Physical activity attenuates postprandial hyperglycaemia in homozygous TBC1D4 loss-of-function mutation carriers

Theresia M. Schnurr, Emil Jørsboe, Alexandra Chadt, Inger K. Dahl-Petersen, Jonas M. Kristensen, Jørgen F.P. Wojtaszewski, Christian Springer, Peter Bjerregaard, Søren Brage, Oluf Pedersen, Ida Moltke, Niels Grarup, Hadi Al-Hasani, Anders Albrechtsen, Marit E. Jørgensen, Torben Hansen*

*Corresponding author for this work

Research output: Contribution to journalJournal articleResearchpeer-review

3 Downloads (Pure)


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 ( under accession EGAD00010001428. Graphical abstract: [Figure not available: see fulltext.]

Original languageEnglish
Issue number8
Pages (from-to)1795-1804
Publication statusPublished - Aug 2021


  • Arctic
  • Gene-environment interaction
  • Lifestyle therapy
  • Physical activity
  • Postprandial hyperglycaemia
  • TBC1D4 loss-of-function


Dive into the research topics of 'Physical activity attenuates postprandial hyperglycaemia in homozygous TBC1D4 loss-of-function mutation carriers'. Together they form a unique fingerprint.

Cite this