Étienne Myette-Côté

The Effect of Exercise with or Without Metformin on Glucose Profiles in Type 2 Diabetes: A Pilot Study.

The studys goals were 1) to confirm the previously observed increase in postprandial glucose levels immediately after exercise in people with type 2 diabetes who are being treated with metformin; 2) to determine how long the increased glucose persists; 3) to examine the effect of skipping a dose of metformin before or after exercise. We recruited 10 participants with type 2 diabetes who were taking metformin. They completed 4 experimental conditions in random order: 1) morning and evening metformin doses, without exercise (M-M); 2) morning and evening metformin doses, with exercise (M-Ex-M); 3) exercise with evening metformin dose only (Ex-M); and 4) morning metformin dose only, with exercise (M-Ex). Exercise consisted of walking for 50 minutes at a moderate intensity at 11 am on the first day of each condition. Glucose was measured for 72 hours using continuous glucose monitoring systems. Standardized breakfasts were provided for 3 days in each condition, and standardized lunches and dinners were provided on the first day. Compared to M-M, M-Ex-M increased the average 2-hour incremental postprandial area under the curve following the 5 standardized meals (p<0.01) but did not affect daily mean glucose or fasting glucose concentrations. M-Ex (p<0.05), but not Ex-M (p=0.08) increased mean glucose concentrations compared to M-Ex-M on day 1. There were no differences among the 3 exercise conditions for fasting or postprandial glucose concentrations. The addition of a bout of exercise to metformin led to an increase in postprandial glucose levels without affecting mean glucose concentrations. Removing a metformin dose before or after exercise did not attenuate this negative effect.

Nutritional ketone salts increase fat oxidation but impair high-intensity exercise performance in healthy adult males

This study investigated the impact of raising plasma beta-hydroxybutyrate (β-OHB) through ingestion of ketone salts on substrate oxidation and performance during cycling exercise. Ten healthy adult males (age, 23 ± 3 years; body mass index, 25 ± 3 kg/m2, peak oxygen uptake, 45 ± 10 mL/(kg·min)-1) were recruited to complete 2 experimental trials. Before enrollment in the experimental conditions, baseline anthropometrics and cardiorespiratory fitness (peak oxygen uptake) were assessed and familiarization to the study protocol was provided. On experimental days, participants reported to the laboratory in the fasted state and consumed either 0.3 g/kg β-OHB ketone salts or a flavour-matched placebo at 30 min prior to engaging in cycling exercise. Subjects completed steady-state exercise at 30%, 60%, and 90% ventilatory threshold (VT) followed by a 150-kJ cycling time-trial. Respiratory exchange ratio (RER) and total substrate oxidation were derived from indirect calorimetry. Plasma glucose, lactate, and ketones were measured at baseline, 30 min post-supplement, post-steady-state exercise, and immediately following the time-trial. Plasma β-OHB was elevated from baseline and throughout the entire protocol in the ketone condition (p < 0.05). RER was lower at 30% and 60% VT in the ketone compared with control condition. Total fat oxidation was greater in the ketone versus control (p = 0.05). Average time-trial power output was ∼7% lower (-16 W, p = 0.029) in the ketone condition. Ingestion of ketone salts prior to exercise increases fat oxidation during steady-state exercise but impairs high-intensity exercise performance.

Facilitators and barriers to occupational health and safety in small and medium-sized enterprises: a descriptive exploratory study in Ontario, Canada

Purpose. The purpose of this particular study was to test a newly created instrument in describing the facilitators and barriers to occupational health and safety in small and medium-sized enterprises (SMEs) in Ontario, Canada. Methods. A cross-sectional design was used to identify the occupational health and safety culture of SMEs in public and private sectors in Ontario. Results. A total of 153 questionnaires were completed. The majority of respondents were female (84%) with a mean age of 49.8 years (SD 10.6). Seventy-four percent were supervisors. Seventy percent of respondents were from the private sector while 30% derived from the public sector including healthcare, community services, and non-profit organizations. Further, conducting regular external safety inspections of the workplace was found to be statistically associated with a safe work environment 2.88 95% CI [1.57, 5.27]. Conclusions. Strategies and training opportunities that focus on how to adapt occupational health and safety legislation to the nature and diversity of SMEs are recommended. Furthermore, employers may use such information to improve safety in their SMEs, while researchers can hopefully use such evidence to develop interventions that are applicable to meeting the occupational health and safety needs of SMEs.

Evaluating the Effects of Metformin Use on Height in Children and Adolescents: A Meta-analysis of Randomized Clinical Trials

IMPORTANCE Metformin hydrochloride use is increasing in children and adolescents. Previous meta-analyses have identified a large variability in the effects of metformin use on body mass index changes but have not considered height changes as a confounder, to our knowledge. OBJECTIVE To conduct a systematic review and meta-analysis of the effects of metformin use on height in children and adolescents. DATA SOURCES Computerized databases, including MEDLINE and EMBASE, were searched up to September 9, 2014, for terms related to metformin and childhood or adolescence. STUDY SELECTION Randomized clinical trials examining the effects of metformin use on height of participants younger than 19 years were considered eligible. Trials with cointerventions other than lifestyle changes were excluded. DATA EXTRACTION AND SYNTHESIS Height, weight, body mass index, age, sex, metformin dosage, and study duration were independently extracted by 2 reviewers. The weighted mean differences for changes in height, weight, and body mass index were compared between the metformin and control groups using random-effects models. MAIN OUTCOME AND MEASURE Height changes. RESULTS Ten studies were included, with a total of 562 participants, 330 (58.7%) of whom were female. The mean age within the studies ranged from 7.9 to 16.1 years, with a high variability in most studies. The duration of metformin interventions lasted from 3 to 48 months. Overall, height changes were not significantly different between the metformin and control groups. However, stratified analyses according to the cumulative metformin dose (in milligrams per day times the number of days of treatment) showed a greater increase in height with metformin use in the 5 studies providing the largest cumulative metformin doses (weighted mean difference, 1.0; 95% CI, 0.0 to 2.0 cm) but not in the 5 studies providing the lowest doses (weighted mean difference, -0.1; 95% CI, -0.7 to 1.0 cm) compared with the control group. CONCLUSIONS AND RELEVANCE Preliminary evidence suggests a dose-response relationship between metformin use and increases in height in children and adolescents compared with a control group. While an approximate 1-cm increase in height may appear small, it is likely underestimated given that many studies were of short duration and included older adolescents, potentially after epiphyseal growth plate closure.

Carbohydrate restriction with postmeal walking effectively mitigates postprandial hyperglycemia and improves endothelial function in type 2 diabetes

Postprandial hyperglycemia has deleterious effects on endothelial function. Restricting carbohydrate intake and postmeal walking have each been shown to reduce postprandial hyperglycemia, but their combination and subsequent effects on endothelial function have not been investigated. Here, we sought to examine the effect of blunting postprandial hyperglycemia by following a low-carbohydrate diet, with or without postmeal walking exercise, on markers of vascular health in type 2 diabetes (T2D). In a randomized crossover design, individuals with T2D ( n = 11) completed three 4-day controlled diet interventions consisting of 1) low-carbohydrate diet alone (LC), 2) low-carbohydrate diet with 15-min postmeal walks (LC + Ex), and 3) low-fat control diet (CON). Fasting blood samples and brachial artery flow-mediated dilation (%FMD) were measured before and after each intervention. Total circulating microparticles (MPs), endothelial MPs, platelet MPs, monocyte-platelet aggregates, and adhesion molecules were assessed as biomarkers of vascular health. There was a significant condition × time interaction for %FMD ( P = 0.01), with post hoc tests revealing improved %FMD after LC + Ex (+0.8 ± 1.0%, P = 0.02), with no change after LC or CON. Endothelial MPs were significantly reduced with the LC diet by ~45% (from 99 ± 60 to 44 ± 31 MPs/μl, P = 0.02), with no change after LC + Ex or CON (interaction: P = 0.04). Total MPs were lower (main effect time: P = 0.02), whereas monocyte-platelet aggregates were higher (main effect time: P < 0.01) after all interventions. Plasma adhesion molecules and C-reactive protein were unaltered. Attenuating postprandial hyperglycemic excursions using a low-carbohydrate diet combined with postmeal walking appears to be an effective strategy to improve endothelial function in individuals with T2D. NEW & NOTEWORTHY Carbohydrate restriction and postmeal walking lower postprandial hyperglycemia in individuals with type 2 diabetes. Here, we show that the combination significantly improved endothelial function and that carbohydrate restriction alone reduced circulating endothelial microparticles in individuals with type 2 diabetes. Listen to this articles corresponding podcast at http://ajpheart.podbean.com/e/low-carb-diet-and-exercise-improve-endothelial-health/ .

Physical fitness improvement in overweight postmenopausal women who do not lose fat mass in response to exercise training.

Objective:The aim of this study was to examine if overweight postmenopausal women who do not experience fat mass loss after a 1-year aerobic exercise (AE) and resistance training (RT) program can still improve physical fitness. Methods:Thirty-one overweight women (body mass index 28-40 kg/m2 or waist circumference ≥88 cm) participated in three weekly supervised AE and RT sessions for 1 year. All women were categorized according to their fat mass changes after the intervention: 14 women were considered as responders (fat mass loss ≥5% of initial fat mass) and 17 as nonresponders (fat mass loss <5% of initial fat mass). The main outcome measures were absolute and relative body strength, peak aerobic capacity, lower limbs power, flexibility, and body composition (DXA). Total energy intake (3-day dietary record) and physical activity level (physical activity scale for the elderly questionnaire) were also measured before, halfway through and after the intervention. Results:At baseline, nonresponders participants had higher body mass index (P = 0.04). After the intervention, relative and absolute upper and lower body strength, peak aerobic capacity (all P < 0.005), and flexibility increased similarly in the nonresponders and responders groups (P = 0.01). Conclusions:Although some participants did not respond to exercise by decreasing fat mass, they still experienced important physical fitness benefits from AE and RT. These results suggest that body composition changes should not be the sole indicator of the benefits of exercise in overweight postmenopausal women.

Detection of Salivary Insulin Following Low versus High Carbohydrate Meals in Humans

Developing non-invasive alternatives to monitor insulin levels in humans holds potential practical value for identifying individuals with, or at risk of developing, insulin resistance. The aims of this study were: (1) to determine if saliva insulin can be used to delineate between low and high postprandial insulin levels following the ingestion of mixed breakfast meals; and (2) to determine if expected differences in postprandial hyperinsulinemia between young lean and young overweight/obese participants could be detected in saliva. Sixteen individuals (n = 8 classified as normal weight (NW); BMI 20.0–24.9 kg/m2, and n = 8 classified as overweight/obese (OO); BMI ≥ 28.0 kg/m2) completed two isocaloric mixed-meal tolerance tests following an overnight fast, consisting of a low-carbohydrate (LC) breakfast or a high-carbohydrate (HC) breakfast. Blood and saliva samples were collected at regular intervals for two hours postprandially. In both groups, plasma and saliva insulin total area under the curve (AUC) and incremental AUC (iAUC) were significantly higher after the HC as compared to the LC meal (all p ≤ 0.005). Insulin AUC and iAUC in both plasma and saliva were higher in OO than in NW after the HC meal (all p ≤ 0.02) but only plasma and saliva total AUC were higher in OO after the LC meal (both p ≤ 0.01). Plasma insulin AUC was significantly correlated with salivary insulin AUC in LC (r = 0.821; p < 0.001) and HC (r = 0.882; p < 0.001). These findings indicate that saliva could potentially be used to delineate between low and high insulin levels following mixed breakfast meals.

Creatine Monohydrate Supplementation Does Not Augment Fitness, Performance, or Body Composition Adaptations in Response to Four Weeks of High-Intensity Interval Training in Young Females.

High-intensity interval training (HIIT) has been shown to improve cardiorespiratory fitness, performance, body composition, and insulin sensitivity. Creatine (Cr) supplementation may augment responses to HIIT, leading to even greater physiological adaptations. The purpose of this study was to determine the effects of 4 weeks of HIIT (three sessions/week) combined with Cr supplementation in recreationally active females. Seventeen females (age = 23 ± 4 yrs; BMI = 23.4 ± 2.4) were randomly assigned to either Cr (Cr; 0.3 g・kg-1・d-1 for 5 d followed by 0.1 g・kg-1・d-1 for 23 days; n = 9) or placebo (PLA; n = 8). Before and after the intervention, VO2peak, ventilatory threshold (VT), time-trial performance, lean body mass and fat mass, and insulin sensitivity were assessed. HIIT improved VO2peak (Cr = +10.2%; PLA = +8.8%), VT (Cr = +12.7%; PLA = +9.9%), and time-trial performance (Cr = -11.5%; PLA = -11.6%) with no differences between groups (time main effects, all p < .001). There were no changes over time for fat mass (Cr = -0.3%; PLA = +4.3%), whole-body lean mass (Cr = +0.5%; PLA = -0.9%), or insulin resistance (Cr = +3.9%; PLA = +18.7%). In conclusion, HIIT is an effective way to improve cardiorespiratory fitness, VT, and time-trial performance. The addition of Cr to HIIT did not augment improvements in cardiorespiratory fitness, performance or body composition in recreationally active females.

Glycemic and Metabolic Effects of Two Long Bouts of Moderate-Intensity Exercise in Men with Normal Glucose Tolerance or Type 2 Diabetes

Background The glycemic and insulinemic responses following 30–60 min of exercise have been extensively studied, and a dose–response has been proposed between exercise duration, or volume, and improvements in glucose tolerance or insulin sensitivity. However, few studies have examined the effects of longer bouts of exercise in type 2 diabetes (T2D). Longer bouts may have a greater potential to affect glucagon, interleukin-6 (IL-6) and incretin hormones [i.e., glucagon-like peptide-1 (GLP-1) and glucose-dependent insulinotropic peptide (GIP)]. Aim To examine the effect of two bouts of long-duration, moderate-intensity exercise on incretins, glucagon, and IL-6 responses before and after exercise, as well as in response to an oral glucose tolerance test (OGTT) conducted the following day. Methods Twelve men, six with and six without T2D, participated in two separate conditions (i.e., exercise vs. rest) according to a randomized crossover design. On day 1, participants either rested or performed two 90 min bouts of treadmill exercise (separated by 3.5 h) at 80% of their ventilatory threshold. All participants received standardized meals on day 1. On day 2 of each condition, glucose and hormonal responses were measured during a 4-h OGTT. Results On day 1, exercise increased IL-6 at the end of the first bout of exercise (exercise by time interaction p = 0.03) and GIP overall (main effect of exercise p = 0.004). Glucose was reduced to a greater extent in T2D following exercise (exercise by T2D interaction p = 0.03). On day 2, GIP and active GLP-1 were increased in the fasting state (p = 0.05 and p = 0.03, respectively), while plasma insulin and glucagon concentrations were reduced during the OGTT (p = 0.01 and p = 0.02, respectively) in the exercise compared to the rest condition for both healthy controls and T2D. Postprandial glucose was elevated in T2D compared to healthy control (p < 0.05) but was not affected by exercise. Conclusion Long-duration, moderate-intensity aerobic exercise can increase IL-6. On the day following exercise, fasting incretins remained increased but postprandial insulin and glucagon were decreased without affecting postprandial glucose. This long duration of exercise may not be appropriate for some people, and further research should investigate why next day glucose tolerance was unchanged.