Over 10% of adults in the US have type 2 diabetes and over 45% are prediabetic. While there are many factors that contribute to the development of insulin insensitivity, poor diet and inactivity are at the top of the list. There are a lot of ways to eat a healthy diet and when it comes to reducing diabetes risk, the keys are eating more whole foods and less ultra-processed foods. These two habits increase fiber intake (a key for blood glucose control) and reduce total calorie intake (a key for weight management).
More goes into the diet, but I will focus on the exercise component for now. VO2 max, strength, and muscle mass are all linked to diabetes and other chronic diseases. This study hits on baseline recommendations and goals to help people with type 2 diabetes and prediabetes.
The first target should be meeting the physical activity guidelines. That act alone dramatically improves glucose control and reduces the risk of progressing from prediabetes to diabetes. Adding in caloric restriction to achieve greater than 4% weight loss leads to more substantial gains in insulin sensitivity. We start to see improvements in pancreatic β-cell function in as little as two weeks.
Both continuous moderate-intensity training and high-intensity interval training are effective. Each patient will respond differently, requiring a personalized approach. As with all health interventions adherence is key. Find the exercise strategy that your patient is most likely to stick with. Whichever strategy you choose, including both aerobic and resistance training. They use different mechanisms for controlling glucose levels, likely inducing an additive effect. Aerobic will be superior for VO2 max while resistance training will be superior for muscle mass and strength.
Lastly, increasing non-exercise physical activity will be beneficial as well. It can’t replace exercise and yield the same benefits but it will help with weight loss.