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The Influence of Hyperglycemia on the Therapeutic Effect of Exercise on Glycemic Control in Patients With Type 2 Diabetes Mellitus

Thomas P. J. Solomon, PhD1,2; Steven K. Malin, PhD3; Kristian Karstoft, MD1,2; Jacob M. Haus, PhD4; John P. Kirwan, PhD3,5
[+] Author Affiliations
1Centre of Inflammation and Metabolism, Rigshospitalet, Copenhagen, Denmark
2Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark
3Department of Pathobiology, Cleveland Clinic, Cleveland, Ohio
4Department of Kinesiology and Nutrition, University of Illinois at Chicago, Chicago
5Metabolic Translational Research Center, Endocrinology & Metabolism Institute, Cleveland, Ohio
JAMA Intern Med. 2013;173(19):1834-1836. doi:10.1001/jamainternmed.2013.7783.
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Randomized clinical trials show that aerobic exercise training improves glycemic control in patients with type 2 diabetes mellitus (T2DM).1 However, interindividual variability is large.2 This may be explained by genetic variability,3 but ambient hyperglycemia4 and pancreatic β-cell function5 may also contribute. We examined whether changes in glycemic control following a 12- to 16-week aerobic exercise training intervention were influenced by the pretraining glycemic state in 105 individuals with impaired glucose tolerance or T2DM.

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Pretraining and Exercise-Induced Change

Individuals with impaired glucose tolerance or type 2 diabetes mellitus underwent 12 to 16 weeks of moderate-intensity exercise training, 5 days per week for 60 minutes per day. Individual subject data points are plotted on both panels; the x-axis represents the pretraining variable, and the y-axis indicates the exercise-induced change, such that the data points above the axis indicate an exercise-induced increase and vice versa. Open circles represent impaired glucose–tolerant subjects, and open triangles represent subjects with type 2 diabetes mellitus. The solid line represents the regression curve, and the dotted line represents the 95% confidence interval. A, There was a nonlinear quadratic relationship between pretraining 2-hour oral glucose tolerance test (OGTT) level and the training-induced change in 2-hour OGTT level (y = 0.06x2 − 1.5x + 7.6 [r2 = 0.26; P = .06] [N =  105]). For every 1-mmol/L increase in pretraining 2-hour glucose level above 13.1 mmol/L (the inflection point of the curve), there was a 0.2-mmol/L loss of improvement in 2-hour glucose level following exercise (to convert glucose to milligrams per deciliter, divide by 0.0555). B, There was also a nonlinear quadratic relationship between pretraining hemoglobin A1c (HbA1c) level and the training-induced change in HbA1c level (y = 0.31x2 − 3.8x + 11.7 [r2 = 0.33; P = .02] [n = 52]). For every 1–percentage-point increase in pretraining HbA1c level above 6.2% (the inflection point of the curve), there was a 0.2–percentage-point loss of improvement in HbA1c level following exercise. C, An inverse linear relationship between pretraining HbA1c level and the training-induced change in aerobic fitness was found (y = −0.11x + 0.91 [r = −0.38; P = .006] [n = 52]). For every 1–percentage-point increase in pretraining HbA1c level, there was 0.11-L/min loss of improvement in maximal oxygen uptake (V̇o2max) following exercise training.

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