Diabetologia

, Volume 60, Issue 12, pp 2432–2442 | Cite as

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

  • Kristian Karstoft
  • Margaret A. Clark
  • Ida Jakobsen
  • Sine H. Knudsen
  • Gerrit van Hall
  • Bente K. Pedersen
  • Thomas P. J. Solomon
Article

Abstract

Aims/hypothesis

The role of glucose effectiveness (SG) 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 SG and insulin sensitivity (SI) in individuals with type 2 diabetes; and (2) to assess the association of changes in SG and SI 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 \( \overset{\cdotp }{V}{\mathrm{O}}_{2\mathrm{peak}} \), respectively, which was measured during the last minute of each interval), and CWT was performed aiming for a moderate walking speed (73% of \( \overset{\cdot }{V}{\mathrm{O}}_{2\mathrm{peak}} \)). 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 SG (mean ± SEM: 0.6 ± 0.1 mg kg−1 min−1, p < 0.05) but not SI (p > 0.05), whereas CWT matched for energy expenditure and time duration improved neither SG nor SI (both p > 0.05). Changes in SG, but not in SI, were associated with changes in mean (β = −0.62 ± 0.23, r2 = 0.17, p < 0.01) and maximum (β = −1.18 ± 0.52, r2 = 0.12, p < 0.05) glucose levels during 24 h continuous glucose monitoring.

Conclusions/interpretation

Two weeks of IWT, but not CWT, improves SG but not SI in individuals with type 2 diabetes. Moreover, changes in SG are associated with changes in glycaemic control. Therefore, increased SG 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).

Keywords

Continuous glucose monitoring Exercise interventions Glucose effectiveness Hyperglycaemic clamp Hyperinsulinaemic clamp Insulin sensitivity Lifestyle intervention(s) Mass action of glucose Pancreatic clamp Training 

Abbreviations

CGM

Continuous glucose monitoring

CWT

Continuous walking training

GIR

Glucose infusion rate

IWT

Interval walking training

Ra

Rate of glucose appearance

RaENDO

Endogenous rate of glucose appearance

RaTOTAL

Total rate of glucose appearance

Rd

Rate of glucose disappearance

RER

Respiratory exchange ratio

SG

Glucose effectiveness

SI

Insulin sensitivity

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Copyright information

© Springer-Verlag GmbH Germany 2017

Authors and Affiliations

  1. 1.The Centre of Inflammation and Metabolism and the Centre for Physical Activity ResearchUniversity of Copenhagen, RigshospitaletCopenhagenDenmark
  2. 2.Department of Clinical Pharmacology, Bispebjerg HospitalCopenhagenDenmark
  3. 3.Clinical Metabolomics Core Facility, Clinical Biochemistry, Rigshospitalet, Department of Biomedical SciencesCopenhagenDenmark
  4. 4.School of Sport, Exercise, and Rehabilitation SciencesUniversity of BirminghamBirminghamUK
  5. 5.Institute of Metabolism and Systems Research (IMSR)University of BirminghamBirminghamUK

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