Abstract
Background: Type 2 diabetes, coronary atherosclerosis, and physical fitness all correlate with insulin resistance, but the relative importance of each component is unknown.
Hypothesis: This study was undertaken to determine the relationship between insulin resistance, maximal oxygen uptake, and the presence of either diabetes or ischemic heart disease.
Methods: The study population comprised 33 patients with and without diabetes and ischemic heart disease. Insulin resistance was measured by a hyperinsulinemic euglycemic clamp; maximal oxygen uptake was measured during a bicycle exercise test.
Results: There was a strong correlation between maximal oxygen uptake and insulin‐stimulated glucose uptake (r = 0.7, p = 0.001), and maximal oxygen uptake was the only factor of importance for determining insulin sensitivity in a model, which also included the presence of diabetes and ischemic heart disease.
Conclusion: Maximal oxygen uptake may be a more important determinant for insulin sensitivity than ischemic heart disease and type 2 diabetes.
Keywords: insulin resistance, maximal oxygen uptake
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References
- 1. Reaven GM: Banting lecture 1988. Roleof insulin resistance in human disease. Diabetes 1988; 37: 1595–1607 [DOI] [PubMed] [Google Scholar]
- 2. Nyholm B, Mengel A, Nielsen S, Skjaerbaek C, Moller N, Alberti KG, Schmitz O: Insulin resistance in relatives of NIDDM patients: The role of physical fitness and muscle metabolism. Diabetologia 1996; 39 (7): 813–822 [DOI] [PubMed] [Google Scholar]
- 3. Dela F, Mikines KJ, von Linstow M, Secher NH, Galbo H: Effect of training on insulin‐mediated glucose uptake in human muscle. Am J Physiol 1992; 263 (6 Pt 1): E1134–1143 [DOI] [PubMed] [Google Scholar]
- 4. Helmrich SP, Ragland DR, Leung RW, Paffenbarger RS: Physical activity and reduced occurrence of non‐insulin‐dependent diabetes mellitus. N Engl J Med 1991; 325 (3): 147–152 [DOI] [PubMed] [Google Scholar]
- 5. DeFronzo RA, Tobin JD, Andres R: Glucose clamp technique: A method for quantifying insulin secretion and resistance. Am J Physiol 1979; 6 (3): E214–E223 [DOI] [PubMed] [Google Scholar]
- 6. Steele R: Influences of glucose loading and of injected insulin on hepatic glucose output. NY Acad Sci 1959; 82 (1): 420–430 [DOI] [PubMed] [Google Scholar]
- 7. Andersen L, Dinesen B, J¢rgensen PN, Poulsen F, R¢der ME: Enzyme immunoassay for intact human insulin in serum or plasma. Clin Chem 1993; 39 (4): 578–582 [PubMed] [Google Scholar]
- 8. Heding LG: Radioimmunological determination of human C‐peptide in serum. Diabetologia 1975(11): 541–548 [DOI] [PubMed]
- 9. WHO technical report series. In WHO, 1985.
- 10. Pan XR, Li GW, Hu YH, Wang JX, Yang WY, An ZX, Hu ZX, Lin J, Xiao JZ, Cao HB, Liu PA, Jiang XG, Jiang YY, Wang JP, Zheng H, Zhang H, Bennett PH, Howard BV: Effects of diet and exercise in preventing NIDDM in people with impaired glucose tolerance. The Da Qing IGT and Diabetes Study. Diabetes Care 1997; 20 (4): 537–544 [DOI] [PubMed] [Google Scholar]
- 11. Bressler P, Bailey SR, Matsuda M, DeFronzo RA: Insulin resistance and coronary artery disease. Diabetologia 1996; 39: 1345–1350 [DOI] [PubMed] [Google Scholar]
- 12. Inchiostro S, Bertoli G, Zanette G, Donadon V: Evidence of higher insulin resistance in NIDDM patients with ischaemic heart disease. Diabetologia 1994; 37 (6): 597–603 [DOI] [PubMed] [Google Scholar]
- 13. Haffner SM, Stern MP, Hazuda HP, Mitchell BD, Patterson JK: Cardiovascular risk factors in confirmed prediabetic individuals. Does the clock for coronary heart disease start ticking before the onset of clinical diabetes? J Am Med Assoc 1990; 263 (21): 2893–2898 [DOI] [PubMed] [Google Scholar]
- 14. Zavaroni I, Bonora E, Pagliara M, Dall'Aglio E, Luchetti L, Buonanno G, Bonati PA, Bergonzani M, Gnudi L, Passeri M, Reaven G: Risk factors for coronary artery disease in healthy persons with hyperinsulinemia and normal glucose tolerance. N Engl J Med 1989; 320: 702–706 [DOI] [PubMed] [Google Scholar]
- 15. Siegel RD, Cupples A, Schaefer EJ, Wilson PW: Lipoproteins, apolipoproteins, and low‐density lipoprotein size among diabetics in the Framingham offspring study. Metabolism 1996; 45 (10): 1267–1272 [DOI] [PubMed] [Google Scholar]
- 16. Blair SN, Kohl HW III, Barlow CE, Paffenbarger RS Jr, Gibbons LW, Macera CA: Changes in physical fitness and all‐cause mortality. A prospective study of healthy and unhealthy men. J Am Med Assoc 1995; 273 (14): 1093–1098 [PubMed] [Google Scholar]
- 17. Lavrencic A, Salobir BG, Keber I: Physical training improves flow‐mediated dilation in patients with the polymetabolic syndrome. Arterioscler Thromb Vasc Biol 2000; 20 (2): 551–555 [DOI] [PubMed] [Google Scholar]
- 18. Goodyear LJ, Hirshman MF, King PA, Horton ED, Thompson CM, Horton ES: Skeletal muscle plasma membrane glucose transport and glucose transporters after exercise. J Appl Physiol 1990; 68 (1): 193–198 [DOI] [PubMed] [Google Scholar]
- 19. Hambrecht R, Fiehn E, Weigl C, Gielen S, Hamann C, Kaiser R, Yu J, Adams V, Niebauer J, Schuler G: Regular physical exercise corrects endothelial dysfunction and improves exercise capacity in patients with chronic heartfailure. Circulation 1998; 98 (24): 2709–2715 [DOI] [PubMed] [Google Scholar]
- 20. Laakso M, Edelman SV, Brechtel G, Baron AD: Impaired insulin‐mediated skeletal muscle blood flow in patients with NIDDM. Diabetes 1992; 41 (9): 1076–1083 [DOI] [PubMed] [Google Scholar]
- 21. Baron AD: Vascular reactivity. Am J Cardiol 1999; 84 (1A): 25J–27J [DOI] [PubMed] [Google Scholar]