Exercise training decreases pancreatic fat content and improves beta cell function regardless of baseline glucose tolerance: a randomised controlled trial
Open accessAbstract
AIMS/HYPOTHESIS: Pancreatic fat accumulation may contribute to the development of beta cell dysfunction. Exercise training improves whole-body insulin sensitivity, but its effects on pancreatic fat content and beta cell dysfunction are unclear. The aim of this parallel-group randomised controlled trial was to evaluate the effects of exercise training on pancreatic fat and beta cell function in healthy and prediabetic or type 2 diabetic participants and to test whether the responses were similar regardless of baseline glucose tolerance. METHODS: Using newspaper announcements, a total of 97 sedentary 40-55-year-old individuals were assessed for eligibility. Prediabetes (impaired fasting glucose and/or impaired glucose tolerance) and type 2 diabetes were defined by ADA criteria. Of the screened candidates, 28 healthy men and 26 prediabetic or type 2 diabetic men and women met the inclusion criteria and were randomised into 2-week-long sprint interval or moderate-intensity continuous training programmes in a 1:1 allocation ratio using random permuted blocks. The primary outcome was pancreatic fat, which was measured by magnetic resonance spectroscopy. As secondary outcomes, beta cell function was studied using variables derived from OGTT, and whole-body insulin sensitivity and pancreatic fatty acid and glucose uptake were measured using positron emission tomography. The measurements were carried out at the Turku PET Centre, Finland. The analyses were based on an intention-to-treat principle. Given the nature of the intervention, blinding was not applicable. RESULTS: At baseline, the group of prediabetic or type 2 diabetic men had a higher pancreatic fat content and impaired beta cell function compared with the healthy men, while glucose and fatty acid uptake into the pancreas was similar. Exercise training decreased pancreatic fat similarly in healthy (from 4.4% [3.0%, 6.1%] to 3.6% [2.4%, 5.2%] [mean, 95% CI]) and prediabetic or type 2 diabetic men (from 8.7% [6.0%, 11.9%] to 6.7% [4.4%, 9.6%]; p = 0.036 for time effect) without any changes in pancreatic substrate uptake (p ≥ 0.31 for time effect in both insulin-stimulated glucose and fasting state fatty acid uptake). In prediabetic or type 2 diabetic men and women, both exercise modes similarly improved variables describing beta cell function. CONCLUSIONS/INTERPRETATION: Two weeks of exercise training improves beta cell function in prediabetic or type 2 diabetic individuals and decreases pancreatic fat regardless of baseline glucose tolerance. This study shows that short-term training efficiently reduces ectopic fat within the pancreas, and exercise training may therefore reduce the risk of type 2 diabetes. TRIAL REGISTRATION: ClinicalTrials.gov NCT01344928 FUNDING: This study was funded by the Emil Aaltonen Foundation, the European Foundation for the Study of Diabetes, the Finnish Diabetes Foundation, the Orion Research Foundation, the Academy of Finland (grants 251399, 256470, 281440, and 283319), the Ministry of Education of the State of Finland, the Paavo Nurmi Foundation, the Novo Nordisk Foundation, the Finnish Cultural Foundation, the Hospital District of Southwest Finland, the Turku University Foundation, and the Finnish Medical Foundation.
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Exercise training could help with diabetes management by improving beta cell function and insulin sensitivity.
“abundant evidence suggests that exercise training could help with diabetes management by improving beta cell function and insulin sensitivity.47”
In an RCT, pancreatic fat decreased in both the healthy group (from 4.4 to 3.6%) and the prediabetes/T2D group (from 8.7 to 6.7%), without significant differences observed for improvement of β-cell function in different exercise strategies.
“The amount of pancreatic fat decreased in both healthy group (from 4.4 to 3.6%) and prediabetes/T2D group (from 8.7 to 6.7%), without significant differences observed for the improvement of β-cell function in different exercise strategies (173).”
From Diabetes and Sarcopenic Obesity: Pathogenesis, Diagnosis, and Treatments (2020) · cites this paper as [173]
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- Authors
- Heiskanen, M. A., Motiani, K. K., Mari, A., Saunavaara, V., Eskelinen, J.-J., Virtanen, K. A., Koivumäki, M., Löyttyniemi, E., Nuutila, P., Kalliokoski, K. K., & Hannukainen, J. C.
- Affiliations
- University of Turku (FI)
- National Research Council (IT)
- Turku University Hospital (FI)
- Åbo Akademi University (FI)
- Corresponding author
- Hannukainen, Jarna C.
- ORCID
- Venue
- Diabetologia
- Published
- 2018-05-02
- Volume
- 61
- Issue
- 8
- Pages
- 1817-1828
- ISSN
- 0012-186X (ISSN-L)
- 1432-0428
- PMC
- PMC6061150
- OpenAlex
- W2802215009
- Cited by
- 142
- References
- 53
- Citations by year
- 2026: 17 · 2025: 9 · 2024: 18 · 2023: 15 · 2022: 25 · 2021: 25 · 2020: 18 · 2019: 9 · 2018: 4
- FWCI
- 14.56
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- Locations
- Diabetologia (publishedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- UTUPub (University of Turku) (submittedVersion)
- CNR ExploRA (submittedVersion, other-oa)
- Funders
- Ministry of Education of the State of Finland
- European Foundation for the Study of Diabetes
- Diabetesliitto
- Suomen Kulttuurirahasto
- Paavo Nurmen Säätiö
- Suomen Lääketieteen Säätiö
- Emil Aaltosen Säätiö
- Suomen Akatemia (251399, 256470, 281440, and 283319)
- Novo Nordisk
- Turku University Foundation
- Hospital District of Southwest Finland
- Orionin Tutkimussäätiö
- Topics
- Health Sciences › Medicine › Surgery › Pancreatic function and diabetes
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Treatment and Management
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes, Cardiovascular Risks, and Lipoproteins
- Keywords
- exercise training, pancreatic fat, beta-cell function, sprint interval training, moderate-intensity continuous training, prediabetes, type 2 diabetes, glucose tolerance, insulin sensitivity, magnetic resonance spectroscopy, positron emission tomography, sedentary adults, glucose-stimulated insulin secretion, insulin resistance, beta-cell dysfunction
- MeSH terms
- Adipose Tissue, Adult, Anthropometry, Blood Glucose, Diabetes Mellitus, Type 2, Female, Glucose Tolerance Test, Humans, Insulin Resistance, Male, Middle Aged, Magnetic Resonance Spectroscopy, Pancreas, Prediabetic State, Exercise, Treatment Outcome, Insulin-Secreting Cells
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