2,000 words (+/- 10%) Critically review the evidence of the role that physical activity can play in the management of type 2 diabetes. Briefly describe the levels of activity among people living with diabetes in your own setting (you can define this as country, region or your own health care organisation). Then drawing on your learning about behaviour change, structured education and physical activity suggest changes in advice or policy which may enhance patient’s participation in physical activity

Introduction

Type 2 diabetes is a chronic metabolic disease characterized by high blood glucose levels and insulin resistance. It is a major public health concern, affecting millions of people worldwide. Physical activity has been recognized as an essential component in the management of type 2 diabetes. This critical review aims to examine the evidence regarding the role physical activity plays in the management of type 2 diabetes. Furthermore, the levels of physical activity among people living with diabetes will be briefly described, followed by suggestions for changes in advice or policy to enhance patient participation in physical activity.

Role of Physical Activity in Type 2 Diabetes Management

Physical activity has numerous benefits in the management of type 2 diabetes. It improves glycemic control, increases insulin sensitivity, and helps in weight management. Regular physical activity has been shown to reduce HbA1c levels, which is the marker of long-term glucose control. It also reduces the risk of cardiovascular disease, a common comorbidity in individuals with type 2 diabetes. Additionally, physical activity improves lipid profile, blood pressure, and overall cardiovascular health.

The American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD) recommend at least 150 minutes of moderate-intensity aerobic activity per week, spread over a minimum of three days, with no more than two consecutive days without exercise. Strength training exercises are also encouraged at least twice a week. Similarly, the World Health Organization (WHO) recommends at least 150 minutes of moderate-intensity aerobic physical activity throughout the week for adults.

Evidence supporting the role of physical activity in type 2 diabetes management comes from various research studies and clinical trials. A meta-analysis of randomized controlled trials found that exercise interventions in people with type 2 diabetes resulted in significant improvements in glycemic control, as indicated by reductions in HbA1c levels. Another systematic review and meta-analysis showed that both aerobic and resistance training have beneficial effects on HbA1c levels, fasting blood glucose, and insulin resistance.

Levels of Physical Activity Among People with Type 2 Diabetes

In the context of physical activity levels among people living with diabetes, it is important to consider the specific setting. For the purposes of this review, the focus will be on the United States. It is estimated that approximately 34.2 million people in the United States have diabetes, with type 2 diabetes accounting for approximately 90-95% of all cases.

However, despite the well-established benefits of physical activity in the management of type 2 diabetes, numerous barriers exist that contribute to low levels of physical activity among people with diabetes. These barriers include lack of knowledge or awareness regarding the benefits of physical activity, lack of motivation, fear of hypoglycemia, lack of access to safe exercise environments, and limited availability of structured exercise programs.

Changes in Advice or Policy to Enhance Patient Participation in Physical Activity

To enhance patient participation in physical activity, changes in advice and policy should be considered. Firstly, healthcare providers should prioritize education and awareness regarding the benefits of physical activity in the management of type 2 diabetes. This can be accomplished through structured education programs, which have been shown to be effective in increasing knowledge and understanding of physical activity recommendations.

Structured education programs should also address the fears and concerns of patients, such as fears of hypoglycemia during exercise. Education on appropriate self-monitoring of blood glucose levels and the importance of keeping a source of fast-acting carbohydrates readily available can help alleviate these fears and provide patients with the necessary tools to engage in physical activity safely.

Furthermore, healthcare organizations and policymakers should work to improve access to safe exercise environments. This can involve partnerships with community centers, gyms, or local parks to provide individuals with diabetes access to exercise facilities. Additionally, healthcare providers can advocate for insurance coverage for structured exercise programs, making them more accessible and affordable for patients.

Conclusion

Physical activity plays a crucial role in the management of type 2 diabetes, improving glycemic control, insulin sensitivity, and cardiovascular health. However, levels of physical activity among people with diabetes remain low due to various barriers. To enhance patient participation in physical activity, changes in advice and policy are needed, including increased education and awareness, addressing patient concerns, and improving access to safe exercise environments. By implementing these changes, healthcare providers and policymakers can better support individuals with type 2 diabetes in achieving optimal health outcomes through regular physical activity.