Effect of Short-Term Low-Intensity Exercise on Insulin Sensitivity, Insulin Secretion, and Glucose and Lipid Metabolism in Non-Obese Japanese Type 2 Diabetic Patients

Abstract

The aim of the present study was to investigate the effects of short-term physical exercise that did not change body mass on insulin sensitivity, insulin secretion, and glucose and lipid metabolism in 39 non-obese Japanese type 2 diabetic patients. Insulin sensitivity and insulin secretion were estimated with homeostasis model assessment insulin resistance (HOMA-IR) and HOMA-B-cell function proposed by Matthews et al., respectively. All patients were hospitalized and were engaged in low-intensity exercise that consisted of walking and dumbbell exercise for successive 7 days. There were no changes in hospital diet and the dose of any medications used throughout the study. Fasting glucose, insulin, and lipids were measured before and after exercise.

After exercise, serum triglyceride levels significantly decreased, but no significant changes were observed in total and HDL cholesterol concentrations. Fasting glucose, insulin, and HOMA-IR levels significantly decreased after exercise, but HOMA-B-cell function did not change during the study. There was no significant difference between BMI levels before and after exercise.

From these results, it can be concluded that short-term (7 days) low-intensity physical exercise combined with hospital diet reduces serum triglycerides, insulin resistance, and fasting glucose levels without affecting BMI in non-obese Japanese type 2 diabetic patients.

Exercise - Insulin Sensitivity - Insulin Secretion - Diabetes - Triglyceride

References

• 1 DeFronzo R A. Lilly Lecture 1987: The triumvirate: beta-cell, muscle, liver: a collusion responsible for NIDDM.  Diabetes. 1988;  37 667-687
• 2 Gerich J E. The genetic basis of type 2 diabetes mellitus: impaired insulin secretion versus impaired insulin sensitivity.  Endocrine Rev. 1998;  19 491-503
• 3 Taniguchi A, Nakai Y, Fukushima M, Kawamura H, Imura H, Nagata I, Tokuyama K. Pathogenic factors responsible for glucose tolerance in patients with NIDDM.  Diabetes. 1992;  41 1540-1546
• 4 Nagasaka S, Tokuyama K, Kusaka I, Hayashi H, Rokkaku K, Nakamura T, Kawakami A, Higashiyama M, Ishikawa S, Saito T. Endogenous glucose production and glucose effectiveness in type 2 diabetic subjects derived from stable-labeled minimal model approach.  Diabetes. 1999;  48 1054-1060
• 5 Taniguchi A, Fukushima M, Sakai M, Nagata I, Doi K, Nagasaka S, Tokuyama K, Nakai Y. Insulin secretion, insulin sensitivity, and glucose effectiveness in non-obese individuals with varying degrees of glucose tolerance (letter).  Diabetes Care. 2000;  23 127-128
• 6 Taniguchi A, Fukushima M, Sakai M, Kataoka K, Miwa K, Nagata I, Doi K, Tokuyama K, Nakai Y. Insulin-sensitive and insulin-resistant variants in non-obese Japanese type 2 diabetic patients.  Diabetes Care (letter). 1999;  22 2100-2101
• 7 Taniguchi A, Fukushima M, Sakai M, Kataoka K, Nagata I, Doi K, Arakawa H, Nagasaka S, Tokuyama K, Nakai Y. The role of the body mass index and triglyceride levels in indentifying insulin-sensitive and insulin-resistant varaints in Japanese non-insulin-dependent diabetic patients.  Metabolism. 2000;  49 1001-1005
• 8 Taniguchi A, Fukushima M, Sakai M, Miwa K, Makita T, Nagata I, Nagasaka S, Doi K, Okumura T, Fukuda A, Kishimoto H, Fukuda T, Nakaishi S, Tokuyama K, Nakai Y. Remnant-like particle cholesterol, triglycerides, and insulin resistance in non-obese Japanese type 2 diabetic patients.  Diabetes Care. 2000;  23 1766-1769
• 9 Mingrone G, Henriksen F L, Greco A V, Krogh L N, Capristo E, Gastaldelli A, Castagneto M, Ferrannini E, Gasbarrini G, Beck-Nielsen H. Triglyceride-induced diabetes associated with familiar lipoprotein lipase deficiency.  Diabetes. 1999;  48 1258-1263
• 10 Jones I R, Sawai A, Taylor R, Miller M, Laker M F, Alberti K GMM. Lowering of plasma glucose concentrations with bezafibrate in patients with moderately controlled NIDDM.  Diabetes Care. 1990;  13 855-863
• 11 Fukushima M, Taniguchi A, Sakai M, Doi K, Nagata I, Nagasaka S, Tokuyama K, Nakai Y. Effect of bezafibrate on insulin sensitivity in non-obese Japanese type 2 diabetic patients.  Diabetes Care (letter). 2000;  23 259
• 12 Ogawa S, Takeuchi K, Sugimura K, Fukuda M, Lee R, Ito S, Sato T. Bezafibrate reduces blood glucose in type 2 diabetes mellitus.  Metabolism. 2000;  49 331-334
• 13 Taniguchi A, Fukushima M, Sakai Y, Tokuyama K, Nagata I, Fukunaga A, Kishimoto H, Doi K, Yamashita Y, Matsuura T, Kitatani N, Okumura T, Nagasaka S, Nakaishi S, Nakai Y. Effects of bezafibrate on insulin sensitivity and insulin secretion in non-obese Japanese type 2 diabetic patients.  Metabolism. 2001;  50 477-480
• 14 Kobayashi M, Shigeta Y, Hirata Y, Omori Y, Sakamoto N, Nambu S, Baba S. Improvement of glucose tolerance in NIDDM by clofibrate: Randomized double-blind study.  Diabetes Care. 1988;  11 495-499
• 15 Paolisso G, Barbagallo M, Petrella G. et al . Effects of simvastatin and atorvastatin administration on insulin resistance and respiratory quotient in aged dyslipidemic non-insulin dependent diabetic patients.  Atherosclerosis. 2000;  150 121-127
• 16 Gyntelberg F, Brennan R, Holloszy J O, Schonfeld G, Rennie M J, Weidman S W. Plasma triglyceride lowering by exercise despite increased food intake in patients with type IV hyperlipoproteinemia.  Am J Clin Nutr. 1977;  30 716-720
• 17 Vanninen E, Uusitupa M, Siitonen O, Laitinen J, Lansimies E. Habitual physical activity, aerobic capacity and metabolic control in patients with newly-diagnosed type 2 (non-insulin-dependent) diabetes mellitus: effect of 1-year diet and exercise intervention.  Diabetologia. 1992;  35 340-346
• 18 Swinburn B A, Boyce V L, Bergman R N, Howard B V, Bogardus C. Deterioration in carbohydrate metabolism and lipoprotein changes induced by modern, high-fat diet in Pima Indians and Caucasians.  J Clin Endocrinol Metab. 1991;  73 156-165
• 19 Lovejoy J, DiGirolamo M. Habitual dietary intake and insulin sensitivity in lean and obese adults.  Am J Clin Nutr. 1992;  55 1174-1179
• 20 Feskens E JM, Bowles C H, Kromhout D. Inverse association between fish intake and risk of glucose intolerance in normoglycaemic elderly men and women.  Diabetes Care. 1991;  14 934-941
• 21 Bogardus C, Ravussin E, Robbins D C, Wolfe R R, Horton E S, Sims E AH. Effect of physical training and diet therapy on carbohydrate metabolism in patients with glucose intolerance and non-insulin-dependent diabetes mellitus.  Diabetes. 1984;  33 311-318
• 22 Yamanouchi K, Shinozaki T, Chikada K, Nishikawa T, Ito K, Shimizu S, Ozawa N, Suzuki Y, Maeno H, Kato K, Oshida Y, Sato Y. Daily walking combined with diet therapy is a useful means for obese NIDDM patients not only to reduce body weight but also improve insulin sensitivity.  Diabetes Care. 1995;  18 775-778
• 23 World Health Org .Diabetes Mellitus: Report of a WHO Study Group. Geneva; World Health Org (Tech. Rep. Ser., no.727) 1985
• 24 Matsuo T, Suzuki M. Effects of dumbbell exercise with and without energy restriction on resting metabolic rate, diet-induced thermogenesis and body composition in mildly obese women.  Asia Pacific J Clin Nutr. 1999;  8 136-141
• 25 Friedewald W T, Levy R I, Fredrickson D S. Estimation of the concentration of low- density lipoprotein cholesterol in plasma without use of the preparative ultracentrifuge.  Clin Chem. 1972;  18 499-508
• 26 Matthews D R, Hosker J P, Rudenski A S, Naylor B A, Treacher D F, Turner R C. Homeostasis model assessment: insulin resistance and B-cell function from fasting plasma glucose and insulin concentrations in man.  Diabetologia. 1985;  28 412-419
• 27 Hermans M P, Levy J C, Morris R J. et al . Comparison of insulin sensitivity tests across a range of glucose tolerance from normal to diabetes.  Diabetologia. 1999;  42 678-687
• 28 Fukushima M, Taniguchi A, Sakai M, Doi K, Nagasaka S, Tanaka H, Tokuyama K, Nakai Y. Homeostasis model assessment as a clinical index of insulin resistance. Comparison with the minimal model analysis (letter).  Diabetes Care. 1999;  22 1911-1912
• 29 Taniguchi A, Nagasaka S, Fukushima M, Sakai M, Nagata I, Doi K, Tanaka H, Yoneda M, Tokuyama K, Nakai Y. Assessment of insulin sensitivity and insulin secretion from the OGTT in non-obese Japanese type 2 diabetic patients: Comparison with minimal model approach (letter).  Diabetes Care. 2000;  23 1439-1440
• 30 Groop L C. Drug treatment of non-insulin-dependent diabetes mellitus. In: Pickup J, Williams G (eds) Textbook of Diabetes. Oxford, U.K.; Blackwell Science 1997 38: 1-38
• 31 Borona E, Kiechl S, Willeit J, Oberhollenzer F, Egger G, Targher G, Alberiche M, Bonadonna R C, Muggeo M. Prevalence of insulin resistance in metabolic disorders. The Bruneck Study.  Diabetes. 1998;  47 1643-1649
• 32 Emoto M, Nishizawa Y, Maekawa K, Hiura Y, Kanda H, Kawagishi T, Shoji T, Okuno Y, Morii H. Homeostasis model assessment as a clinical index of insulin resistance in type 2 diabetic patients treated with sulfoylureas.  Diabetes Care. 1999;  22 818-822
• 33 Stumvoll M, Mitrakou A, Pimenta R J, Jenssen T, Yki-Jarvinen H, Haeften T V, Haring H, Fritsche A, Gerich J. Assessment of insulin secretion from the oral glucose tolerance test in white patients with type 2 diabetes (letter).  Diabetes Care. 2000;  23 1440-1441
• 34 Taniguchi A, Nakai Y, Doi K, Fukuzawa H, Fukushima M, Kawamura H, Tokuyama K, Suzuki M, Fujitani J, Tanaka H, Nagata I. Insulin sensitivity, insulin secretion, and glucose effectiveness in nobese subjects: a minimal model analysis.  Metabolism. 1995;  44 1397-1400
• 35 Saltin B, Lindgarde F, Houston M, Horlin R, Nygaard E, Gad P. Physical training and glucose tolerance in middle-aged men with chemical diabetes.  Diabetes. 1979;  28 (Suppl. 1) 30-32
• 36 Schneider S H, Amorosa L F, Kachadurian A K, Ruderman N B. Studies of the mechanisms of improved glucose control during regular exercise in type 2 (non-insulin-dependent) diabetes.  Diabetologia. 1984;  26 355-360
• 37 Krotkiewski M, Lonnroth P, Mandroukas K, Wroblewski Z, Rebuffe-Scrive M, Holm G, Smith U, Bjorntorp P. The effect of physical training on insulin secretion and effectiveness and on glucose metabolism in obesity and type 2 (non-insulin-dependent) diabetes mellitus.  Diabetologia. 1985;  28 881-890
• 38 Reitman J S, Vasquez B, Klimes I, Nagulesparan M. Improvement of glucose homeostasis after exercise training in non-insulin-dependent diabetes.  Diabetes Care. 1984;  7 434-441
• 39 Rogers M A, Yamamoto C, King D S, Hagberg J M, Ehsani A A, Holloszy J O. Improvement in glucose tolerance after 1 wk of exercise in patients with mild NIDDM.  Diabetes Care. 1988;  11 623-628
• 40 Heath G W, Gavin V JR, Hinderliter J M, Hagberg J M, Holloszy J O. Effects of exercise and lack of exercise on glucose tolerance and insulin sensitivity.  J Appl Physiol. 1983;  55 512-527
• 41 King D S, Dalsky G P, Clutter W E. Effects of exercise and lack of exercise on insulin sensitivity and responsiveness.  J Appl Physiol. 1988;  64 1942-1946
• 42 Trovati M, Carta Q, Cavalot F, Vitaly S, Banaudi C, Lucchina P G, Flocci F, Emanuelli G, Lenti G. Influence of physical training on blood glucose control, glucose tolerance, insulin secretion, and insulin action in non-insulin-dependent diabetic patients.  Diabetes Care. 1984;  7 416-420
• 43 Choi C S, Kim C H, Lee W J, Park J Y, Hong S K, Lee K U. Elevated plasma proinsulin/insulin ratio is a marker of reduced insulin secretory capacity in healthy young men.  Horm Metab Res. 1999;  31 267-270
• 44 Cononie C C, Goldberg A P, Rogus E, Hagberg J M. Seven consecutive days of exercise lowers plasma insulin responses to an oral glucose challenge in sedentary elderly.  J Am Geriatr Soc. 1994;  42 394-398
• 45 Hickey M S, Gavigan A P, McCammon M R. Effects of 7 days of exercise training on insulin action in morbidly obese men.  J Clin Exerc Physiol. 1999;  1 24-28
• 46 Kang J, Goss F L, Robertson R J, DaSilva S G, Hagberg J M, Suminski R R, Kelley D E, Utter A C. Effect of exercise intensity on glucose and insulin metabolism in obese individuals and obese NIDDM patients.  Diabetes Care. 1996;  19 341-349
• 47 Vanninen E, Uusitupa M, Siitonen O, Laitinen J, Lansimiles E. Habitual physical activity, aerobic capacity and metabolic control in patients with newly-diagnosed type 2 (non-insulin-dependent) diabetes mellitus: effect of 1-year diet and exercise intervention.  Diabetologia. 1992;  35 340-346
• 48 Reaven G M, Lerner R L, Stern M P, Farquhar J W. Role of insulin in endogenous hypertriglyceridemia.  J Clin Invest. 1967;  46 1756-1767
• 49 Sane T, Taskinen M R. Does familiar hypertriglyceridemia predispose to NIDDM?.  Diabetes Care. 1993;  16 1494-1501
• 50 Steiner G. Insulin and hypertriglyceridemia. In: Waldhausl WK (ed) Diabetes. Amsterdam, The Netherlands; Excerpta Medica 1979: 590-593
• 51 Bieger W P, Michel G, Barwich D, Biehl K, Wirth A. Diminished insulin receptors on monocytes and erythrocytes in hypertriglyceridemia.  Metabolism. 1984;  33 982-987
• 52 Jacob S, Stumvoll M, Becker R, Koch M, Nielsen M, Loblein K K, Maerker E, Volk A, Renn W, Balletshofer B, Machicao F, Rett K, Haring H U. The PPARγ-2 polymorphism Pro12Ala is associated with better insulin snesitivity in the offspring of type 2 diabetic patients.  Horm Metab Res. 2000;  32 413-416