Role of Skeletal Muscle in Insulin Resistance and Glucose Uptake
Open accessAbstract
The skeletal muscle is the largest organ in the body, by mass. It is also the regulator of glucose homeostasis, responsible for 80% of postprandial glucose uptake from the circulation. Skeletal muscle is essential for metabolism, both for its role in glucose uptake and its importance in exercise and metabolic disease. In this article, we give an overview of the importance of skeletal muscle in metabolism, describing its role in glucose uptake and the diseases that are associated with skeletal muscle metabolic dysregulation. We focus on the role of skeletal muscle in peripheral insulin resistance and the potential for skeletal muscle-targeted therapeutics to combat insulin resistance and diabetes, as well as other metabolic diseases like aging and obesity. In particular, we outline the possibilities and pitfalls of the quest for exercise mimetics, which are intended to target the molecular mechanisms underlying the beneficial effects of exercise on metabolic disease. We also provide a description of the molecular mechanisms that regulate skeletal muscle glucose uptake, including a focus on the SNARE proteins, which are essential regulators of glucose transport into the skeletal muscle. © 2020 American Physiological Society. Compr Physiol 10:785-809, 2020.
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Physical exercise and activity can induce the secretion of myokines with anti-inflammatory effects, mediated through the effects of IL-6 and Tumour Necrosis Factor α (TNF-α).
“Physical exercise and activity can induce the secretion of myokines with anti-inflammatory effects [17,42], mediated through the effects of IL-6 and Tumour Necrosis Factor α (TNF-α) [17].”
From Optimised Skeletal Muscle Mass as a Key Strategy for Obesity Management (2025) · cites this paper as [17]
The “Mechanisms of myokine action” section (page not available) says exercise can induce myokine secretion and that exercise-induced IL-6 can have anti-inflammatory effects. It does not describe TNF-α as mediating those effects; instead, it associates TNF activity with pro-inflammatory signaling and the onset of insulin resistance. (LLM, conf=0.88)
Experimental — accuracy not yet measuredThis process is an important contributor to the enhanced risk for the development of T2D (and other metabolic dysfunction) in older age, which in turn is driven by aging-associated acceleration of IR within the SM.
“This process is an important contributor to the enhanced risk for the development of T2D (and other metabolic dysfunction) in older age, which in turn is driven by aging-associated acceleration of IR within the SM [17].”
From Optimised Skeletal Muscle Mass as a Key Strategy for Obesity Management (2025) · cites this paper as [17]
The sections “Links between aging and skeletal muscle insulin resistance” and “Importance of skeletal muscle in insulin resistance” link aging, muscle dysfunction, insulin resistance, and T2D risk (page numbers unavailable). The copy does not establish that insulin resistance in skeletal muscle accelerates with age or that this acceleration drives the increased risk of T2D and other metabolic dysfunction. (LLM, conf=0.82)
Experimental — accuracy not yet measuredThere is an aging-related decline in SM-mediated metabolic function that manifests with a diminishment of mitochondrial function and capacity for thermogenic energy expenditure.
“Furthermore, there is also an aging-related decline in SM-mediated metabolic function that manifests with a diminishment of mitochondrial function and capacity for thermogenic energy expenditure [17,33].”
From Optimised Skeletal Muscle Mass as a Key Strategy for Obesity Management (2025) · cites this paper as [17]
The section “Links between aging and skeletal muscle insulin resistance” states that aging of human skeletal muscle involves a gradual decline in mitochondrial function and muscle mass. It does not establish an aging-related decline in the capacity for thermogenic energy expenditure; the thermogenesis mention found is in a reference title, not a finding the paper reports about aging. (LLM, conf=0.88)
Experimental — accuracy not yet measuredThe development of SO can be viewed as a toxic feedback loop in which obesity and IMCL worsen IR and beget sarcopenia, and sarcopenia further worsens IR and contributes towards worsening obesity and progression of IMCL.
“The development of SO can therefore be viewed as a toxic feedback loop in which obesity and IMCL worsen IR and beget sarcopenia, and sarcopenia further worsens IR and contributes towards worsening obesity and progression of IMCL [17].”
From Optimised Skeletal Muscle Mass as a Key Strategy for Obesity Management (2025) · cites this paper as [17]
The “Combined effects of aging and obesity on insulin resistance” section (page unavailable) describes sarcopenic obesity as a toxic feedback loop in which increased fat mass and decreased muscle mass exacerbate one another, with insulin resistance at their juncture. The “Links between obesity/inflammation and skeletal muscle insulin resistance” section also says obesity increases the risk of insulin resistance. The cited paper does not establish the claimed progression of intramyocellular lipid (IMCL) in either direction, or the full sequence in which insulin resistance causes sarcopenia. (LLM, conf=0.85)
Experimental — accuracy not yet measuredIrisin is stimulated by PGC1α, and mediates beneficial metabolic effects through the beiging of white AT, thereby activating UCP1 and inducing enhanced thermogenesis within the white AT.
“Irisin is stimulated by ‘Peroxisome proliferator-activated receptor-Gamma Coactivator 1α’ (PGC1α), and mediates beneficial metabolic effects through the beiging of white AT [17,49], thereby activating UCP1 and inducing enhanced thermogenesis within the white AT.”
From Optimised Skeletal Muscle Mass as a Key Strategy for Obesity Management (2025) · cites this paper as [17]
In “Mechanisms of myokine action,” the paper says PGC1α stimulates irisin expression and that irisin is thought to promote white-adipose beiging, which activates UCP1. The claim is more definite than the paper: it says irisin mediates these effects and induces enhanced thermogenesis within white adipose tissue, whereas the passage explicitly associates increased thermogenesis with brown adipose tissue. (LLM, conf=0.84)
Experimental — accuracy not yet measured
In the context of overconsumption of dietary fat with the absence of regular physical exercise, IMCL may worsen IR within the SM.
“In the context of overconsumption of dietary fat with the absence of regular physical exercise, IMCL may worsen IR within the SM [17,68].”
From Optimised Skeletal Muscle Mass as a Key Strategy for Obesity Management (2025) · cites this paper as [17]
The sections on obesity and skeletal-muscle inflammation link overnutrition, high-fat diets, and saturated fatty acids to insulin resistance. They do not establish that intramyocellular lipids (IMCL) worsen insulin resistance specifically when regular exercise is absent; searches for “IMCL” and “intramyocellular lipid” did not locate that mechanism in the paper’s discussion. (LLM, conf=0.82)
Experimental — accuracy not yet measuredSkeletal muscle is responsible for up to 80% of postprandial glucose uptake.
“Specifically, skeletal muscle is responsible for up to 80% of postprandial glucose uptake (150, 151).”
From Sex differences in the metabolism of glucose and fatty acids by adipose tissue and skeletal muscle in humans (2025) · cites this paper as [151]
Enhanced metabolic dysfunction within the SM can also be influenced by T2D itself, other chronic diseases, and even a sedentary lifestyle, mediated through a process termed 'secondary aging'.
“In addition to ‘normal aging’, enhanced metabolic dysfunction within the SM can also be influenced by T2D itself, other chronic diseases, and even a sedentary lifestyle, mediated through a process termed ‘secondary aging’ [17,34].”
From Optimised Skeletal Muscle Mass as a Key Strategy for Obesity Management (2025) · cites this paper as [17]
The SM accounts for >80% of glucose uptake in the post-prandial period following an oral glucose load, with linear increases in uptake over time.
“Furthermore, the SM accounts for >80% of glucose uptake in the post-prandial period following an oral glucose load, with linear increases in uptake over time [17,20].”
From Optimised Skeletal Muscle Mass as a Key Strategy for Obesity Management (2025) · cites this paper as [17]
Unlike normal aging, the deleterious effects of secondary aging on the SM can be delayed through engagement in healthy lifestyle behaviours such as exercise and increased physical activity.
“Unlike normal aging, the deleterious effects of secondary aging on the SM can be delayed through engagement in healthy lifestyle behaviours such as exercise and increased physical activity [17,35].”
From Optimised Skeletal Muscle Mass as a Key Strategy for Obesity Management (2025) · cites this paper as [17]
The SM can be considered as a primary driver of whole-body IR.
“Given its important role in glucose handling, the SM can be considered as a primary driver of whole-body IR [17].”
From Optimised Skeletal Muscle Mass as a Key Strategy for Obesity Management (2025) · cites this paper as [17]
There is a gradual reduction in SM mass with aging, which often becomes meaningful clinically from around the age of 50 years.
“As intimated earlier, there is a gradual reduction in SM mass with aging, which often becomes meaningful clinically from around the age of 50 years [17].”
From Optimised Skeletal Muscle Mass as a Key Strategy for Obesity Management (2025) · cites this paper as [17]
Myokines (>600 peptides identified to date) influence the physiological function of the AT and other organs including bones and the brain.
“Myokines (>600 peptides identified to date) influence the physiological function of the AT and other organs including bones and the brain [17].”
From Optimised Skeletal Muscle Mass as a Key Strategy for Obesity Management (2025) · cites this paper as [17]
IR within the SM can develop independently of and decades prior to the onset of β-cell failure and the onset of T2D in those at high metabolic risk.
“Indeed, IR within the SM can develop independently of and decades prior to the onset of β-cell failure and the onset of T2D in those at high metabolic risk [17,21].”
From Optimised Skeletal Muscle Mass as a Key Strategy for Obesity Management (2025) · cites this paper as [17]
The skeletal muscle (SM) plays a key role in influencing metabolic health and efficiency.
“We resurrect the SM as a tissue hidden in plain sight and provide an overview of the key role that the SM plays in influencing metabolic health and efficiency.”
From Optimised Skeletal Muscle Mass as a Key Strategy for Obesity Management (2025) · cites this paper as [17]
IR in the SM plays a major role in the development of hyperglycaemia and T2D and other metabolic dysfunctions in the context of obesity, with a diminished overall uptake of glucose by the SM.
“It follows that IR in the SM plays a major role in the development of hyperglycaemia and T2D and other metabolic dysfunctions in the context of obesity, with a diminished overall uptake of glucose by the SM [17].”
From Optimised Skeletal Muscle Mass as a Key Strategy for Obesity Management (2025) · cites this paper as [17]
IL-15 is released from the SM in response to exercise and muscle contraction, and has both anti-inflammatory and AT-reducing effects.
“Interleukin-15 (IL-15) is released from the SM in response to exercise and muscle contraction, and has both anti-inflammatory and AT-reducing effects [17].”
From Optimised Skeletal Muscle Mass as a Key Strategy for Obesity Management (2025) · cites this paper as [17]
Myostatin acts as a negative regulator of SM mass, and its ablation or mutation can lead to muscle hypertrophy.
“Myostatin acts as a negative regulator of SM mass, and its ablation or mutation can lead to muscle hypertrophy [17].”
From Optimised Skeletal Muscle Mass as a Key Strategy for Obesity Management (2025) · cites this paper as [17]
Skeletal muscle is the largest organ in the human body and serves as a regulator of glucose homeostasis, responsible for 80% of postprandial circulating glucose uptake.
“The skeletal muscle, which is the largest organ in the human body, also serves as a regulator of glucose homeostasis and is responsible for 80% of postprandial circulating glucose uptake.16”
From Imaging of Sarcopenia in Type 2 Diabetes Mellitus (2024) · cites this paper as [16]
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- Authors
- Merz, K. E., & Thurmond, D. C.
- Affiliations
- City Of Hope National Medical Center (US)
- Corresponding author
- Thurmond, Debbie C.
- Venue
- Comprehensive Physiology
- Publisher
- Wiley
- Published
- 2020-07-08
- Volume
- 10
- Issue
- 3
- Pages
- 785-809
- ISSN
- 2040-4603 (ISSN-L)
- PMC
- PMC8074531
- OpenAlex
- W3048198206
- Cited by
- 494
- References
- 365
- Citations by year
- 2026: 54 · 2025: 105 · 2024: 166 · 2023: 107 · 2022: 51 · 2021: 10 · 2020: 1
- Type
- other
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Comprehensive physiology (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institutes of Health (5r01dk102233-08, DK067912, DK102233)
- National Institute of Diabetes and Digestive and Kidney Diseases (R01-DK-102233, R01DK112917, R01DK067912, R01DK134652)
- Topics
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Molecular Biology › Metabolism, Diabetes, and Cancer
- Health Sciences › Medicine › Physiology › Adipose Tissue and Metabolism
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes, Cardiovascular Risks, and Lipoproteins
- Keywords
- skeletal muscle, insulin resistance, glucose uptake, glucose homeostasis, exercise mimetics, SNARE proteins, glucose transport, diabetes mellitus, obesity, aging, metabolic disorders
- MeSH terms
- Animals, Biological Transport, Diabetes Mellitus, Type 2, Glucose, Homeostasis, Humans, Insulin Resistance, Metabolic Diseases, Signal Transduction, Muscle, Skeletal
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