EXERCISE AND DIABETES - NEW INSIGHTS AND THERAPEUTIC GOALS

Exercise is frequently recommended in the treatment of diabetes mellitus. Recent studies have improved our understanding of the acute and long-term metabolic and hormonal effects of physical activity in both healthy controls and in people with diabetes, In insulin dependent diabetes mellitus (IDDM), exercise, in and of itself, does not have a significant effect on overall glycemic control and should be encouraged primarily for its nonglycemic benefits. Hypoglycemia is the predominant risk associated with exercise in individuals with IDDM and can be reduced by adjusting the insulin and diet prescription in response to information obtained from frequent self-monitoring of blood glucose. In contrast, in non insulin-dependent diabetes mellitus (NIDDM), exercise improves one of the most prominent basic pathophysiologic features of this condition, namely insulin resistance, and as a consequence, is an important component of management along with diet and/or drug therapy. In addition to the positive effects on overall glycemic control, exercise in NIDDM also results in nonglycemic benefits in these patients. The subgroup of NIDDM individuals who have mild to moderately impaired glucose tolerance appears most likely to benefit from exercise. However, because people with NIDDM frequently have other con current medical conditions, the adverse effects of exercise, particularly in relation to cardiac risks, must be monitored. In both IDDM and NIDDM, appropriate medical screening and patient education before starting on an exercise program are mandatory to achieve the best quality of life responses and metabolic effects. Exercise remains an important component of the management of diabetes, but its role in the therapy for NIDDM and IDDM is clearly distinct.