Can Inflatable Compression Boots Help Lower Blood Glucose?
Jeffrey Martin, PhD
Exercise physiologist at Edward Via College of Osteopathic Medicine at Auburn University
American Diabetes Association Research Funding
An odd-looking apparatus that sharp-eyed sports fans may have spotted on the sidelines of professional basketball and football games may one day serve as a treatment for diabetes.
Imagine a computer-controlled blood pressure cuff, but for your lower body. Inside what looks like hip-high boots, inflatable chambers empty and fill with air, massaging the legs in a pulsing rhythm.
Originally developed for people with circulation problems, so-called external pneumatic compression devices have become popular among athletes. “They’re big in the sports market—triathletes, football players, and marathon runners all use them for recovery,” says Jeffrey Martin, PhD, an exercise physiologist at Edward Via College of Osteopathic Medicine at Auburn University. “[The pressure] is dynamic and pulsatile, which mimics skeletal muscle contraction.”
A similar method, called enhanced external counterpulsation, is being tested as a treatment for heart disease and stroke patients. It has been used as a treatment for people with diabetes-related complications, as well. But the apparatus is large, expensive, and requires a doctor’s close supervision. Martin wondered if he could get similar results from compression boots instead.
In previous experiments with patients without diabetes, Martin’s team showed that the compression boots do more than just move blood around. The pressure seemed to change the way blood vessels—what researchers call the vascular, or circulatory, system—and muscle cells worked. In particular, the treatment increased levels of a key protein (called PGC-1 alpha) that regulates how cells burn energy. It’s also produced during endurance exercise, and research suggests it makes muscle cells more efficient and able to take in more glucose.
The results made Martin wonder if the treatments might benefit people with diabetes, too. Diabetes is closely linked to vascular disease. Problems with blood flow and damage to the blood vessels contribute to complications such as heart disease, eye disease (retinopathy), and kidney disease. And day to day, vascular problems may make it harder to control blood glucose, due, in part, to impaired delivery of insulin and/or glucose. “There is definitely an association between elevated blood glucose levels and vascular function,” Martin says. “We’re coming at it from a different angle. If we can improve vascular function, maybe we can improve glycemic control.”
Think about it this way: Muscle cells absorb glucose from the blood and store it, a process that’s impaired in people with diabetes. Giving muscle cells a tune-up with the help of compression treatment might be one way to bring blood glucose levels down. “More PGC-1 alpha would help push glucose uptake,” Martin says. If muscle cells could take in more glucose from the blood, people with diabetes could achieve lower blood glucose levels.
To test his theory, Martin is putting together an experiment with the help of a grant from the American Diabetes Association. First, he plans to recruit 40 people who have type 2 diabetes but aren’t taking insulin. Although using the boots wouldn’t hurt people with type 1, Martin is focusing his research on people with type 2 who can still produce enough insulin to avoid injections.
Half of the participants will be asked to use the compression boots for three months; the other half will get a placebo in the form of inert lotion to rub on their legs. Martin will measure oral glucose tolerance (which looks at blood glucose levels before and two hours after a sweet drink is consumed) and vascular function. He’ll also take samples of muscle tissue before the treatment begins and after it’s over, and then again three months later.
By comparing the two groups, he hopes to find out if the boots can improve the way muscle cells work, and whether the treatment can lower blood glucose levels. “We’d like to know if they need to be used all the time, or if one course of treatment is enough,” Martin says. “We hope there’s a continued benefit.”
If the boots work, Martin says they could be an effective treatment for people who have been diagnosed with type 2 diabetes recently. “It’s a good point to jump in,” he says.
The boots aren’t a cure, but for the right patients, they could make a difference. If his experiments show they’re effective, it could help convince insurance companies or Medicare to cover the cost of the devices, which is about $1,500. “We’re not looking to replace normal therapies. It’s a device people can use at home that’s going to be comfortable and easy,” Martin says.
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