Metabolic changes following a 1-year diet and exercise intervention in patients with type 2 diabetes - PubMed (original) (raw)

Randomized Controlled Trial

doi: 10.2337/db09-1239. Epub 2009 Dec 22.

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Randomized Controlled Trial

Metabolic changes following a 1-year diet and exercise intervention in patients with type 2 diabetes

Jeanine B Albu et al. Diabetes. 2010 Mar.

Abstract

Objective: To characterize the relationships among long-term improvements in peripheral insulin sensitivity (glucose disposal rate [GDR]), fasting glucose, and free fatty acids (FFAs) and concomitant changes in weight and adipose tissue mass and distribution induced by lifestyle intervention in obese individuals with type 2 diabetes.

Research design and methods: We measured GDR, fasting glucose, and FFAs during a euglycemic clamp and adipose tissue mass and distribution, organ fat, and adipocyte size by dual-energy X-ray absorptiometry, CT scan, and adipose tissue biopsy in 26 men and 32 women in the Look-AHEAD trial before and after 1 year of diet and exercise aimed at weight loss.

Results: Weight and fasting glucose decreased significantly (P < 0.0001) and significantly more in men than in women (-12 vs. -8% and -16 vs. -7%, respectively; P < 0.05), while FFAs during hyperinsulinemia decreased and GDR increased significantly (P < 0.00001) and similarly in both sexes (-53 vs. -41% and 63 vs. 43%; P = NS). Men achieved a more favorable fat distribution by losing more from upper compared with lower and from deeper compared with superficial adipose tissue depots (P < 0.01). Decreases in weight and adipose tissue mass predicted improvements in GDR but not in fasting glucose or fasting FFAs; however, decreases in FFAs during hyperinsulinemia significantly determined GDR improvements. Hepatic fat was the only regional fat measure whose change contributed independently to changes in metabolic variables.

Conclusions: Patients with type 2 diabetes undergoing a 1-year lifestyle intervention had significant improvements in GDR, fasting glucose, FFAs and adipose tissue distribution. However, changes in overall weight (adipose tissue mass) and hepatic fat were the most important determinants of metabolic improvements.

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Figures

FIG. 1.

FIG. 1.

Absolute amounts in kg (A) or cm2 (B–C) on the _y_-axis and the relative distribution as percent of total fat (A) or percent of total area (B–C) shown as means ± SEM of upper-body (UB-Fat) and lower-body (gluteo-femoral [GF-Fat]) fat by DEXA (A); VAT and deep (Deep SAT) and superficial (Superficial SAT) abdominal adipose tissue (AT) areas measured at L4–L5 by CT (B); and subfascial and superficial subcutaneous adipose tissue areas measured at mid-thigh (one leg) by CT (C) before and after 1 year of intervention; P values are shown for differences in the relative distribution.

FIG. 2.

FIG. 2.

A: The relationships between the change in weight and the change in GDR (mg · kg−1 · FFM−1), both expressed as a percent of the baseline values (r = −0.50; P = 0.0006). B: The change in GDR (mg · kg FFM−1 · min−1) and the change in fasting glucose, both expressed as percent of the baseline values (r = −0.37; P = 0.005). C: The change in the liver-to-spleen attenuation ratio measured by CT and the change in plasma FFAs at steady state during the clamp (clamp FFAs [logged values]) (r = −0.33; P = 0.014); correlation coefficients and P values shown are from models where sex and site were added as factors. ▴, men; ○, women.

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