The effects of a combined exercise programme aerobic and resistance on blood glucose, incretin, metabolic and inflammatory mediators that could control the diabetes and improve insulin sensitivity in type 2 diabetes patients

An excessive number of calories consumed daily, in addition to a sedentary lifestyle, are the main causes of increasing type 2 diabetes (T2D) prevalence worldwide (LEE, H.K. et al., 2010). Diabetes is usually accompanied by hypertension, lipid disorders and obesity. The aim of this study isto show that combination exercise is effective. It will compare T2D and non-diabetes (ND) volunteers doing combination exercise consisting of resistance and cycling. The interventions are minor and fairly short consisting of 12 episodes of exercise over 6 weeks, yet this was enough to produce measurable change and improvement. This included the re-categorization of two T2D volunteers to being ND, using normal metrics. Method: in each exercise session the participant should perform a combined exercise program consists of 30 min of resistance exercise followed by 20 min moderate cycling. This is done twice a week for 6 weeks. At the beginning of each session the participants have to stretch-up for 11 steps of stretching, then he/she must cycle for five minutes to warm up. The RE consist of 3 sets, in each set the volunteer performed (squat, chest, back, biceps and triceps) 10 times. HbA1c, lipid profile, weight, BMI, waist and lung capacity also measured at baseline and the 12th exercise session. OGTT were done at the beginning, after 1st session and finally after session 12. Moreover, BG and HR measured before exercise, after 1st, 2ndand 3rd RE then after 10 and 20 minutes of AE. BP also checked before exercise after RE and then after AE. RPE were checked after 1st, 2nd and 3rd RE as well as after 10 and 20 minutes AE. Blood samples collected at base line after these sessions (S1, S2, S4, S6, S8, S10 and S12), centrifuge and refrigerate the plasma to be analysed later by a commercially-available enzyme-linked immunosorbent assay (ELISA) and by The Evidence Investigator™ Biochip Array technology (Randox, UK). Results: After just six weeks, there was a reduction in the HbA1c level for the T2D volunteers which is significant (P= 0.000). Moreover, in ND the reduction was also significant (P= 0.000). In T2D, the OGTT result shows that the AUC of BG for the 1st OGTT was (30.55±2.5 mmol/L/h) but then decreased in the 2nd and 3rd OGTT, finally decreasing to (24.4±1.9 mmol/L/h). This reduction reflects a clear improvement in the IS in T2D. It shows that the reduction of BG in the OGTT after chronic effect of exercise was better than acute effect (after the first session). Meanwhile in ND, the AUC for the 1st OGTT was (14.9±3.2 mmol/L/h) and although became (13.9±3.0 mmol/L/h) in the 2nd OGTT returned to the original in the third reading. In the T2D group who are using (Metformin and SGT2-I group), their result shows elevation in GLP-1 in the assessment of both acute and chronic effect of the programme. GLP-1 in this group was (3.9±1.5) and increased to (8.4±1.2), (P= 0.345) after S1 and then increased more to (11.0±0.8), (P=0.196) after 6 weeks of exercise. Conclusion: In T2D and ND combination exercise has a beneficial effect on HbA1c, the improvement was higher in T2D. The anthropometric variables (weight, waist, BMI and lung capacity) improved significantly as well in T2D and ND. OGTT shows a very significant improvement of BG and insulin level in both groups that was higher in T2D, which shows that there was an improvement in insulin sensitivity. Exercise is also important to improve GLP-1 secretion. Despite the range of studies on incretin undertaken here, still there is a need to compare the effect of exercise and different types of pharmacological therapy on GLP1. This study compared the effect of exercise on T2D plus medication in volunteers. It has been found that within T2D group only Metformin and SGT2-I group was improved. Both SGLT2 inhibitors and metformin have been found to affect body weight and this may explain the improvement of GLP-1 level, suggesting an area for future investigation. Finally, exercise has different effect on the inflammatory markers, it shows elevation of IL-6 in T2D after 6 weeks of exercise. CRP represent significant reduction after 6 weeks as well which illustrates that exercise has good impact in decreasing inflammation by reducing CRP. Moreover, there is a little published data on the effect of exercise and medication type on the inflammatory markers. The present study illustrates a significant reduction in Cystatin C after 6 weeks within T2D group who are using (metformin and DDP4-I). Therefore, there is increasing concern that some medication plus exercise improve inflammatory markers which need further investigations