Question 831

Apr 30, 2016

Mr. Huang is a 61-year-old Asian-American businessman who comes in to see you for a follow-up appointment. He was diagnosed with type 2 diabetes 4 years ago and has a long-standing history (15 years) of hypertension and hypercholesterolemia, which are currently well controlled. Current medications are metformin (1500 mg/day), lisinopril and simvastatin. He is overweight (BMI 29 kg/m2), but feels he has a healthy diet and gets out for a 25-30 minute walk 3 or 4 times per week. He feels great, but over the last nine months or so, he has noticed that his home average glucose levels are in the 180-198 mg/dL range. At today’s visit, his A1C is 8.3%.

Mr. Huang achieves good glycemic control with his lifestyle modifications, metformin and linagliptin and returns every 6 months for follow-up visits. Three years after initiating this treatment plan, he returns to your clinic for his 6-month check-up. When asked how his diabetes management is going at home, he shares that recently he has been “unable to really get out and get as much exercise as he knows he should due to his creaky, old knees acting up.” His current office A1C is 8.8%. You discuss with him what the next management steps may be to achieve his individualized glycemic goal. A long-acting insulin analogue was added to his treatment.

What is the best advice you can give Mr. Huang regarding exercise?


Answer: D. He should be as physically active as possible and introduce resistance training at least 2 times per week to his routine.

Current physical recommendations for individuals with type 2 diabetes are: 150 min/week of moderate-intensity aerobic exercise and, in the absence of contraindications, be encouraged to perform resistance training at least 2x week. Meta-analysis has shown the positive benefit of resistance training on metabolic control, weight management and quality of life. For those that have difficulty engaging in aerobic activity, resistance training has been shown to be safe and efficacious.

Diabetes Care July 2013 36:7 1884-1890; published ahead of print February 12, 2013, doi:10.2337/dc12-1153