Exercise in the Therapy of Diabetes Mellitus

Abstract

Physical activity has long been recognized as having beneficial effects for patients with diabetes mellitus. It has been shown that regular exercise results in improved glucose levels, lower HgbA1C, lower blood pressure, and beneficial changes in lipid and coagulation profiles. Most of the benefits of exercise appear to be related to improved insulin sensitivity and require activity that occurs on a regular basis and is associated with depletion of glycogen and lipids in key tissues such as muscle and liver. The beneficial effect of exercise on insulin sensitivity may also be useful in the prevention of progression to overt diabetes in individuals at high risk as well as diminishing the risk of premature cardiovascular disease in those with the so-called metabolic syndrome. Regular exercise is generally safe but can be associated with some risk in patients with established vascular and micro-vascular disease. The major risk of exercise is the development of hypoglycemia in patients on insulin or insulin secretagogues. This is particularly true of patients with type 1 diabetes who may require a more formal exercise prescription and a set of recommendations to exercise safely. Recent advances in insulin administration and especially continuous glucose monitoring may make exercise regimens safer and more widely used in patients at higher risk.