Effects of 7 days of exercise training on insulin sensitivity and responsiveness in type 2 diabetes mellitus

John P Kirwan, Thomas P J Solomon, Daniel M Wojta, Myrlene A Staten, John O Holloszy, John P Kirwan, Thomas P J Solomon, Daniel M Wojta, Myrlene A Staten, John O Holloszy

Abstract

The objectives of this study were to determine whether 1) the improvement in insulin action induced by short-term exercise training in patients with type 2 diabetes is due to an improvement in insulin sensitivity, an improvement in insulin responsiveness, or a combination of improved insulin sensitivity and responsiveness and 2) short-term exercise training results in improved suppression of hepatic glucose production by insulin. Fourteen obese patients with type 2 diabetes, age 64 +/- 2 yr, underwent a two-stage hyperinsulinemic euglycemic clamp procedure, first stage 40 mU.m(-2).min(-1) insulin infusion, second stage 1,000 mU.m(-2).min(-1) insulin infusion, together with a [3-(3)H]glucose infusion, before and after 7 days of exercise. The training consisted of 30 min of cycling and 30 min of treadmill walking at approximately 70% of maximal aerobic capacity daily for 7 days. The exercise program resulted in improvements in insulin action in the absence of weight loss. Glucose disposal rates during the euglycemic clamp were significantly increased at both hyperinsulinemic stages after training (40 mU: 1.84 +/- 0.32 to 2.67 +/- 0.37 mg.kg(-1).min(-1), P < 0.0001; 1,000 mU: 7.57 +/- 0.61 to 8.84 +/- 0.56 mg.kg(-1).min(-1), P = 0.008). Hepatic glucose production, both in the basal state (3.17 +/- 0.43 vs. 2.54 +/- 0.26 mg.kg(-1).min(-1), P = 0.05) and during the 40-mU clamp stage (1.15 +/- 0.41 vs. 0.46 +/- 0.20 mg.kg(-1).min(-1), P = 0.03), was significantly reduced after training. One week of vigorous exercise training can induce significant improvements in insulin action in type 2 diabetes. These improvements include increased peripheral insulin sensitivity and responsiveness as well as enhanced suppression of hepatic glucose production.

Figures

Fig. 1.
Fig. 1.
Effects of the 7-day exercise training program on insulin sensitivity and responsiveness. Glucose disposal rates (GDR) during the 40 (P < 0.0001) and 1,000 mU·m−2·min−1 (P = 0.008) hyperinsulinemic clamp stages were significantly greater following the 7-day program. P values indicate pre- vs. poststudy comparisons. White bars represent prestudy GDR; black bars represent poststudy GDR. Data are means ± SE; n = 14.
Fig. 2.
Fig. 2.
Effects of the 7-day exercise training program on endogenous glucose production. [3-3H]glucose was used to assess glucose kinetics at baseline and during each stage of hyperinsulinemia. Exercise training led to a decrease in basal endogenous hepatic glucose production (HGP) (P = 0.05) plus a reduction in insulin-stimulated HGP during the 40 mU·m−2·min−1 hyperinsulinemic stage of the clamp (P = 0.03). HGP was completely suppressed during the 1,000 mU·m−2·min−1 stage prior to and after training. P values indicate pre- vs. poststudy comparisons. White bars represent prestudy HGP; black bars represent poststudy HGP. Data are means ± SE; n = 12.

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