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Item
#6
Exercise
Has a Clinically Significant Impact on Glycemic Control
Independent of Weight Loss
Exercise
significantly reduces the risk of complications from diabetes.
A meta-analysis of 14 controlled randomized and nonrandomized
clinical trials of the effects of exercise of at least 8 weeks'
duration in patients with type 2 diabetes led investigators to two
important conclusions:
1)
The 0.66% reduction in HbA1c seen on average in
patients who exercised can be expected to significantly reduce the
risk of complications. The magnitude of this short-term reduction
was similar to that noted with intensive glucose-lowering therapy
in the United Kingdom Prospective Diabetes Study (UKPDS). 2)
Exercise did not have a significant impact on weight loss,
suggesting that the beneficial glycemic effect of exercise is not
dependent on weight loss. As stated by the investigators, exercise
decreases insulin resistance in the liver and muscles and
increases glucose disposal through a number of mechanisms that are
not necessarily associated with changes in body weight. Thus,
exercise should be viewed as beneficial on its own.
The 504 patients included in the 14
trials had had type 2 diabetes for a mean of 4.3 years. Mean age
was 55 years; 50% were women. The exercise programs lasted at
least 8 weeks (range 8 to 52 weeks), and compliance was verified
through direct supervision or exercise diaries. No subjects were
receiving drug therapy for diabetes.
Twelve studies used aerobic training
and two used resistance training. Intensity was moderate, with
patients typically performing about three 1-hour workouts per
week.
At
the end of the study periods, the weighted mean HbA1c
was 7.65% in the exercise groups and 8.31% in controls (P<0.001).
Weighted mean body mass was 83.02 kg in the exercise groups and
82.48 kg in controls (P=0.76), a difference of 0.54 kg.
Exercise
was combined with diet in two of the studies. The effect on HbA1c
was similar to that of exercise alone, a weighted mean reduction
of 0.76% (P=0.008). The average weight loss from baseline
was 0.9 kg (P=0.70) in the exercise groups, 3.4 kg (P=0.11)
in the exercise plus diet groups, 2.5 kg (P=0.29) in the
diet groups, and 0.8 kg (P=0.73) in the controls.
When
discussing the importance of diet in glycemic control, the authors
suggested that exercise might produce a greater reduction in
cardio vascular risk than that recorded with insulin and
sulfonylureas in the UKPDS, because unlike insulin and
sulfonylureas, exercise has other cardioprotective effects and is
not associated with weight gain.
Several
possible explanations were offered to account for the minimal
weight loss that occurred in subjects who exercised: 1) that
exercise was of moderate intensity and relatively short duration;
2) subjects may have increased their food intake and reduced their
usual daily activities; and 3) subjects who were inactive at entry
to the studies may have increased their lean body mass so that the
weight loss did not reflect the amount of fat lost.
Finally,
it is interesting to note that the authors analyzed studies
investigating various ethnic populations. They suggested that
these results can be widely generalized to middle-aged patients
with diverse ethnic backgrounds. However, only one study involved
individuals above the age of 65, so application to older patients
with diabetes may not be appropriate based on this analysis.
Boulé NG et al.
Effects of exercise on glycemic control and body mass in type 2
diabetes mellitus: a meta-analysis of controlled clinical trials.
JAMA. 2001;286:1218-1227.
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FACT:
6
airliners with 133 people on board crashing daily are equivalent
to the number of people dying with diabetes every day.
================================
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