Effects of insulin resistance and insulin secretion on the efficacy of interventions to retard development of type 2 diabetes mellitus: the DA Qing IGT and Diabetes Study. Insulin resistance, intramyocellular lipid content, and plasma adiponectin in patients with type 1 diabetes. [Effects of resistant starch on insulin resistance of type 2 diabetes mellitus patients]. A Novel Fasting Blood Test for Insulin Resistance and Prediabetes Changes in Insulin Resistance and HbA1c Are Related to Exercise-Mediated Changes in Body Composition in Older Adults With Type 2 Diabetes The insulin resistance phenotype (muscle or liver) interacts with the type of diet to determine changes in disposition index after 2 years of intervention: the CORDIOPREV-DIAB randomised clinical trial Long-standing, insulin-treated type 2 diabetes patients with complications respond well to short-term resistance and interval exercise training. Effective exercise modality to reduce insulin resistance in women with type 2 diabetes. Lifestyle intervention in people with insulin-dependent diabetes mellitus (IDDM) The Therapeutic Potential of Resistant Starch in Modulation of Insulin Resistance, Endotoxemia, Oxidative Stress and Antioxidant Biomarkers in Women with Type 2 Diabetes: A Randomized Controlled Clinical Trial Restoration of acute insulin response in T2DM subjects 1 month after biliopancreatic diversion. The impact of exercise training compared to caloric restriction on hepatic and peripheral insulin resistance in obesity. Improvements in glucose tolerance and insulin action induced by increasing energy expenditure or decreasing energy intake: a randomized controlled trial. Resistance Exercise Did Not Alter Intramuscular Adipose Tissue but Reduced Retinol-binding Protein-4 Concentration in Individuals with Type 2 Diabetes Mellitus Outcome of intensive integrated intervention in participants with impaired glucose regulation in China Effects of 1-year orlistat treatment compared to placebo on insulin resistance parameters in patients with type 2 diabetes. Free fatty acid-induced hepatic insulin resistance is attenuated following lifestyle intervention in obese individuals with impaired glucose tolerance.
OBJECTIVE To investigate the effects of insulin resistance ( IR ) and insulin secretion ( IS ) on the development of diabetes mellitus in individuals with impaired glucose tolerance ( IGT ) who underwent lifestyle interventions .  METHODS 284 out of 577 individuals with IGT identified by population -based screening in Da Qing , China , who were r and omized to undergo diet change and /or increased physical activity  had baseline fasting and 2 h post-load insulin determinations . They were followed for 6 years for the development of diabetes . IR and IS were assessed using calculated indices based on fasting plasma insulin and glucose . The interactions of IR , IS , obesity and plasma glucose and the effects of the lifestyle interventions were evaluated using Cox Proportional Hazards analysis . RESULTS Both IR and IS were significantly associated with the development of diabetes . Lifestyle interventions were more effective in those with lower IT and higher IS at baseline . Diet plus exercise interventions result ed in significantly lower incidence of diabetes , even after controlling for IR , IS , BMI and 2hrPG . CONCLUSION Both IR and beta-cell function were predictors of diabetes in Chinese with IGT . Lifestyle intervention reduced the incidence of DM and these interventions were more effective in those with less IR Insulin resistance is a key pathogenic factor of type 2 diabetes ( T2DM ) ; in contrast , in type 1 diabetes ( T1DM ) it is considered a secondary alteration . Increased intramyocellular lipid ( IMCL ) content accumulation and reduced plasma adiponectin were suggested to be pathogenic events of insulin resistance in T2DM . This study was design ed to assess whether IMCL content and plasma adiponectin were also associated with the severity of insulin resistance in T1DM . We studied 18 patients with T1DM , 7 older and overweight/obese patients with T2DM , and 15 nondiabetic , insulin-resistant offspring of T2DM parents ( OFF ) and 15 healthy individuals ( NOR ) as appropriate control groups matched for anthropometric features with T1DM patients by means of the euglycemic hyperinsulinemic clamp combined with the infusion of [6,6 - 2H2]glucose and 1H magnetic resonance spectroscopy of the calf muscles . T1DM and T2DM patients showed reduced insulin-stimulated glucose metabolic clearance rate ( MCR : 5.1 + /- 0.6 and 3.2 + /- 0.8 ml x kg(-1 ) min(-1 ) ) similar to OFF ( 5.3 + /- 0.4 ml x kg(-1 ) x min(-1 ) ) compared with NOR ( 8.5 + /- 0.5 ml x kg(-1 ) min(-1 ) , P < 0.001 ) . Soleus IMCL content was increased in T1DM ( 112 + /- 15 AU ) , T2DM ( 108 + /- 10 AU ) and OFF ( 82 + /- 13 AU ) compared with NOR ( 52 + /- 7 AU , P < 0.05 ) and the result was inversely proportional to the MCR ( R2 = 0.27 , P < 0.001 ) ; an association between IMCL content and Hb A1c was found only in T1DM ( R2 = 0.57 , P < 0.001 ) . Fasting plasma adiponectin was reduced in T2DM ( 7 + /- 1 microg/ml , P = 0.01 ) and OFF ( 11 + /- 1 microg/ml , P = 0.03 ) but not in T1DM ( 25 + /- 6 microg/ml ) , whose plasma level was increased with respect to both OFF ( P = 0.03 ) and NOR ( 16 + /- 2 microg/ml , P = 0.05 ) . In conclusion , in T1DM , T2DM , and OFF , IMCL content was associated with insulin resistance , demonstrating that IMCL accretion is a marker of insulin resistance common to both primary genetically determined and secondary metabolic ( chronic hyperglycemia ) alterations . The increased adiponectin levels in insulin-resistant patients with T1DM , in contrast to the reduced levels found in patients with T2DM and in OFF , demonstrated that the relationship of adiponectin to insulin resistance in humans is still unclear OBJECTIVE To observe the effects of resistant starch ( RS ) on insulin resistance ( IR ) in type 2 diabetes mellitus patients . METHODS All 40 patients with type 2 diabetes mellitus were r and omly divided into two groups : Group A and Group B. Cross- design of two stages ( I , II ) was used during observation . Group A received RS 30 g/d as an intervention group for ahead of 4 weeks ( I stage ) , while group B as a control group . Group B was given RS in late 4 weeks ( II stage ) , while Group A as served control group . Blood was taken the first day and on the latest day in each stage . Fasting blood glucose ( FBG ) , post blood glucose ( PBG ) , fructosamine ( FMN ) , total cholesterol ( TC ) , triglyceridemic ( TG ) , insulin sensitive index ( ISI ) , and body mass index ( BMI ) were measured , respectively . RESULTS As Compared with the control group , ISI was higher and FBG , PBG , TC , TG , FMN and BMI were significantly lower in intervention group ( P < 0.05 ) . CONCLUSION RS should be effective in improving IR of type 2 diabetes mellitus patients Background : Insulin resistance ( IR ) can precede the dysglycemic states of prediabetes and type 2 diabetes mellitus ( T2DM ) by a number of years and is an early marker of risk for metabolic and cardiovascular disease . There is an unmet need for a simple method to measure IR that can be used for routine screening , prospect i ve study , risk assessment , and therapeutic monitoring . We have reported several metabolites whose fasting plasma levels correlated with insulin sensitivity . These metabolites were used in the development of a novel test for IR and prediabetes . Methods : Data from the Relationship between Insulin Sensitivity and Cardiovascular Disease Study were used in an iterative process of algorithm development to define the best combination of metabolites for predicting the M value derived from the hyperinsulinemic euglycemic clamp , the gold st and ard measure of IR . Subjects were divided into a training set and a test set for algorithm development and validation . The result ing calculated M score , MQ , was utilized to predict IR and the risk of progressing from normal glucose tolerance to impaired glucose tolerance ( IGT ) over a 3 year period . Results : MQ correlated with actual M values , with an r value of 0.66 . In addition , the test detects IR and predicts 3 year IGT progression with areas under the curve of 0.79 and 0.70 , respectively , outperforming other simple measures such as fasting insulin , fasting glucose , homeostatic model assessment of IR , or body mass index . Conclusions : The result , Quantose ™ , is a simple test for IR based on a single fasting blood sample and may have value as an early indicator of risk for the development of prediabetes and T2DM OBJECTIVE To investigate changes in body composition after 12 months of high-intensity progressive resistance training ( PRT ) in relation to changes in insulin resistance ( IR ) or glucose homeostasis in older adults with type 2 diabetes . RESEARCH DESIGN AND METHODS One-hundred three participants were r and omized to receive either PRT or sham exercise 3 days per week for 12 months . Homeostasis model assessment 2 of insulin resistance ( HOMA2-IR ) and glycosylated hemoglobin ( HbA1c ) were used as indices of IR and glucose homeostasis . Skeletal muscle mass ( SkMM ) and total fat mass were assessed using bioelectrical impedance . Visceral adipose tissue , mid-thigh cross-sectional area , and mid-thigh muscle attenuation were quantified using computed tomography . RESULTS Within the PRT group , changes in HOMA2-IR were associated with changes in SkMM ( r = −0.38 ; P = 0.04 ) and fat mass ( r = 0.42 ; P = 0.02 ) . Changes in visceral adipose tissue tended to be related to changes in HOMA2-IR ( r = 0.35 ; P = 0.07 ) . Changes in HbA1c were related to changes in mid-thigh muscle attenuation ( r = 0.52 ; P = 0.001 ) . None of these relationships were present in the sham group ( P > 0.05 ) . Using ANCOVA models , participants in the PRT group who had increased SkMM had decreased HOMA2-IR ( P = 0.05 ) and HbA1c ( P = 0.09 ) compared with those in the PRT group who lost SkMM . Increases in SkMM in the PRT group decreased HOMA2-IR ( P = 0.07 ) and HbA1c ( P < 0.05 ) compared with those who had increased SkMM in the sham group . CONCLUSIONS Improvements in metabolic health in older adults with type 2 diabetes were mediated through improvements in body composition only if they were achieved through high-intensity PRT Abstract Aims /hypothesisThe aim of the study was to determine whether basal insulin resistance ( IR ) phenotype ( muscle and /or liver ) determines the effect of long-term consumption of a Mediterranean diet or a low-fat diet on tissue-specific IR and beta cell function . Methods The study was performed in 642 patients included in The effect of an olive oil rich Mediterranean diet on type 2 diabetes mellitus risk and incidence study ( CORDIOPREV-DIAB ) . A total of 327 patients were r and omised to a Mediterranean diet ( 35 % fat ; 22 % from monounsaturated fatty acids ) and 315 to a low-fat diet ( < 28 % fat ) . At baseline , the patients were classified into four phenotypes according to the type of IR : ( 1 ) no IR ; ( 2 ) muscle IR ; ( 3 ) liver IR ; ( 4 ) muscle + liver IR . The hepatic insulin resistance index ( HIRI ) , muscular insulin sensitivity index ( MISI ) and disposition index were analysed at baseline and after 2 years of follow-up . Results At baseline , 322 patients presented  no IR , 106 presented muscle IR , 109 presented liver IR , and 105 presented muscle + liver IR . With both dietary interventions , HIRI decreased in all patients ( p < 0.001 ) and MISI increased in muscle IR and muscle + liver IR patients ( p < 0.01 ) . Long-term intake of the Mediterranean diet increased the disposition index and insulinogenic index in the muscle IR patients ( p = 0.042 and p = 0.044 , respectively ) and the disposition index in the muscle + liver IR patients ( p = 0.048 ) , whereas the low-fat diet increased the disposition index in the liver IR patients ( p = 0.017 ) . Conclusions /interpretationAlthough both diets improve insulin sensitivity , there are differences based on basal IR phenotypes . Moreover , according to insulinogenic and disposition index data , a low-fat diet might be more beneficial to patients with liver IR , whereas patients with muscle IR and muscle + liver IR might benefit more from a Mediterranean diet . Trial registration Clinical Trials.gov NCT00924937 Funding The study was supported by the Ministerio de Economia y Competitividad ( AGL2012/39615 ) and by the Ministerio de Ciencia e Innovacion ( PIE14/00005 and PI13/00023 OBJECTIVE To determine the feasibility and the benefits of combined resistance and interval exercise training on phenotype characteristics and skeletal muscle function in deconditioned , type 2 diabetes ( T2D ) patients with polyneuropathy . DESIGN Short-term , single-arm intervention trial . METHODS Eleven male T2D patients ( age : 59.1+/-7.5 years ; body mass index : 32.2+/-4.0 kg/m2 ) performed progressive resistance and interval exercise training thrice a week for 10 weeks . Besides primary diabetes outcome measures , muscle strength ( MUST ) , maximal workload capacity ( Wmax ) , whole-body peak oxygen uptake ( VO2peak ) and muscle oxidative capacity ( MUOX ) , intramyocellular lipid ( IMCL ) and glycogen ( IMCG ) storage , and systemic inflammation markers were determined before and after training . Daily exogenous insulin requirements ( EIR ) and historic individualized EIR were gathered and analysed . RESULTS MUST and Wmax increased with 17 % ( 90 % confidence intervals 9 - 24 % ) and 14 % ( 6 - 21 ) respectively . Furthermore , mean arterial blood pressure declined with 5.5 mmHg ( -9.7 to -1.4 ) . EIR dropped with 5.0 IU/d ( -11.5 to 1.5 ) compared with baseline . A decline of respectively -0.7 mmol/l ( -2.9 to 1.5 ) and -147 micromol/l ( -296 to 2 ) in fasting plasma glucose and non-esterified fatty acids concentrations were observed following the intervention , but these were not accompanied by changes in VO2peak , MUOX , IMCL or IMCG , and blood glycolysated haemoglobin , adiponectin , tumor necrosis factor-alpha and /or cholesterol concentrations . CONCLUSION Short-term resistance and interval exercise training is feasible in deconditioned T2D patients with polyneuropathy and accompanied by moderate improvements in muscle function and blood pressure . Such a specific exercise regimen may provide a better framework for future exercise intervention programmes in the treatment of deconditioned T2D patients OBJECTIVE The purpose of this study was to evaluate whether a combined resistance and aerobic training program would improve insulin sensitivity compared with aerobic training alone in postmenopausal women with type 2 diabetes . A second objective was to relate the improved insulin sensitivity to changes in abdominal adipose tissue ( AT ) and thigh muscle density . RESEARCH DESIGN AND METHODS A total of 28 obese postmenopausal women with type 2 diabetes were r and omly assigned to one of three 16-week treatments : control , aerobic only training ( Ae only ) , or aerobic plus resistance training ( Ae+RT ) . Pre- and posttreatment outcome measures included glucose disposal by hyperinsulinemic-euglycemic clamp and computed tomography scans of abdominal AT and mid-thigh skeletal muscle . RESULTS Glucose infusion rates increased significantly ( P < 0.05 ) in the Ae+RT group . Both exercise groups had reduced abdominal subcutaneous and visceral AT and increased muscle density . The Ae+RT training group exhibited a significantly greater increase in muscle density than the Ae only group . Improved glucose disposal was independently associated with changes in subcutaneous AT , visceral AT , and muscle density . Muscle density retained a relationship with glucose disposal after controlling for abdominal AT . CONCLUSIONS Adding resistance training to aerobic training enhanced glucose disposal in postmenopausal women with type 2 diabetes . The improved insulin sensitivity is related to loss of abdominal subcutaneous and visceral AT and to increased muscle density Objective : To investigate the impact of intensive lifestyle education on dietary practice s , exercise and metabolic measurements in people with insulin-dependent diabetes mellitus ( IDDM ) . Design : Sixty-one volunteer subjects with IDDM were r and omised to intensive ( Group 1 ) or st and ard ( Group 2 ) education programmes for six months . During a second six month period of observation Group 1 subjects received routine surveillance for their condition and those in Group 2 were given intensive advice ( phase 2 ) . Current insulin regimens were modified to optimise glycaemic control before the start of the intervention phase . Nutrient intakes , weight , blood pressure , glycated haemoglobin ( HbA ) , plasma lipids , lipoproteins and maximal oxygen consumption ( VO max ) were measured at the time of recruitment and at three monthly intervals during the trial and phase 2 . Setting : Department of Human Nutrition at the University of Otago . Results : Glycated haemoglobin decreased significantly in both groups between recruitment and r and omisation , the improvement being sustained during the six months of the r and omised trial and for group 1 during the six months of post trial observation . A further decrease was seen in Group 2 during the second six month period when they were given intensive advice . Comparable changes were seen with total and low density lipoprotein ( LDL ) cholesterol in Group 1 during the trial , but significant decreases were only seen in Group 2 in association with intensive intervention ( phase 2 ) . These changes occurred in parallel with increases in intakes of carbohydrate and monounsaturated fatty acids , a reduction in intakes of total and saturated fat , and an improvement in maximum oxygen consumption . Conclusions : A lifestyle programme for people with IDDM results in modest changes in diet and exercise habits sufficient to improve measures of glycaemic control and lipoprotein mediated risk of coronary heart disease independent of changes in insulin regime . More innovative approaches to achieve lifestyle changes are required to meet current recommendations which in turn are likely to produce even greater beneficial changes than those observed here . Sponsorship : This study was supported by the Eli Lilly Research Grant ( Eli Lilly and Company ( New Zeal and ) Ltd ) , The Deans Research Grant ( Otago Medical School , New Zeal and ) and The New Zeal and Dietetic Association ( Abbott Award ) Aims : This trial aims to determine the effects of resistant starch ( RS ) subtype 2 ( RS2 ) on glycemic status , metabolic endotoxemia and markers of oxidative stress . Methods : A r and omized , controlled , parallel-group clinical trial group of 56 females with type 2 diabetes mellitus ( T2DM ) was divided to 2 groups . The intervention group ( n = 28 ) and control group ( n = 28 ) received 10 g/day RS2 or placebo for 8 weeks , respectively . Fasting blood sample s were taken to determine glycemic status , endotoxin , high sensitivity C-reactive protein ( hs-CRP ) , malondialdehyde ( MDA ) , total antioxidant capacity ( TAC ) , antioxidant enzymes concentrations as well as uric acid at baseline and after the intervention . Results : After 8 weeks , RS2 caused a significant decrease in the levels of MDA ( -34.10 % ) , glycosylated hemoglobin ( -9.40 % ) , insulin ( -29.36 % ) , homeostasis model of insulin resistance ( -32.85 % ) and endotoxin ( -25.00 % ) , a significant increase in TAC ( 18.10 % ) and glutathione peroxidase ( 11.60 % ) as compared with control . No significant changes were observed in fasting plasma glucose , quantitative insulin sensitivity check index , hs-CRP , superoxide dismutase , catalase and uric acid in the RS2 group as compared with the control group . Conclusion : Supplementation with RS2 may be improved glycemic status , endotoxemia and markers of oxidative stress in patients with T2DM OBJECTIVE Biliopancreatic diversion ( BPD ) restores normal glucose tolerance in a few weeks in morbid obese subjects with type 2 diabetes , improving insulin sensitivity . However , there is less known about the effects of BPD on insulin secretion . We tested the early effects of BPD on insulin secretion in obese subjects with and without type 2 diabetes . METHODS AND PROCEDURES Twenty-one consecutive morbid obese subjects , 9 with type 2 diabetes ( T2DM ) and 12 with normal fasting glucose ( NFG ) were evaluated , just before and 1 month after BPD , by measuring body weight ( BW ) , glucose , adipocitokines , homeostasis model assessment of insulin resistance ( HOMA-IR ) , acute insulin response ( AIR ) to e.v . glucose and the insulinogenic index adjusted for insulin resistance ( [DeltaI5/DeltaG5]/HOMA-IR ) . RESULTS Preoperatively , those with T2DM differed from those with NFG in showing higher levels of fasting glucose , reduced AIR ( 57.9 + /- 29.5 vs. 644.9 + /- 143.1 pmol/l , P < 0.01 ) and reduced adjusted insulinogenic index ( 1.0 + /- 0.5 vs. 17.6 + /- 3.9 1/mmol(2 ) , P < 0.001 ) . One month following BPD , in both groups BW was reduced ( by approximately 11 % ) , but all subjects were still severely obese ; HOMA-IR and leptin decreased significanlty , while high-molecular weight ( HMW ) adiponectin and adjusted insulinogenic index increased . In the T2DM group , fasting glucose returned to non-diabetic values . AIR did not change in the NFG group , while in the T2DM group it showed a significant increase ( from 58.0 + /- 29.5 to 273.8 + /- 47.2 pmol/l , P < 0.01 ) . In the T2DM group , the AIR percentage variation from baseline was significantly related to changes in fasting glucose ( r = 0.70 , P = 0.02 ) , suggesting an important relationship exists between impaired AIR and hyperglycaemia . DISCUSSION BPD is able to restore AIR in T2DM even just 1 month after surgery . AIR restoration is associated with normalization of fasting glucose concentrations CONTEXT It has been difficult to distinguish the independent effects of caloric restriction versus exercise training on insulin resistance . OBJECTIVE Utilizing metabolic feeding and supervised exercise training , we examined the influence of caloric restriction vs. exercise training with and without weight loss on hepatic and peripheral insulin resistance . DESIGN , PARTICIPANTS , AND INTERVENTION Thirty-four obese , older subjects were r and omized to : caloric restriction with weight loss ( CR ) , exercise training with weight loss ( EWL ) , exercise training without weight loss ( EX ) , or controls . Based on an equivalent caloric deficit in EWL and CR , we induced matched weight loss . Subjects in the EX group received caloric compensation . Combined with [6,6(2)H(2)]glucose , an octreotide , glucagon , multistage insulin infusion was performed to determine suppression of glucose production ( SGP ) and insulin-stimulated glucose disposal ( ISGD ) . Computed tomography scans were performed to assess changes in fat distribution . RESULTS Body weight decreased similarly in EWL and CR , and did not change in EX and controls . The reduction in visceral fat was significantly greater in EWL ( -71 + /- 15 cm(2 ) ) compared to CR and EX . The increase in SGP was also almost 3-fold greater ( 27 + /- 2 % ) in EWL . EWL and CR promoted similar improvements in ISGD [ + 2.5 + /- 0.4 and 2.4 + /- 0.9 mg x kg fat-free mass (FFM)(-1 ) x min(-1 ) ] , respectively . CONCLUSIONS EWL promoted the most significant reduction in visceral fat and the greatest improvement in SGP . Equivalent increases in ISGD were noted in EWL and CR , whereas EX provided a modest improvement . Based on our results , EWL promoted the optimal intervention-based changes in body fat distribution and systemic insulin resistance BACKGROUND Weight loss , through calorie restriction or increases in energy expenditure via exercise , improves glucose tolerance and insulin action . However , exercise-induced energy expenditure may further improve glucoregulation through mechanisms independent of weight loss . OBJECTIVE The objective was to assess the hypothesis that weight loss through exercise-induced energy expenditure improves glucoregulation and circulating factors involved in insulin action to a greater extent than does similar weight loss through calorie restriction . DESIGN Sedentary men and women aged 50 - 60 y with a body mass index ( kg/m(2 ) ) of 23.5 - 29.9 were r and omly assigned to 1 of 2 weight-loss interventions [ 12 mo of exercise training ( EX group ; n = 18 ) or calorie restriction ( CR group ; n = 18 ) ] or to a healthy lifestyle ( HL ) control group ( n = 10 ) . The insulin sensitivity index and areas under the curve for glucose and insulin were assessed with an oral-glucose-tolerance test . Adiponectin and tumor necrosis factor alpha concentrations were measured in fasting serum . Fat mass was measured by dual-energy X-ray absorptiometry . RESULTS Yearlong energy deficits were not significantly different between the EX and CR groups , as evidence d by body weight and fat mass changes . The insulin sensitivity index increased and the glucose and insulin areas under the curve decreased in the EX and CR groups , remained unchanged in the HL group , and did not differ significantly between the EX and CR groups . Marginally significant increases in adiponectin and decreases in the ratio of tumor necrosis factor alpha to adiponectin occurred in the EX and CR groups but not in the HL group . CONCLUSIONS Weight loss induced by exercise training or calorie restriction improves glucose tolerance and insulin action in nonobese , healthy , middle-aged men and women . However , it does not appear that exercise training-induced  weight loss results in greater improvements than those that result from calorie restriction alone Lipid accumulation in muscle is associated with diminished insulin sensitivity . It was hypothesized that resistance exercise decreases muscular adipose tissue and reduces the level of retinol-binding protein-4 ( RBP4 ) , which is linked to adipose tissue and insulin sensitivity in diabetics . Forty-four women with type 2 diabetes were r and omly assigned to three groups for a period of 12 weeks : control ( asked to maintain a sedentary lifestyle ) ; resistance exercise ( elastic b and exercise at moderate intensity five times per week ) ; and aerobic exercise ( walking for 60 min at moderate intensity five times per week ) . Subcutaneous ( SCAT ) , subfascial ( SFAT ) and intramuscular ( IMAT ) adipose tissues at mid-thigh level were assessed using computed tomography , and RBP4 level and insulin sensitivity ( fractional disappearance rate of insulin , k ITT ) were assessed before and after intervention . Changes in SCAT , SFAT , IMAT , RBP4 and k ITT were similar among the three groups . Within-group analysis revealed that body mass index and waist circumference decreased significantly in both exercise groups , but RBP4 decreased significantly only with resistance exercise . Resistance exercise did not alter muscular adipose tissue or improve insulin sensitivity Introduction This study investigated the outcomes and identified influencing factors of intensive integrated intervention over 2 years in Chinese patients with impaired glucose regulation ( IGR ) . Methods Adults in Beijing , China , were screened for IGR using the 75 g oral glucose tolerance test . Participants with IGR received lifestyle and health education ; those who still had IGR after 1 year were r and omly assigned to either a routine care group or to an intensive integrated intervention group . Results Of 2344 adults screened , 463 had IGR . Of these , 210 adults had IGR after 1 year and were therefore recruited and r and omized to an intensive integrated intervention group ( n=106 ) or a control group ( n=104 ) . The percentage of patients who reached the set targets of plasma glucose , blood pressure , body mass index , or triglycerides was significantly higher in the intensive integrated intervention group . None of the patients within the intensive integrated intervention group progressed to diabetes , whereas eight ( 9.3 % ) cases of the control group developed type 2 diabetes mellitus ( T2DM ) . Logistic regression analysis showed that both an increase in waist circumference and systolic blood pressure ( SBP ) were positively correlated with the development of T2DM , whereas improvement in islet beta cell function was negatively correlated with the development of T2DM . Conclusions Intensive integrated intervention may significantly decrease the conversion rate of IGR to T2DM , and increase the conversion ratio to normal glucose tolerance . The increase of waist circumference or SBP and the deterioration of islet beta cell function may be important risk factors for progression from prediabetes to diabetes WHAT IS KNOWN AND OBJECTIVE The behavioural approach is usually slow and not always sufficient to achieve optimal targets in weight and metabolic control in obese diabetic patients , and a pharmacological treatment is often necessary . The aim of this study was to compare the effects of orlistat and placebo on body weight , glycaemic and lipid profile and insulin resistance in patients with type 2 diabetes . METHODS Two hundred and fifty-four obese , diabetic patients were enrolled in this study and r and omized to take orlistat 360 mg or placebo for 1year . We evaluated at baseline and after 3 , 6 , 9 and 12months body weight , waist circumference ( WC ) , body mass index ( BMI ) , glycated haemoglobin ( HbA(1c ) ) , fasting plasma glucose ( FPG ) , post-pr and ial plasma glucose ( PPG ) , fasting plasma insulin ( FPI ) , homeostasis model assessment insulin resistance index ( HOMA-IR ) , lipid profile , retinol-binding protein-4 ( RBP-4 ) , resistin , visfatin and high-sensitivity C-reactive protein ( Hs-CRP ) . RESULTS AND DISCUSSION We observed a significant reduction in body weight , WC , BMI , lipid profile , RBP-4 and visfatin in the orlistat group but not in control group . Faster improvements in HbA(1c ) , PPG , FPI , HOMA-IR , resistin and Hs-CRP were recorded with orlistat than with placebo . A similar decrease in FPG was seen in the two groups . Significant predictors of change in insulin resistance ( HOMA-IR ) were RBP-4 and resistin concentration in the orlistat group ( r=-0·53 , P<0·05 , and r=-0·59 , P<0·01 , respectively ) . WHAT IS NEW AND CONCLUSION To the best of our knowledge , this is the first study investigating the effect of orlistat on insulin resistance and markers of inflammation . Orlistat improved lipid profile and led to faster glycaemic control and insulin resistance parameters than the control , without any serious adverse event . Orlistat also improved RBP-4 and visfatin , effects not observed with placebo OBJECTIVE The objective of the study was to examine the effects of an exercise/diet lifestyle intervention on free fatty acid (FFA)-induced hepatic insulin resistance in obese humans . RESEARCH DESIGN AND METHODS Obese men and women ( n = 23 ) with impaired glucose tolerance were r and omly assigned to either exercise training with a eucaloric ( EU ; approximately 1800 kcal ; n = 11 ) or hypocaloric ( HYPO ; approximately 1300 kcal ; n = 12 ) diet for 12 wk . Hepatic glucose production ( HGP ; milligrams per kilogram fat-free mass(-1 ) per minute(-1 ) ) and hepatic insulin resistance were determined using a two-stage sequential hyperinsulinemic ( 40 mU/m(2 ) . min(-1 ) ) euglycemic ( 5.0 mm ) clamp with [3-(3)H]glucose . Measures were obtained at basal , during insulin infusion ( INS ; 120 min ) , and insulin plus intralipid/heparin infusion ( INS/FFA ; 300 min ) . RESULTS At baseline , basal HGP was similar between groups ; hyperinsulinemia alone did not completely suppress HGP , whereas INS/FFA exhibited less suppression than INS ( EU , 4.6 + /- 0.8 , 2.0 + /- 0.5 , and 2.6 + /- 0.4 ; HYPO , 3.8 + /- 0.5 , 1.2 + /- 0.3 , and 2.3 + /- 0.4 , respectively ) . After the intervention the HYPO group lost more body weight ( P < 0.05 ) and fat mass ( P < 0.05 ) . However , both lifestyle interventions reduced hepatic insulin resistance during basal ( P = 0.005 ) and INS ( P = 0.001 ) conditions , and insulin-mediated suppression of HGP during INS was equally improved in both groups ( EU : -42 + /- 22 % ; HYPO : -50 + /- 20 % , before vs. after , P = 0.02 ) . In contrast , the ability of insulin to overcome FFA-induced hepatic insulin resistance and HGP was improved only in the HYPO group ( EU : -15 + /- 24 % vs. HYPO : -58 + /- 19 % , P = 0.02 ) . CONCLUSIONS Both lifestyle interventions are effective in reducing hepatic insulin resistance under basal and hyperinsulinemic conditions . However , the reversal of FFA-induced hepatic insulin resistance is best achieved with a combined exercise/caloric-restriction intervention
However , it can significantly decrease postintervention and reduction data of FPG , FI , HbA1c , and HOMA-IR .
Heterogeneity was eliminated by subgroup analysis according to baseline BMI .
There was no significant difference in the amelioration of QUICKI between the ITC and control groups .
However , the difference was statistically significant and the heterogeneity was eliminated after subgroup analysis according to intakes of ITC .
Conclusion Supplementation of ITC can ameliorate IR in T2DM , especially in obese T2DM patients , but the effects are controversial in obese patients
Background Insulin resistance ( IR ) is a physiological condition related to type 2 diabetes mellitus ( T2DM ) and obesity , which is associated with high blood insulin and glucose .
Inulin-type carbohydrate ( ITC ) is a kind of fermentable fructan that can reduce glucose and ameliorate IR in an animal model , but the effect in clinical trials is controversial .
Objective The authors conducted a systematic literature review to evaluate the effect of ITC supplementation in ameliorating IR in T2DM and obese patients .