Exp Clin Endocrinol Diabetes 2008; 116(10): 577-581
DOI: 10.1055/s-2008-1065331
Article

© Georg Thieme Verlag KG Stuttgart · New York

Beneficial Effects of External Muscle Stimulation on Glycaemic Control in Patients with Type 2 Diabetes

B. Rose 1 , M. Lankisch 1 , C. Herder 1 , K. Röhrig 1 , K. Kempf 1 , S. Labrenz 1 , J. Hänsler 2 , W. Koenig 3 , L. Heinemann 2 , S. Martin 1
  • 1Institute for Clinical Diabetes Research, German Diabetes Center, Leibniz Center at Heinrich-Heine-University, Duesseldorf, Germany
  • 2Profil Institute for Metabolic Research, Neuss, Germany
  • 3Department of Internal Medicine II-Cardiology, University of Ulm Medical Center, Ulm, Germany
Further Information

Publication History

received 03.03.2008 first decision 06.03.2008

accepted 06.03.2008

Publication Date:
13 May 2008 (online)

Abstract

Physical activity improves insulin sensitivity and metabolic control in patients with type 2 diabetes. Moreover, regular exercise can reduce systemic levels of immune markers associated with diabetes development. As patients with physical impairments are not able to exercise sufficiently, the aim of this study was to investigate whether high-frequency external muscle stimulation (hfEMS) improves metabolic and immunologic parameters in patients with type 2 diabetes and might therefore serve as complementary lifestyle therapy. Sixteen patients (12 men/4 women, age 57±11 years (mean±SD); BMI 34.5±5.2 kg/m2; HbA1c 7.4±1.1%) on oral antihyperglycaemic therapy were enrolled in this study. After a run-in phase of 2 weeks, every patient received an hfEMS device (HITOP 191, gbo-Medizintechnik AG, Rimbach/Germany) for daily treatment of femoral musculature for 6 weeks. Thereafter, patients were followed up for additional 4 weeks without hfEMS treatment. At each visit, clinical parameters were assessed and blood samples were drawn for metabolic and immunologic parameters. Immune markers (cytokines, chemokines, adipokines and acute-phase proteins) representative for the different arms of the immune system were analysed. hfEMS treatment resulted in significant reductions of body weight (−1.2 kg [−2.7 kg; −0.5 kg]; p<0.05; median [25th percentile; 75th percentile]), BMI (−0.4 kg/m2 [−0.8 kg/m2; −0.1 kg/m2]; p<0.05) and HbA1c (−0.4% [−0.9%; −0.1%]; p<0.05) which were sustained during the follow-up period. Systemic levels of IL-18 tended to be increased after hfEMS treatment (171 vs. 149 pg/ml; p=0.06), while all other immune markers remained virtually unchanged. Treatment with hfEMS in this first proof-of-principle study has beneficial effects on body weight and improves glycaemic control in patients with type 2 diabetes, which may be associated with changes in subclinical inflammation. Taken together, hfEMS might represent an additional treatment option for patients with type 2 diabetes not being able to exercise.

References

  • 1 Standards of medical care in diabetes . Diabetes Care. 2007;  30 ((Suppl 1)) S4-S41
  • 2 Christ-Roberts CY, Pratipanawatr T, Pratipanawatr W, Berria R, Belfort R, Kashyap S, Mandarino LJ. Exercise training increases glycogen synthase activity and GLUT4 expression but not insulin signaling in overweight nondiabetic and type 2 diabetic subjects.  Metabolism. 2004;  53 1233-1242
  • 3 Gale EA, Beattie SD, Hu J, Koivisto V, Tan MH. Recruitment to a clinical trial improves glycemic control in patients with diabetes.  Diabetes Care. 2007;  30 2989-2992
  • 4 Hainaut K, Duchateau J. Neuromuscular electrical stimulation and voluntary exercise.  Sports Med. 1992;  14 100-113
  • 5 Hamada T, Hayashi T, Kimura T, Nakao K, Moritani T. Electrical stimulation of human lower extremities enhances energy consumption, carbohydrate oxidation, and whole body glucose uptake.  J Appl Physiol. 2004;  96 911-916
  • 6 Hardin DS, Azzarelli B, Edwards J, Wigglesworth J, Maianu L, Brechtel G, Johnson A, Baron A, Garvey WT. Mechanisms of enhanced insulin sensitivity in endurance-trained athletes: effects on blood flow and differential expression of GLUT 4 in skeletal muscles.  J Clin Endocrinol Metab. 1995;  80 2437-2446
  • 7 Helge JW, Stallknecht B, Pedersen BK, Galbo H, Kiens B, Richter EA. The effect of graded exercise on IL-6 release and glucose uptake in human skeletal muscle.  J Physiol. 2003;  546 299-305
  • 8 Herder C, Haastert B, Muller-Scholze S, Koenig W, Thorand B, Holle R, Wichmann HE, Scherbaum WA, Martin S, Kolb H. Association of systemic chemokine concentrations with impaired glucose tolerance and type 2 diabetes: results from the Cooperative Health Research in the Region of Augsburg Survey S4 (KORA S4).  Diabetes. 2005;  54 ((Suppl 2)) S11-S17
  • 9 Herder C, Schneitler S, Rathmann W, Haastert B, Schneitler H, Winkler H, Bredahl R, Hahnloser E, Martin S. Low-grade inflammation, obesity, and insulin resistance in adolescents.  J Clin Endocrinol Metab. 2007;  92 4569-4574
  • 10 Houmard JA, Tanner CJ, Slentz CA, Duscha BD, MacCartney JS, Kraus WE. Effect of the volume and intensity of exercise training on insulin sensitivity.  J Appl Physiol. 2004;  96 101-106
  • 11 Huang H, Iida KT, Sone H, Ajisaka R. The regulation of adiponectin receptors expression by acute exercise in mice.  Exp Clin Endocrinol Diabetes. 2007;  115 417-422
  • 12 Karavidas AI, Raisakis KG, Parissis JT, Tsekoura DK, Adamopoulos S, Korres DA, Farmakis D, Zacharoulis A, Fotiadis I, Matsakas E, Zacharoulis A. Functional electrical stimulation improves endothelial function and reduces peripheral immune responses in patients with chronic heart failure.  Eur J Cardiovasc Prev Rehabil. 2006;  13 592-597
  • 13 Kennedy JW, Hirshman MF, Gervino EV, Ocel JV, Forse RA, Hoenig SJ, Aronson D, Goodyear LJ, Horton ES. Acute exercise induces GLUT4 translocation in skeletal muscle of normal human subjects and subjects with type 2 diabetes.  Diabetes. 1999;  48 1192-1197
  • 14 Kirk A, Mutrie N, MacIntyre P, Fisher M. Increasing physical activity in people with type 2 diabetes.  Diabetes Care. 2003;  26 1186-1192
  • 15 Kolb H, Mandrup-Poulsen T. An immune origin of type 2 diabetes?.  Diabetologia. 2005;  48 1038-1050
  • 16 Kriketos AD, Gan SK, Poynten AM, Furler SM, Chisholm DJ, Campbell LV. Exercise increases adiponectin levels and insulin sensitivity in humans.  Diabetes Care. 2004;  27 629-630
  • 17 Krug LM, Haire-Joshu D, Heady SA. Exercise habits and exercise relapse in persons with non-insulin-dependent diabetes mellitus.  Diabetes Educ. 1991;  17 185-188
  • 18 Levy JC, Matthews DR, Hermans MP. Correct homeostasis model assessment (HOMA) evaluation uses the computer program.  Diabetes Care. 1998;  21 2191-2192
  • 19 Lindstrom J, Louheranta A, Mannelin M, Rastas M, Salminen V, Eriksson J, Uusitupa M, Tuomilehto J. The Finnish Diabetes Prevention Study (DPS): Lifestyle intervention and 3-year results on diet and physical activity.  Diabetes Care. 2003;  26 3230-3236
  • 20 Muller S, Martin S, Koenig W, Hanifi-Moghaddam P, Rathmann W, Haastert B, Giani G, Illig T, Thorand B, Kolb H. Impaired glucose tolerance is associated with increased serum concentrations of interleukin 6 and co-regulated acute-phase proteins but not TNF-alpha or its receptors.  Diabetologia. 2002;  45 805-812
  • 21 Petersen AM, Pedersen BK. The anti-inflammatory effect of exercise.  J Appl Physiol. 2005;  98 1154-1162
  • 22 Poole RB, Harrold CP, Burridge JH, Byrne CD, Holt RI. Electrical muscle stimulation acutely mimics exercise in neurologically intact individuals but has limited clinical benefits in patients with type 2 diabetes.  Diabetes Obes Metab. 2005;  7 344-351
  • 23 Reichstein L, Labrenz S, Ziegler D, Martin S. Effective treatment of symptomatic diabetic polyneuropathy by high-frequency external muscle stimulation.  Diabetologia. 2005;  48 824-828
  • 24 Requena SB, Padial PP, Gonzalez-Badillo JJ. Percutaneous electrical stimulation in strength training: an update.  J Strength Cond Res. 2005;  19 438-448
  • 25 Ross R. Does exercise without weight loss improve insulin sensitivity?.  Diabetes Care. 2003;  26 944-945
  • 26 Ross R, Dagnone D, Jones PJ, Smith H, Paddags A, Hudson R, Janssen I. Reduction in obesity and related comorbid conditions after diet-induced weight loss or exercise-induced weight loss in men. A randomized, controlled trial.  Ann Intern Med. 2000;  133 92-103
  • 27 Smith JK, Dykes R, Douglas JE, Krishnaswamy G, Berk S. Long-term exercise and atherogenic activity of blood mononuclear cells in persons at risk of developing ischemic heart disease.  JAMA. 1999;  281 1722-1727
  • 28 Toledo FG, Menshikova EV, Ritov VB, Azuma K, Radikova Z, DeLany J, Kelley DE. Effects of physical activity and weight loss on skeletal muscle mitochondria and relationship with glucose control in type 2 diabetes.  Diabetes. 2007;  56 2142-2147
  • 29 Troseid M, Lappegard KT, Claudi T, Damas JK, Morkrid L, Brendberg R, Mollnes TE. Exercise reduces plasma levels of the chemokines MCP-1 and IL-8 in subjects with the metabolic syndrome.  Eur Heart J. 2004;  25 349-355
  • 30 Walker KZ, Piers LS, Putt RS, Jones JA, O’Dea K. Effects of regular walking on cardiovascular risk factors and body composition in normoglycemic women and women with type 2 diabetes.  Diabetes Care. 1999;  22 555-561

Correspondence

B. Rose

Institute for Clinical Diabetes Research

German Diabetes Center

Leibniz Center at Heinrich-Heine-University

Auf'm Hennekamp 65

40225 Duesseldorf

Germany

Phone: +49/211/338 25 75

Fax: +49/211/338 25 92

Email: bettina.rose@ddz.uni-duesseldorf.de

    >