Role of Exercise for Type 2 Diabetic Patient Management

Harry T. Pigman, MD, David X. Gan, MD, DrPH, and Marie A. Krousel-Wood, MD

Disclosures

South Med J. 2002;95(1) 

In This Article

Abstract and Introduction

Background. Exercise is integral to the management of type 2 diabetes. Unfortunately, the majority of adults with type 2 diabetes do not engage in regular exercise.
Methods. Three hundred patients with type 2 diabetes were randomly selected from a patient pool of diabetic patients encountered in 1996 at the Department of Veterans Affairs Medical Center in New Orleans, Louisiana. Medical records from October 1996 to June 1999 were reviewed. Information about exercise, alcohol intake, smoking, medications, laboratory results, and other variables was extracted from medical records. Patients with mean glycosylated hemoglobin (HbA1c) <8.0 (good diabetic control) were compared with those who had poor diabetic control (mean (HbA1c) ≥8.0). The effect of exercise in the management of type 2 diabetes was assessed.
Results. After adjustment for other variables, patients without exercise had an odds ratio of 2.71 (95% CI, 1.38-5.32) for poor diabetic control compared with patients with exercise.
Conclusions. These findings suggest that exercise by itself is important for type 2 diabetes management.

Type 2 diabetes is a major health problem in the United States, affecting an estimated 16 million people, costing more than $90 billion per year and accounting for about one sixth of all expenditures for health care.[1] Ninety percent of patients with diabetes have type 2 diabetes (formerly known as non-insulin-dependent diabetes). The prevalence of type 2 diabetes has increased over the past two decades in the United States.[1] The mortality rate among patients with diabetes is 11 times higher than that among people without type 2 diabetes.

Life-style interventions that combine counseling for dietary management, weight reduction, and increased physical activity are pivotal in type 2 diabetes management with respect to glycemic control.[2] Adequate physical activity relative to food (calories) intake prevents obesity, which is a major modifiable risk factor for type 2 diabetes. In addition, physical activity may independently enhance insulin sensitivity and glucose tolerance.[3,4,5,6,7] The possible benefits of exercise for patients with type 2 diabetes are substantial; data from recent studies support the importance of long-term exercise programs for the treatment and prevention of type 2 diabetes and its complications.

Evidence has accumulated suggesting that the progressive decrease with aging in fitness, muscle mass, and strength is in part preventable by maintaining regular exercise. The decrease in insulin sensitivity with aging is also partly due to a lack of physical activity. Lower levels of physical activity are especially likely in the population with type 2 diabetes. The benefit of exercise in improving the metabolic abnormalities of type 2 diabetes is probably greatest when it is used early in its progression from insulin resistance to impaired glucose tolerance to overt hyperglycemia requiring treatment with oral glucose-lowering agents and finally to insulin dependence.[8] Unfortunately, it is estimated that 60% to 80% of the adult population in the United States do not meet the recommended levels of physical activity,[9] and data from a nationally representative survey study have shown that adults with diabetes are even less likely to engage in regular physical activity than adults in general.[10]

With the publication of new clinical reviews, it is becoming increasingly clear that exercise may be a therapeutic tool in a variety of patients with or at risk for diabetes; however, like any therapy, its effects are not clearly understood.[10,11,12] This study was conducted in patients with type 2 diabetes at the Department of Veterans Affairs Medical Center in New Orleans (VAMCNO). The aim of the study was to evaluate the effects of exercise in management of patients with type 2 diabetes.

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