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Clinician’s Corner: Type-2 diabetes and Exercise

Since the first line treatment of Type-2 diabetes is lifestyle modification (diet and exercise) let’s discuss the benefits of exercise this week.

Benefits of Exercise:

  • Exercise lowers blood sugar levels, improves insulin sensitivity, and strengthens the heart.
  • Strength training, which increases muscle and reduces fat, may be particularly helpful for people with diabetes.
  • Exercise will lower HbA1c by: 1-2%
  • The challenge with Diet and Exercise is that a review of the adherence literature suggests that as a group, patients with diabetes are largely nonadherent. In one early study, only 7% of the diabetic patients were judged to be “fully adherent with all aspects of their regimen”. Which put another way 93% of our patients will NOT adhere to diet and exercise in the treatment of Type-2 diabetes. Because of this, the American Diabetes Association recommends starting metformin therapy at the first visit. http://care.diabetesjournals.org/content/20/2/215.full.pdf).

Use it or Lose it Study

To do this, ten healthy young men decreased their daily activity level from a mean of 10,501+/-808 to 1,344+/-33 steps/day for 2 weeks. After two weeks of this inactivity the results were:

  • energy expenditure was reduced
  • body weight increased
  • decline in lean body mass in the trunk and legs
  • 6–7% reduction in cardiorespiratory fitness
  • 17% drop in peripheral insulin sensitivity. Which means, by simply increasing a patient’s activity level, they can have about a 17% decrease in the insulin they require.

Source: J Appl Physiol. 2010 May;108(5):1023-4.

Remind your patients of the following benefits for exercise:

  • A 5-10 percent weight-loss can result in a five point increase in HDL cholesterol (good cholesterol).
  • Losing 5-10 percent of body weight was shown to decrease triglycerides by an average of 40 mg/dl
  • By losing 5-10 percent of one’s weight, blood pressure, both systolic and diastolic, decrease by 5 mmHg on average
  • A 5-10 percent weight-loss can decrease HbA1c by half a point on average.
  • A 5-10 percent weight-loss may improve sleep apnea and sometimes if the apnea was not very severe, one can be weaned from the CPAP breathing machine.

Encourage your patients to follow all aspects of their physician’s treatment plan. We pharmacists are the “adherence experts” as well as the drug experts. With only 7% of our patients adhering to drugs, diet and exercise we can make a big impact in their treatment of Type-2 diabetes.

Have a great day on the bench!

Pete Kreckel Thompson Pharmacy Broad Avenue