Physical Activity and Type 2 Diabetes: In Search of a Personalized Approach to Improving β-Cell Function

Abstract

Type 2 diabetes mellitus (T2DM) is one of the most widespread diseases worldwide. Lifestyle interventions, including diet and physical activity (PA), are fundamental non-pharmacological components of T2DM therapy. Exercise interventions are strongly recommended for people with or at risk of developing or already with overt diabetes, but adherence to PA guidelines in this population is still challenging. Furthermore, the heterogeneity of T2DM patients, driven by differing residual β-cell functionality, as well as the possibility of practicing different types and intensities of PA, has led to the need to develop tailored exercise and training plans. Investigations on blood glucose variation in response to exercise could help to clarify why individuals do not respond in the same way to PA, and to guide the prescription of personalized treatments. The aim of this review is to offer an updated overview of the current evidence on the effects of different regimens and modalities of PA regarding glucose sensing and β-cell secretory dynamics in individuals with prediabetes or T2DM, with a special focus on β-cell function.

Exercise training modalities in prediabetes: a systematic review and network meta-analysis

“…Firstly, exercise activates the insulin signaling pathway associated with AKT/PKB, increasing insulin receptor content and phosphorylation levels ( 61 ). Secondly, it can enhance the pathophysiological pathways associated with insulin resistance, upregulating the expression of GLUT 4 glucose transporters, increasing their translocation, promoting cellular glucose utilization and improving insulin resistance ( 61 , 79 , 80 ). These pathways comprise promoting mitochondrial biosynthesis and attenuating insulin resistance through activation of the AMPK/PGC-1α (Proliferator-activated receptor ɤ coactivator-α) pathway ( 81 ); inhibiting nuclear factor-κB (NF-κB) expression, reducing the levels of inflammatory factors such as tumor necrosis factor-alpha (TNF-α), exerting its anti-inflammatory effect ( 81 , 82 ); stimulating the antioxidant mediator, nuclear erythroid 2 p45-related factor 2 (Nrf2), thereby enhancing the expression of glutathione to counteract oxidative stress caused by diabetes ( 83 , 84 ); increasing the levels of galanin peptide and gene expression significantly to accelerate GLUT4 translocation and glucose uptake in myocytes and adipocytes ( 85 ).…”

The ratio of alanine aminotransferase to high-density lipoprotein cholesterol is positively correlated with the insulin resistance in American adults: a population-based cohort study

“…Based on Model 2, the race, moderate activities, diabetes, SBP, education level, WC, drinking, TC, HbA1c, DBP, serum albumin, eGFR, TG were added as covariates to Model 3. Subgroup analyses stratified by BMI (<30 kg/m2 and ≥ 30 kg/m2), gender (male and female), diabetes (yes and no), age (<50 and ≥ 50 years), moderate activities (yes and no), education level (high school or above and less than high school) and drinking (yes and no) were conducted (19)(20)(21)(22). To examine the potential effect modification within subgroups, interaction terms were employed between subgroup indicators, followed by likelihood ratio tests.…”

Association between serum uric acid‐to‐high‐density lipoprotein cholesterol ratio and insulin resistance in an American population: A population‐based analysis

“…Model 1, no covariate was adjusted; In Model 2, adjustment was made for BMI and age; based on Model 2, the race, moderate activities, diabetes, SBP, education level, WC, alcohol drinking, HbA1c, DBP, serum albumin, eGFR as covariates were added to Model 3. Subgroup analysis stratified by BMI (<25 and ≥25 kg/m 2 ), gender (male and female), diabetes (yes and no), age (<50 and ≥50 years), moderate activities (yes and no), education level (high school or above and less than high school), and alcohol drinking (yes and no) were conducted 21 , 22 , 23 , 24 . To examine the potential effect modification within subgroups, interaction terms were employed between subgroup indicators, followed by likelihood ratio tests.…”