Ratzmann K P, Zander E, Witt S, Schulz B
Endokrinologie. 1981 Apr;77(2):233-41.
The effect of a physical training and low caloric diet (700 calories/day) for 4 weeks on insulin sensitivity in vivo, body weight and serum lipids was investigated in 10 obese asymptomatic diabetics (normal fasting plasma glucose and pathological glucose tolerance). Glucose tolerance and insulin secretion pattern were characterized by means of a 2h-glucose infusion test (12 mg/kg/min) primed by an initial injection of 0.33 g/kg glucose. Insulin responsiveness in vivo was estimated by means of a 1h-insulin infusion test (two 30-min. periods of 8 and 16 mU/kg insulin MC-Actrapid, primed by initial injection of 1 and 2 mU/kg, respectively). Under comparable steady-state insulin levels the decrease in plasma glucose and free fatty acids (FFA) was considered as estimate of insulin sensitivity in vivo. Physical working capacity (PWC170) was determined by means of a bicycle ergometer test in stepwise working loads. The training programme consisted of daily 15 min. bicycle ergometer training periods (75% of the maximal working capacity) in the morning and a 1 h mild physical training on a bicycle in the afternoon. After the combined training and diet programme the mean decrease in absolute and relative body weight amounted to 11.9 +/- 1.07 kg and 16.7 +/- 1.2%, respectively. There was a significant decrease of plasma triglycerides whereas the decrease in cholesterol was modest. Physical fitness increased by delta PWC170 of 31.1 +/- 11.6 W. In addition, the combined training and diet programme for 4 weeks resulted in a significant improvement of insulin sensitivity in vivo as indicated by an augmented insulin-induced decrease in plasma glucose and FFA (17.60 +/- 3.91%, vs 36.40 +/- 5.54%; p less than 0.05 and 35.90 +/- 6.95% vs 56.50 +/- 3.63%; p less than 0.05; respectively). Our findings provide direct evidence that physical training and low caloric diet enhance insulin sensitivity in vivo. From the practical point of view our results suggest the potential benefits of physical training in the treatment of obese asymptomatic diabetics.
在10名肥胖无症状糖尿病患者（空腹血糖正常但葡萄糖耐量异常）中，研究了为期4周的体育锻炼和低热量饮食（700卡路里/天）对体内胰岛素敏感性、体重和血脂的影响。通过2小时葡萄糖输注试验（12毫克/千克/分钟）并先注射0.33克/千克葡萄糖来表征葡萄糖耐量和胰岛素分泌模式。通过1小时胰岛素输注试验（两个30分钟时段，分别为8和16微单位/千克胰岛素MC-Actrapid，先分别注射1和2微单位/千克）来评估体内胰岛素反应性。在可比的稳态胰岛素水平下，血浆葡萄糖和游离脂肪酸（FFA）的降低被视为体内胰岛素敏感性的评估指标。通过在逐步增加工作负荷的情况下进行自行车测力计测试来测定身体工作能力（PWC170）。训练计划包括每天上午15分钟的自行车测力计训练时段（最大工作能力的75%）和下午1小时的轻度自行车体育锻炼。在联合训练和饮食计划之后，绝对体重和相对体重的平均降低分别达到11.9±1.07千克和16.7±1.2%。血浆甘油三酯显著降低，而胆固醇的降低幅度较小。身体适应性提高，PWC170增加了31.1±11.6瓦。此外，为期4周的联合训练和饮食计划导致体内胰岛素敏感性显著改善，表现为胰岛素诱导的血浆葡萄糖和FFA降低增加（分别为17.60±3.91%，对比36.40±5.54%；p<0.05和35.90±6.95%对比56.50±3.63%；p<0.05）。我们的研究结果提供了直接证据，表明体育锻炼和低热量饮食可增强体内胰岛素敏感性。从实际角度来看，我们的结果表明体育锻炼在治疗肥胖无症状糖尿病患者方面具有潜在益处。
