Aerobic and Resistance Training for Patients With Type 2 Diabetes—Reply

In Reply: Dr Lin and colleagues suggest that group differences in baseline insulin resistance as quantified by HOMA-IR may be driving the findings of our trial. Of the participants, 18% were taking insulin at baseline, which greatly affects the measurement of fasting plasma insulin. As such, it is of little value to calculate HOMA-IR using the baseline insulin data. The prevalence of insulin use was similar across the control, resistance, aerobic, and combination groups (17%, 12%, 21%, and 22%, respectively). When participants using insulin were removed from the analysis, baseline fasting insulin was similar across treatment groups (mean, 16.4 μIU/mL; 95% confidence interval [95% CI], 12.7-20.0 μIU/mL, in the control group; mean, 18.1 μIU/mL; 95% CI, 15.4-20.8 μIU/mL, in the resistance exercise group; mean, 15.8 μIU/mL; 95% CI, 12.9-18.6 μIU/mL, in the aerobic exercise group; and mean, 16.3 μIU/mL; 95% CI, 13.5-19.0 μIU/mL, in the combination exercise group; P = .65) as was baseline HOMA-IR value (mean, 6.5; 95% CI, 5.1-8.0, in the control group; mean, 6.9; 95% CI, 5.9-8.0, in the resistance exercise group; mean, 5.4; 95% CI, 4.3-6.6, in the aerobic exercise group; and mean, 5.9; 95% CI, 4.8-7.0, in the combination exercise group; P = .23). Thus, we do not think that different baseline levels of insulin resistance account for our findings of the combination of aerobic and resistance training being superior in lowering HbA_1c than either modality alone.