Which type of physical activity has the greatest impact on blood glucose levels in patients with pre-DM?

THE physical activity is almost always within the list of basic guidelines that we pass on to patients with different purposes, and in many these times the recommendations are made vaguely and without a clear intention. Furthermore, despite having learned in the medical course that the daily practice of exercise brings benefits, we often do not question the real impact of these and what outcomes we are thinking about avoiding when we guide such measure to a specific patient.

A good example of the positive impact of physical activity is pre-diabetes (diagnosed with altered fasting blood glucose levels, between 100 and 125 mg/dL, or glycated hemoglobin – HbA1c – between 5.7% and 6.4%), a situation that substantially increases the risk of developing diabetes in the years subsequent ones. To avoid the risk of progression, measures such as lifestyle change (MEV) and metformin have been evaluated in classic studies such as the 2002 DPP published in the NEJM. At a mean follow-up of 2.8 years, there was a 58% reduction in the incidence of DM in the SEM group compared to 31% in the metformin group (both compared to usual care), ie, SEM was superior to metformin in reducing incidence of DM. The SEM consisted of changes in diet, frequent reassessments made by professionals who monitored the patients, and moderate-intensity physical activity 150 minutes/week.

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Aerobic activity (AAA) vs. control (AC): mean difference: – 0.673 (-0.94 to -0.4, 95% CI)

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Conclusions

Although it does not exactly specify the effect of exercise on diabetes prevention, this meta-analysis showed evidence of its positive impact on the reduction of HbA1c in different modalities. Both aerobic activity and resistance activity and the association between them impact on the improvement of glycated levels in participants with pre-DM. This is important because we have evidence to recommend the activity that best fits the patient’s profile in face of other comorbidities that they present or even physical limitations for a certain type of exercise.

Bringing it to clinical practice, we must make it clear that physical activity is a fundamental part of the treatment, whether it is for which way the patient prefers, but as long as it is done with adequate frequency and intensity.

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