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Abstract

An elevated homeostatic model assessment of insulin resistance index (HOMA-IR) ≥ 2.5 is commonly used to classify insulin resistance (IR). IR is a well-established precursor to the development of diabetes and other metabolic diseases. Exercise is a well-established intervention for the improvement of metabolic health but the comparison of the effect of exercise among IR and insulin sensitive (IS) non-diabetic adults with the use continuous glucose monitoring has not been adequately studied.  PURPOSE: To determine if non-diabetic individuals with insulin resistance have attenuated improvement in exercise-induced improvement in metabolic health and CGM metrics of glycemic control in comparison to their insulin sensitive counterparts. METHODS: Twenty-one (10 males, 11 females) adults (age 27.2 ± 4.9 years, BMI 25.6 ± 4.7 kg/m2, fasting glucose 89.5 mg/dL), including 12 insulin-sensitive and 9 insulin-resistant participants were enrolled in this study. HOMA IR was calculated from fasting blood glucose (FBG) and insulin and was used to classify participants as IS (HOMA IR 2max on treadmill, followed by 3 upper and 3 lower body resistance exercises at 60-75% one repetition max, 3 times a week for 8 weeks. Average indices of twenty-four-hour (24hr) CGM from the first and last 10 days of the intervention were used to measure improvements in glycemic variability. Two-way repeated measures ANOVA were used to analyze the results at 0.05 alpha RESULTS: Fasting insulin did not change in IS (7.0 ± 3.9 to 6.9 ± 3.6 UI/ul, p>0.05) but decreased in IR (16.2 ± 3.7 to 12.1 ± 5.6 ulU/mL, p0.05) but decreased in IR (3.6 ±0.7 to 2.8± 1.4, p0.05). HbA1c improved in IR (5.3±0.4 to 5.1 ±0.3 %, p 0.05) but improved in IR (121.1± 12.9 to 112.8± 7.3 mg/dL, p0.05). Continuous Overlapping Net Glycemic Action Index did not change in IS (108.2±10.22 to 107.3±8.6, p>0.05) but improved in IR (109.0 ±11.1 to100.5±6.3, pCONCLUSION: Exercise-induced improvement in cardiometabolic health and CGM-derived metrics of glycemic control are not attenuated among insulin resistant non-diabetic adults. Concurrent endurance and resistance exercise training improves cardiometabolic health in both IS and IR individuals, with IR participants demonstrating equal or greater improvement to the same training stimulus. These findings support the use of HOMA-IR to identify normoglycemic individuals who may derive substantial metabolic benefit from early exercise intervention and prevent the development of diabetes type 2.

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