The supportive effect of supplementation with α-keto acids on physical training in type 2 diabetes mellitus.
The maintenance of physical activity is crucial for the prevention and management of type 2 diabetes (T2D), and exercise induced changes including production of metabolites like ammonia can result in fatigue and exercise intolerance. Nutritional supplements may serve as an effective measure in supporting patients undergoing physical training by acting on their metabolism. This study investigates the effects of supplementation with α-keto acids (KAS) on exercise tolerance and glucose control in T2D patients. In a double-blind, placebo-controlled, randomized study 28 T2D patients underwent 6 weeks training on a cycle ergometer while they were supplemented with either a placebo or KAS (0.2 g kg(-1) body weight each day). The weekly training volume, power output at maximum and lactic threshold, leg muscle torque, the plasma concentration and 8 h urinary discharge of glucose, ammonia and urea were determined before and after the training as well as after one week of recovery. With KAS the patients did significantly more voluntary exercise (213 vs. 62 min, P < 0.01), reached a higher VO2max (27.3 vs. 24.8 ml min(-1) kg(-1)), higher power output (224 vs. 193 watts, P < 0.05) and greater endurance capacity (108 vs. 96 watts at lactic threshold, P < 0.05). Although the patients without KAS improved their glucose control after the training (P < 0.05), this effect could not be maintained after recovery as it was in the KAS group, where there was a prolonged benefit in glucose control. KAS also affected the ammonia and urea metabolism. KAS delivered supportive effects on the physical training along with a prolonged benefit in glucose control in T2D patients.