Abstract
Studies demonstrate that post-meal walking decreases postprandial hyperglycemia in type 2 diabetic patients but it has never been tested with the active treatment comparator. The objective of this study was to determine the effect of post-meal walking on glycemic control compared with one prandial insulin in type 2 diabetic patients who failed basal insulin. A randomized controlled cross-over study of post-meal walking or one prandial insulin was done in type 2 diabetic patients who were being treated with basal insulin between May 2017 and March 2018. In post-meal walking group, patients walked after meal for 15-20 minutes one meal a day every day for 6 weeks. In prandial insulin (basal plus) group, one prandial insulin was injected before breakfast or main meal with rapid-acting insulin. The primary outcome was a difference in HbA1c reduction in post-meal walking compared with basal plus groups. Fourteen patients completed the study. By intention-to-treat analysis, HbA1c was reduced by -0.05(range:-1.08 to 0.74) and -0.19(range:-0.8 to 0.56) % in post-meal walking and basal plus groups respectively. By per-protocol analysis, post-meal walking and basal plus groups decreased HbA1c by 0.13(range:-0.74 to 1.08) and 0.2(range:-0.56 to 0.8) %, respectively. There was were no significant differences in HbA1c reduction from baseline in each group and between groups in both intention-to-treat and per-protocol analysis. Fructosamine levels were decreased by 17.5(-59 to 43) and 10(-15 to 40) μmol/L, respectively at 3 and 6 weeks in post-meal walking group whereas the respective changes in basal plus group were 12.5(-17 to 64) and 17.5(-28 to 38) μmol/L and there were no significant differences in fructosamine reduction from baseline in each group and between groups. In conclusion, although post-meal walking might be as effective as one prandial insulin to improve glycemic control in type 2 diabetic patients who failed basal insulin but the magnitude of reduction was small. A longer-term study with a larger sample size or with a different walking protocol is required.
Highlights
Several diabetes guidelines [1, 2] recommend initiation of basal insulin in type 2 diabetic patients after failure to oral hypoglycemic drugs (OHD)
Recent studies demonstrate that increased physical activity by walking after meal for 10–20 minutes can reduce postprandial plasma glucose (PPG) better than walking before meal [5,6,7,8,9,10,11,12]
Our results indicated that in patients with type 2 diabetes who were being treated with basal insulin, the HbA1c reduction by post-meal walking or one prandial insulin injection were not different at 6 weeks
Summary
Several diabetes guidelines [1, 2] recommend initiation of basal insulin in type 2 diabetic patients after failure to oral hypoglycemic drugs (OHD). Increased physical activity is recommended as the mainstay therapy for type 2 diabetic patients especially those who are overweight or obese [3, 4]. Recent studies demonstrate that increased physical activity by walking after meal (post-meal walking) for 10–20 minutes can reduce postprandial plasma glucose (PPG) better than walking before meal [5,6,7,8,9,10,11,12]. Colberg et al [12] showed that post-dinner walking in type 2 diabetic subjects decreased PPG at 1 hour after meal about 40 mg/dl compared with those without. None of the previous studies compares PPG-lowering effect of post-meal walking with that of the active comparators
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