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Exercise resistance across the prediabetes phenotypes: Impact on insulin sensitivity and substrate metabolism

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Abstract

Prediabetes is a heterogeneous term that encompasses different origins of insulin resistance and insulin secretion that contribute to distinct patterns of hyperglycemia. In fact, prediabetes is an umbrella term that characterizes individuals at high risk for developing type 2 diabetes (T2D) and/or cardiovascular disease (CVD). Based on current definitions there are at least 3 distinct phenotypes of prediabetes: impaired fasting glucose (IFG), impaired glucose tolerant (IGT), or the combination of both (IFG + IGT). Each phenotype is clinically relevant as they are uniquely recognized as having different levels of risk for progressing to T2D and CVD. Herein, we discuss the underlying pathophysiology that characterizes IFG, IGT and the combination, as well as examine how some of these phenotypes appear resistant to traditional exercise interventions. We propose that substrate metabolism differences between the prediabetes phenotypes may be a unifying mechanism that explains the inter-subject variation in response to exercise seen across obese, metabolic syndrome, pre-diabetic and T2D patients in the current literature. Ultimately, a better understanding of the pathophysiologic mechanisms that govern disturbances responsible for fasting vs. postprandial hyperglycemia and the combination of both is important for designing optimal and personalized exercise treatment strategies that treat and prevent hyperglycemia and CVD risk.

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Acknowledgments

SKM wrote the manuscript and EJB, ZL, and AW reviewed/edited the manuscript.

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Authors and Affiliations

  1. Applied Metabolism & Physiology Laboratory, Department of Kinesiology, University of Virginia, 210 Emmet St., 225A Memorial Gymnasium, Charlottesville, VA, USA

    Steven K. Malin & Arthur Weltman

  2. Division of Endocrinology and Metabolism, University of Virginia, Charlottesville, VA, USA

    Steven K. Malin, Zhenqi Liu, Eugene J. Barrett & Arthur Weltman

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  1. Steven K. Malin
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  2. Zhenqi Liu
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  3. Eugene J. Barrett
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  4. Arthur Weltman
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Correspondence to Steven K. Malin.

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Malin, S.K., Liu, Z., Barrett, E.J. et al. Exercise resistance across the prediabetes phenotypes: Impact on insulin sensitivity and substrate metabolism. Rev Endocr Metab Disord 17, 81–90 (2016). https://doi.org/10.1007/s11154-016-9352-5

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  • DOI: https://doi.org/10.1007/s11154-016-9352-5

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