Problem

Impaired glucose regulation (IGR) is the pre-stage of diabetes. The prevalence of IGR is dramatically increased in China, from 15.5% in 2007 [1] to 50.1% in 2010 [2]. According to the 20-year follow-up study of the China Da Qing Diabetes Prevention Study [3], 92% of the pre-diabetes patients will develop diabetes in 20 years, which will cast a big economic burden in China. The islet beta cell volume of pre-diabetes populations has already decreased by 40%, and the vascular lesions and the risk factors have already appeared in pre-diabetes, or even earlier stage[4]. To win the battle in fighting diabetes, we should move forward to the stage of pre-diabetes, to the most timely improve the insulin resistance, and protect islet beta cells, to prevent further loss of bets cell function, so as to prevent type 2 diabetes and the risk factors of cardiovascular disease. Exercise and diet are considered the cornerstones of diabetes treatment [5]. It is generally accepted that regular exercise provides substantial health benefits to individuals with type 2 diabetes. The Diabetes Prevention Program showed that the lifestyle intervention in pre-diabetes population reduced the incidence of diabetes by 58% [6]. The type of exercise the participants (both diabetes and pre-diabetes) used was mainly aerobic. The exact effect of resistance training on pre-diabetes is unclear. Strasser et al [7] reported that resistance training can improve the glucose control of pre-diabetes, in contrast, a 12-week study displayed that resistance exercise cannot reduce the A1c [8]. Our 12-week study involved 112 pre-diabetes patients (resistance training 38, aerobic 37, and control 37) showed that both resistance training and aerobic exercise can reduce insulin resistance, fasting and post-prandial blood glucose, and A1c, but due to the small number of participants and relatively short duration of intervention, the effects of type 2 diabetes prevention were not confirmed, and the difference between resistance training and aerobic exercise in improving A1c, insulin resistance and BMI did not reach the statistical significance. So it is necessary to conduct a multicenter RCT, with relatively larger number of participants and longer time intervention. Therefore, the primary goal of this study is to compare the effects of resistance training and aerobic exercise in type 2 diabetes prevention, and the secondary goal is to compare the impact of these 2 different types of exercise on metabolic control, insulin resistance, BMI and visual fat among patients with pre-diabetes. Reference 1. Yang WY, Lu JM, Weng JP, et al. Prevalence of diabetes among men and women in China[J]. N Engl J Med, 2010, 362(12): 1090-1101. 2. Xu Y, Wang L, He J, et al. Prevalence and control of diabetes in Chinese adults[J]. JAMA, 2013, 310(9): 948-959. 3. Li G, Zhang P, Wang J, et al. The long-term effect of lifestyle interventions to prevent diabetes in the China Da Qing Diabetes Prevention Study: a 20-year follow-up study[J]. Lancet, 2008, 371(9626): 1783-1789. 4. David M, Mayer B, Ralph A, et al. Impaired Fasting Glucose and Impaired Glucose Tolerance[J]. Diabetes Care, 2007, 30(3): 753-759. 5. Praet SF, van Loon LJ. Exercise: the brittle cornerstone of type 2 diabetes treatment[J] . Diabetologia, 2008, 51(3): 398-401. 6. Diabetes Prevention Program Research Group. Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin[J]. N Engl J Med 2002; 346 :393-403. 7. Strasser B, Sibert U, Schobersberger W, et al. Resistance training in the treatment of the metabolic syndrome: a systematic review and meta-analysis of the effect of resistance training on metabolic clustering in patients with abnormal glucose metabolism[J]. Sports Med, 2010, 40(5): 397-415. 8. Geirsdottir OG, Arnarson A, Briem K, et al. Effect of 12-week resistance exercise program on body composition, muscle strength, physical function, and glucose metabolism in healthy, insulin-resistant, and diabetic elderly Icelanders[J]. J Gerontol A Biol Sci Med Sci, 2012, 67(11): 1259-1265.

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