第49届欧洲糖尿病研究协会年会(EASD2013)于9月23-27日在西班牙巴塞罗那召开。当地时间9月24日下午，“Exercise physiology and impact on ageing”专场上，一项小型初步研究数据显示，每日肌肉电刺激训练1周可改善半数以上2型糖尿病患者的
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| Michael Joubert博士 |
神经肌肉电刺激(NMES)是指通过经皮电极给予高频电流(100Hz~150Hz)刺激运动神经元诱导无意识的肌肉收缩。
“我们知道，2型糖尿病人群由于缺少动机、致残并发症或合并症以及功能失调，很难坚持体力活动，”法国Caen大学医院医学和内分泌学科Michael Joubert博士在报告中说。“神经肌肉电刺激可以替代传统的体力活动，尤其是对于久坐的患者。”
ELECTRODIAB初步研究纳入18例患者，每天接受25分钟的双侧股四头肌NMES。纳入接受口服降糖药和/或
1周的训练使胰岛素的敏感性增加24.9±35.8 % (P =0.016)，超过50%的患者有效果，表现为胰岛素的敏感性增加超过10%。这些患者的基线胰岛素敏感性显著较低。
Joubert博士，由间接测热法测得的瞬时能量消耗“非常低”，仅有2%。我们认为，低能量消耗和对胰岛素敏感性影响大这之间的差异表明，体液或内分泌机制参与其中。
研究人员使用正常血糖高胰岛素钳夹评估了基线、NMES 1小时后、完成一周训练后的第2天的胰岛素敏感性。研究人员还监测了体力活动和饮食。没有报告严重不良事件， 16例患者希望继续长期治疗。
Joubert博士，目前正在进行一项后续研究，关注的是门诊6周神经肌肉电刺激对血糖控制的影响。
研究摘要：
| Electrodiab study: impact of bi-quadricipital muscular electrostimulation on insulin sensitivity in type 2 diabetic subjects（ELECTRODIAB研究：双侧股四头肌神经肌肉电刺激对2型糖尿病患者胰岛素敏感性的影响） |
| Background and aims: Physical activity improves insulin sensitivity and promotes type 2 diabetes (T2D) control. However, physical activity guidelines are rarely applied due to lack of motivation or to concomitant diseases (diabetic foot, coronary artery disease⋯). Muscular electro-stimulation (MES) enhances both muscles strength and volume. Metabolic effect of MES on insulin sensitivity is explored in this study, as an alternative to physical activity. Materials and methods: Prospective multicentric 4 weeks pilot study. Inclusion criterias : T2D ; 18-75 years ; BMI > 25 ; 6-9% HbA1c ; treatment with oral hypoglycemic agents (OHA) and/or GLP1 analogs > 3 months. Usual physical activity was controlled with a body monitoring system and dietary intake was controlled with dietary self reports during the study. Insulin sensitivity was evaluated with 3 euglycemic hyperinsulinemic clamps (EHC) (80mUI/m2/min) for each subject : baseline (T0), one hour after a unique MES session (T1), and after one week of ambulatory daily MES training (T2). Each MES session was a 25 minutes bi-quadricipital simultaneous stimulation with a 4 channel electrostimulator. Patients were asked to increase stimulation to maximal tolerated intensity. Indirect calorimetry energy expenditure (EE) was also evaluated at rest and during the first MES session. Results: 15 patients T2D were included (age 60.1±9.0 years ; diabetes duration 12.3±7.0 years; BMI 32.9±5.2 ; HbA1c 7.3±0.8%). For overall population (responders and non-responders), insulin sensitivity (M-Value) increased of 11.3±40.8% (ns) and 28.3±38.4% (p<0.05) at T1 and T2 vs T0, respectively. For the 8/15 responders, M-Value increased of 36.8±37.7% (ns) and 58.3±24.9% (p<0.05) at T1 and T2 vs T0, respectively. During the first MES session, for a mean stimulation intensity of 25.8±5.6/100, energy expenditure (EE) (indirect calorimetric measure) increased of 93.6±176.8 Kcal/h (ie +5.2±9.4% from EE at rest) (ns). During the daily MES training week, patients increased stimulation intensity with a week mean of 37.1±12.9/100. Concerning tolerance, 8/15 subjects felt moderate muscle pain (n=7) and/or skin pain (n=4) during or after MES sessions. 14/15 patients would perform regular MES sessions on the long term, 3 times/week for 10/14 patients. Conclusion: A one week training with daily biquadricipital 25 minutes MES sessions significantly improves insulin sensitivity of ~ 30% in orally treated type 2 diabetic patients. This substantial improvement of insulin sensitivity occurs despite a weak EE increase during MES (+5,2±9,4%, p=0,055). This discrepancy suggests a specific metabolic effect of MES. Furthermore, this weak EE increase allows to consider the extent of this physical treatment in T2D patients with cardiovascular deconditioning, a usual sedentary population. All together, these data encourages further longer term research on the effect of MES on glycemic control. |
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