Active lifestyle and diabetes

The findings of Tanasescu et al⁵ in the current issue and the sampling of a rich scientific literature regarding diabetes, physical activity, and fitness demonstrate convincingly that a lifestyle of physical activity is associated with reduced risk of CVD, cardiovascular death, and total mortality in men and women with type 2 diabetes. Moreover, the available data suggest that regular exercise reduces the risk of developing diabetes. The latter is important because the diagnosis of diabetes is often delayed for years after the onset of the disease. Surprisingly, although physical activity has an important place in the treatment of type 2 diabetes, it is an underutilized therapy for the condition. The well-established benefits of exercise on cardiovascular health lend themselves ideally to the type 2 diabetic: Over 60% of type 2 diabetics have hypertension, and both an atherogenic lipid profile and obesity are part of the recognized syndrome underlying diabetes. Moreover, several metabolic effects of exercise underlie the mortality benefits specific to diabetes. These include better glucose control, reduction in triglycerides, and weight loss. We now have data to support this contention from the recent Danish randomized trial of a case management strategy for diabetes, including an exercise prescription, reporting a 50% reduction in complications associated with diabetes.²⁰ The findings of Tanasescu et al⁵ and other recent studies should encourage healthcare providers to recognize physical activity as part of the standard treatment for patients with glucose intolerance or established diabetes.