Physical activity attenuates postprandial hyperglycaemia in homozygous TBC1D4 loss-of-function mutation carriers
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Abstract: Aims/hypothesis: The common muscle-specific TBC1D4 p.Arg684Ter loss-of-function variant defines a subtype of non-autoimmune diabetes in Arctic populations. Homozygous carriers are characterised by elevated postprandial glucose and insulin levels. Because 3.8% of the Greenlandic population are homozygous carriers, it is important to explore possibilities for precision medicine. We aimed to investigate whether physical activity attenuates the effect of this variant on 2 h plasma glucose levels after an oral glucose load. Methods: In a Greenlandic population cohort (n = 2655), 2 h plasma glucose levels were obtained after an OGTT, physical activity was estimated as physical activity energy expenditure and TBC1D4 genotype was determined. We performed TBC1D4–physical activity interaction analysis, applying a linear mixed model to correct for genetic admixture and relatedness. Results: Physical activity was inversely associated with 2 h plasma glucose levels (β[main effect of physical activity] −0.0033 [mmol/l] / [kJ kg−1 day−1], p = 6.5 × 10−5), and significantly more so among homozygous carriers of the TBC1D4 risk variant compared with heterozygous carriers and non-carriers (β[interaction] −0.015 [mmol/l] / [kJ kg−1 day−1], p = 0.0085). The estimated effect size suggests that 1 h of vigorous physical activity per day (compared with resting) reduces 2 h plasma glucose levels by an additional ~0.7 mmol/l in homozygous carriers of the risk variant. Conclusions/interpretation: Physical activity improves glucose homeostasis particularly in homozygous TBC1D4 risk variant carriers via a skeletal muscle TBC1 domain family member 4-independent pathway. This provides a rationale to implement physical activity as lifestyle precision medicine in Arctic populations. Data repository: The Greenlandic Cardio-Metabochip data for the Inuit Health in Transition study has been deposited at the European Genome-phenome Archive (https://www.ebi.ac.uk/ega/dacs/EGAC00001000736) under accession EGAD00010001428. Graphical abstract:
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Funder: Karen Elise Jensens Fond; doi: http://dx.doi.org/10.13039/501100004046
Funder: European Foundation for the Study of Diabetes; doi: http://dx.doi.org/10.13039/501100001648
Funder: NunaFonden
Funder: Danish Diabetes Academy; doi: http://dx.doi.org/10.13039/100015223
Funder: Lundbeckfonden; doi: http://dx.doi.org/10.13039/501100003554
Funder: Villum Fonden; doi: http://dx.doi.org/10.13039/100008398
Funder: Det Frie Forskningsråd; doi: http://dx.doi.org/10.13039/501100004836
Funder: Steno Diabetes Center
Funder: Commission for Scientific Research Greenland
Funder: Novo Nordisk Foundation Center for Basic Metabolic Research; doi: http://dx.doi.org/10.13039/501100011747
Funder: Medical Research Council Greenland
Funder: Medical Research Council Denmark
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1432-0428
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Novo Nordisk Fonden (NNF16OC0019986)