442
• Main Authors: Karstoft, Kristian, Clark, Margaret A., Jakobsen, Ida, Knudsen, Sine H., van Hall, Gerrit, Pedersen, Bente K., Solomon, Thomas P. J.
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01.12.2017; Springer Nature B.V
• Subjects: Diabetes; Diabetes mellitus; Energy expenditure; Evidence-based medicine; Exercise; Glucose; Glucose metabolism; Glucose monitoring; Grants; Human Physiology; Hyperglycemia; Insulin; Internal Medicine; Medicine; Medicine & Public Health; Metabolic Diseases; Metabolism; Pancreas; Physical activity; Physical training; Pregnancy; Smoking; Walking; Continuous glucose monitoring; Training; Pancreatic clamp; Insulin sensitivity; Mass action of glucose; Exercise interventions; Hyperinsulinaemic clamp; Lifestyle intervention(s); Glucose effectiveness; Hyperglycaemic clamp
• ISSN: 0012-186X; 1432-0428
• DOI: 10.1007/s00125-017-4406-0

Aims/hypothesis The role of glucose effectiveness ( S G ) in training-induced improvements in glucose metabolism in individuals with type 2 diabetes is unknown. The objectives and primary outcomes of this study were: (1) to assess the efficacy of interval walking training (IWT) and continuous walking training (CWT) on S G and insulin sensitivity ( S I ) in individuals with type 2 diabetes; and (2) to assess the association of changes in S G and S I with changes in glycaemic control. Methods Fourteen participants with type 2 diabetes underwent three trials (IWT, CWT and no training) in a crossover study. Exclusion criteria were exogenous insulin treatment, smoking, pregnancy, contraindications to structured physical activity and participation in recurrent training (>90 min/week). The trials were performed in a randomised order (computerised-generated randomisation). IWT and CWT consisted of ten supervised treadmill walking sessions, each lasting 60 min, over 2 weeks. IWT was performed as repeated cycles of 3 min slow walking and 3 min fast walking (aiming for 54% and 89% of V · O 2 peak , respectively, which was measured during the last minute of each interval), and CWT was performed aiming for a moderate walking speed (73% of V ⋅ O 2 peak ). A two-step (pancreatic and hyperinsulinaemic) hyperglycaemic clamp was implemented before and after each trial. All data were collected in a hospitalised setting. Neither participants nor assessors were blinded to the trial interventions. Results Thirteen individuals completed all procedures and were included in the analyses. IWT improved S G (mean ± SEM: 0.6 ± 0.1 mg kg −1  min −1 , p  < 0.05) but not S I ( p  > 0.05), whereas CWT matched for energy expenditure and time duration improved neither S G nor S I (both p  > 0.05). Changes in S G , but not in S I , were associated with changes in mean (β = −0.62 ± 0.23, r 2  = 0.17, p  < 0.01) and maximum (β = −1.18 ± 0.52, r 2  = 0.12, p  < 0.05) glucose levels during 24 h continuous glucose monitoring. Conclusions/interpretation Two weeks of IWT, but not CWT, improves S G but not S I in individuals with type 2 diabetes. Moreover, changes in S G are associated with changes in glycaemic control. Therefore, increased S G is likely an important mechanism by which training improves glycaemic control in individuals with type 2 diabetes. Trial registration: ClinicalTrials.gov NCT02320526 Funding: CFAS is supported by a grant from TrygFonden. During the study period, the Centre of Inflammation and Metabolism (CIM) was supported by a grant from the Danish National Research Foundation (DNRF55). The study was further supported by grants from Diabetesforeningen, Augustinusfonden and Krista og Viggo Petersens Fond. CIM/CFAS is a member of DD2—the Danish Center for Strategic Research in Type 2 Diabetes (the Danish Council for Strategic Research, grant no. 09–067009 and 09–075724).