, 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



The role of glucose effectiveness (S G) 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 S G and insulin sensitivity (S I) in individuals with type 2 diabetes; and (2) to assess the association of changes in S G and S I with changes in glycaemic control.


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.


Thirteen individuals completed all procedures and were included in the analyses. IWT improved S G (mean ± SEM: 0.6 ± 0.1 mg kg−1 min−1, p < 0.05) but not S I (p > 0.05), whereas CWT matched for energy expenditure and time duration improved neither S G nor S I (both p > 0.05). Changes in S G, but not in S I, were associated with changes in mean (β = −0.62 ± 0.23, r 2 = 0.17, p < 0.01) and maximum (β = −1.18 ± 0.52, r 2 = 0.12, p < 0.05) glucose levels during 24 h continuous glucose monitoring.


Two weeks of IWT, but not CWT, improves S G but not S I in individuals with type 2 diabetes. Moreover, changes in S G are associated with changes in glycaemic control. Therefore, increased S G is likely an important mechanism by which training improves glycaemic control in individuals with type 2 diabetes.

Trial registration: NCT02320526


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).


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



Continuous glucose monitoring


Continuous walking training


Glucose infusion rate


Interval walking training


Rate of glucose appearance


Endogenous rate of glucose appearance


Total rate of glucose appearance


Rate of glucose disappearance


Respiratory exchange ratio


Glucose effectiveness


Insulin sensitivity



R. Rovsing, H. Villumsen, L. Foged, M. G. Høiberg, L. Kjølbo, I. A. Müller, L. S. Hansen, S. Thorsen and C. K. Olsen (The Centre for Physical Activity Research [CFAS], Rigshospitalet, Denmark) are acknowledged for their technical assistance. M. Ried-Larsen (CFAS) is acknowledged for statistical assistance.

Data availability

The data that support the findings of this study are available on request from the corresponding author (KK), given that this does not violate the laws of the Danish Data Protection Agency.


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).

Duality of interest

The authors declare that there is no duality of interest associated with this manuscript.

Contribution statement

KK designed the study and obtained the funding. TPJS and BKP contributed to the study design. KK, MAC, IJ and SHK acquired the data. KK, MAC, GvH and TPJS analysed and interpreted the data. KK wrote the manuscript. All authors reviewed and revised the manuscript and approved the final version. KK is the guarantor for the work as a whole.


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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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