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Exercise and 24-h Glycemic Control: Equal Effects for All Type 2 Diabetes Patients?

VAN DIJK, JAN-WILLEM1; MANDERS, RALPH J. F.1; CANFORA, EMANUEL E.1; MECHELEN, WILLEM VAN2; HARTGENS, FRED3; STEHOUWER, COEN D. A.4; VAN LOON, LUC J. C.1

Medicine & Science in Sports & Exercise: April 2013 - Volume 45 - Issue 4 - p 628–635
doi: 10.1249/MSS.0b013e31827ad8b4
Clinical Sciences

Purpose We assessed the effect of a single bout of moderate-intensity exercise on subsequent 24-h glycemic control in 60 type 2 diabetes patients. Moreover, we examined whether individual responses to exercise were related to subjects’ baseline characteristics, including age, body mass index, diabetes duration, exercise performance, medication, and HbA1c content.

Methods Sixty type 2 diabetes patients (insulin-treated, n = 23) participated in a randomized crossover experiment. Patients were studied on two occasions for 3 d under strict dietary standardization but otherwise free-living conditions. Parameters of glycemic control (means [95% confidence interval]) were assessed by continuous glucose monitoring over the 24-h period after a single bout of moderate-intensity endurance-type exercise or no exercise at all (control).

Results Type 2 diabetes patients experienced hyperglycemia (blood glucose >10 mmol·L−1) for as much as 8:16 h:min (6:44 to 9:48 h:min) per day. The prevalence of hyperglycemia was reduced by 31% to 5:38 h:min (3:17 to 7:00 h:min) over the 24-h period after the exercise bout (P < 0.001). Moreover, exercise lowered average blood glucose concentrations by 0.9 mmol·L−1 (0.7 to 1.2) and reduced glycemic variability (P < 0.05). The response to exercise showed considerable variation between subjects and correlated positively with HbA1c levels (r = 0.38, P < 0.01). Nevertheless, even well-controlled patients with an HbA1c level below 7.0% (n = 28) achieved a 28% reduction in the daily prevalence hyperglycemia after exercise (P < 0.01).

Conclusions A single bout of moderate-intensity exercise substantially improves glycemic control throughout the subsequent day in insulin- and non–insulin-treated type 2 diabetes patients. Of all baseline characteristics, only subjects’ HbA1c level is related to the magnitude of response to exercise. Nevertheless, the present study demonstrates that even well-controlled patients benefit considerably from the blood glucose-lowering properties of daily exercise.

1Department of Human Movement Sciences, NUTRIM School for Nutrition, Toxicology and Metabolism, Maastricht University Medical Centre+, Maastricht, THE NETHERLANDS;2Department of Public and Occupational Health, EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, THE NETHERLANDS;3Departments of Epidemiology and Surgery, CAPHRI School for Public Health and Primary Care; and 4Department of Internal Medicine, CARIM Cardiovascular Research Institute Maastricht, Maastricht University Medical Centre+, Maastricht, THE NETHERLANDS

Address for correspondence: Luc J.C. van Loon, Ph.D., Department of Human Movement Sciences, Maastricht University Medical Centre+, PO Box 616, 6200 MD Maastricht, The Netherlands; E-mail: L.vanloon@maastrichtuniversity.nl.

Submitted for publication July 2012.

Accepted for publication October 2012.

©2013The American College of Sports Medicine