OBJECTIVE -The purpose of this study was to evaluate whether a combined resistance and aerobic training program would improve insulin sensitivity compared with aerobic training alone in postmenopausal women with type 2 diabetes. A second objective was to relate the improved insulin sensitivity to changes in abdominal adipose tissue (AT) and thigh muscle density. RESEARCH DESIGN AND METHODS-A total of 28 obese postmenopausal women with type 2 diabetes were randomly assigned to one of three 16-week treatments: control, aerobic only training (Ae only), or aerobic plus resistance training (AeϩRT). Pre-and posttreatment outcome measures included glucose disposal by hyperinsulinemic-euglycemic clamp and computed tomography scans of abdominal AT and mid-thigh skeletal muscle.RESULTS -Glucose infusion rates increased significantly (P Ͻ 0.05) in the AeϩRT group. Both exercise groups had reduced abdominal subcutaneous and visceral AT and increased muscle density. The AeϩRT training group exhibited a significantly greater increase in muscle density than the Ae only group. Improved glucose disposal was independently associated with changes in subcutaneous AT, visceral AT, and muscle density. Muscle density retained a relationship with glucose disposal after controlling for abdominal AT.CONCLUSIONS -Adding resistance training to aerobic training enhanced glucose disposal in postmenopausal women with type 2 diabetes. The improved insulin sensitivity is related to loss of abdominal subcutaneous and visceral AT and to increased muscle density.

Although innovations in injectable therapy for T2D may help address the current pattern of poor glycemic control, improved communication between patients and caregivers is also a powerful approach and can be implemented with existing therapies.

Insulin lispro is a human insulin analog that dissociates more rapidly than human regular insulin after subcutaneous injection, resulting in higher insulin levels at an earlier point in time and a shorter duration of action. The aim of the study was to evaluate if this pharmacokinetic difference would translate into better postprandial and overall control in 30 IDDM patients (age, 35.1 +/- 1.5 years; male-female ratio, 17:13; BMI, 24.8 +/- 0.5 kg/m2; HbA1c, 8.03 +/- 0.13% at baseline) treated with continuous subcutaneous insulin infusion (CSII; Disetronic H-TRON V100) in a double-blind crossover clinical study. Patients were randomized to insulin lispro or human regular insulin for 3 months before crossing over to the other insulin for another 3 months. All meal boluses were given immediately before breakfast, lunch, and supper. An eight-point blood glucose profile was measured once weekly, and HbA1c levels were measured monthly. At the end of the 3-month treatment period, HbA1c levels were significantly lower with insulin lispro, compared with human regular insulin: 7.66 +/- 0.13 vs. 8.00 +/- 0.16% (P = 0.0041). While preprandial, bedtime, and 2:00 A.M. values for blood glucose were not significantly different, 1-h postprandial blood glucose was significantly improved after breakfast, lunch, and dinner with insulin lispro, compared with human regular insulin: 8.35 vs. 9.79 mmol/l (P = 0.006), 7.58 vs. 8.74 mmol/l (P = 0.049), and 7.85 vs. 9.01 mmol/l (P = 0.03). The incidence of hypoglycemia per 30 days (blood glucose levels, <3.0 mmol/l) was 8.4 +/- 1.3 before randomization, decreasing to 6.0 +/- 0.9 for insulin lispro and to 7.6 +/- 1.3 for regular insulin during the last month of the study. Two patients in each group reported insulin precipitation. We conclude that insulin lispro improves glycemic control in CSII without increasing the risk of hypoglycemia.

OBJECTIVE -Glucagon-like peptide 1 (GLP-1) is an insulinotropic gut hormone that, when given exogenously, may be a useful agent in the treatment of type 2 diabetes. We conducted a 3-month trial to determine the efficacy and safety of GLP-1 in elderly diabetic patients.RESEARCH DESIGN AND METHODS -A total of 16 patients with type 2 diabetes who were being treated with oral hypoglycemic agents were enrolled. Eight patients (aged 75 Ϯ 2 years, BMI 27 Ϯ 1 kg/m 2 ) remained on usual glucose-lowering therapy and eight patients (aged 73 Ϯ 1 years, BMI 27 Ϯ 1 kg/m 2 ), after discontinuing hypoglycemic medications, received GLP-1 delivered by continuous subcutaneous infusion for 12 weeks. The maximum dose was 120 pmol ⅐ kg Ϫ1 ⅐ h Ϫ1 . Patients recorded their capillary blood glucose (CBG) levels (four times per day, 3 days per week) and whenever they perceived hypoglycemic symptoms. The primary end points were HbA 1c and CBG determinations. Additionally, changes in ␤-cell sensitivity to glucose, peripheral tissue sensitivity to insulin, and changes in plasma ghrelin levels were examined.RESULTS -HbA 1c levels (7.1%) and body weight were equally maintained in both groups. The usual treatment group had a total of 87 CBG measurements of Յ3.6 mmol/l during the study, and only 1 such measurement (3.5 mmol/l) was recorded in the GLP-1 group. Infusion of GLP-1 enhanced glucose-induced insulin secretion (pre: 119 Ϯ 21; post: 202 Ϯ 51 pmol/l; P Ͻ 0.05) and insulin-mediated glucose disposal (pre: 29.8 Ϯ 3.3; post: 35.9 Ϯ 2.3 mol ⅐ kg Ϫ1 ⅐ min Ϫ1 ; P Ͻ 0.01). No effect of GLP-1 treatment was seen on the fasting plasma ghrelin levels. Although plasma ghrelin levels decreased during both portions of the clamp, a drug effect was not present.CONCLUSIONS -A GLP-1 compound is a promising therapeutic option for elderly diabetic patients. Diabetes Care 26:2835-2841, 2003G lucagon-like peptide 1 (GLP-1), which is secreted from enteroendocrine cells of the intestine in response to food (1,2), is insulinotropic in type 2 diabetic patients (1-5). Even with pharmacological concentrations, it does not cause hypoglycemia because it has little or no insulinotropic effect on glucose levels Ͻ4 mmol/l (1,2). GLP-1 is, therefore, a promising agent for the treatment of type 2 diabetes.Aging is characterized by a progressive increase in the prevalence of diabetes; by 75 years of age, ϳ20% of the population is afflicted (6). Many patients are treated with sulfonylureas and ultimately with insulin. Unfortunately, the risk of severe hypoglycemia associated with these agents increases with age (6). We previously demonstrated that GLP-1 has insulinotropic activity in elderly diabetic patients and it enhances their insulin-and non-insulin-mediated glucose uptake (7-9). Because of its ability to ameliorate multiple metabolic defects and because hypoglycemia might not be an issue, GLP-1 and its analogs may prove to be valuable therapeutic agents in this population. GLP-1 also has pleiotropic effects (10): it decreases glucagon release, inhibits gastric emptying,...

OBJECTIVE -To assess the prevalence of undiagnosed diabetes and glucose intolerance in individuals Ն40 years of age who contacted their family physician for routine care.RESEARCH DESIGN AND METHODS -The study used a stratified randomized selection of family physicians across Canada that was proportional to provincial and urban/rural populations based on Statistics Canada Census data (1996). Consecutive patients Ն40 years of age were screened for diabetes. If a casual fingerprick blood glucose was Ͼ5.5 mmol/l, the patient returned for a fasting venous blood glucose test. If the fasting blood glucose was 6.1-6.9 mmol/l, a 2-h 75-g post-glucose load venous blood glucose was obtained. Results of these tests were used to classify patients in diagnostic categories.RESULTS -Data were available for 9,042 patients. Previously undiagnosed diabetes was discovered in 2.2% of the patients, and new glucose intolerance was found in an additional 3.5% of patients. Overall, 16.4% of patients had previously known diabetes. The decrease in fasting plasma glucose criterion from 7.8 to 7.0 mmol/l resulted in a 2.2% versus a 1.6% prevalence of new diabetes. Several risk factors were reported in a significantly greater proportion of patients with new glucose intolerance and either new and known diabetes compared with the normal glucose tolerance group of patients. CONCLUSIONS -Routine screening for diabetes by family physicians is justified in patients Ն40 years of age, given the finding of previously undiagnosed diabetes in 2.2% of these patients and newly diagnosed glucose intolerance in an additional 3.5% of these patients. Another 16.4% of primary care patients Ն40 years of age have known diabetes. This has important implications regarding health resources and physician education.