Influence of Physical Training on Blood Glucose Control, Glucose Tolerance, Insulin Secretion, and Insulin Action in Non-insulin-dependent Diabetic Patients

Trovati, Mariella; Carta, Q; Cavalot, Franco; Vitali, Saverio; Banaudi, C; Lucchina, Pietro Greco; Fiocchi, Franco; Emanuelli, G; Lenti, G

doi:10.2337/diacare.7.5.416

Cited by 169 publications

(86 citation statements)

References 9 publications

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“…Both normal control subjects and patients with type II diabetes have been shown to have a 30-35% increase in insulin-stimulated glucose disposal after physical training when studied by the hyperinsulinemic-euglycemic clamp technique (7,76,77). This increase in insulin sensitivity correlates well with the training-induced increase in Vo 2max (8,78,79) and is thought to be primarily due to increased glucose uptake by muscle because no changes have been observed in hepatic glucose production rates.…”

Section: Exercise In Type II Diabetessupporting

confidence: 48%

Role and Management of Exercise in Diabetes Mellitus

Horton

1988

Diabetes Care

111

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As more is understood about the physiology of exercise, in both normal and diabetic subjects, its role in the treatment of diabetes is becoming better defined. Whereas people with diabetes may derive many benefits from regular physical exercise, there are also several hazards that make exercise difficult to manage. In type I (insulin-dependent) diabetes, there are risks of hypoglycemia during or after exercise or of worsening metabolic control if insulin deficiency is present. Type II (non-insulin-dependent) diabetic patients treated with sulfonylureas are also at some increased risk of developing hypoglycemia during or after exercise, although this poses less of a problem than with insulin treatment. In individuals treated by diet alone, regulation of blood glucose during exercise is usually not a significant problem and exercise can be used as an adjunct to diet to achieve weight loss and improved insulin sensitivity. When obese type II diabetic patients are treated with very low calorie diets, adequate amounts of carbohydrate must be provided to ensure maintenance of normal muscle glycogen content, particularly if individuals wish to participate in highintensity exercise that places a heavy workload on specific muscle groups. On the other hand, moderateintensity exercise such as vigorous walking can be tolerated by individuals on very low calorie, carbohydrate-restricted diets after an appropriate period of adaptation. A number of strategies can be employed to avoid hypoglycemia in type I diabetic patients, and both type I and II diabetic patients should be examined carefully for long-term complications of their disease, which may be made worse by exercise. These considerations have led many diabetologists to consider exercise beneficial in the management of diabetes for

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Section: Exercise In Type II Diabetessupporting

confidence: 48%

Role and Management of Exercise in Diabetes Mellitus

Horton

1988

Diabetes Care

111

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“…In our study, the intervention group maintained their AUC C-peptide measure despite becoming more insulin sensitive, consistent with this group effecting a 'real' increase in b-cell function. Exercise interventions for preservation of b-cell function in Type 2 diabetes that have not accounted for changes in insulin sensitivity have provided conflicting results [32], whereas studies that have accounted for insulin sensitivity change have reported more consistently [33]. We have used disposition index in the further analysis of our data because it is an established measure of b-cell function that models for insulin sensitivity [17,19].…”

Section: Discussionmentioning

confidence: 99%

Exercise to preserve β‐cell function in recent‐onset Type 1 diabetes mellitus (EXTOD) – a randomized controlled pilot trial

et al. 2017

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Aim Residual b-cell function is present at the time of diagnosis with Type 1 diabetes. Preserving this b-cell function reduces complications. We hypothesized that exercise preserves b-cell function in Type 1 diabetes and undertook a pilot trial to address the key uncertainties in designing a definitive trial to test this hypothesis.Methods A randomized controlled pilot trial in adults aged 16-60 years diagnosed with Type 1 diabetes within the previous 3 months was undertaken. Participants were assigned to control (usual care) or intervention (exercise consultation every month), in a 1 : 1 ratio for 12 months. The primary outcomes were recruitment rate, drop out, exercise adherence [weeks with ≥ 150 min of self-reported moderate to vigorous physical activity (MVPA)], and exercise uptake in the control group. The secondary outcomes were differences in insulin sensitivity and rate of loss of b-cell function between intervention and control at 6 and 12 months.Results Of 507 individuals who were approached, 58 (28 control, 30 intervention) entered the study and 41 completed it. Participants were largely white European males, BMI 24.8 AE 3.8 kg/m 2 , HbA 1c 75 AE 25 mmol/mol (9 AE 2%). Mean level of objectively measured MVPA increased in the intervention group (mean 243 to 273 min/week) and 61% of intervention participants reached the target of ≥ 150 min/week of self-reported MVPA on at least 42 weeks of the year. Physical activity levels fell slightly in the control group (mean 277 to 235 min of MVPA/week). There was exploratory evidence that intervention group became more insulin sensitive and required less insulin. However, the rate of loss of b-cell function appeared similar between the groups, although the change in insulin sensitivity may have affected this.Conclusion We show that it is possible to recruit and randomize people with newly diagnosed Type 1 diabetes to a trial of an exercise intervention, and increase and maintain their exercise levels for 12 months. Future trials need to incorporate measures of greater adherence to exercise training targets, and include more appropriate measures of b-cell function. (Clinical Trials

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“…Physical training has mostly been shown to improve insulin sensitivity in healthy humans regardless of age [82,[98][99][100][101], in obese non-diabetic subjects [102,103], in both patients with insulin-dependent diabetes and NIDDM [104][105][106][107]. Regular exercise is also beneficial in older subjects and improves insulin sensitivity even to levels typical of younger individuals, independent of changes in weight and body composition [99][100][101].…”

Section: Insulin Resistancementioning

confidence: 99%

Exercise and the metabolic syndrome

1997

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One of the first people to introduce the metabolic syndrome -or trisyndrome mé tabolique -in the scientific literature was Camus in 1966 [1]. However, this entity did not receive much interest until Reaven in 1988 introduced syndrome X, characterised by hypertension, impairment in glucose and lipid metabolism and insulin resistance [2]. The metabolic syndrome -also called the insulin resistance syndrome -is a multifaceted syndrome characterised by five major abnormalities: obesity, hypertension, insulin resistance, glucose intolerance (impaired glucose tolerance/non-insulin-dependent diabetes mellitus (NIDDM)), and dyslipidaemia (hypertriglyceridaemia and low HDL-cholesterol). In addition, a number of other abnormalities such as microalbuminuria, hyperuricaemia, hyperfibrinogenaemia and increased levels of plasminogen activator inhibitor I and low concentrations of tissue plasminogen activator are often associated with the syndrome. The clinical importance of the metabolic syndrome is mainly due to the clustering of simultaneously occurring atherosclerotic risk factors in the same individual [2][3][4][5][6][7][8][9].The aetiology of the metabolic syndrome is poorly understood; both genetic and environmental factors are involved [2][3][4][5][6][7][8][9]. Possible common denominators for the various components of the syndrome are not known, although hyperinsulinaemia/insulin resistance are important characteristics in most of the abnormalities.The prevalence rate of the metabolic syndrome varies depending on the population studied and the definition applied. As in any syndrome, not all features are present in the same individual. The estimated prevalence rate of the metabolic syndrome in western countries is 25-35 % [2-9]. On the other hand, both Ferrannini and Rupp [8, 9] have reported that only about one-third of an adult study population was free of all major characteristics of the metabolic syndrome. Since the prevalence of hypertension, insulin resistance and glucose intolerance usually increase with increasing age, the prevalence of the metabolic syndrome will probably also rise in the aging western society.A number of pharmacological therapies can be used for the treatment of the metabolic syndrome; but the results of most of the available therapies are often unsatisfactory, although some trials with metformin and thiazolidinediones have been encouraging [6, 10, 11].Low levels of physical activity are related to most components of the metabolic syndrome [12][13][14][15][16]. Consequently this offers a unique opportunity to employ increased physical activity in the prevention and treatment of the metabolic syndrome and its components. This review will focus on the role of physical activity and exercise in the prevention and treatment of the metabolic syndrome. ObesityThe prevalence of obesity (body mass index (BMI) > 27 kg/m 2 ) is currently 25-35 % in most western societies, and is increasing [17]. If the prevalence continues to increase, as during the past decades, by the year 2230, 100 % of the adult Uni...

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Influence of Physical Training on Blood Glucose Control, Glucose Tolerance, Insulin Secretion, and Insulin Action in Non-insulin-dependent Diabetic Patients

Cited by 169 publications

References 9 publications

Role and Management of Exercise in Diabetes Mellitus

Role and Management of Exercise in Diabetes Mellitus

Exercise to preserve β‐cell function in recent‐onset Type 1 diabetes mellitus (EXTOD) – a randomized controlled pilot trial

Exercise and the metabolic syndrome

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