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Ten days of milder cold without shivering left insulin sensitivity unchanged

The 2021 Nature Communications study repeated the 2015 cold-acclimation experiment in nine patients with type 2 diabetes at 16–17°C and found no insulin benefit.

The paper

Metabolic responses to mild cold acclimation in type 2 diabetes patients

Remie CME, Moonen MPB, Roumans KHM, Nascimento EBM, et al.. Nature Communications, 2021;12(1):1516.

Read the paper ↗PubMed 33750795 ↗Free full text ↗

See the study at a glance

Design
Single-group before-and-after study
People
9 patients with type 2 diabetes
Who they were
Patients with type 2 diabetes in the Netherlands.
What they did
Ten days in a room set to 16–17°C. It measured 16.4°C on average. Time in the room built from 2 hours on the first day to 6 hours a day from day 3, and the researchers avoided overt shivering.
How long
10 days

These numbers came out of it

No gain

Insulin sensitivity didn't improve over the ten days.

16.4°C

The room measured 16.4°C on average. That made it about 1.4°C warmer than the room in the 2015 study that found a 43% gain.

9

Nine patients went through the cold, and the study had no control group.

The researchers did this

In 2015 a Dutch group reported that ten days of cold air raised insulin sensitivity about 43% in eight patients with type 2 diabetes.Source 2 · Clinical trialShort-term cold acclimation improves insulin sensitivity in patients with type 2 diabetes mellitusHanssen MJW, Hoeks J, Brans B, et al.. Nature Medicine, 2015.Read the paper ↗PubMed ↗ For this study the same group set the room at 16–17°C and kept the patients from visibly shivering. The room averaged 16.4°C. That was about 1.4°C warmer than the first time.Source 1 · Clinical trialMetabolic responses to mild cold acclimation in type 2 diabetes patientsRemie CME, Moonen MPB, Roumans KHM, et al.. Nature Communications, 2021.Read the paper ↗PubMed ↗

Nine patients built up from 2 hours on the first day to 6 hours a day from day 3 to day 10. Their insulin sensitivity didn't improve, and neither did their liver fat or the levels of glucose and fats in their blood after meals.Source 1 · Clinical trialMetabolic responses to mild cold acclimation in type 2 diabetes patientsRemie CME, Moonen MPB, Roumans KHM, et al.. Nature Communications, 2021.Read the paper ↗PubMed ↗ The researchers saw only mild effects on fat burning while fasting and on energy use after meals.

The patients reported much less shivering than the 2015 group had. The authors proposed that cold needs some muscle contraction to improve insulin sensitivity.Source 1 · Clinical trialMetabolic responses to mild cold acclimation in type 2 diabetes patientsRemie CME, Moonen MPB, Roumans KHM, et al.. Nature Communications, 2021.Read the paper ↗PubMed ↗ A 2024 study that made adults with overweight or obesity shiver for an hour a day for ten days did report better glucose tolerance.Source 3 · Clinical trialCold acclimation with shivering improves metabolic health in adults with overweight or obesitySellers AJ, van Beek SMM, Hashim D, et al.. Nature Metabolism, 2024.Read the paper ↗PubMed ↗

The study can't tell you these things

  • Nine patients took part, and there was no control group.
  • The room was warmer than in 2015 and shivering was avoided, so the design can't say which change mattered.
  • The cold came from room air for hours a day, so the result says nothing direct about cold water.

We cited these sources

  1. 01Remie CME, Moonen MPB, Roumans KHM, Nascimento EBM, Gemmink A, Havekes B, et al.. Metabolic responses to mild cold acclimation in type 2 diabetes patients. Nature Communications. 2021;12(1):1516. doi:10.1038/s41467-021-21813-0 PMID 33750795
  2. 02Hanssen MJW, Hoeks J, Brans B, van der Lans AAJJ, Schaart G, van den Driessche JJ, et al.. Short-term cold acclimation improves insulin sensitivity in patients with type 2 diabetes mellitus. Nature Medicine. 2015;21(8):863-865. doi:10.1038/nm.3891 PMID 26147760
  3. 03Sellers AJ, van Beek SMM, Hashim D, Baak R, Pallubinsky H, Moonen-Kornips E, et al.. Cold acclimation with shivering improves metabolic health in adults with overweight or obesity. Nature Metabolism. 2024;6(12):2246-2253. doi:10.1038/s42255-024-01172-y PMID 39643644