Pancreatic β-cell function is a stronger predictor of changes in glycemic control after an aerobic exercise intervention than insulin sensitivity

Thomas P J Solomon, Steven K Malin, Kristian Karstoft, Sangeeta R Kashyap, Jacob M Haus, John P Kirwan

Research output: Contribution to journalArticlepeer-review

47 Citations (Scopus)


CONTEXT: Understanding intersubject variability in glycemic control following exercise training will help individualize treatment.

OBJECTIVE: Our aim was to determine whether this variability is related to training-induced changes in insulin sensitivity or pancreatic β-cell function.

DESIGN, SETTING, AND PARTICIPANTS: We conducted an observational clinical study of 105 subjects with impaired glucose tolerance or type 2 diabetes.

INTERVENTIONS AND MAIN OUTCOME MEASURES: Individual subject changes in fitness (VO2max), glycemia (glycosylated hemoglobin, fasting glucose, oral glucose tolerance test), insulin sensitivity (hyperinsulinemic-euglycemic clamp), oral glucose-stimulated insulin secretion (GSIS), and disposition index (DI) were measured following 12 to 16 weeks of aerobic exercise training. Regression analyses were used to identify relationships between variables.

RESULTS: After training, 86% of subjects increased VO2max and lost weight. Glycosylated hemoglobin, fasting glucose, and 2-hour oral glucose tolerance test were reduced in 69%, 62%, and 68% of subjects, respectively, while insulin sensitivity improved in 90% of the participants. Changes in glycemic control were congruent with changes in GSIS such that 66% of subjects had a reduction in first-phase GSIS, and 46% had reduced second-phase GSIS. Training increased first- and second-phase DI in 83% and 74% of subjects. Training-induced changes in glycemic control were related to changes in GSIS (P < .05), but not insulin sensitivity or DI, and training-induced improvements in glycemic control were largest in subjects with greater pretraining GSIS.

CONCLUSIONS: Intersubject variability in restoring glycemic control following exercise is explained primarily by changes in insulin secretion. Thus, baseline and training-induced changes in β-cell function may be a key determinant of training-induced improvements in glycemic control.

Original languageEnglish
Pages (from-to)4176-86
Number of pages11
JournalThe Journal of clinical endocrinology and metabolism
Issue number10
Publication statusPublished - Oct 2013


  • Adult
  • Blood Glucose
  • Body Mass Index
  • Diabetes Mellitus, Type 2
  • Exercise
  • Exercise Therapy
  • Female
  • Glucose Intolerance
  • Glucose Tolerance Test
  • Humans
  • Insulin Resistance
  • Insulin-Secreting Cells
  • Male
  • Obesity
  • Treatment Outcome
  • Weight Loss


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