Title:Exercise and Postprandial Glycemic Control in Type 2 Diabetes
VOLUME: 12 ISSUE: 3
Author(s):Monica L. Kearney and John P. Thyfault
Affiliation:Department of Molecular and Integrative Physiology, University of Kansas Medical Center, Mailstop 3043, 3901 Rainbow Boulevard, Kansas City, MO, USA.
Keywords:Exercise, type 2 diabetes, postprandial glucose, glycemic control, mixed meal tolerance test, continuous glucose
monitoring.
Abstract:Individuals with type 2 diabetes (T2D) have poor glycemic control which contributes to
cardiovascular disease and other diabetic comorbidities. The often relied upon measures of fasting
glucose and glycosylated hemoglobin (HbA1c) do not accurately represent glycemic control because
they do not reflect what occurs after meals and throughout the day in the free-living condition. An accumulating
body of evidence now suggests that postprandial glucose fluctuations are more tightly correlated
with microvascular and macrovascular morbidities and cardiovascular mortality than HbA1c or
fasting glucose, stagnant measure of glycemia. Thus, effective therapies are needed which will improve
not only HbA1c and fasting glucose, but also regulation of postprandial glycemia. Further, testing for glycemic control
should employ a challenge that simulates the free-living condition to best determine how glucose is regulated after
meals and throughout the day. Unlike medications, which generally have a poor effect at improving postprandial glucose,
exercise is effective in reducing postprandial glycemic excursions in as little as a few days. However, how this is accomplished
and the optimal prescription for reducing postprandial glycemic excursions and maintaining improvements in
postprandial glycemic control have yet to be elucidated. Still further, the utility of a mixed meal test in providing the optimal
challenge for detecting exercise-induced changes in postprandial glycemic control has value that warrants further
investigation. Thus, the purpose of this review is to summarize the literature regarding exercise in treating postprandial
glycemia in T2D and to review strengths and weaknesses in the current methodology for assessing changes in glycemic
control.
