Physical Activity and Reduced Occurrence of Non-Insulin-Dependent Diabetes Mellitus

Helmrich, Susan P.; Ragland, David R; Leung, Rosanna; Paffenbarger, Ralph S.

doi:10.1056/nejm199107183250302

Cited by 1,443 publications

(726 citation statements)

References 30 publications

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“…Physical inactivity or muscle disuse is linked to the development of insulin resistance and type 2 diabetes [12,13], whereas exercise training can reduce insulin resistance [14,15]. The present findings of a marked difference in limb palmitate kinetics between arm and leg might be interpreted from the perspective of a different activity pattern between the two extremities.…”

Section: Discussionmentioning

confidence: 58%

“…Moreover, the relationship between intramuscular lipid accumulation and insulin resistance has been described [10,11]. Physical inactivity or muscle disuse is recognised as one of the risk factors for the development of insulin resistance and type 2 diabetes [12,13]. Against this, it has been shown that exercise training can reduce insulin resistance in the leg of diabetic patients [14,15].…”

Section: Introductionmentioning

confidence: 99%

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Heterogeneity in limb fatty acid kinetics in type 2 diabetes

et al. 2005

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Aims/hypothesis: In order to test the hypothesis that disturbances in skeletal muscle fatty acid metabolism with type 2 diabetes are not equally present in the upper and lower limbs, we studied fatty acid kinetics simultaneously across the arm and leg of type 2 diabetic patients (n=6) and matched control subjects (n=7) for 5 h under baseline conditions and during a 4-h hyperinsulinaemiceuglycaemic clamp. Methods: Limb fatty acid kinetics was determined by means of continuous [U-13 C]palmitate infusion and measurement of arteriovenous differences. Results: The systemic palmitate rate of appearance was 3.6±0.4 and 2.7±0.3 μmol·kg lean body mass −1 ·min −1 and decreased during the clamp by 26% (p=0.04) and 43% (p<0.01) in the diabetic patients and in the control subjects respectively. At baseline, palmitate uptake across the arm was similar in the two groups, whereas leg palmitate uptake was lower than in the arm in the diabetic patients. During the clamp, palmitate uptake decreased in the arm (−48%, p=0.02) and the leg (−38%, p=0.04) of the control subjects, whereas it decreased in the arm (−30%, p=0.04) but not in the leg of the diabetic patients. Similarly, during the clamp palmitate release was substantially suppressed in the arm (−47%, p<0.01) and the leg of the control subjects (−45%, p<0.01), but only in the arm of the diabetic patients (−45%, p<0.01). Conclusions/interpretation: The present data indicate that type 2 diabetes is characterised by heterogeneity in the dysregulation of skeletal muscle fatty acid metabolism, with only the leg, but not the arm, showing an impairment of fatty acid kinetics at baseline and during a hyperinsulinaemic-euglycaemic clamp causing a physiological increase in insulin concentration.

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Section: Discussionmentioning

confidence: 58%

Section: Introductionmentioning

confidence: 99%

Heterogeneity in limb fatty acid kinetics in type 2 diabetes

et al. 2005

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“…Commuting and leisure-time physical activity are inversely associated with BMI in the Inter99 Study [11], and prospective studies have shown that physical activity can reduce the risk of diabetes independently of BMI or other measures of overweight/obesity [5,6,[37][38][39][40]. However, physical activity may also reduce total body fat and/or its distribution and facilitate weight maintenance, which indirectly reduces the risk of diabetes [35,[40][41][42].…”

Section: Discussionmentioning

confidence: 99%

Differential relationship between physical activity and progression to diabetes by glucose tolerance status: the Inter99 Study

Engberg

Glümer²,

Witte

et al. 2009

Diabetologia

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Aims/hypothesis The aim of the study was to analyse how strongly commuting and leisure-time physical activity affect progression to diabetes and to study whether this relationship is different in individuals with isolated impaired fasting glucose (i-IFG) and isolated impaired glucose tolerance (i-IGT). Methods We studied the incidence of diabetes in 4,031 individuals without diabetes at baseline who participated in the baseline and 5 year follow-up examinations of a population-based primary prevention study, the Inter99 Study. Glucose tolerance status at baseline and at followup were based on OGTTs. Commuting and leisure-time physical activity at baseline were assessed by questionnaire. We present rate ratios from Poisson regression analyses adjusted for relevant confounders. Results The progression rate to diabetes was lower among physically active individuals in the total study population and particularly among those with i-IGT. The associations were attenuated and lost statistical significance after further adjustment for BMI. We observed no impact of physical activity on the progression to diabetes in individuals with i-IFG. Conclusions/interpretation Physical activity was associated with a lower progression to diabetes in the total study population and in individuals with i-IGT, a condition primarily characterised by muscle insulin resistance. Physical activity did not predict progression to diabetes in individuals with i-IFG, a condition primarily characterised by hepatic insulin resistance. Our results suggest that there is a differential relationship between physical activity and progression to diabetes among those with i-IFG and i-IGT. Therefore, clinical trials testing the effect of physical activity on progression from i-IFG to diabetes are needed.

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“…28,29 An epidemiological study by Helmrich et al 30 demonstrated that the incidence rates for diabetes mellitus declined as energy expenditure increased. For each 500-kcal per week increment in energy expenditure, the age-adjusted risk of diabetes mellitus was reduced by 6%.…”

Section: Level Of Activitymentioning

confidence: 99%

“…In another epidemiological study of over 20 000 US male physicians by Manson et al, 31 an inverse association was found between regular exercise and the subsequent development of diabetes mellitus, supporting the study by Helmrich. 30 Placing healthy subjects at bed rest voluntarily for 7 days resulted in a moderate deterioration in oral glucose tolerance and increased plasma insulin levels both fasting and in response to an oral glucose load. 32 If obese subjects who have insulin resistance and elevated plasma insulin levels are placed at bed rest, they will manifest a further worsening of carbohydrate tolerance.…”

Section: Level Of Activitymentioning

confidence: 99%

Risk factors for atherogenesis and cardiovascular autonomic function in persons with spinal cord injury

et al. 1999

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Persons with spinal cord injury (SCI) have been recognized to have several metabolic changes that adversely impact their risk for cardiovascular disease. An increased prevalence of disorders of carbohydrate metabolism and dyslipidemia may be related predominantly to paralysis with immobilization and associated loss of lean body tissue and gain in relative adiposity. Studies have reported an increased risk of vascular disease in those with SCI. As such, an understanding of the constellation of carbohydrate and lipid changes that occur after SCI is relevant to the clinical practice of medicine in this population. Oral glucose tolerance testing and associated studiesImpaired glucose tolerance and diabetes mellitus are more prevalent in individuals with SCI than in those who are able-bodied. 1 ± 4 In most of the individuals with SCI and abnormal carbohydrate tolerance, resistance to insulin mediation of glucose uptake by peripheral tissues may be demonstrable. In the presence of insulin resistance, the normal homeostatic response to glucose challenge is increased pancreatic b-cell secretion of insulin. If the compensatory response of the pancreas is insu cient to control the serum glucose concentration, worsening of carbohydrate tolerance will ensue.Bauman et al 3 performed a 75 g oral glucose tolerance test in 100 male veterans with SCI and in 50 able-bodied veteran controls. According to criteria established by the World Health Organization, 5 22% of those with SCI were diabetic whereas only 6% of the control group were diabetic. Eighty-two per cent of the controls had normal oral glucose tolerance, compared with 38% of those with quadriplegia and 50% of those with paraplegia. Subjects with SCI had signi®cantly higher mean plasma glucose and insulin values at several points during the oral glucose tolerance test when compared with controls ( Figure 1). In subgroups, determinants of insulin sensitivity were measured: per cent lean body mass, per cent fat mass, and cardiopulmonary ®tness. Values for insulin sensitivity were linearly related with those of ®tness (VO 2 max) determined from a progressive incremental upper-body exercise stress test. Insulin sensitivity was suggestively correlated with lean body mass, and negatively correlated with body fat. Thus, in a relatively small subgroup of untrained subjects with paraplegia, the strongest determinant of insulin sensitivity was cardiopulmonary ®tness.In 201 non-veteran subjects with SCI, Bauman et al 2 studied the relationship of oral carbohydrate tolerance after a 75 g glucose load to several variables, including level and completeness of lesion, gender, ethnicity, age, duration of injury, and anthropometric measures. Of the total group, 27 (13%) had diabetes mellitus and 56 (29%) had impaired glucose tolerance. 2,6 The subjects with complete tetraplegia had sign®cantly worse carbohydrate tolerance (Figure 2) and were more frequently classi®ed with a disorder of carbohydrate tolerance than the other neurological de®cit subgroups. 2 There were no signi®cant gend...

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Physical Activity and Reduced Occurrence of Non-Insulin-Dependent Diabetes Mellitus

Abstract: Increased physical activity is effective in preventing NIDDM, and the protective benefit is especially pronounced in persons at the highest risk for the disease.

Cited by 1,443 publications

References 30 publications

Heterogeneity in limb fatty acid kinetics in type 2 diabetes

Heterogeneity in limb fatty acid kinetics in type 2 diabetes

Differential relationship between physical activity and progression to diabetes by glucose tolerance status: the Inter99 Study

Risk factors for atherogenesis and cardiovascular autonomic function in persons with spinal cord injury

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