Physical Activity/Exercise and Diabetes: A Position Statement of the American Diabetes Association

Bidirectional causality of physical exercise in retinal neuroprotection

Physical exercise is recognized as an effective intervention to improve mood, physical performance, and general well-being. It achieves these benefits through cellular and molecular mechanisms that promote the release of neuroprotective factors. Interestingly, reduced levels of physical exercise have been implicated in several central nervous system diseases, including ocular disorders. Emerging evidence has suggested that physical exercise levels are significantly lower in individuals with ocular diseases such as glaucoma, age-related macular degeneration, retinitis pigmentosa, and diabetic retinopathy. Physical exercise may have a neuroprotective effect on the retina. Therefore, the association between reduced physical exercise and ocular diseases may involve a bidirectional causal relationship whereby visual impairment leads to reduced physical exercise and decreased exercise exacerbates the development of ocular disease. In this review, we summarize the evidence linking physical exercise to eye disease and identify potential mediators of physical exercise-induced retinal neuroprotection. Finally, we discuss future directions for preclinical and clinical research in exercise and eye health.

A comprehensive view of muscle glucose uptake: regulation by insulin, contractile activity, and exercise

Skeletal muscle is the main site of glucose deposition in the body during meals and the major glucose utilizer during physical activity. Although in both instances the supply of glucose from the circulation to the muscle is of paramount importance, in most conditions the rate-limiting step in glucose uptake, storage, and utilization is the transport of glucose across the muscle cell membrane. This step is dependent upon the translocation of the insulin- and contraction-responsive glucose transporter GLUT4 from intracellular storage sites to the sarcolemma and T tubules. Here, we first analyze how glucose can traverse the capillary wall into the muscle interstitial space. We then review the molecular processes that regulate GLUT4 translocation in response to insulin and muscle contractions and the methodologies utilized to unravel them. We further discuss how physical activity and inactivity, respectively, lead to increased and decreased insulin action in muscle and touch upon sex differences in glucose metabolism. Although many key processes regulating glucose uptake in muscle are known, the advent of newer and bioinformatics tools has revealed further molecular signaling processes reaching a staggering level of complexity. Much of this molecular mapping has emerged from cellular and animal studies and more recently from application of a variety of -omics in human tissues. In the future, it will be imperative to validate the translatability of results drawn from experimental systems to human physiology.

Risk factors for diabetic foot ulcer in diabetic patients at the Tehran diabetes clinic: a case-control study

Background and objective

: Diabetic foot ulcer (DFU) is one of the main health challenges of diabetes complications worldwide. A wide range of factors may increase the risk of DFU. This study aimed to investigate the risk factors of DFU among diabetic patients.

Methods

This case-control study was conducted on 800 diabetic patients at the Tehran diabetes clinic of the Endocrinology and Metabolism Research Institute in Iran. The case group included 400 diabetic patients diagnosed with DFU, while the control group included 400 diabetic patients without DFU. Data were collected through medical records, validated questionnaires, and clinical examinations. The association between factors and the risk of DFU was analyzed using both crude and adjusted logistic regression models, adjusting for confounders based on a directed acyclic graphs.

Results

The final adjusted model demonstrated significant direct associations between the risk of DFU with a longer duration of diabetes, a history of previous DFU, peripheral neuropathy, retinopathy, high blood pressure, severe kidney function loss, and good foot self-care. However, there were significant inverse associations between DFU risk with female gender, higher education levels, being married, use of oral diabetes drugs, higher hemoglobin levels, and high physical activity.

Conclusions

The risk of DFU was significantly associated with the following factors: diabetes duration, previous DFU history, peripheral neuropathy, retinopathy, blood pressure, kidney function, foot self-care, gender, education levels, marital status, diabetes drugs, hemoglobin levels, and physical activity. Further studies, especially ones in multicenter cohorts with a special focus on novel risk factors, are warranted to expand on our findings.

Supplementary Information

The online version contains supplementary material available at 10.1007/s40200-025-01582-z.

Uniformity and stability of saliva composition based on glucose concentration analysis

Saliva holds promise as a biomarker for glucose monitoring due to its non-invasive and self-collection characteristics. However, its viscosity may lead to uneven glucose distribution, reflecting the uniformity of saliva, and individual glycemic control factors such as diet may affect salivary glucose concentration, reflecting the stability of saliva. To address these concerns, this study aims to evaluate the uniformity and stability of salivary glucose concentrations. Macro-rheological properties (shear viscosity, elastic modulus, and viscous modulus) and micro-morphological characteristics of saliva were analyzed using a rheometer and Scanning Electron Microscopy and Energy-Dispersive X-ray Spectroscopy (SEM-EDS) techniques. Salivary glucose uniformity and stability were assessed under room-temperature static conditions, fasting saliva over a one-month period, and in postprandial states. Results showed that saliva exhibits shear-thinning behavior, with shear viscosity decreasing from 0.1 Pa∙s to 0.001 Pa∙s as shear rate increases from 0.1 to 150 s-1. This shear-thinning property, linked to the porous glycoprotein network observed through micro-morphological analysis, may influence analyte distribution. Despite the inherent viscosity, salivary glucose concentrations demonstrated high uniformity: 89 % of fasting samples and 92 % of postprandial samples showed less than 10 % variation when divided into three portions. Regarding stability, salivary glucose levels in healthy individuals remained consistently more stable than those in diabetic patients across various conditions, including static room-temperature storage of fasting saliva, fasting saliva over one month, and postprandial saliva. For example, fasting glucose levels over one month in diabetic patients (7.38 ± 6.3 mg/dL) were higher and less stable than those observed in healthy individuals (1.674 ± 0.72 mg/dL). This study confirms that fasting salivary glucose is both homogeneous and sufficiently stable, supporting its potential as a viable biomarker for blood glucose monitoring.

A multifactorial intervention to improve cardiovascular outcomes in adults with type 2 diabetes and current or previous diabetic foot ulcer disease: Protocol for a multi-centre randomised control trial (MiFoot study)

BACKGROUND

In the United Kingdom, the prevalence of diabetes-related foot ulcer disease (DFUD) is 6.3%, and cardiovascular disease (CVD) is the leading cause of mortality in people with DFUD. This study aims to evaluate the effectiveness of a multifactorial intervention to reduce CVD events and mortality in adults with type 2 diabetes (T2D) and DFUD.

METHODS

The MiFoot study is a multi-centre, pragmatic randomised controlled trial to test intervention effectiveness and cost-effectiveness compared to usual care that will include an internal feasibility study and a process evaluation. English-speaking adults (≥18 years; n = 392) with T2D and current/previous (within 5 years) DFUD will be recruited from multiple sites across the United Kingdom and randomised 1:1 to intervention (MiFoot multifactorial intervention plus usual care) or control (usual care), with data collected at baseline, 12- and 24-month follow-up. The MiFoot intervention comprises an individualised assessment with a healthcare practitioner to optimise treatment and assess the suitability of physical activity participation; group-based disease self management education and physical activity sessions; and a digital-based programme, consisting of cohort-relevant topics, physical activity guidance and peer support functionality. The primary outcome will be extended major adverse cardiovascular events (MACE, i.e. myocardial infarction, stroke, cardiovascular death, peripheral arterial bypass, coronary artery bypass, coronary angioplasty or peripheral artery angioplasty) at 24 months.

DISCUSSION

This study will provide evidence on the feasibility and clinical effectiveness, and cost-effectiveness of a multifactorial intervention to prevent or slow the progression of CVD-related complications in the extremely high-risk population with T2D and DFUD.

Exercise training benefits pancreatic islet by modulating the insulin-like growth factor 1/phosphatidylinositol 3-kinase/protein kinase B pathway

BACKGROUND

Diabetes is characterized by insulin resistance as well as impaired insulin production, with β-cell dysfunction playing a critical role in disease progression. Exercise is known to improve insulin sensitivity, but its effects on pancreatic islet quality and function remain poorly understood. This work hypothesized that swimming training enhances glycemic control and insulin secretion by upregulating the insulin-like growth factor 1 (IGF-1)/phosphatidylinositol 3-kinase/protein kinase B (PI3K/AKT) pathway in streptozotocin (STZ)-induced diabetic rats.

AIM

To investigate the effects of swimming on pancreatic islet quality and function in STZ-induced diabetic rats via the IGF-1/PI3K/AKT pathway.

METHODS

Twenty-six Sprague-Dawley rats were grouped into diabetic and control groups, with each group further split into exercise and sedentary subgroups. Diabetic rats were induced with STZ. The exercise groups underwent swimming training for 60 minutes/day, 5 days/week, for 8 weeks. Body weight, food intake, blood glucose, insulin, lipids, and muscle glycogen were measured. Pancreatic islet morphology and the protein expression levels of IGF-1, PI3K, and AKT were analyzed. Data were analyzed using two-way repeated-measure ANOVA, followed by Tukey’s post-hoc test.

RESULTS

Exercise training significantly improved body weight [diabetic exercise group (D-Ex): 390.66 ± 50.14 g vs diabetic sedentary group (D-Sed): 315.89 ± 50.12 g, P < 0.05], reduced blood glucose (D-Ex: 12.21 ± 4.43 mmol/L vs D-Sed: 17.79 ± 2.05 mmol/L, P < 0.05), and increased insulin levels (D-Ex: 53.50 ± 15.31 pmol/L vs D-Sed: 25.31 ± 10.23 pmol/L, P < 0.05) in diabetic rats. It also enhanced islet morphology, increased IGF-1 expression, and activated the PI3K/AKT pathway (P < 0.05). In-vitro experiments confirmed that IGF-1 positively regulated insulin expression and inhibited β-cell apoptosis via the PI3K/AKT pathway.

CONCLUSION

Exercise training improves pancreatic islet quality and function in diabetic rats by modulating the IGF-1/PI3K/AKT pathway, highlighting its therapeutic potential for diabetes management.

Supporting women with diabetes experiencing menopause: A workshop to co-design research recommendations for improving the understanding of and support for women with diabetes experiencing menopause

AIMS

Based on direct feedback on the challenges faced by women with diabetes navigating menopause, the Diabetes Research Steering Groups (DRSGs), organised by Diabetes UK, conducted a workshop aimed at outlining key research priorities in this area. The statement will provide actionable recommendations for researchers and funders, ensuring future studies address the unique needs and lived experiences of women living with diabetes during this life phase. The DRSGs also highlighted the need to bring researchers and healthcare professionals in the field of diabetes together with those working in women's health to collaborate in this field. The goal is to bridge the gap in understanding and support, driving research that informs more effective care strategies and improves quality of life during this critical and often challenging life stage.

METHODS

In November 2023, Diabetes UK convened a workshop on diabetes and menopause, bringing together 49 participants, including people with lived experience, researchers, healthcare professionals, and representatives from charities and funding bodies. The workshop began with presentations from experts and case studies, followed by small-group discussions facilitated by Diabetes UK staff. Participants were asked to identify key evidence gaps and refine research questions related to diabetes and menopause. Groups focused on thematic topics, discussing barriers and potential solutions. Insights from these discussions were collated and thematically analysed, resulting in key recommendations to address health inequalities in diabetes research.

RESULTS

The following key areas were identified for increased future research focus: Improving the understanding of the mechanisms underlying the impact of menopause on blood glucose control in women with diabetes Understanding the safety and efficacy of treatments, technology, and exercise in the management of diabetes and menopause Understanding how to best support women from underserved communities in their management of diabetes and menopause Understanding the impact of menopause on the mental health of women with diabetes and tailoring psychosocial interventions that support women during this period. Supporting healthcare professional education in how to effectively support women with diabetes experiencing menopause. Exploring how innovative models of care can support women with diabetes experiencing menopause more effectively.

CONCLUSIONS

This position statement presents recommendations to address the unmet needs of women with diabetes experiencing menopause. The diabetes research community is to act upon these recommendations to ensure the views and needs of this group are well-represented.

Elevated glycated haemoglobin affects Achilles tendon properties and walking capacity in healthy people without a diagnosis of diabetes

The aim of this study was to test the hypothesis that individuals with an increase in HbA1c (i.e. above the regular but below the diabetic threshold) exhibit an impairment in the Achilles tendon structure and walking capacity, due to the adverse effect of the advanced glycation end-product. One hundred fifty-eight participants matched for gender, age, physical activity and BMI, were divided in two cohorts based on the HbA1c level: normal HbA1c (NGH; <39 mmol/molHb; n = 79) and altered HbA1c (AGH; >=39 mmol/molHb; n = 79). Each participant performed several walking trials to evaluate the kinematic parameters during walling at the self-selected speed and a quantitative MRI scan of the Achilles tendon (AT) to obtain its intrinsic characteristics (i.e. T2* relaxation time short and long component). The AT T2* relaxation time short component (a parameter related to the tendon collagen quality) was reduced in AGH compared to NGH. Furthermore, AGH exhibited a slower self-selected walking speed (NGH: 1.59 ± 0.18 m/s; AGH:1.54 ± 0.16 m/s) and a shorter stride length (NGH: 1.59 ± 0.13 m; AGH:1.55 ± 0.11 m). Our data suggest that a non-pathological increase in HbA1c is able to negatively affect AT collagen quality and walking capacity in healthy people. These results highlight the importance of glycemic control, even below the pathological threshold. Since diabetes could alter several biological pathways, further studies are necessary to determine which mechanisms and their timing, regarding the HbA1c rise, affect tendon composition and, consequently, walking capacity.

Impact of resistance training on cardiometabolic health-related indices in patients with type 2 diabetes and overweight/obesity: a systematic review and meta-analysis of randomised controlled trials

OBJECTIVE

To evaluate the effects of resistance training on cardiometabolic health-related outcomes in patients with type 2 diabetes mellitus (T2DM) and overweight/obesity.

DESIGN

Systematic review and meta-analysis of randomised controlled trials (RCTs).

DATA SOURCES

PubMed, Web of Science, Scopus, Science Direct, Cochrane Library and Google Scholar databases were searched from inception up to May 2024. The search strategy included the following keywords: diabetes, resistance exercise and strength training.

ELIGIBILITY CRITERIA FOR SELECTING STUDIES

RCTs published in English comparing resistance training alone with non-exercising standard treatment. Participants were adults diagnosed with T2DM and concurrent overweight/obesity (body mass index (BMI) ≥25 kg/m2).

RESULTS

A total of 18 RCTs qualified involving 1180 patients (48.6/51.4 female/male ratio; 63.3±7.0 years; 29.3±4.3 kg/m2). Waist circumference (standardised mean differences (SMD) -0.85 cm, 95% CI -1.66 to -0.04), waist-to-hip ratio (SMD -0.72, 95% CI -1.30 to -0.15), high-density lipoprotein cholesterol (SMD +0.40 mg/dL, 95% CI 0.07 to -0.72), triglycerides (SMD -0.54 mg/dL, 95% CI -1.06 to -0.02), fasting blood glucose (SMD -0.65 mmol/L, 95% CI -1.19 to -0.12), fasting insulin (SMD -0.74 uIU/mL, 95% CI -1.12 to -0.36) and glycated haemoglobin (SMD -0.32%, 95% CI -0.63 to -0.01) improved compared with standard treatment. The risk of bias was low to unclear, and the quality of evidence was very low to moderate.

CONCLUSIONS

Resistance training as a standalone exercise intervention in the management and treatment of T2DM with concurrent overweight/obesity is associated with many cardiometabolic benefits when compared with standard treatment without exercise.

PROSPERO REGISTRATION NUMBER

CRD42022355612.

Effect of lifestyle intervention on systemic oxidative stress in kidney transplant recipients: A post-hoc analysis of the Active Care after Transplantation (ACT) randomized controlled trial

BACKGROUND

Oxidative stress is associated with adverse outcomes in kidney transplant recipients (KTR), including graft failure, morbidity, and mortality. Since both exercise training and dietary modifications have the potential to improve redox status, we aimed to investigate the potential mitigating effects of exercise or exercise plus diet intervention on circulating levels of free thiols (R-SH) as marker of systemic redox status in KTR.

METHODS

We conducted a post-hoc analysis of the Active Care after Transplantation (ACT) study, a randomized controlled lifestyle intervention trial which proved to enhance physical functioning of KTR. Systemic R-SH levels were quantified at baseline, 3-months, and 15-months (end of study) using a colorimetric detection method. Estimated marginal means (EMM) were reported using general linear mixed models.

RESULTS

KTR were randomized to usual care (n = 40), exercise intervention (n = 54), or exercise plus diet intervention (n = 55). At 3 months post-baseline, systemic R-SH concentrations decreased significantly in the control group, while the intervention groups showed a less pronounced decrease, although the difference compared to control nearly reached statistical significance in either the exercise intervention group (EMM +20.2 μM (95%CI -1.4, +41.9), P = 0.067) or the exercise plus diet intervention group (EMM +18.9 μM (95%CI -2.7, +40.4), P = 0.086). At 15 months post-baseline, R-SH concentrations further decreased in the exercise intervention group, resulting in a difference compared to control of +9.0 μM (95%CI -14.4, +32.3; P = 0.45), whereas R-SH concentrations increased to above baseline in the exercise plus diet intervention group, with a statistically significant difference compared to control of +32.8 μM (95%CI +9.4, +56.2; P = 0.006).

CONCLUSIONS

Lifestyle changes involving exercise and diet positively impacted systemic R-SH, suggesting that reducing oxidative stress through lifestyle interventions could potentially contribute to clinical benefits in KTR.

Evaluation of the toxicity potential of exercise and atorvastatin/metformin combination therapy on STZ-diabetic rats

Exercise is recommended for individuals with diabetes, and metformin and atorvastatin are commonly prescribed to diabetic patients. However, these two drugs have potential effects that may lead to toxicity in the skeletal muscle system. Therefore, the effects and potential interactions of combining these two drugs on skeletal muscle performance and structure were investigated in vivo in an experimental diabetes model. Male Wistar rats were divided into six groups: a sedentary control group (N) and five treatment groups-exercise (C), diabetes (D), diabetes with metformin (MET), diabetes with atorvastatin (ATO), and diabetes with metformin and atorvastatin (MET + ATO). In the diabetes model experimentally created with streptozotocin (STZ; 45 mg/kg, i.p.) and metformin (300 mg/kg/day), atorvastatin (10 mg/kg/day) was administered to drug groups by gavage during the 4-week study period. The rats were allowed to run (at moderate level) for 30 min, 5 days a week, on the treadmill. At the end of the study, blood samples and gastrocnemius muscle tissues of the rats were obtained under ketamine anesthesia (100 mg/kg; i.p). The effects of combining exercise and medication on skeletal muscle were assessed by examining the levels of significant biomarkers including PGC-1α, UCP-3, and MyHCs, as well as analyzing oxidative stress/antioxidant capacity parameters in muscle tissue samples. Additionally, relevant biochemical indicators were determined in serum samples. The quantity and morphology of mitochondria in muscle tissue were assessed using transmission electron microscopy. It was observed in the study that some toxic effects associated with the use of drugs alone were reduced by combination therapy. It is thought that this study will contribute to the literature in the evaluation of the effects of drugs and their combined use in Type 1 diabetes under exercise conditions.

Continuous Exposure of Nonobese Adult Male Rats to a Soft-Textured, Readily Absorbable Diet Induces Insulin Resistance and Derangements in Hepatic Glucose and Lipid Metabolism

BACKGROUND

Type 2 diabetes (T2D) is characterized by insulin resistance and defective insulin secretion. Previously, we found that rats fed soft pellets (SPs) on a 3-h restricted schedule over 14 wk demonstrated glucose intolerance and insulin resistance with disruption of insulin signaling.

OBJECTIVES

This study aims to determine 1) the time required for an SP diet to induce insulin resistance, and 2) whether the metabolic derangements in rats fed SPs can be reversed by changing to a standard control diet.

METHODS

We performed glucose tolerance tests and calculated the homeostasis model assessment of insulin resistance (HOMA-IR) to evaluate the insulinemic response to glucose and assess insulin resistance in nonobese male rats fed control pellets (CPs) or SPs on a 3-h restricted schedule (10:00-13:00) for 4 and 9 wk. At 11 wk, we switched half of the insulin-resistant SP group to CPs [soft-to-control pellets (SCPs)] and after an additional 11 wk evaluated changes in glucose and lipid metabolism across the 3 groups.

RESULTS

The glucose tolerance test results in the SP and CP rats did not differ at 4 or 9 wk. The insulin levels in the SP group were higher than in the CP group at both time points (P < 0.05). The HOMA-IR was significantly higher in the SP rats at 9 wk compared with the controls (P < 0.05). At 22 wk, the HOMA-IR, blood glucose levels at 30 min after initiating feeding, hepatic glucose metabolism, and lipid synthesis in rats fed SPs continuously were significantly greater than in those fed CPs (P < 0.05); however, these values in the SCP rats did not differ from those in the CP rats.

CONCLUSIONS

A continuous diet of soft-textured, readily absorbable food may be an important and reversible underlying driver in T2D pathogenesis.

Challenges to Lifestyle Medicine for Type 2 Diabetes in Iran: A Synoptic Review

Type 2 diabetes (T2D) is a major public health issue in Iran. The principal context for T2D management is the prevention of cardiovascular disease development and progression. These preventive strategies can be enhanced with routine implementation of comprehensive lifestyle modification, guideline-directed medical therapies, and creation of infrastructure that considers social determinants of health, ethnocultural variables, and financial challenges. In this synoptic review, scientific evidence sourced from Iran is analyzed to identify tactics to optimize the lifestyle medicine component of T2D care in Iran. Important evidence-based factors gleaned from the literature were curated into 9 categories: self-care, dietary adherence, mental health, self-comparison, transcultural adaptation, family support and community engagement, physical activity, the global pandemic, and service delivery. These categories were then assigned to 1 of 4 a priori aspects challenging diabetes care in Iran: behavioral factors, belief system, drivers, and implementation. By codifying discussion points and individual tactics, the improvement and optimization of T2D care in Iran can be facilitated. This reductionist model of approaching lifestyle medicine and complex chronic disease such as T2D can be applied to other ethnocultural populations.

Optimizing the lifestyle of patients with type 2 diabetes mellitus - Systematic review on the effects of combined diet-and-exercise interventions

AIM

To investigate the effects of combined diet-and-exercise interventions in patients with type 2 diabetes mellitus (T2DM).

DATA SYNTHESIS

A systematic literature search was conducted on PubMed, Web of Science, SPORTDiscus and BISp Surf databases (latest update in June 2024). A total of 14706 records was identified. After screening procedures, 11 randomized controlled trials (n = 24 reports) were included. The included studies compared either the effects of a) a combined intervention versus a diet-only intervention or b) different combinations of diet and exercise. The overall quality of the included study reports was moderate (evaluated with the Risk of Bias 2 (RoB2) tool). Effects of adding exercise to a (calorie-restricted) diet were primarily reflected in increased physical fitness/performance. In far fewer cases, additional beneficial effects on glycemic control, number of subjects taking medication, body weight, body composition, or lipid profile were reported. Combined with regular exercise, an energy-restricted low-carbohydrate (LC) diet with either high-fat (HF) or high-protein (HP) contents showed superior effects compared with an energy-matched conventional (CONV) diet in terms of improvements in medication use (HF-LC versus CONV diet), lipids (HF-LC or HP-LC versus CONV diet) or wellbeing (HP-LC versus CONV diet) in some studies.

CONCLUSIONS

Complementing a dietary intervention with regular exercise can have additional health benefits in T2DM, specifically improved physical fitness/performance. LC diets might be superior to other diets when combined with regular exercise. Other diet-and-exercise combinations than those analyzed in this review need to be investigated.

REVIEW REGISTRATION NUMBER

CRD42023458830.

Effect of Physical Activity and Dietary Changes on Management of Type 2 Diabetes Mellitus Patients: A Case-Control Study in Bangladesh

BACKGROUND

Type 2 diabetes mellitus (T2DM) is a growing public health issue in Bangladesh, projected to affect 13.7 million individuals by 2045. Physical inactivity and poor dietary habits increase the risk of complications. This study examined the effects of physical activity and lifestyle modifications on T2DM management.

METHODS

A case-control study was conducted at Manikganj District Diabetic Hospital with 334 T2DM patients (aged 45-60 years). The case group (n = 167) followed structured physical activity and dietary modifications, while the control group (n = 167) did not. Data on socio-demographics, lifestyle and glycaemic markers-fasting plasma glucose (FPG), postprandial plasma glucose (PPG) and HbA1c-were collected at baseline, 3 months and 6 months. Chi-square tests and ordinal logistic regression models assessed associations between lifestyle factors and glycaemic outcomes.

RESULTS

The control group had significantly higher plasma glucose levels, associated with gender (p < 0.001), treatment type (p = 0.004), medical adherence (p = 0.009), food habits (p = 0.007) and BMI (p = 0.005). The case group showed a significant FPG reduction from 10.035 mmol/L to 6.261 mmol/L (p < 0.001), with similar trends for PPG and HbA1c. Males had 1.8 times higher odds of elevated FPG, while poor adherence increased this risk 2.5-fold.

CONCLUSIONS

Lifestyle modifications significantly improve glycaemic control in T2DM patients. Strengthening adherence to medical advice and integrating structured interventions into routine care could enhance diabetes management in Bangladesh.

The Role of Plant-Based Nutrition and Exercise in Metabolic Syndrome: A Narrative Review

BACKGROUND/OBJECTIVES

Metabolic syndrome (MetS) is a prevalent health condition characterized by central obesity, insulin resistance, hypertension, and dyslipidemia, increasing the risk of cardiovascular disease and type 2 diabetes. Lifestyle interventions, particularly plant-based nutrition and exercise, are essential for managing MetS. While both strategies are well-documented independently, their synergistic effects remain less explored. This narrative review integrates findings from both domains to evaluate their combined impact on metabolic syndrome. The review examines the individual and combined impacts of plant-based nutrition and exercise on MetS-related metabolic dysfunction.

METHODS

A comprehensive review of 114 peer-reviewed studies was conducted to assess the role of plant-based diets and structured physical activity in improving insulin sensitivity, lipid profiles, inflammation, and weight management. Studies investigating the mechanisms through which dietary components and exercise modalities influence metabolic health were analyzed, along with behavioral and psychological factors affecting long-term adherence.

RESULTS

Plant-based diets, particularly those high in fiber, polyphenols, and healthy fats, improve glucose metabolism, reduce inflammation, and enhance cardiovascular health. Exercise complements these benefits by increasing insulin sensitivity, promoting fat oxidation, and improving lipid metabolism. When combined, plant-based nutrition and exercise provide superior metabolic outcomes, including greater reductions in visceral adiposity, improved endothelial function, and enhanced glycemic control.

CONCLUSIONS

Plant-based nutrition and structured exercise are effective strategies for managing MetS. Their synergistic effects highlight the importance of integrated lifestyle interventions for long-term metabolic health.

Diabetes mellitus secondary to endocrine diseases: a position statement of the working group of the club of the Italian society of endocrinology (SIE)-Nutrition hormones and metabolism

PURPOSE

This position statement addressed the limited scientific literature on the management of diabetes mellitus secondary to endocrinopathies, despite its frequent occurrence in hormonal diseases such as acromegaly, Cushing's syndrome, primary hyperaldosteronism, pheochromocytoma, hyperthyroidism, and neuroendocrine tumors. The aim was to review the pathophysiological mechanisms, clinical features, and management strategies, focusing on nutritional and pharmacological approaches.

METHODS

A comprehensive review of existing literature was conducted regarding studies on diabetes secondary to endocrinopathies and the effects of treatments for these conditions, such as somatostatin analogues and pancreatic surgery. Particular emphasis was placed on understanding glucose metabolism derangements and the interplay between endocrine excess and therapeutic interventions.

RESULTS

Secondary diabetes arises not only from hormone excess but also as a consequence of treatments for endocrine disorders. For instance, somatostatin analogues, while effective in resolving hormone hypersecretion, impair glucose metabolism by inhibiting pancreatic insulin secretion. Similarly, pancreatic surgery for neuroendocrine tumors often exacerbates glycemic disturbances. The management of secondary diabetes requires a multidisciplinary approach that includes treating the underlying endocrine disorder, tailoring antidiabetic therapy, and optimizing nutritional strategies to mitigate metabolic disruptions.

CONCLUSION

Diabetes secondary to endocrinopathies presents unique challenges due to its complex etiology and the metabolic effects of treatments. This position statement underscores the importance of an integrated management approach, offering guidance for clinicians in addressing this multifaceted condition. Further research is needed to develop evidence-based guidelines for optimal care.

Level of adherence to physical activity recommendations among adults with type 2 diabetes in Qatar and associated factors: a cross-sectional study

BACKGROUND

Regular physical activity (PA) has beneficial health effects in controlling and managing diabetes. Identifying key factors associated with poor adherence to PA recommendations among patients with type 2 diabetes (T2D) has significant implications for future targeted interventions aimed at improving adherence and health outcomes in this population. The present study aims to determine the level of adherence to PA recommendations and the associated factors among adults with T2D in Qatar.

METHODS

This was a cross-sectional study in which secondary data collected from the Qatar Biobank were used. This was a population-based study including Qatari nationals and long-term residents. The amount of time spent performing moderate- and vigorous-intensity aerobic PA per week was self-reported. Adherence to PA recommendations was defined according to the WHO guidelines for adults and older adults (aged 18 years and older) with chronic conditions.

RESULTS

The study included 2,386 adults with T2D aged 18 years and older. Nine out of ten individuals failed to meet the PA recommendations, and 86.2% did not participate in any moderate- or vigorous-intensity aerobic PA. The main factors associated with not adhering to PA recommendations were older age, female sex, lower educational attainment, lower monthly income, treatment with tablets or tablets plus insulin compared with diet alone, sleeping less than 5 hours per day, and extended use of screen-based devices during weekends.

CONCLUSIONS

Most adults with type 2 diabetes in Qatar do not meet physical activity recommendations, with lower adherence among older adults, females, those with high screen time, specific treatments, and lower education or income. Diabetes management and education should include targeted interventions to address barriers, while public health efforts should reduce sedentary behavior and improve access to physical activity for disadvantaged groups.

Innovative Cardiac Rehabilitation: Effects of Adaptive Postural Balance Exercise on Coronary Artery Disease and Type 2 Diabetes

Purpose

This study aimed to evaluate the effects of Adaptive Postural Balance Cardiac Rehabilitation Exercise (APBCRE) on glycolipid metabolism and exercise endurance in patients with coronary artery disease (CAD) and type 2 diabetes mellitus (T2DM). Specifically, we compared the efficacy of APBCRE with aerobic exercise (AE) alone and irregular exercise (IE).

Patients and Methods

This randomized controlled trial included 348 patients with CAD, comprising 261 patients with T2DM and 87 non-diabetic CAD patients as a control group. Participants were randomly assigned to one of four groups: the APBCRE group, the AE group, the IE group, or the non-diabetic AE control group. The intervention lasted 8 weeks, including a structured 6-week training phase. Metabolic markers and exercise endurance were assessed at baseline (week 1) and post-intervention (week 8). Cardiopulmonary exercise testing (CPET) was utilized to individualize exercise prescriptions and optimize intervention intensity.

Results

The APBCRE group demonstrated significant improvements in fasting blood glucose (FBG) (-11.34%, from 7.89 to 6.99 mmol/L, p < 0.05), HbA1c (-8.87%, from 7.20% to 6.56%, p < 0.05), and LDL-C levels (-12.21%, from 2.44 to 2.14 mmol/L, p < 0.05) compared to the AE and IE groups. While both APBCRE and AE improved lipid profiles, APBCRE demonstrated superior enhancements in exercise endurance, with ˙VO 2 max increasing by 18.71% (from 14.19 to 16.86 mL/min/kg, p < 0.05) and AT ˙VO 2 increasing by 16.00% (from 11.62 to 13.48 mL/min/kg, p < 0.05).

Conclusion

These findings support the efficacy of APBCRE in improving glycolipid metabolism, exercise endurance, and neuromuscular coordination in patients with CAD and T2DM compared to AE alone.

Diabetes Mellitus and Associated Vascular Disease: Pathogenesis, Complications, and Evolving Treatments

Diabetes mellitus is a metabolic disorder, characterized by elevated blood sugar levels (hyperglycemia) and insulin dysregulation. This disease is associated with morbidity and mortality, including significant potential vascular complications. High levels of hyperglycemia lead to not only elevated levels of reactive oxygen species but also advanced glycation end products, which are detrimental to the vascular endothelium and reduce protective compounds such as nitric oxide and prostacyclin. This damage contributes to the development of both macrovascular and microvascular complications. The present investigation explores the pathophysiological mechanisms of diabetic vascular complications and evaluates current management strategies, including lifestyle modifications, pharmacological treatments, and emerging therapies. The review underscores the importance of ongoing progress in diabetes management and patient education to lead to optimal patient-health outcomes and quality of life for individuals with diabetes mellitus.

Nutrition and diet in type 2 diabetes management

This article aims to provide health professionals involved in diabetes management with nutrition options to support their advice and guidance when speaking to patients. The review examines dietary strategies for managing type 2 diabetes, focusing on their impact on glycaemic control, weight loss and long-term health outcomes. Diets and nutrition options, including the Mediterranean and Nordic diets, low calorie consumption and medical nutrition therapy, can be effective in regulating blood glucose levels, improving lipid profiles and reducing the risk of cardiovascular disease. Health professionals need a comprehensive understanding of optimal nutrition plans to personalise dietary interventions and improve patient outcomes.

Comparative efficacy of various mind-body exercise types on cardiometabolic health in patients with type 2 diabetes: a network meta-analysis of randomized controlled trials

OBJECTIVE

This study aims to compare the efficacy of different mind-body exercises (MBEs) on cardiometabolic risk factors in patients with type 2 diabetes mellitus (T2DM) using a network meta-analysis of randomized controlled trials (RCTs).

METHODS

This study followed PRISMA guidelines and was registered in PROSPERO (CRD42025630741). A systematic search of PubMed, Cochrane Library, Web of Science, and Embase was conducted up to December 15, 2024, using MeSH terms related to mind-body therapies and cardiometabolic risk in type 2 diabetes. Randomized controlled trials (RCTs) evaluating mind-body exercises (MBEs) on glucose metabolism, body composition, cardiovascular physiology, and lipid metabolism were included. Data extraction and risk of bias assessment (RoB 2 tool) were performed independently by two reviewers. Network meta-analysis was conducted using R (gemtc package) and Stata 17.0, with effect sizes reported as mean difference (MD) or standardized mean difference (SMD). Evidence quality was assessed using CINeMA.

RESULTS

This network meta-analysis compared the effects of various mind-body exercise interventions on ten cardiometabolic risk factors. Meditative Exercise (ME) was most effective in reducing fasting plasma glucose (SUCRA = 97.9%, SMD = -7.23, 95% CI: -8.27 to -6.20), while Mindfulness Intervention Training (MIT) showed the greatest benefit for glycated hemoglobin (SUCRA = 92.2%, MD = -0.78, 95% CI: -1.12 to -0.44) and blood pressure reduction (SBP: SUCRA = 86.1%, MD = -13.00, 95% CI: -17.22 to -8.78; DBP: SUCRA = 99.8%, MD = -6.00, 95% CI: -7.64 to -4.36), significantly outperforming conventional exercise. Yoga with Meditation (YWM) was most effective in lowering body mass index (SUCRA = 99.4%, MD = -2.90, 95% CI: -4.05 to -1.75). CINeMA assessments rated most comparisons as very low certainty due to within-study bias and between-study heterogeneity. Nevertheless, consistency was supported by node-splitting analysis, and no significant publication bias was detected, indicating robust and reliable findings.

CONCLUSION

Compared with conventional exercise intervention, MBE exerts unique and superior effects on various cardiometabolic risk factors in T2DM, underscoring their potential as effective and integrative interventions for personalized diabetes management. Clinicians should consider incorporating MBEs, such as MIT, ME, and YWM, into treatment plans based on individual patient needs, particularly for glycemic control, weight management, and cardiovascular health. Further research is warranted to explore the long-term benefits and optimal implementation strategies, especially given the heterogeneity in intervention protocols and the relatively short duration of the included trials.

Connecting underlying factors in the associations between perceived neighborhood social environments and type 2 Diabetes: Serial mediation analyses

AIMS

This study tested direct and indirect associations between perceived neighborhood social environments and type 2 diabetes (T2D), serially mediated via health-related (physical activity [PA], body mass index [BMI]), psychosocial factors, and inflammation.

METHODS

Data came from the Midlife in the United States (MIDUS 3 [2013-2014] and MIDUS 3 Biomarker Project [2017-2022]; n = 518). T2D (yes/no) was based on the American Diabetes Association criteria. Perceived neighborhood social cohesion and safety were assessed separately (higher scores = more favorable neighborhoods). PA, BMI, perceived stress, depression, and c-reactive protein (CRP) were included as mediators in the associations between exposure and the outcome adjusting for covariates.

RESULTS

Higher social cohesion was indirectly related to lower likelihood of T2D, serially mediated through PA, BMI, and CRP (odds ratio [OR] = 1.00; 95 % bias-corrected confidence interval [BC CI] = 0.99, 1.00). Higher social cohesion and safety were indirectly associated with a lower likelihood of T2D, serially mediated via stress, depression, and CRP (Social cohesion: OR = 0.98; 95 % BC CI = 0.96, 1.00; and safety: OR = 0.98; 95 % BC CI = 0.96, 1.00, all p < 0.05).

CONCLUSIONS

This study may be the first to demonstrate underlying potential mechanisms through which socially cohesive and safe neighborhoods lower the risk of T2D. These pathways present potential targets for interventions to reduce the risk.

Management and Medical Care for Individuals with Type 1 Diabetes Running a Marathon

Background: Limited data exist on managing type 1 diabetes mellitus (T1DM) during long-distance endurance events such as marathons. This study aimed to assess glycemic control and participant safety during a marathon. Methods: Five men with T1DM, participating in the 22nd Poznan Marathon, were recruited. They completed health questionnaires and received training on glycemic management. Their physical capacity was assessed (including maximal oxygen uptake on a cycle ergometer). Participants reduced their insulin doses and consumed breakfast 2.5-3 h before the race. During the marathon, self-monitoring blood glucose (SMBG) and ketone levels were measured at five checkpoints (start, 10 km, 19 km, 30 km, and finish). The medical team followed a pre-approved protocol, providing carbohydrate and fluid supplementation as needed. Glycemia was monitored by two continuous glucose monitoring (CGM) systems (FreeStyle Libre 2 and Dexcom G6) and SMBG. Results: The participants' median age was 44 years (34-48), with a diabetes duration of 10 years (6-14), and a BMI of 22.5 kg/m2 (22.0-23.3). All finished the marathon in an average time of 4:02:56 (±00:43:11). Mean SMBG was 125.6 (±43.5) mg/dL, while CGM readings were 149.6 (±17.9) mg/dL (FreeStyle Libre 2) and 155.4 (±12.9) mg/dL (Dexcom G6). One participant experienced prolonged hypoglycemia undetected by CGM, whereas another developed symptomatic hypoglycemia between SMBG measurements. Conclusions: Safe marathon completion in people with T1DM requires individualized insulin dose adjustments, appropriate carbohydrate supplementation, and dedicated medical support at checkpoints. Combining CGM with periodic SMBG measurements further enhances safety and helps to detect potential glycemic excursions.

Effects of high-intensity interval walking training on muscle strength, walking ability, and health-related quality of life in people with diabetes accompanied by lower extremity weakness: A randomized controlled trial

AIMS/INTRODUCTION

This study examined the effects of high-intensity interval walking training (IWT) compared to moderate-intensity continuous walking training (CWT) on muscle strength, walking ability, and health-related quality of life (QOL) in people with diabetes accompanied by lower extremity weakness.

MATERIALS AND METHODS

People with diabetes accompanied by low isometric knee extensor strength using a simple manual dynamometer (n = 50) were screened and randomly divided into 2 groups: CWT (n = 25) and IWT (n = 25). Both groups were instructed by a physical therapist to perform walking training with the goal of 120 min/week over a 5-month period. The primary outcome, mean change of isometric knee extensor strength, and secondary outcomes, such as gait speed and health-related QOL, were measured at baseline and the end of the intervention.

RESULTS

At the end of the intervention, there was no significant difference in the degree of change in isometric knee extension strength between the two groups. However, there was a significant increase in changes in gait speed and physical QOL in the IWT group (gait speed, P < 0.01; physical QOL, P < 0.05).

CONCLUSIONS

The present study showed that IWT for people with diabetes accompanied by lower extremity weakness did not improve knee extension muscle strength compared to CWT but did improve walking ability and physical QOL.

Swimming Exercise Pretreatment Attenuates Postoperative Delirium-Like Behavior in Type 2 Diabetic Rats by Enhancing Mitochondrial Biogenesis Through Activation of SIRT2 Deacetylation

Postoperative delirium (POD) is a common postsurgical complication that seriously affects patients' prognosis and imposes a heavy burden on families and society. Type 2 diabetes mellitus (T2DM) is a major risk factor for POD. The susceptibility mechanisms of POD in T2DM individuals and the role of exercise preconditioning remain unclear. Adult rats with and without T2DM were used to assess the promotive effect of diabetes on postoperative delirium-like behavior. The diabetic rats were also subjected to a swimming exercise program before surgery. The potential beneficial effect of exercise preconditioning on postoperative cognition was evaluated by examining neurobehavior, hippocampal neuroinflammation, mitochondrial morphology, and function in diabetic rats. Finally, underlying mechanisms were further analyzed by exploring the role of the sirtuin family in vivo and in vitro. We found that performing tibial fracture surgery resulted in delirium-like behavior and inhibited hippocampal mitochondrial biogenesis in diabetic rats but not in healthy rats. Preoperative swimming exercise was beneficial in attenuating delirium-like behavior, inhibiting neuroinflammation, and improving mitochondrial biogenesis and function. Preoperative swimming exercise achieved these positive effects by upregulating SIRT2-mediated peroxisome proliferator-activated receptor gamma coactivator-1 alpha (PGC-1α) deacetylation and activating mitochondrial biogenesis in T2DM rats.

Liquid Bridge Cutting Valves for Microfluidic Passive Distribution and Sequential Reaction

In bioanalysis, precisely isolating liquid reactions in distinct systems or at different temporal sequences is vital for ensuring accurate results devoid of crosstalk. However, passive liquid isolation is unattainable through existing microfluidic valves. Here, liquid bridge cutting valves (LBCVs) are introduced to automatically segregate liquids by establishing airlocks, offering an innovative microfluidic structure for liquid distribution. The principle of liquid bridge breakup is studied and applied to the design of LBCVs. Additionally, monolithic chips connecting units with LBCVs in different topologies facilitate sequential sampling and reactions, achieving the detection of sweat glucose and lactate in wearable applications, as well as cortisol ELISA on the chips. As a missing puzzle piece of microfluidic elements in liquid separation, LBCVs can be seamlessly integrated with maturing microfluidic structures, creating a lab-on-a-chip device to enable complex fluid manipulation for individual healthcare monitoring and clinical scenarios.

Relationship Between Physical Activity Levels and Type 2 Diabetes in Adults: Zahedan Adult Cohort Study, Iran

Background

Given the influence of lifestyle on type 2 diabetes mellitus (T2DM), the present study aimed to investigate the association between physical activity (PA) intensity and T2DM among sedentary and active participants in the Zahedan Adult Cohort Study (ZACS), Iran.

Methods

This cross-sectional study was conducted as part of the population-based Persian Prospective Epidemiological Research Studies in Iran (Persian Cohort). The baseline data from the ZACS collected between 2015 and 2019 were utilized. A total of 10,004 adults aged 35-70 years were included in the analysis. Data were gathered through self-reported questionnaires covering general information, socioeconomic status, sleep status, medical history, and PA. Anthropometric measurements and biochemical parameters were obtained from participants after a 12-h fasting period. The data were analyzed using descriptive statistics, independent-sample t-test, chi-square, and logistic regression tests in SPSS22.

Results

The study found that the majority of the 10,004 adult participants (81.2%) were sedentary, while only 18.8% were classified as active. Sedentary participants exhibited significantly higher mean values for various health markers, including age, education, sleep duration, weight, body mass index (BMI), and blood lipid levels, as well as higher prevalence of hypertension, cardiac conditions, and stroke compared to active participants. Additionally, 21.7% of the participants had T2DM, which was associated with older age, longer sleep duration, higher weight and BMI, and abnormal waist circumference. The prevalence of diabetes increased with higher BMI, from 4.8% in underweight to 27.1% in obese participants, and was 77% in sedentary individuals compared to 16% in active individuals. Even after adjusting for demographic factors (OR = 0.65, p < 0.001), lipid levels (odds ratio [OR] = 0.68, p = 0.001), sleep status (OR = 0.72, p = 0.001), and family history (OR = 0.66, p = 0.001), active individuals were found to have a significantly lower likelihood of being diabetic compared to their sedentary counterparts.

Conclusions

The findings revealed a clear association between sedentary lifestyles and an increased risk of T2DM. Physical inactivity was correlated with adverse health markers and an elevated incidence of T2DM, which was mitigated by an active lifestyle. These results underscore the importance of public health initiatives to promote PA as a critical strategy for diabetes prevention.

Southeast Asian, African, and Middle East Expert Consensus on Structured Physical Activity-Dance, Exercise, and Sports

Physical inactivity (PIA) is a pressing public health issue globally, contributing significantly to the rise of non-communicable diseases (NCD), such as cardiovascular disease and type 2 diabetes. The World Health Organization emphasises the importance of regular physical activity (PA) for preventing and managing NCDs. Initiatives to promote active living have gained momentum, ranging from community programs to workplace wellness campaigns, all focused on reducing sedentary lifestyles in modern society. Structured Physical Activity-Dance, Exercise, and Sports (SPADES) has emerged as an innovative approach to addressing PIA and promoting holistic health. After thoroughly reviewing existing literature from PubMed and Google Scholar databases, a panel of experts developed consensus statements through in-depth discussions, and the strength of concurrence on these statements was voted on using a Likert scale. The panel reached a consensus on the best strategies for PA, dance, exercise, sports, and key factors to consider during PA. This consensus targets individuals with metabolic diseases, particularly in regions like South Asia, East Africa, the Gulf, and Latin America, where these conditions are highly prevalent. The SPADES guidelines emphasise overcoming the barriers people with metabolic disorders face in achieving adequate PA, providing tailored recommendations to improve health outcomes for this population.

The Glycemic Impact of Protein Ingestion in People With Type 1 Diabetes

In individuals with type 1 diabetes, carbohydrate is commonly recognized as the primary macronutrient influencing postprandial glucose levels. Accumulating evidence indicates that protein ingestion also contributes to the increment in postprandial glucose levels, despite endocrine and metabolic responses different from those with carbohydrate ingestion. However, findings regarding protein ingestion's glycemic effect in people with type 1 diabetes are equivocal, with the magnitude of glycemic response seemingly dependent on the rate of absorption and composition of protein ingested. Therefore, the aim of this article is to outline the physiological mechanisms by which ingested protein influences blood glucose regulation in individuals with type 1 diabetes and provide clinical implications on use of dietary protein in the context of glycemic management. Specifically, protein ingestion raises plasma amino acid levels, which directly or indirectly (via gut hormones) stimulates glucagon secretion. Together with the increase in gluconeogenic precursors and an absent endogenous insulin response in individuals with type 1 diabetes, this provides a synergistic physiological environment for increased endogenous glucose production and subsequently increasing circulating glucose levels for several hours. While there is a dearth of well-controlled studies in this area, we provide clinical implications and directions for future research regarding the potential for using ingestion of fast-absorbing protein (such as whey protein) as a tool to prevent and mitigate overnight- and exercise-induced hypoglycemia in people with type 1 diabetes.

Diabetes Attitudes, Wishes and Needs in the Dominican Republic (DR-DAWN2)

PurposeThe purpose of this study was to assess the psychosocial status of people with diabetes and their perceived quality of received health care services in a local outpatient center in Santo Domingo, Dominican Republic.MethodsCross-sectional study that included 385 Dominican adults with diabetes. Demographic and clinical information was collected. Key psychometric indicators were collected by using the WHO-5 Well-Being Index, EuroQol-5D Visual Analogue Scale (EQ-VAS), Problem Areas in Diabetes Scale, Summary of Diabetes Self-Care Activities, and Patient Assessment of Chronic Illness Care.ResultsThe mean EQ-VAS score was 77.6 (SD 18). Of all the participants, 18.7% exhibited symptoms of depression, with higher rates among women and younger age groups. Diabetes-related distress was present in 22.6% of participants, particularly among younger individuals and those employed. Physical activity was the self-care activity with the lowest reported adherence. Perceptions of received health care services aligned moderately with the chronic care model (CCM), with a higher perceived alignment in patients that were enrolled in a chronic disease management program.ConclusionsPatients with diabetes report having a reduced quality of life and significant psychological burdens, with a high rate of depressive symptoms and diabetes-related distress and a low adherence to self-care behaviors. The enrollment in chronic disease management programs improved patients' perception of received health care services, reporting a more coordinated care and experiencing more patient activation, which could improve health outcomes. These findings underline the need for psychological screening, patient-centered care, and broader implementation of the CCM to improve health outcomes in this population.

The Moderating Effect of Age on the Association Between Circadian Syndrome and Instrumental Activities of Daily Living Disability in People With Diabetes: A Cross-Sectional Study

PURPOSE

To examine the association between circadian syndrome (CircS) and instrumental activities of daily living (IADL) disability in middle-aged and older adults with diabetes, as well as the moderating effect of age on CircS and IADL disability.

METHOD

Participants included 939 individuals with diabetes. IADL disability was defined as having trouble finishing specific tasks. CircS was defined as having four or more specific symptoms. Binary logistic regression analysis was used to examine associations among CircS, age, and IADL disability.

RESULTS

Of total participants, 29.3% had IADL disability. CircS and age were associated with IADL disability (CircS: odds ratio [OR] = 1.898, 95% confidence interval [CI] [1.370, 2.630]; age: OR = 1.045, 95% CI [1.027, 1.063]; both p < 0.001). The interaction effect of age on CircS and IADL disability was significant (OR = 1.047, 95% CI [1.004, 1.092], p = 0.032).

CONCLUSION

Individuals with diabetes and CircS had a higher risk of IADL disability than those without CircS, and the difference in predicted probabilities of IADL disability between the two groups increased with age. [Journal of Gerontological Nursing, 51(4), 37-45.].

Effects of a 12-week lower limb resistance training with breathing regulation in patients with diabetes-related foot ulcers: A randomized controlled trial

Patients with diabetes-related foot ulcers may require hospitalization and face an increased risk of amputation, which can significantly impact their quality of life. One potential solution is exercise, which can regulate blood glucose levels, improve wound healing, and enhance overall well-being. This randomized controlled trial aimed to evaluate the impact of a lower limb resistance training program combined with breathing-regulation techniques on glycemic control, wound healing, and quality of life in patients with diabetes-related foot ulcers. Patients hospitalized for type 2 diabetes-related foot ulcers were recruited from a single medical center and randomly divided into two groups. The control group (n = 31) received standard treatment, while the exercise group (n = 28) received standard treatment along with lower limb resistance training and breathing-regulation techniques. Assessments of fasting blood glucose levels, hemoglobin A1c (HbA1c) levels, wound healing, and quality of life were carried out at the start of the study and week 4, week 8, and week 12 of the intervention. The exercise group demonstrated significant improvements in fasting blood glucose and HbA1c levels, as well as in physical health, psychological well-being, social relationships, and environmental aspects of quality of life over the 12 weeks compared to both the control group and the baseline (p < .05). However, no significant change was observed in wound healing (p > .05). The resistance training program for the lower limbs, combined with breathing-regulation techniques, is recommended for improving blood glucose levels and quality of life over 12 weeks.

Combined effects of time-restricted eating and exercise on short-term blood glucose management in individuals with Type 2 Diabetes Mellitus: The TREx study, a randomised controlled trial

AIMS

Time-restricted eating (TRE) is a chrono-nutrition strategy where the daily 'eating window' is reduced to 8-10 h. We investigated the acute (14-h) effects of TRE, with and without post-meal exercise, on blood glucose and insulin concentrations in people with type 2 diabetes mellitus.

METHODS

Fourteen participants (5 F, 9 M; HbA1c: 7.6 ± 1.0%) completed four conditions in this randomised crossover study: CON (eating window, 0800-2000 h), CON with exercise (CON + Ex; 0800-2000 h + 15 min walking at 60% VO2peak, 45 min post-meal), TRE (eating window 1000-1800 h), and TRE with exercise (TRE + Ex, 1000-1800 h + 15 min walking as per CON + Ex), with standardised meals. Venous blood samples were collected at 26-timepoints and analysed for glucose and insulin concentrations. Statistical analysis used linear mixed-effects models with P < 0.05.

RESULTS

Reducing the eating window had little effect on plasma glucose 14-h area under the curve (AUC). Exercise reduced insulin 14-h AUC (P=0.01) with no additive effect of TRE.

CONCLUSION

Post-meal exercise lowered 14-h insulin AUC, neither 8-h TRE nor post-meal exercise altered 14-h blood glucose compared with 12-h eating window. Future work should focus on long-term effects of TRE combined with exercise for enhancing blood glucose in people with type 2 diabetes mellitus.

Proposed Practical Guidelines to Improve Glycaemic Management by Reducing Glycaemic Variability in People with Type 1 Diabetes Mellitus

INTRODUCTION

For decades, glycaemic variability (GV) was ignored in clinical practice because its precise assessment was challenging and there were no specific recommendations to reduce it. However, the current widespread use of continuous glucose monitoring (CGM) systems has changed this situation. Associations between high GV and risk of hypoglycaemia, onset of macro- and microvascular complications and mortality have been described in type 1 diabetes (T1D). It is therefore important to identify the causes of excessive glycaemic excursions and make recommendations for people with T1D to achieve better glycaemic management by minimising GV in both the short term and the long term.

METHODS

To achieve these aims, a panel comprising four endocrinologists, one diabetes nurse educator and one nutritionist worked together to reach a consensus on the detection of triggers of GV and propose clinical guidelines to reduce GV and improve glycaemic management by reducing the risk of hypoglycaemias.

RESULTS AND CONCLUSIONS

In total, four different areas of interest were identified, in which the insufficient education and/or training of people with T1D could lead to higher GV: physical activity; dietary habits; insulin therapy, especially when pump-based systems are not used; and other causes of GV increase. Practical, easy-to-follow recommendations to reduce GV in daily activities were then issued, with the aim of enabling people with T1D to reduce either hypoglycaemia or hyperglycaemia episodes. By doing this, their quality of life may be improved, and progression of chronic complications may be prevented or delayed.

Development, validation, and pilot testing of the physical activity promotion program booklet for women with gestational diabetes mellitus

Physical Activity (PA) promotion is an essential component of the comprehensive management of Gestational Diabetes Mellitus (GDM). Even though the literature is available regarding the importance of PA, limited access to reliable sources of information hinders involvement in recommended PA during pregnancy. The present study aims to develop, validate, and pilot test the Physical Activity Promotion Program (PAPP) booklet for women with GDM. The booklet was developed based on the previous literature, validated by seven experts, and administered to 38 participants for 8 weeks. The level of PA was evaluated with the Global Physical Activity Questionnaire before and after the intervention. The Scale Content Validity Index of the booklet was 0.98. The Flesch readability ease score and Flesch Kincaid grade level were 62 and 6.9, respectively. The validation scores showed that the booklet is appropriate and the readability score indicated a "standard" description style. There was a significant increase in the level of PA (MD = -320, 95% CI = -360, -250, d = -0.96, p < .001) and reduced Sedentary Behavior (MD = 45, 95% CI = 37.5, 60, d = 1, p < .001) post-intervention. The PAPP booklet was found to be a valid and reliable source of information and improves the level of PA among women with GDM.

LIVING - protocol for a pragmatic randomized controlled trial investigating the effect of three different levels of diabetes self-management programs

BACKGROUND

In Denmark, Type 2 Diabetes (T2D) care includes diabetes self-management programs (DSMPs) delivered by municipalities. Following a successful pilot study, a DSMP was expanded to include a digital platform and flexible educational materials. While exercise therapy is recognized as essential in T2D management, high-quality studies on DSMPs incorporating exercise are limited. This trial assesses the (cost)effectiveness of three interventions with escalating intensity, hypothesizing that higher intensity enhances diabetes management competence and reduces complication risk.

METHODS/DESIGN

A pragmatic randomized controlled trial will assess three different DSMP interventions in six Danish municipalities acting as trial sites. Each site will implement one of three versions of Lev Livet: a short version (SLL), a full version (FLL), or the full version with high intensity exercise (FLL + H). At each site, 48 participants will be randomly assigned (2:1) to intervention or control groups. Primary outcome is perceived competence in diabetes (questionnaire). Other outcomes measure physical activity level (accelerometer),HbA1c, disease progression, physical function, and self-reported metrics. The trial is approved by the Danish National Center for Ethics (case no 1-10-72-107-23) and registered at ClinicalTrials.gov (NCT06091501).

DISCUSSION

The LIVING trial has the potential to establish whether the Lev Livet program is effective and cost effective and how it can be implemented in municipalities. By analyzing dose-response relationships, the trial may refine intervention frequency and intensity, improve diabetes management, and inform both national and international guidelines for accessible, effective diabetes care.

Scoping Review of the Health Benefits of Stretching Exercises in Patients with Type 2 Diabetes Mellitus

This study aimed to clarify the current state of research on the effects of stretching exercises on the health of patients with type 2 diabetes mellitus (T2DM). A scoping review of the literature was conducted in December 2024, using four databases. Experimental and clinical studies were included if they compared stretching exercises with non-stretching exercises for T2DM-related health outcomes. The primary search terms used were "diabetes mellitus, type 2," "muscle stretching exercises," and "range of motion, articular.". Eleven studies met our inclusion criteria. Eight studies focused on blood glucose levels, one of which assessed the functional capacity. The remaining studies investigated plantar pressure, shoulder joint mobility/pain/disability, and fatigue, with one study addressing each outcome. This review indicates that stretching exercises may affect a variety of health parameters, including blood glucose regulation, in patients with T2DM but emphasizes the need for further high-quality research to determine their effectiveness.

High-intensity interval training improves insulin sensitivity in individuals with prediabetes

OBJECTIVE

To examine the separate and combined effects of low-volume high-intensity interval training (HIIT) and walking compared with no training on insulin sensitivity and skeletal metabolic capacity in individuals with prediabetes.

DESIGN

Individuals were randomized to: (1) control (no exercise), (2) HIIT (3 × 20 s's cycle sprint 3 times weekly), (3) HIIT + walking (walking >10 000 steps/day), or (4) walking for 12 weeks.

METHODS

Insulin sensitivity was assessed by an oral glucose tolerance test at baseline and end-of-trial. Additionally, proteins important for mitochondria capacity and insulin sensitivity were measured in the vastus lateralis muscle.

RESULTS

Seventy sedentary individuals with prediabetes (women n = 36; age: 60.8 ± 11.3 years (mean ± SD); body mass index: 31.6 ± 4.4 kg/m2; fasting plasma glucose: 6.6 ± 0.8 mmol/L; glycated hemoglobin A1c 5.7 ± 0.4% (39.0 ± 4.3 mmol/mol) were included. Compared with control, peripheral insulin sensitivity (measured by the Cederholm index) was significantly improved with HIIT (estimated treatment difference [ETD]: 18.5% [95% confidence interval (CI): 7.4; 28.3%] and HIIT + walking [ETD: 15.7% (95% CI: 4.4; 25.6%)]), but not with walking alone (ETD: 9.4% [95% CI: -2.5; 19.9%]). Whole-body insulin sensitivity (measured by the Matsuda index) was significantly increased with HIIT + walking (ETD: 28.0% [95% CI: 10.3; 42.3%]) and walking alone (ETD: 42.3% [95% CI: 28.3; 53.5%]), but not with HIIT alone (ETD: 17.0% [95% CI: -4.0; 33.7%]). Protein expression of proteins involved in mitochondrial capacity in skeletal muscle and glucose uptake were most improved with HIIT + walking, and no significant effects were observed with walking alone.

CONCLUSIONS

Twelve weeks of low-volume HIIT training can improve glucose control and induces adaptations in skeletal muscle important for metabolic health in individuals with prediabetes.

Exploring air insole pressure and walking durations effects on microcirculation in healthy individuals to optimize diabetic foot ulcers prevention

To evaluate the impact of air insole on reducing the risk of diabetic foot ulcers (DFUs) in healthy individuals through microcirculation assessment, which considers blood flow as a critical factor due to the role of peripheral vascular disease in DFU development. The study analyzes the interaction between air insole pressure and walking duration. Repeated-measures design was used to assess the effects of two walking durations (10 and 20 min) and three air insole pressures (80, 160, and 240 mmHg), resulting in six walking conditions tested in 13 healthy participants. The average blood flow in the first metatarsal head (M1) was quantified using data from the last 3 min of the 10 min post-exercise period. The results of one-way ANOVA showed that the 80 mmHg air insole pressure was significantly lower microcirculation than 240 mmHg with 10 min walking duration (129.4 ± 9.1 vs 163.1 ± 12.6 PU, P = 0.035). The paired t-test showed three significant differences in the effects of the walking duration in all air insole pressures. (1) 10 min walking duration was significantly lower compared to 20 min with 80 mmHg air insole pressure (129.4 ± 9.1 vs 203.6 ± 10.1 PU, P = 0.001); (2) 10 min walking duration was significantly lower compared to 20 min with 160 mmHg air insole pressure (142.5 ± 10.6 vs 206.0 ± 12.5 PU, P = 0.001); (3) 10 min walking duration was significantly lower compared to 20 min with 240 mmHg (163.1 ± 12.6 vs 219.1 ± 11.8 PU, P = 0.008). This study highlights that walking with an air insole pressure of 80 mmHg for 20 minutes influences microcirculation at the first metatarsal head, potentially offering important benefits for individuals at risk of pressure-related injuries, such as DFUs.

Disparities in diabetic foot examinations: a cross-sectional analysis of the behavioural risk factor surveillance system

AIM

This study aimed to identify how frequent poor mental health days, a depressive disorder diagnosis, frequent poor physical health days, or physical inactivity affect annual foot examinations in individuals with diabetes.

BACKGROUND

Diabetes mellitus (DM), particularly type 2, is a growing problem in the United States and causes serious health complications such as cardiovascular disease, end-stage renal disease, peripheral neuropathy, foot ulcers, and amputations. There are guidelines in place for the prevention of foot ulcers in individuals with diabetes that are not often followed. Poor mental health and poor physical health often arise from DM and contribute to the development of other complications.

METHODS

We performed a cross-sectional analysis of the 2021 Behavioural Risk Factor Surveillance System dataset to determine the relationship between annual foot examinations and frequent poor mental health days, a depressive disorder diagnosis, frequent poor physical health days, or physical inactivity using a bivariate logistic regression model. The regression model was controlled for age, sex, race/ethnicity, health insurance, level of education, current smoking status, and Body Mass Index (BMI) category.

FINDINGS

Our results showed that 72.06% of individuals with frequent poor mental health days received a foot check, compared with 76.38% of those without poor mental health days - a statistically significant association (AOR: 1.25; 95% CI: 1.09-1.43). Of those reporting a sedentary lifestyle, 73.15% received a foot check, compared with 77.07% of those who were physically active, which was also statistically significant (AOR: 1.31; 95% CI: 1.14-1.49). Although individuals reporting depressive disorder diagnoses and frequent poor physical health days had lower rates of foot examinations, these results were not statistically significant. To reduce rates of foot ulcers and possible amputations, we recommend the implementation of counselling or support groups, increased mental health screening, educational materials, or exercise classes.

Mobile Health Biometrics to Enhance Exercise and Physical Activity Adherence in Type 2 Diabetes (MOTIVATE-T2D): a decentralised feasibility randomised controlled trial delivered across the UK and Canada

OBJECTIVES

Assess the feasibility of a mobile health (mHealth)-supported home-delivered physical activity (PA) intervention (MOTIVATE-T2D) in people with recently diagnosed type 2 diabetes (T2D).

DESIGN

Feasibility multicentre, parallel group, randomised controlled trial (RCT).

SETTING

Participants were recruited from England and Canada using a decentralised design.

PARTICIPANTS

Adults (40-75 years) recently diagnosed with T2D (5-24 months).

INTERVENTIONS

Participants were randomised 1:1 to intervention (MOTIVATE-T2D) or active control groups. Participants codesigned 6month- home-delivered, personalised, progressive PA programmes supported by virtual behavioural counselling. MOTIVATE-T2D used biofeedback from wearable technologies to support the programme. The active control group received the same intervention without wearables.

OUTCOMES

The primary outcomes were recruitment rate, retention and adherence to purposeful exercise. Clinical data on effectiveness were collected as exploratory outcomes at baseline, 6 and 12 months, with HbA1c and systolic blood pressure (BP) proposed as primary outcomes for a future full RCT.

RESULTS

n=135 eligible participants expressed an interest in the trial, resulting in 125 participants randomised (age 55±9 years, 48% female, 81% white), a recruitment rate of 93%. Retention at 12 months was 82%. MOTIVATE-T2D participants were more likely to start (OR 10.4, CI 3.4 to 32.1) and maintain purposeful exercise at 6 (OR 7.1, CI 3.2 to 15.7) and 12 months (OR 2.9, CI 1.2 to 7.4). Exploratory clinical outcomes showed a potential effect in favour of MOTIVATE-T2D, including proposed primary outcomes HbA1c and systolic BP (between-group mean differences: HbA1c: 6 months: -5% change from baseline, CI -10 to 2: 12 months: -2% change from baseline, CI -8 to -4; systolic BP: 6 months: -1 mm Hg, CI -5 to 3: 12 months: -4 mm Hg, CI -8 to 1).

CONCLUSIONS

Our findings support the feasibility of delivering the MOTIVATE-T2D mHealth-supported PA intervention for people with recently diagnosed T2D and progression to a full RCT to examine its clinical and cost-effectiveness.

TRIAL REGISTRATION NUMBER

ISRCTN: 14335124; ClinicalTrials.gov: NCT0465353.

A multi-level approach to reduce exploding type 2 diabetes in Pakistan

Pakistan has the third-highest rate of type 2 diabetes globally, following China and India, making this a significant public health crisis. Despite the severity of the issue, efforts from health and policy practitioners to address it remain limited. With millions already diagnosed as pre-diabetic, the rising incidence of diabetes is rapidly becoming a public health emergency that demands immediate attention. This policy brief provides an accessible overview of diabetes, focusing on its types, mechanisms, and preventive measures. It also identifies key contributing factors, such as dietary habits, obesity, physical inactivity, and the influence of modern dietary trends, while proposing strategies for individuals, communities, and policymakers to combat this growing epidemic in Pakistan. The brief emphasizes the need for a multi-level approach that includes public awareness, education, behavioral and dietary changes, and policy interventions to reverse the trend. Strategies discussed include promoting healthy eating, increasing physical activity, managing obesity, and enhancing access to affordable, healthy food. Additionally, the brief highlights the importance of community and government support, such as public health campaigns, infrastructure improvements, and legislative efforts. By adopting this comprehensive approach, Pakistan can take meaningful steps to address the diabetes epidemic and improve public health outcomes.

The Effect of Creatine Supplementation on Lean Body Mass with and Without Resistance Training

Background/Objectives: Creatine monohydrate (CrM) is considered to be one of the most effective supplements for enhancing lean body mass during resistance training. However, CrM may influence body water content, potentially confounding lean body mass measurements. Therefore, this randomised controlled trial assessed the effect of CrM alone on lean body mass following a supplement wash-in, and when combined with a resistance training program. Methods: Sixty-three (34 females, 29 males, 31 ± 8 years) participants were randomised to supplement with CrM (5 g/day for 13 weeks: wash-in + 12-week resistance training) or serve as a control (received no creatine or placebo). Lean body mass was measured using dual X-ray absorptiometry at baseline, post 7-day wash-in, and post 12 weeks of resistance training. Both groups began the same training program post CrM wash-in. Results: After the 7-day wash-in, the supplement group gained 0.51 ± 1.79 kg more lean body mass than the control group (p = 0.03). Following the wash-in, both groups gained 2 kg after resistance training (p < 0.0001), with no between-group difference in lean body mass growth (p = 0.71). Sex-disaggregated analysis showed that the supplement group, only in females, gained 0.59 ± 1.61 kg more lean body mass than the controls (p = 0.04). There were no group differences in lean body mass growth following resistance training in females (p = 0.10) or males (p = 0.35). Conclusions: A 7-day CrM wash-in increased lean body mass, particularly in females. Thereafter, CrM did not enhance lean body mass growth when combined with resistance training, likely due to its short-term effects on lean body mass measurements. A maintenance dose of higher than 5 g/day may be necessary to augment lean body mass growth.

The Effect of Vitamin D3 Injection Combined With High-Intensity Interval Training on Excessive Autophagy in the Heart Tissue of Type 2 Diabetes-Induced Rats: An Analysis of the mTOR-Beclin-1-Fyco-1-Cathepsin D Pathway

Introduction: This study investigated the effect of vitamin D3 injection combined with high-intensity interval training on cell signaling pathways involved in excessive autophagy, specifically the mTOR (mechanistic target of rapamycin)-Beclin-1-Fyco-1 (FYVE and coiled-coil domain-containing protein 1)-cathepsin D pathway, in the heart tissue of Type 2 diabetes-induced rats. Method: In this experimental study, 32 male Wistar rats were fed a high-fat diet for 6 weeks to induce Type 2 diabetes, followed by a single subcutaneous injection of 35 mg/kg streptozotocin (STZ). The rats were then randomly assigned to one of four groups: (1) diabetes control (DC), (2) diabetes + HIIT (DT), (3) diabetes + vitamin D3 (DV), and (4) diabetes + HIIT + vitamin D3 (DTV). HIIT sessions were conducted for 8 weeks, five times per week, at an intensity of 85%-95% of maximum running speed (V max), while vitamin D3 was administered weekly via subcutaneous injection at a dose of 10,000 IU/kg. Twenty-four hours after the intervention period, heart and left ventricular tissues were collected for analysis of the levels of autophagy signaling proteins mTOR, phosphorylated mechanistic target of rapamycin (pmTOR), Beclin-1, Fyco-1, and cathepsin D. Results: Two-way ANOVA revealed that Type 2 diabetes significantly increased the levels of Beclin-1, Fyco-1, and cathepsin D (p < 0.001) while significantly reducing the levels of mTOR and pmTOR (p < 0.001). HIIT, vitamin D3 injection, and their combined treatment significantly decreased the levels of Beclin-1, Fyco-1, and cathepsin D and increased the levels of mTOR and pmTOR compared to the diabetes control group (p < 0.001). Conclusion: Type 2 diabetes increases autophagy in the left ventricle, marked by altered levels of key autophagy proteins. HIIT and vitamin D3 injections mitigate these effects by enhancing mTOR signaling and reducing excessive autophagy. These interventions show promise as nonpharmacological strategies to improve cardiac health in Type 2 diabetes and could be incorporated into clinical and rehabilitation programs.

Prevalence and Risk Factors of Obesity Among Type 2 Diabetic Participants in Abha, Saudi Arabia: A Cross-Sectional Study

Background: The prevalence of obesity among type 2 diabetic participants is a growing concern globally, including in Abha, Saudi Arabia. This study aimed to investigate the prevalence and its associated risk factors of obesity among type 2 diabetic participants in Abha. Methods: A cross-sectional study targeted 400 type 2 diabetic participants in Abha, Saudi Arabia. A hybrid method (snowball sampling + purposive) techniques were used to obtain an adequate sample size. Data were collected after obtaining telephonic or digital consent; the questionnaire was shared with participants who were able and willing to complete it independently those with type 2 diabetes who wished to participate but were unable to complete the questionnaire on their own. The researcher conducted a telephonic interview and recorded their responses. The questionnaire captured demographic details, Anthropometric history, medical history, lifestyle habits, and type 2 Diabetes (T2DM) specific factors. Data were analyzed using IBM SPSS Statistics for Windows, Version 27.0. Results: The overall prevalence of obesity among the type 2 DM study participants was 46.0%, 115 participants (28.8%) fell into the Obesity Grade I category, 43 (10.8%) as Obesity Grade II, while 26 (6.5%) were classified as Obesity Grade III, the overall median BMI of participants was 29.3 ± 5.88. Significant bio-demographic factors associated with obesity included age, gender, educational level, marital status, and co-morbidities (p < 0.05). Notably, females and older adults exhibited higher obesity rates. Significant lifestyle factors included the frequency and type of physical activity, soft drink consumption, and attempts to control weight. Participants who exercised regularly and avoided soft drinks had lower obesity rates. Multiple logistic regression analysis identified age, gender, co-morbidities, family history of obesity, regular dinner consumption, soft drink consumption, and exercise frequency as significant predictors of obesity (p < 0.05). Conclusions: The study determined a high prevalence of obesity among type 2 diabetic participants in Abha, Saudi Arabia, with significant associations with bio-demographic and lifestyle factors. Interventions targeting weight management, physical activity, dietary habits, and health education are urgently needed to address obesity in this population. Further research is recommended to explore these associations longitudinally and to develop tailored intervention strategies.

Effects of Lifestyle Interventions to Promote Physical Activity on Physical Activity and Glycated Hemoglobin in Patients with Type 2 Diabetes: a Systematic Review and Meta-Analysis

BACKGROUND

Numerous studies have explored the impact of controlled exercise interventions in type 2 diabetes, as physical activity can positively influence its progression. However, our understanding of how broader lifestyle interventions can effectively promote physical activity in practical real-world scenarios remains limited.

OBJECTIVE

This systematic review and meta-analysis aimed to investigate the potential of lifestyle interventions targeting the promotion of physical activity on physical activity outcomes and glycated hemoglobin (HbA1c), providing a comprehensive understanding of both behavioral and clinical impacts.

METHODS

We performed a systematic review and meta-analysis, searching three databases and examined the study design, structure, and content of the lifestyle interventions. We assessed physical activity and HbA1c as endpoints and performed a multivariate meta-regression to explore physical activity's impact on HbA1c.

RESULTS

This review incorporated 13 studies (n = 5301 patients), with heterogeneity in intervention designs, components, and durations. Lifestyle interventions showed a slight increase in physical activity, equivalent to an average of 9.0 min more total physical activity per day (95% confidence interval 5.8, 12.2) and 1.7 min more moderate-to-vigorous physical activity per day (95% confidence interval 1.1, 2.3), irrespective of objective (e.g., accelerometers) or subjective measurement (e.g., questionnaires) method. However, HbA1c reduction through these interventions was minimal 0.09% (95% confidence interval - 0.20, 0.03). The effect of physical activity was - 0.04 (standard error = 0.05, 95% confidence interval - 0.15, 0.06), suggesting that physical activity does not act as a moderator for changes in HbA1c.

CONCLUSIONS

Lifestyle interventions effectively increase physical activity but have limited impact on HbA1c compared to controls. The role of physical activity as a moderator for changes in HbA1c remains uncertain. Further research is needed to enhance the efficacy of these interventions in reducing HbA1c in individuals with type 2 diabetes.

Joint Effects of Physical Activity and Body Mass Index on Prevalent Diabetes in a Nationally Representative Sample of 1.9 Million US Adults

Aim: To investigate the joint effects of physical activity (PA) and body mass index (BMI) on prevalent diabetes mellitus in a nationally representative sample of US adults. Materials and Methods: Data were pooled from five US Behavioral Risk Factor Surveillance System (BRFSS) surveys from 2011 to 2019. Cross-sectional associations between independent and combined PA and BMI status and diabetes were analysed using Poisson's log-linear regression with a robust-error variance, reported by adjusted prevalence ratios (APRs). These models were adjusted for relevant sociodemographic, behavioral, and health-related factors. Results: Data was available for 1,913,732 individuals (≥ 18 years). Considering individuals highly active and with normal weight as the reference group, there was an association between decreasing levels of PA and increasing BMI and diabetes prevalence. APRs ranged from APR = 1.09 (nonactive, normal weight group; 95% CI = 1.09-1.09), 1.67 (nonactive, overweight group; 95% CI = 1.67-1.67), 2.23 (nonactive, Class I obesity group; 95% CI = 2.23-2.23), 2.71 (nonactive, Class II obesity group; 95% CI = 2.71-2.71), and 3.17 (nonactive, Class III obesity group; 95% CI = 3.16-3.17). Conclusions: BMI appears to be a substantially larger predictor of diabetes compared to PA in a large population-level sample of US adults. PA provided modest reductions in the prevalence of diabetes but did not attenuate the detrimental impact of overweight and increasing levels of obesity on diabetes prevalence.