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How To Drop Blood Sugars By 12%

Regular physical activity is a cornerstone of diabetes management and can drop blood sugars by 12% if done after dinner.

Regular physical activity is a cornerstone of diabetes management. So a study was done to evaluate whether specifying the timing of walking in relation to meals enhances the benefits conferred by current physical activity guidelines.

Researchers concluded that telling patients with type 2 diabetes to “Take a short walk right after meals” may be one of the best exercise prescriptions a clinician can give.  Results from the randomized crossover study show that post-meal blood glucose levels dropped 12%, on average, when patients with type 2 diabetes walked for 10 minutes after three daily meals compared with walking for 30 minutes at any time of day (P = .034).

Andrew N Reynolds, MD, from the University of Otago in Dunedin, New Zealand added that most of this effect came from a 22% glycemic drop in the 3-hour period following the after-dinner walk. “The improvement was particularly striking after the evening meal when the most carbohydrate was consumed and sedentary behaviors were highest,” they say in their paper published October 17 in Diabetologia.

Since postprandial glycemia is an independent determinant of glycemic control as well as cardiovascular risk, the timing of physical activity may provide significant additional health benefits to patients with type 2 diabetes.

The findings also make a strong case for updating current guidelines, the researchers assert.  “The benefits relating to physical activity following meals suggest that current guidelines should be amended to specify post-meal activity, particularly when meals contain a substantial amount of carbohydrate.”

Current activity guidelines recommend that patients with type 2 diabetes get a minimum of 150 minutes of moderate physical activity each week, or about 30 minutes a day over 5 days. Daily exercise can be completed at one time or at different times throughout the day.

Dr. Reynolds added that postprandial physical activity may make it possible for patients to avoid an increased total insulin dose or additional mealtime insulin injections to lower glucose levels after eating.

Higher insulin doses might, in turn, be associated with weight gain in patients with type 2 diabetes, many of whom are already overweight or obese.

It is very easy to say to your patients, ‘Go for a walk after your meals’ and then to follow up at each subsequent clinical visit. Since the prescribed level of activity was so modest (30 minutes total each day), the results may be applicable to a wide group of patients with type 2 diabetes mellitus, Dr Reynolds added.

The post-meal walking study, conducted at the University of Otago between September 2013 and February 2015, enrolled 41 patients with a mean age of 60 years. Mean duration of diabetes was 10 years.

Patients were randomized to an exercise prescription of two weeks of walking 30 minutes each day or to walking for 10 minutes right after three daily meals. After the 30-day washout period, participants switched to the other exercise prescription. No changes were made to diet or to other lifestyle factors. Patients wore accelerometers to measure physical activity as well as continuous glucose-monitoring systems. Interestingly, patients walked longer when they walked after meals, although the researchers aren’t sure why.

Dr. Reynolds explained that, “Prescriptions were matched in activity and duration and differed only with regard to the specified time of walking.”  He added, “We may not have the evidence to comment on why this is so, but, there are important clinical repercussions to this finding.”

Future studies that include biochemical or cell-based measurements may reveal how increased walking after meals reduces blood glucose levels.

In the meantime, the researchers are conducting follow-up research to identify factors that motivate or prevent people with type 2 diabetes from following a regular walking prescription, which they hope will be of use to physicians to help promote adherence to regular walking routines; they expect to publish this work soon, Dr Reynolds said.

Practice Pearls:

  • Advice to walk after meals is more effective for lowering postprandial glycemia in type 2 diabetes mellitus than advice that does not specify timing.
  • Walking after eating can help to lower your patients’ insulin requirements, which can help to maintain weight.
  • The prescribed level of activity was very modest at 30 minutes total each day.

Reynolds, A.N., Mann, J.I., Williams, S. et al. Diabetologia (2016). doi:10.1007/s00125-016-4085-2