Low-intensity exercise reduces the prevalence of hyperglycemia in type 2 diabetes.

INTRODUCTION Glycemic instability is a severely underestimated problem in type 2 diabetes treatment. Therapeutic targets should aim to reduce postprandial blood glucose excursions. Exercise prescription can effectively improve glucose homeostasis and reduce the risk of cardiovascular complications. AIM To assess the impact of a single, isoenergetic bout of low- (LI) and high-intensity (HI) exercise on the prevalence of hyperglycemia throughout the subsequent 24-h postexercise period in longstanding type 2 diabetes patients. METHODS Nine sedentary, male type 2 diabetes patients (age = 57 +/- 2 yr, body mass index = 29.0 +/- 1.0 kg x m(-2), Wmax = 2.2 +/- 0.2 W x kg(-1) body weight) were selected to participate in a randomized crossover study. Subjects performed an isoenergetic bout of endurance-type exercise for 60 min at 35% Wmax (LI) or 30 min at 70% Wmax (HI) or no exercise at all (NE). Thereafter, glycemic control was assessed during the subsequent 24-h postexercise period by continuous glucose monitoring under strict dietary standardization but otherwise free-living conditions. RESULTS Average 24-h glucose concentrations were reduced after the LI exercise bout (7.8 +/- 0.9 mmol x L(-1)) when compared with the control experiment (9.4 +/- 0.8 mmol x L(-1); P < 0.05). The HI exercise bout did not significantly lower mean glucose concentrations (8.7 +/- 0.7 mmol x L(-1); P = 0.14). Hyperglycemia was prevalent for as much as 35% +/- 9% throughout the day (NE). A single bout of exercise reduced the prevalence of hyperglycemia by 50% +/- 4% (P < 0.05) and 19% +/- 9% (P = 0.13) in the LI and HI exercise experiments, respectively. CONCLUSIONS A single bout of LI, as opposed to HI, exercise substantially reduces the prevalence of hyperglycemia throughout the subsequent 24-h postexercise period in longstanding type 2 diabetes patients.

[1]  P. García-Rovés,et al.  Prevention of glycogen supercompensation prolongs the increase in muscle GLUT4 after exercise. , 2003, American journal of physiology. Endocrinology and metabolism.

[2]  F. Sternberg,et al.  On line continuous monitoring of subcutaneous tissue glucose in men by combining portable glucosensor with microdialysis , 1992, Diabetologia.

[3]  R. Holman,et al.  Association of glycaemia with macrovascular and microvascular complications of type 2 diabetes (UKPDS 35): prospective observational study , 2000, BMJ : British Medical Journal.

[4]  M. Kjaer,et al.  The effect of moderate exercise on postprandial glucose homeostasis in NIDDM patients , 1997, Diabetologia.

[5]  W. Hopkins,et al.  Effects of Different Modes of Exercise Training on Glucose Control and Risk Factors for Complications in Type 2 Diabetic Patients , 2006, Diabetes Care.

[6]  Glen P. Kenny,et al.  Effects of Exercise on Glycemic Control and Body Mass in Type 2 Diabetes Mellitus: A Meta-analysis of Controlled Clinical Trials , 2001 .

[7]  S. Anton,et al.  Adherence to exercise prescriptions: effects of prescribing moderate versus higher levels of intensity and frequency. , 2002, Health psychology : official journal of the Division of Health Psychology, American Psychological Association.

[8]  B. Zinman,et al.  Management of Hyperglycemia in Type 2 Diabetes: A Consensus Algorithm for the Initiation and Adjustment of Therapy , 2006, Diabetes Care.

[9]  R. Holman,et al.  Intensive blood-glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes (UKPDS 33). UK Prospective Diabetes Study (UKPDS) Group. , 1998 .

[10]  R. Holman,et al.  Effect of intensive blood-glucose control with metformin on complications in overweight patients with type 2 diabetes (UKPDS 34) , 1998, The Lancet.

[11]  R. Turner,et al.  Homeostasis model assessment: insulin resistance and β-cell function from fasting plasma glucose and insulin concentrations in man , 1985, Diabetologia.

[12]  Glen P. Kenny,et al.  Physical Activity/Exercise and Type 2 Diabetes , 2006, Diabetes Care.

[13]  H. Kuipers,et al.  Glycaemic instability is an underestimated problem in Type II diabetes. , 2006, Clinical science.

[14]  J Hans DeVries,et al.  Comparison of a needle-type and a microdialysis continuous glucose monitor in type 1 diabetic patients. , 2005, Diabetes care.

[15]  A. Maran,et al.  Continuous glucose monitoring in conditions other than diabetes , 2004, Diabetes/metabolism research and reviews.

[16]  Andrea Mari,et al.  A Model-Based Method for Assessing Insulin Sensitivity From the Oral Glucose Tolerance Test , 2001 .

[17]  J. Shaw,et al.  Home-based resistance training is not sufficient to maintain improved glycemic control following supervised training in older individuals with type 2 diabetes. , 2005, Diabetes care.

[18]  W. Haskell,et al.  Glucoregulation and hormonal responses to maximal exercise in non-insulin-dependent diabetes. , 1990, Journal of applied physiology.

[19]  Claude Colette,et al.  Contributions of fasting and postprandial plasma glucose increments to the overall diurnal hyperglycemia of type 2 diabetic patients: variations with increasing levels of HbA(1c). , 2003, Diabetes care.

[20]  Carl J Caspersen,et al.  Relationship of walking to mortality among US adults with diabetes. , 2003, Archives of internal medicine.

[21]  L. C. V. van Loon,et al.  Exercise: the brittle cornerstone of type 2 diabetes treatment , 2008, Diabetologia.

[22]  F. G. Benedict,et al.  A Biometric Study of Human Basal Metabolism. , 1918, Proceedings of the National Academy of Sciences of the United States of America.

[23]  H. Woerle,et al.  Diagnostic and therapeutic implications of relationships between fasting, 2-hour postchallenge plasma glucose and hemoglobin a1c values. , 2004, Archives of internal medicine.

[24]  F. Dela,et al.  The effect of intense exercise on postprandial glucose homeostasis in Type II diabetic patients , 1999, Diabetologia.

[25]  W. Saris,et al.  Inhibition of adipose tissue lipolysis increases intramuscular lipid use in type 2 diabetic patients , 2005, Diabetologia.

[26]  F Valgimigli,et al.  A microdialysis technique for continuous subcutaneous glucose monitoring in diabetic patients (part 2). , 2003, Biosensors & bioelectronics.

[27]  G A Colditz,et al.  Walking compared with vigorous physical activity and risk of type 2 diabetes in women: a prospective study. , 1999, JAMA.

[28]  H. Kuipers,et al.  Influence of acute exercise on hyperglycemia in insulin-treated type 2 diabetes. , 2006, Medicine and science in sports and exercise.

[29]  R. Robertson,et al.  Effect of Exercise Intensity on Glucose and Insulin Metabolism in Obese Individuals and Obese NIDDM Patients , 1996, Diabetes Care.

[30]  R. Manders,et al.  Protein hydrolysate co-ingestion does not modulate 24 h glycemic control in long-standing type 2 diabetes patients , 2009, European Journal of Clinical Nutrition.

[31]  S. Genuth,et al.  The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin-dependent diabetes mellitus. , 1993, The New England journal of medicine.

[32]  L. C. V. van Loon,et al.  Optimizing the therapeutic benefits of exercise in Type 2 diabetes. , 2007, Journal of applied physiology.

[33]  F Valgimigli,et al.  A microdialysis technique for continuous subcutaneous glucose monitoring in diabetic patients (part 1). , 2003, Biosensors & bioelectronics.

[34]  Antonio Ceriello,et al.  Impaired glucose tolerance and cardiovascular disease: the possible role of post-prandial hyperglycemia. , 2004, American heart journal.

[35]  M. Taskinen,et al.  What does postprandial hyperglycaemia mean? , 2004, Diabetic medicine : a journal of the British Diabetic Association.

[36]  Alberto Maran,et al.  Continuous subcutaneous glucose monitoring in diabetic patients: a multicenter analysis. , 2002, Diabetes care.

[37]  A. Ceriello.  Postprandial hyperglycemia and diabetes complications: is it time to treat? , 2005, Diabetes.