How Physical Activity reduces Type 2 Diabetes risk and the need to take Insulin

I suspect a lot of Jamaicans are going to start walking more often after reading this bit of news.

Two (2) new studies published in Diabetologia (The Journal of the European Association for the Study of Diabetes [EASD]) suggest that walking and other physical activity reduces the risk of developing T2D (Type 2 Diabetes) and helps type 2 diabetes suffers manage their symptoms, based on when you do you physical activity.

This study is significant, as albeit walking is generally known to be good for you, in New Zealand, no specific time of day (Gibb, 2016, 20 October) is specified for doing walking and other physical activity for the best results!

Sounds exciting? Let’s dive in!

Reducing the Risk of Type 2 Diabetes – Walking more often prevents T2D in the future

Dr Andrea Smith and colleagues examined the results of twenty three (23) cohort studies on the relationship between physical activities (Springer, 2016, October 21) and prevention of Type 2 Diabetes. Hailing from the Health Behaviour Research Centre, University College London and Institute of Public Health, University of Cambridge, he wears an awful lot of hats.

geezam-how-physical-activity-reduces-type-2-diabetes-risk-and-the-need-to-take-insulin-13-11-2016-lhdeer-2

But this particular hat in the form of his published research involved the meta-analysis of 1,245,904 non-diabetic individuals from the following countries:

  • Asia
  • Australia
  • Europe
  • USA

Among this group, 82,319 individual developed T2D over a period of 3 to 23.1 years. The researcher discovered that:

  • 26% reduction in the risk of developing T2D among participants who achieved 11.25 metabolic equivalent of task (MET) hours/week

Joint senior author on the study, Dr Søren Brage (MRC Epidemiology Unit, University of Cambridge), concluded that, quote:  “Our results suggest that the health benefits of physical activity are apparent even at levels below the recommended levels, compared to not doing any activity, but also that benefits are greater still for those who exceed the minimum recommendations, such that even when PA was as high as 60 MET hours/week benefits continued to occur, with the risk of developing T2D being more than halved in those individuals”.

Current public health guidelines recommend a minimum of 150 min of moderate to vigorous Physical exercise or 75 min vigorous PA (VPA) a week. 30% of adults don’t meet these targets, often lying via various means, especially in this age of fitness trackers whose readings can be easily faked to make you look great in the eyes of your peers.

This is huge news, as previous studies have included diet and Physical activity so it was not possible to say if the reduction in risk was due to diet or Physical activity separately. The researchers were seeking to recommend higher levels of Physical activity as a means of increasing the health benefit to diabetes sufferers; this latest research may prove this conclusively, once replicated.

Dr. Andrea Smith and colleagues make a call for city developer to rethink how they design cities to encourage people to do more physical exercise: “Our study favours a ‘some is good but more is better’ guideline, in which specific targets are mainly used for a psychological effect. There is no clear cut-off at which benefits are not achieved and health benefits increase at activity levels well beyond current recommendations. Building environments that encourages physical activity as part of everyday life may prevent substantial personal suffering and economic burden. Given the current obesity and diabetes epidemic there is a pressing need to make our towns and cities places where getting around on foot or by bike feels like the natural choice”.

The evidence is clear; walking, riding a bicycle or jogging by itself is can prevent the onset of T2D. But when is the best time to engage in Physical Exercise? And is there any hope for people already suffering from T2D?

Walking and diabetes- 30 minute walk 5 minutes after a meal reduces need for insulin

This is where the second study comes into play.

Published in the same Diabetologia, Professor Jim Mann, Dr Andrew Reynolds and colleagues from the University of Otago, Dunedin, Otago, New Zealand, sought a connection between walking and meals (Springer, 2016, October 21) to determine when the best time to do Physical Exercise.

geezam-how-physical-activity-reduces-type-2-diabetes-risk-and-the-need-to-take-insulin-13-11-2016-lhdeer-1

The researchers had forty one (41) adults aged 18-75 with T2D comply with a prescribed walking regime fitted with accelerometers while keeping their diet or lifestyle habits the same over a 14-day study period.

This walking regiment included:

  • 30 minutes of walking each day,
  • 3 sets of 10 minutes of walking each day

The researchers laid done the condition that they could do their thirty (30) minutes of walking as a single block or in three (3) sets of ten (10) minutes no more than five (5) minutes after each main meal. During the fourteen (14) days of the experiment, the following medical readings were taken:

  • Blood samples
  • Height
  • Waist size
  • Weight

Day seven (7) of the experiment saw the participants fitted with a CGMS (glucose-monitoring system) and each participant had to keep a reflective journal on their food consumption. After a thirty (30)-day break, this regime was repeated with the alternative walking regime as listed above i.e. if some participants did 30 minutes of walking each day, they switched around and did 3 sets of 10 minutes of walking each day.

The study found that:

  • Exercising after meals delivered a greater benefit from physical activity
  • Participants had a significantly lower blood glucose levels

The CGNS data revealed that Physical Activity had an effect on Postprandial glycaemia, a factor known to be an independent determinant of cardiovascular risk. The Study found that during the ‘post-meal walking intervention’:

  • 12% lower Postprandial glycaemia on using regular PA advice i.e. exercise anytime
  • 22% lower Postprandial glycaemia on using ‘post-meal walking intervention’ advice i.e. exercise five minutes after a meal

This was evident by the lower blood glucose levels in the ‘post-meal walking intervention’ after the evening meal to quote the study: “Although the prescriptions were matched in total walking time, the advice to walk after each main meal resulted in significantly greater overall activity. The improvement in overall postprandial glycaemia was largely accounted for by lower blood glucose levels after the evening meal, when carbohydrate consumption was high and participants tended to be more sedentary”.

One such benefit may be the need to take insulin at all, to quote the study: “Postprandial physical activity may avoid the need for an increased total insulin dose or additional mealtime insulin injections that might otherwise have been prescribed to lower glucose levels after eating. An increase in insulin dose might, in turn, be associated with weight gain in patients with T2D, many of whom are already overweight or obese”.

Conclusion – Walking is good to prevent T2D as well as managing Blood glucose levels

Overall, a thirty (30) minute walk five (5) minutes after a meal not only reduces your chances of developing T2D but for those who already have the disease helps reduce the Postprandial glycaemia cardiovascular risk factors.

Combined with a proper diet, it may even help wean patients off taking regular insulin.

To quote the study: “The benefits relating to physical activity following meals suggest that current guidelines should be amended to specify post-meal activity, particularly when meals contain a substantial amount of carbohydrate”.

Somehow I suspect the pharmaceutical industry may not like this study! As for me, more walking will become necessary as I get older.

References:

  1. (2016, October 21). The importance of the amount of physical activity on the risk of developing type 2 diabetes. Retrieved from https://www.sciencedaily.com/releases/2016/10/161021123123.htm
  2. Gibb, J. (2016, 20 October). Post-meal walk tool to manage diabetes. Retrieved from https://www.odt.co.nz/news/dunedin/post-meal-walk-tool-manage-diabetes
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