Association between aerobic capacity and the improvement in glycemic control after the exercise training in type 2 diabetes.
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ABSTRACT:
SUBMITTER: Nojima H
PROVIDER: S-EPMC5563031 | biostudies-other | 2017
REPOSITORIES: biostudies-other
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Project description:ObjectivesPhysical exercise is recommended for individuals with type 1 diabetes, yet the effects of exercise on glycemic control are not well established. We evaluated the impact of different modes of exercise on glycemic control in people with type 1 diabetes.MethodsIn a 3-week randomized crossover trial, 10 adults with type 1 diabetes (4 men and 6 women, aged 33±6 years; duration of diabetes, 18±10 years; glycated hemoglobin level, 7.4%±1%) were assigned to 3 weeks of intervention: aerobic exercise (treadmill at 60% of maximum volume of oxygen utilization), resistance training (8 to 12 repetitions of 5 upper and lower body exercises at 60% to 80% of 1 repetition maximum) or no exercise (control). During each exercise week, participants completed 2 monitored 45 min exercise sessions. For each week of the study, we analyzed participants' insulin pump data, sensor glucose data and meal intake using a custom smart-phone application. The primary outcome was the percentage of time in range (glucose >3.9 mmol/L and ≤10 mmol/L) for the 24 h after each bout of exercise or rest during the control week. The study was registered on ClinicalTrials.gov (NCT:02687893).ResultsAerobic exercise caused a mean glucose reduction during exercise of 3.94±2.67 mmol/L, whereas the reduction during resistance training was 1.33±1.78 mmol/L (p=0.007). The mean percentage time in range for the 24 h after resistance training was significantly greater than that during the control period (70% vs. 56%, p=0.013) but not after aerobic exercise (60%).ConclusionsThe results indicate that when various confounders are considered, resistance training could improve glycemic control in this population.
| S-EPMC6591112 | biostudies-literature
Project description:Severely burned children experience a chronic state of sympathetic nervous system activation that is associated with hypermetabolic/cardiac stress and muscle wasting. Metformin, a diabetes medication, helps control hyperglycemia in obese diabetic populations, and exercise has been shown to improve exercise strength and aerobic exercise capacity after severe burns. However, whether exercise improves glycemic control in burned children and whether combining exercise and metformin improves outcomes to a greater degree than exercise alone are unknown. We tested the hypothesis that a 6-wk exercise program combined with short-term metformin administration (E + M) improves aerobic and strength exercise capacity to a greater degree than exercise and placebo (E), while improving glucose tolerance and muscle metabolic function. We found that, before exercise training, the metformin group compared with the placebo group had attenuated mitochondrial respiration (pmol·s-1·mg-1) for each state: state 2 (-22.5 ± 3), state 3 (-42.4 ± 13), and oxphos (-58.9 ± 19) ( P ≤ 0.02, M vs. E + M group for each state). However, in the E + M group, exercise increased mitochondrial respiration in each state ( P ≤ 0.05), with respiration being comparable to that in the E group (each P > 0.05). In both groups, exercise induced comparable improvements in strength (change from preexercise, Δ1.6 ± 0.6 N-M·kgLBM) and V̇o2peak (Δ9 ± 7 mlO2·kgLBM) as well as fasting glucose (Δ19.3 ± 13 mg·dl) and glucose AUC (Δ3402 ± 3674 mg·dl-1·min-1), as measured by a 75-g OGTT (all P ≤ 0.03). Exercise reduced resting energy expenditure in E + M (Δ539 ± 480 kcal/24 h, P < 0.01) but not E subjects ( P = 0.68). Both groups exhibited reduced resting heart rate (Δ30 ± 23 beats/min, P ≤ 0.02). These data indicate that short-term metformin combined with exercise provides no further improvement beyond that of exercise alone for strength, exercise capacity, and glycemic control.
| S-EPMC5899215 | biostudies-literature
Project description:To determine the effects of supervised structured aerobic exercise training (SSAET) program on fasting blood glucose level (FBGL), plasma insulin level (PIL), glycemic control (GC), and insulin resistance (IR) in type 2 diabetes mellitus (T2DM).Riphah Rehabilitation and Research Centre (RRRC) was the clinical setting for this randomized controlled trial, located at Pakistan Railways General Hospital (PRGH), Rawalpindi, Pakistan. Study duration was 18 months from January 1, 2015 to June 30, 2016. Patients of both genders ranging 40-70 years of age with at least one year of history of T2DM were considered eligible according to WHO criteria, while patients with other chronic diseases, history of smoking, regular exercise and diet plan were excluded. Cohorts of 195 patients were screened out of whom 120 fulfilled the inclusion criteria. Amongst them 102 agreed to participate and were assigned to experimental (n=51) and control (n=51) groups. Experimental group underwent SSAET program, routine medication and dietary plan, whereas the control group received routine medication and dietary plan, while both group received treatment for 25 weeks. The blood samples were taken at baseline and on the completion of 25 weeks. The investigation of fasting blood glucose level, plasma insulin level, and glycemic control was conducted to calculate IR.Patients with T2DM in experimental group (n=51) treated with SSAET program, routine medication and dietary plan significantly improved FBGL (pre-mean= 276.41±25.31, post-mean=250.07±28.23), PIL (pre-mean=13.66±5.31, post-mean=8.91±3.83), GC (pre-mean=8.31±1.79, post-mean 7.28±1.43), and IR (pre-mean=64.95±27.26, post-mean 37.97±15.58), as compared with patients in control group treated with routine medication and dietary plan in whom deteriorations were noted in FBGL (pre-mean=268.19±22.48, post-mean=281.41±31.30), PIL(pre-mean=14.14±5.48, post-mean=14.85±5.27) GC (pre-mean=8.15±1.74, post-mean=8.20±1.44, and IR (pre-mean=64.49±23.63. post-mean=70.79 ±23.30). Statistically at the baseline the results were not significant (p>0.05), but at the completion of 25 weeks intervention all the variable showed significant results (p<0.05.It is concluded that a 25 weeks SSAET program along with routine medical management is more effective treatment in the management of fasting blood glucose level, glycemic control, plasma insulin level and insulin resistance as compared with routine medical management and dietary plan in the management of T2DM.
| S-EPMC5510106 | biostudies-other
Project description:AimsTo assess the determinants of exercise training-induced improvements in glucose control (HbA1C) including changes in serum total adiponectin and FFA concentrations, and skeletal muscle peroxisome proliferator-activated receptor-γ coactivator-1α (PGC-1α) protein content.MethodsA sub-cohort (n = 35; 48% men; 74% Caucasian) from the HART-D study undertaking muscle biopsies before and after 9 months of aerobic (AT), resistance (RT), or combination training (ATRT).ResultsChanges in HbA1C were associated with changes in adiponectin (r = -0.45, P = 0.007). Participants diagnosed with type 2 diabetes for a longer duration had the largest increase in PGC-1α (r = 0.44, P = 0.008). Statistical modeling examining changes in HbA1C suggested that male sex (P = 0.05), non-Caucasian ethnicity (P = 0.02), duration of type 2 diabetes (r = 0.40; P<0.002) and changes in FFA (r = 0.36; P<0.004), adiponectin (r = -0.26; P<0.03), and PGC-1α (r = -0.28; P = 0.02) explain ∼65% of the variability in the changes in HbA1C.ConclusionsDecreases in HbA1C after 9 months of exercise were associated with shorter duration of diabetes, lowering of serum FFA concentrations, increasing serum adiponectin concentrations and increasing skeletal muscle PGC-1α protein expression.Trial registrationClinicalTrials.gov NCT00458133.
| S-EPMC3689775 | biostudies-literature
Project description:Aims/hypothesisCardiovascular events and death are better predicted by postprandial glucose (PPG) than by fasting blood glucose or HbA(1c). While chronic exercise reduces HbA(1c) in patients with type 2 diabetes, short-term exercise improves measures of insulin sensitivity but does not consistently alter responses to the OGTT. The purpose of this study was to determine whether short-term exercise training improves PPG and glycaemic control in free-living patients with type 2 diabetes, independently of the changes in fitness, adiposity and energy balance often associated with chronic exercise training.MethodsUsing continuous glucose monitors, PPG was quantified in previously sedentary patients with type 2 diabetes not using exogenous insulin (n = 13, age 53 ± 2 years, HbA(1c) 6.6 ± 0.2% (49.1 ± 1.9 mmol/mol)) during 3 days of habitual activity and during the final 3 days of a 7 day aerobic exercise training programme (7D-EX) which does not elicit measurable changes in cardiorespiratory fitness or body composition. Diet was standardised across monitoring periods, with modifications during 7D-EX to offset increases in energy expenditure. OGTTs were performed on the morning following each monitoring period.Results7D-EX attenuated PPG (p < 0.05) as well as the frequency, magnitude and duration of glycaemic excursions (p < 0.05). Conversely, average 24 h blood glucose did not change, nor did glucose, insulin or C-peptide responses to the OGTT.Conclusions/interpretation7D-EX attenuated glycaemic variability and PPG in free-living patients with type 2 diabetes but did not significantly alter responses to the laboratory-based OGTT. These effects appeared to be independent of changes in fitness, body composition or energy balance. ClinicalTrials.gov numbers: NCT00954109 and NCT00972452.FundingThis project was funded by the University of Missouri Institute for Clinical and Translational Sciences (CRM), NIH grant T32 AR-048523 (CRM), Diabetes Action Research and Education Foundation (JPT). Medtronic supplied CGMS sensors at a discounted rate.
| S-EPMC4500040 | biostudies-literature
Project description:ObjectiveGiven the transient nature of exercise-induced improvements in insulin sensitivity, it has been speculated that daily exercise is preferred to maximize the benefits of exercise for glycemic control. The current study investigates the impact of daily exercise versus exercise performed every other day on glycemic control in type 2 diabetic patients.Research design and methodsThirty type 2 diabetic patients (age 60 ± 1 years, BMI 30.4 ± 0.7 kg/m(2), and HbA(1c) 7.2 ± 0.2%) participated in a randomized crossover experiment. Subjects were studied on three occasions for 3 days under strict dietary standardization but otherwise free-living conditions. Blood glucose homeostasis was assessed by continuous glucose monitoring over 48 h during which subjects performed no exercise (control) or 60 min of cycling exercise (50% maximal workload capacity) distributed either as a single session performed every other day or as 30 min of exercise performed daily.ResultsThe prevalence of hyperglycemia (blood glucose >10 mmol/L) was reduced from 7:40 ± 1:00 h:min per day (32 ± 4% of the time) to 5:46 ± 0:58 and 5:51 ± 0:47 h:min per day, representing 24 ± 4 and 24 ± 3% of the time, when exercise was performed either daily or every other day, respectively (P < 0.001 for both treatments). No differences were observed between the impact of daily exercise and exercise performed every other day.ConclusionsA short 30-min session of moderate-intensity endurance-type exercise substantially reduces the prevalence of hyperglycemia throughout the subsequent day in type 2 diabetic patients. When total work is being matched, daily exercise does not further improve daily glycemia compared with exercise performed every other day.
| S-EPMC3329820 | biostudies-literature
Project description:The oxygen transport system in mammals is extensively remodelled in response to repeated bouts of activity, but many reptiles appear to be 'metabolically inflexible' in response to exercise training. A recent report showed that estuarine crocodiles (Crocodylus porosus) increase their maximum metabolic rate in response to exhaustive treadmill training, and in the present study, we confirm this response in another crocodilian, American alligator (Alligator mississippiensis). We further specify the nature of the crocodilian training response by analysing effects of training on aerobic [citrate synthase (CS)] and anaerobic [lactate dehydrogenase (LDH)] enzyme activities in selected skeletal muscles, ventricular and skeletal muscle masses and haematocrit. Compared to sedentary control animals, alligators regularly trained for 15 months on a treadmill (run group) or in a flume (swim group) exhibited peak oxygen consumption rates higher by 27 and 16%, respectively. Run and swim exercise training significantly increased ventricular mass (~11%) and haematocrit (~11%), but not the mass of skeletal muscles. However, exercise training did not alter CS or LDH activities of skeletal muscles. Similar to mammals, alligators respond to exercise training by increasing convective oxygen transport mechanisms, specifically heart size (potentially greater stroke volume) and haematocrit (increased oxygen carrying-capacity of the blood). Unlike mammals, but similar to squamate reptiles, alligators do not also increase citrate synthase activity of the skeletal muscles in response to exercise.
| S-EPMC2768110 | biostudies-other
Project description:BACKGROUND:Aerobic training (AT) improves glycemic control in patients with type 2 diabetes. However, the role of the progression of training variables remains unclear. The objective of this review was to analyze the effects of progressive AT (PAT) and non-progressive AT (NPAT) on glycated hemoglobin (HbA1c) in patients with type 2 diabetes. METHODS:Data sources used were PubMed, Cochrane Central, Embase, SPORTDiscus, and LILACS. Studies that evaluated the effect of at least 12 weeks of PAT and NPAT compared to a control condition on HbA1c levels in type 2 diabetes patients were eligible for analysis. Two independent reviewers screened the search results, extracted the data, and assessed the risk of bias. Effect sizes (ESs) were calculated using the standardized mean difference in HbA1c levels between the intervention and control groups using a random-effect model. RESULTS:Of 5848 articles retrieved, 24 randomized clinical trials (825 participants) were included. Among the included studies, 92% reported to have performed a randomization process, 8% presented allocation concealment, 21% reported blinding of outcome assessment, and 38% reported complete outcome data. AT reduced HbA1c levels by 0.65% (ES: - 1.037; 95% confidence interval [CI]: - 1.386, - 0.688; p < 0.001). The reduction in HbA1c induced by PAT was 0.84% (ES: - 1.478; 95% CI - 2.197, - 0.759; p < 0.001), and NPAT was 0.45% (ES: - 0.920; 95% CI - 1.329, - 0.512; p < 0.001). Subgroup analysis of the different forms of progression showed a reduction in HbA1c levels of 0.94% (ES: - 1.967; 95% CI - 3.783, - 0.151; p = 0.034) with progression in volume, 0.41% (ES: - 1.277; 95% CI - 2.499, - 0.056; p = 0.040) with progression in intensity, and 1.27% (ES: - 1.422; 95% CI - 2.544, - 0.300; p = 0.013) with progression in both volume and intensity. Subgroup analysis of the different modalities of AT showed a reduction of 0.69% (ES: - 1.078; 95% CI - 1.817, - 0.340; p = 0.004) with walking and/or running and of 1.12% (ES: - 2.614; 95% CI - 4.206, - 1.022; p = 0.001) with mixed protocols while progressive training was adopted. In non-progressive protocols, a significant HbA1c reduction was only found with walking and/or running (- 0.43%; ES: - 1.292; 95% CI - 1.856, - 0.72; p < 0.001). CONCLUSION:The effect of PAT on glycemic control was greater than that of NPAT, especially when volume and intensity were progressively incremented throughout the interventions.
| S-EPMC6555839 | biostudies-other
Project description:BackgroundReduced cholesterol efflux capacity (CEC) of HDLs is likely to increase cardiovascular risk in type 1 diabetes (T1D). We aimed to assess whether improvement of glycemic control in T1D patients is associated with changes in CEC in relation with changes in carbamylation of HDLs.MethodsIn this open-label trial, 27 uncontrolled T1D patients were given a three-month standard medical intervention to improve glycemic control. HDL fraction was isolated from plasma, and CEC was measured on THP-1 macrophages. Carbamylation of HDLs was evaluated by an immunoassay. Control HDLs from healthy subjects were carbamylated in vitro with potassium cyanate.ResultsHbA1c decreased from 11.4% [10.2-12.9] (median [1st-3rd quartiles]) at baseline to 8.1% [6.6-9.0] after the three-month intervention (P < 0.00001). The CEC of HDLs increased after intervention in 19 (70%) patients (P = 0.038). At the same time, the carbamylation of HDLs decreased in 22 (82%) patients after intervention (P = 0.014). The increase in CEC significantly correlated with the decrease in carbamylated HDLs (r = -0.411, P = 0.034), even after adjustment for the change in HbA1c (β = -0.527, P = 0.003). In vitro carbamylation of control HDLs decreased CEC by 13% (P = 0.041) and 23% (P = 0.021) using 1 and 10 mmol/L of potassium cyanate, respectively.ConclusionsThe improvement of CEC in relation to a decrease in the carbamylation of HDLs may likely contribute to the beneficial cardiovascular effect of glycemic control in T1D patients.Trial registrationNCT02816099 ClinicalTrials.gov.
| S-EPMC9375300 | biostudies-literature
Project description:ObjectiveThe purpose of the study was to examine the acute effects of the timing of exercise on the glycemic control during and after exercise in T2D.MethodsThis study included 26 T2D patients (14 women and 12 men) who were treated with metformin. All patients were tested on four occasions: metformin administration alone (Metf), high-intensity interval training (HIIT) performed at 30 minutes (EX30), 60 minutes (EX60), and 90 minutes (EX90) postbreakfast, respectively. Glucose, insulin, and superoxide dismutase (SOD) activity were examined.ResultsGlucose decreased significantly after the exercise in EX30, EX60, and EX90. Compared with Metf, the decline in glucose immediately after the exercise was larger in EX30 (-2.58?mmol/L; 95% CI, -3.36 to -1.79?mmol/L; p < 0.001), EX60 (-2.13?mmol/L; 95% CI, -2.91 to -1.34?mmol/L; p < 0.001), and EX90 (-1.87?mmol/L; 95% CI, -2.65 to -1.08?mmol/L; p < 0.001), respectively. Compared with Metf, the decrease in insulin was larger in EX30 and EX60 (both p < 0.001).ConclusionsTiming of exercise is a factor to consider when prescribing exercise for T2D patients treated with metformin. This trial is registered with ChiCTR-IOR-16008469 on 13 May 2016.
| S-EPMC5896215 | biostudies-literature