Optimal Timing for Exercise: Enhancing Blood Sugar Control in Type 2 Diabetes Patients

by Amir Hussein
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Type 2 diabetes patients

Researchers from Brigham and Women’s Hospital and Joslin Diabetes Center have conducted a study indicating that engaging in physical activity during the afternoon can significantly improve blood glucose control in individuals with type 2 diabetes. By analyzing data from the Look AHEAD study, the team discovered that those who were most active in the afternoon experienced the greatest reduction in blood glucose levels and were more likely to discontinue diabetes medications.

In their analysis of the Look AHEAD study, researchers from Brigham and Joslin Diabetes Center found that participants who engaged in physical activity during the afternoon exhibited greater reductions in blood sugar compared to those who were most active at other times of the day.

Type 2 diabetes affects over 37 million Americans, with 90-95% of the diagnosed population falling into this category. Lifestyle interventions, including a healthy diet and regular physical activity, play crucial roles in diabetes management. A recent collaboration between investigators at Brigham and Women’s Hospital and Joslin Diabetes Center utilized data from the Look AHEAD (Action for Health in Diabetes) study, a randomized controlled trial that compared intensive lifestyle intervention with diabetes support and education for individuals diagnosed with type 2 diabetes, overweight or obese. The study aimed to track the development of cardiovascular disease over time. In this particular study, the research team examined whether physical activity at specific times of the day correlated with greater improvements in blood glucose control. The results, published in Diabetes Care, suggest that patients with type 2 diabetes who engaged in physical activity during the afternoon demonstrated the most significant improvements after one year of the trial.

Jingyi Qian, PhD, co-corresponding author from the Division of Sleep and Circadian Disorders at the Brigham, stated, “In this study, we have shown that adults with type 2 diabetes experienced the greatest improvement in glucose control when they were most active in the afternoon. Our findings contribute to the existing knowledge that physical activity is beneficial and highlight the potential importance of timing.”

Medical professionals recommend regular physical activity for diabetes patients to manage their blood glucose levels. Elevated blood glucose levels can increase the risk of heart disease, vision impairment, and kidney disease in individuals with type 2 diabetes.

The research team analyzed physical activity data from the first and fourth years of the Look AHEAD study, incorporating information from over 2,400 participants. Participants wore waist accelerometry recording devices to measure their physical activity levels. Upon reviewing the year 1 data, the Brigham and Joslin team discovered that individuals engaging in moderate-to-vigorous physical activity during the afternoon experienced the most substantial reductions in blood glucose levels. Moreover, the afternoon activity group maintained the reduced blood glucose levels when comparing the year 4 data. Additionally, this group had the highest likelihood of discontinuing glucose-lowering/diabetes medications.

The Brigham and Joslin team acknowledge certain limitations in their investigation, such as the observational nature of their study and the lack of measurement for confounding factors like sleep and dietary intake.

In future studies, the team intends to experimentally test their findings to explore the underlying mechanisms that may explain how the timing of physical activity influences blood glucose control. Such investigations may allow for more personalized physical activity recommendations for patients.

Co-corresponding author Roeland Middelbeek, MD, an assistant investigator at Joslin Diabetes Center, stated, “Timing does seem to matter. Moving forward, we may acquire additional data and experimental evidence to provide patients with more specific recommendations.”

Reference: “Association of Timing of Moderate-to-Vigorous Physical Activity With Changes in Glycemic Control Over 4 Years in Adults With Type 2 Diabetes From the Look AHEAD Trial” by Jingyi Qian, Qian Xiao, Michael P. Walkup, Mace Coday, Melissa L. Erickson, Jessica Unick, John M. Jakicic, Kun Hu, Frank A.J.L. Scheer, Roeland J.W. Middelbeek and Look AHEAD Research Group, 25 May 2023, Diabetes Care.
DOI: 10.2337/dc22-2413

The study received funding from the National Heart, Lung, and Blood Institute (K99-HL-148500, R01-HL140574), National Institute on Aging (RF1AG059867 and RF1AG064312), and National Institute of Diabetes and Digestive and Kidney Diseases (K23-DK114550). The Look AHEAD study was supported by the Department of Health and Human Services through cooperative agreements from the National Institutes of Health, NIDDK: DK57136, DK57149, DK56990, DK57177, DK57171, DK57151, DK57182, DK57131, DK57002, DK57078, DK57154, DK57178, DK57219, DK57008, DK57135, and DK56992. Additional funding was provided by the National Heart, Lung, and Blood Institute, National Institute of Nursing Research, National Center on Minority Health and Health Disparities, National Institutes of Health Office of Research on Women’s Health, and the Centers for Disease Control and Prevention. The research was supported in part by the NIDDK Intramural Research Program. The study also received support from various medical institutions and organizations.

Disclosure: Several organizations, including Federal Express, Health Management Resources, Johnson & Johnson, LifeScan Inc., Optifast-Novartis Nutrition, Roche Pharmaceuticals, Ross Product Division of Abbott Laboratories, SlimFast Foods Company, and Unilever, have made significant contributions to the Look AHEAD study. Furthermore, J.M.J. serves on the scientific advisory board for Wondr Health, Inc., F.A.J.L.S. is a member of the Sleep Research Society Board of Directors, and R.J.W.M. has received research funding from Novo Nordisk (unrelated to this work).

Frequently Asked Questions (FAQs) about Type 2 diabetes patients

What is the key finding of the study conducted by Brigham and Joslin researchers?

The key finding of the study is that engaging in physical activity during the afternoon can significantly improve blood glucose control in individuals with type 2 diabetes, leading to a reduction in the need for diabetes medications.

How many participants were involved in the Look AHEAD study?

The Look AHEAD study included data from over 2,400 participants.

Did the study consider other factors that may influence blood glucose control?

The study acknowledges limitations, such as its observational nature and the lack of measurement for confounding factors like sleep and dietary intake. However, it highlights the potential importance of timing physical activity for improved blood glucose control.

What are the potential implications of these findings?

The findings suggest that timing of physical activity may play a role in optimizing blood glucose control for individuals with type 2 diabetes. Further research is needed to explore the underlying mechanisms and provide more personalized recommendations for patients.

How can regular physical activity benefit individuals with type 2 diabetes?

Regular physical activity is recommended for individuals with type 2 diabetes as it can help manage blood glucose levels and reduce the risk of complications such as heart disease, vision impairment, and kidney disease.

Who funded the study?

The study received funding from the National Heart, Lung, and Blood Institute, National Institute on Aging, and National Institute of Diabetes and Digestive and Kidney Diseases, among others. The Look AHEAD study was supported by cooperative agreements from the National Institutes of Health.

What are some of the limitations of the study?

Limitations of the study include its observational nature, the inability to measure certain confounding factors, and the need for further experimental investigations to better understand the underlying mechanisms.

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