Treatment Regimes in Diabetes and Their Impact on Biomarkers

Abstract

In our modern society, we are faced with a mismatch between our evolutionary past as a human species and the current challenges arising from a modern society, where physical inactivity and the consumption of energy-dense foods are indulged and ubiquitous. It is with no surprise that over the past century, this paradigm has led to an increase in the incidence and prevalence of several noncommunicable chronic diseases, including obesity, cardiovascular diseases, neurodegenerative diseases, cancer, and the special focus of this chapter, type 2 diabetes mellitus (T2DM), in which the lipid and inflammatory profiles play a major role in the pathophysiology.In the following sections, we will provide an insight on how the lipid and inflammatory profiles are related to the pathophysiology of T2DM and shed some light on how acute and chronic exercise can impact and ameliorate the metabolic dysfunction in T2DM individuals. In the first section, we will address the relationship of the lipid biomarkers with both obesity and T2DM by examining the classic pathophysiology of dyslipidemia, while going into further detail on the organ-crosstalk among the adipose tissue, muscle, and liver. At the muscle level, we will highlight the interrelationships between intramyocellular lipids and lipid intermediates and the development of muscle insulin resistance, whereas, at the liver, we will discuss how intrahepatic lipids are a strong lipid biomarker capable of predicting hepatic insulin resistance and other obesity-related complications. We will then connect how acute and chronic exercise can impact these aforementioned lipid biomarkers through a mechanistic approach, as well as provide a detailed review of the most recent results from randomized controlled trials (RCT) on the classic, clinically used lipid biomarkers (e.g., low- and high-density lipoprotein cholesterol and triglycerides). In the second section, we will review the link between adipose tissue dysfunction and chronic low-grade inflammation in both obesity and T2DM, while taking a closer look at the inflammatory biomarkers that have been mostly studied in the exercise physiology field and that have been implicated in the pathophysiology of T2DM. Finally, and following the same trend as the first section on lipid biomarkers, we will discuss the impact of acute and chronic exercise on the inflammatory milieu and review the most recent RCT investigations, while focusing on the impact of certain exercise characteristics, such as the duration, intensity, and type of intervention.KeywordsDyslipidemiaObesityInsulin resistanceAerobicResistanceCytokinesAdipokinesMyokinesLipid intermediatesRandomized controlled trials