TY - JOUR

T1 - Effects of an intensive lifestyle intervention on the underlying mechanisms of improved glycaemic control in individuals with type 2 diabetes

T2 - a secondary analysis of a randomised clinical trial

AU - Johansen, Mette Y.

AU - Karstoft, Kristian

AU - MacDonald, Christopher S.

AU - Hansen, Katrine B.

AU - Ellingsgaard, Helga

AU - Hartmann, Bolette

AU - Albrechtsen, Nicolai J. Wewer

AU - Vaag, Allan A.

AU - Holst, Jens J.

AU - Pedersen, Bente K.

AU - Ried-Larsen, Mathias

PY - 2020

Y1 - 2020

N2 - Aims/hypothesis The aim was to investigate whether an intensive lifestyle intervention, with high volumes of exercise, improves beta cell function and to explore the role of low-grade inflammation and body weight.Methods This was a randomised, assessor-blinded, controlled trial. Ninety-eight individuals with type 2 diabetes (durationResults At baseline, individuals were 54.8 years (SD 8.9), 47% women, type 2 diabetes duration 5 years (IQR 3-8) and HbA(1c)was 49.3 mmol/mol (SD 9.2); 6.7% (SD 0.8). The intensive lifestyle group showed 40% greater improvement in the disposition index compared with the standard care group (ratio of geometric mean change [RGM] 1.40 [95% CI 1.01, 1.94]) from baseline to 12 months' follow-up. Plasma concentration of IL-1 receptor antagonist (IL-1ra) decreased 30% more in the intensive lifestyle group compared with the standard care group (RGM 0.70 [95% CI 0.58, 0.85]). Statistical single mediation analysis estimated that the intervention effect on the change in IL-1ra and the change in body weight explained to a similar extent (59%) the variance in the intervention effect on the disposition index.Conclusions/interpretation Our findings show that incorporating an intensive lifestyle intervention, with high volumes of exercise, in individuals with type 2 diabetes has the potential to improve beta cell function, associated with a decrease in low-grade inflammation and/or body weight.

AB - Aims/hypothesis The aim was to investigate whether an intensive lifestyle intervention, with high volumes of exercise, improves beta cell function and to explore the role of low-grade inflammation and body weight.Methods This was a randomised, assessor-blinded, controlled trial. Ninety-eight individuals with type 2 diabetes (durationResults At baseline, individuals were 54.8 years (SD 8.9), 47% women, type 2 diabetes duration 5 years (IQR 3-8) and HbA(1c)was 49.3 mmol/mol (SD 9.2); 6.7% (SD 0.8). The intensive lifestyle group showed 40% greater improvement in the disposition index compared with the standard care group (ratio of geometric mean change [RGM] 1.40 [95% CI 1.01, 1.94]) from baseline to 12 months' follow-up. Plasma concentration of IL-1 receptor antagonist (IL-1ra) decreased 30% more in the intensive lifestyle group compared with the standard care group (RGM 0.70 [95% CI 0.58, 0.85]). Statistical single mediation analysis estimated that the intervention effect on the change in IL-1ra and the change in body weight explained to a similar extent (59%) the variance in the intervention effect on the disposition index.Conclusions/interpretation Our findings show that incorporating an intensive lifestyle intervention, with high volumes of exercise, in individuals with type 2 diabetes has the potential to improve beta cell function, associated with a decrease in low-grade inflammation and/or body weight.

KW - Beta cell function

KW - Exercise

KW - Glycaemic control

KW - Insulin secretion

KW - Insulin sensitivity

KW - Low-grade inflammation

KW - Type 2 diabetes

KW - BETA-CELL FUNCTION

KW - ORAL GLUCOSE-TOLERANCE

KW - INSULIN SENSITIVITY

KW - WEIGHT-LOSS

KW - EXERCISE

KW - RESISTANCE

KW - MELLITUS

KW - MUSCLE

U2 - 10.1007/s00125-020-05249-7

DO - 10.1007/s00125-020-05249-7

M3 - Journal article

C2 - 32816096

VL - 63

SP - 2410

EP - 2422

JO - Diabetologia

JF - Diabetologia

SN - 0012-186X

ER -