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Physical training may enhance -cell function in type 2 diabetes

¹Copenhagen Muscle Research Centre and ²Department of Medical Physiology, The Panum Institute, University of Copenhagen, 2200 Copenhagen N; ³Clinic for Spinal Cord Injuries and ⁴Department of Orthopedic Medicine T, Rigshospitalet, 2100 Copenhagen Ø ⁵Department of Urology, Herlev University Hospital, DK 2730 Herlev; and ⁶Department of Rheumatology, Bispebjerg Hospital, Bispebjerg, 2400 Copenhagen NV, Denmark

Submitted 4 February 2004 ; accepted in final form 2 July 2004

In healthy young subjects, training increases insulin sensitivity but decreases the capacity to secrete insulin. We studied whether training changes -cell function in type 2 diabetic patients. Patients, stratified into "moderate" and "low" secretors according to individual C-peptide responses to an intravenous glucagon test, were randomly assigned to a training program [ergometer cycling 30–40 min/day, including at least 20 min at 75% maximum oxygen consumption (O_{2 max}), 5 days/wk for 3 mo] or a sedentary schedule. Before and after the intervention (16 h after last training bout), a sequential hyperglycemic (90 min at 11, 18, and 25 mM) clamp was performed. An intravenous bolus of 5 g of arginine was given at the end. Training increased O_{2 max} 17 ± 13% and decreased heart rate during submaximal exercise (P < 0.05). During the 3 mo of sedentary lifestyle, insulin and C-peptide responses to the clamp procedures were unchanged in both moderate and low secretors. Likewise, no change in -cell response was seen after training in the low secretors (n = 5). In contrast, moderate secretors (n = 9) showed significant increases in -cell responses to 18 and 25 mM hyperglycemia and to arginine stimulation. Glucagon responses to arginine as well as measures of insulin sensitivity and Hb A_1c levels were not altered by training. In conclusion, in type 2 diabetic patients, training may enhance -cell function if the remaining secretory capacity is moderate but not if it is low. The improved -cell function does not require changes in insulin sensitivity and Hb A_1c concentration.

C-peptide; insulin; arginine; hyperglycemic clamp

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