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ExTiDi study

Laatste wijziging: 24 January 2022

Influence of timing of training on sugar control in males with type 2 diabetes


Principal Investigator: Prof. Dr. Dominique Hansen


In the care of type 2 diabetes, exercise intervention is considered a cornerstone. According to international clinical guidelines, such intervention would lead to a significant improvement in glycemic control, lipid profile, body composition, physical fitness, and muscle strength. Moreover, the impact of different training modalities on changes in glycemic control in type 2 diabetes patients has been described. However, the optimal timing of exercise training (before breakfast in fasting condition, or after breakfast in postprandial condition) remains unknown in type 2 diabetes patients. It is hypothesized that exercise training in the fasted state up regulates intramuscular fatty acid turnover and hereby prevents accumulation of intramuscular fat and/or improves fat oxidation capacity. This would translate into a better preservation of insulin sensitivity and lead to a better glycemic control. On the other hand, when exercise sessions are implemented within a few hours after breakfast, the magnitude of postprandial hyperglycemia is significantly lower in type 2 diabetes patients. A suppression in postprandial hyperglycemia would lead to a significant decrease in blood HbA1c content and lead to a better glycemic control.


In this study, 50 subjects with type 2 diabetes are randomly assigned to 3 months of endurance training (3 days/week, at 65% of VO2max, for 45 minutes/session) before breakfast (in fasting condition) or immediately after breakfast (in postprandial condition). At entry of intervention, and after 3 months of participation, following measurements are executed:  blood sample analysis (glucose, insulin, HbA1c, lipid profile), fasting blood sample and euglycemic hyperinsulinemic clamp test (glucose, insulin), maximal cycling exercise test (VO2max, Wmax, HRmax), low-intensity exercise test (substrate selection based on RER), bone mineral density scan (body composition), and muscle biopsy (muscle fiber type composition, oxidative enzyme activity, glycogen and IMTG content). Ahead of these measurements, lipid-lowering and glucose-lowering medication are stopped for 3 days, and food intake is standardized.