A 39-year-old, overweight (BMI 27 kg/m2) patient comes into your office for his annual wellness examine. Routine labs show random plasma glucose of 176 mg/dL, so you ask him to return for a fasting plasma glucose and A1C. The results show a FPG 139 mg/dL and A1C of 7.7%. He is resistant to the idea of starting medication and is very keen on pursuing a trial period of dietary modifications and an exercise program, especially after you tell him about the benefits of moderate exercise on diabetes. Which of the following statements about exercise is true?
Answer C. Exercise can reduce all-cause mortality by up to 38%.
A recently published study (meta-analysis of 12 studies and prospective cohort data), led by Diewrtje Sluik form the German Institute of Human Nutrition Potsdam-Rehbrucke, confirmed that physical activity lowers basal insulin levels, lowers A1C levels and lowers the risk of cardiovascular disease and total mortality by up to 38% in patients with type 2 diabetes. Compared to physically inactive adults, moderately active persons were associated with the best improvement in risk for death. Participants who engaged in more intense/higher levels of exercise still showed impressive risk reduction, but it was slightly less than the moderate exercise group.
Patients, who are newly diagnosed with type 2 diabetes, have A1Cs near target (<7.5%) and who are highly motivated to engage in lifestyle modifications may be given the opportunity to pursue lifestyle modifications for a 3-6 month period. If lifestyle modifications are not successful, pharmacotherapy can be initiated after the trial period. Reference(s):
Sluik D, Buijsse B, Muckelbauer R, et al. Physical activity and mortality in individuals with diabetes mellitus: A prospective study and meta-analysis. Arch Intern Med. 2012; 172(17):1285-1295.
Inzucchi S, et al. Management of hyperglycemia in type 2 diabetes: A patient-centered approach. Position statement of the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD). Diabetes Care. 2012; 35(6):1364-1379.