How effective are weight loss and exercise in controlling blood sugar in seniors?

A recent study in Diabetes Care shows that a lifestyle intervention improves glycemic control and age-related outcomes in older people with diabetes with comorbidities. The authors of the study1 point out that the elderly have the highest prevalence of diabetes in the American population. This results from adiposity and physical inactivity with aging.2 Although lifestyle intervention is recommended as the first-line treatment for diabetes at all ages, little is known about the effectiveness of this approach in older people. To fill this gap, researchers conducted a randomized controlled trial, the LISD (Lifestyle Intervention for Seniors with Diabetes) study performed at Baylor College of Medicine and Michael E. DeBakey VA Medical Center, from April 2015 to December 2020. Read: Undiagnosed diabetes may be common in hospitalized COVID-19 patients Methodology in brief A total of 100 adults aged 65 to 85 with type 2 diabetes, were randomly assigned to each of two groups: group one, intensive lifestyle intervention or group two, healthy lifestyle, for a period of one year. The first consisted of a weight management program and physical training three times a week. The 90-minute sessions included: 15 minutes of warm-up and flexibility exercises, 30 minutes of aerobic exercise, 30 minutes of resistance exercise and 15 minutes of balance exercise. The second consisted of group educational sessions on a healthy diet during monthly visits. Participants in this group were not required to follow an external weight loss or exercise program. The primary endpoint was change in HbA1c level. Secondary measures included gluco-regulation, body composition, physical function and quality of life. Read: A simple approach to improving gestational diabetes management Principle results Of the 100 patients in the study, 84 completed it (about 40% of the patients were Black). The participants were taking different types of diabetes medication and nearly half were on insulin therapy. The mean (± standard deviation) HbA1c level improved more in the IIMV group than in the MVS group (0.8 ± 0.1% vs 0.1 ± 0.1%), in association with a improved insulin sensitivity (1.2 ± 0.2 vs 0.4 ± 0.2) and an increase in overall glucose sensitivity index (26.0 ± 8.9 vs 13.0 ± 8.4 x 109 min-1; p < 0.001 to 0.04 between groups). Body weight and visceral fat decreased more in the first group than in the second group (-8.4 ± 0.6 vs -0.3 ± 0.6 kg and -261 ± 29 vs -30 ± 27 cm3; p < 0.001 for each comparison). The physical performance test score increased more in the first group than in the second group (2.9 ± 0.6 vs -0.1 ± 0.4; p < 0.001) as did the VO2 peak (2. 2 ± 0.3 vs -1.2 ±0.2 mL/kg/min; p < 0.001). Strength, gait, and the Physical Component Summary score of the 36-Item Short Form Survey also improved more in the first group (all p < 0.004). The total insulin dose decreased by 19.8 ± 4.4 units/d in the first group. Finally, episodes of mild hypoglycaemia (adverse effect) were noted more often the intensive lifestyle intervention. Talking points These results suggest that it may not be too late in this population of older adults with diabetes (mean age 72 years) to begin a lifestyle intervention that may supplement or reduce the need of medical therapy. This type of intervention could directly counter the adiposity and physical inactivity that are mainly responsible for the increase in insulin resistance associated with age, in association with a decrease in the function of the β cells of the pancreas.3 Aging and obesity are also associated with increased glucagon production by pancreatic α cells, which may contribute to hyperglycemia by increasing hepatic glucose production.4 In conclusion, a lifestyle intervention strategy is found to be highly effective in improving the metabolic and functional health of older adults with diabetes. References 1. Celli, A. et al. (2022). Lifestyle Intervention Strategy to Treat Diabetes in Older Adults: A Randomized Controlled Trial. Diabetes Care 45(9), 1943-1952. 2. Amati, F. et al. (2009). Physical inactivity and obesity underlie the insulin resistance ofaging. Diabetes Care 32, 1547-1549. 3. Lee, P.G. and Halter, J.B. (2017). The pathophysiology of hyperglycemia in older adults: clinical considerations. Diabetes Care 40, 444-452. 4. Basu, R. et al. (2003). Mechanisms of the age-associated deterioration in glucose tolerance: contribution of alterations in insulin secretion, action, and clearance. Diabetes 52, 1738-1748. This article has been translated from its original French and originally appeared on our sister site Profession Santé. Read: Heads or tails: What statistical models tell us about the probability of living beyond 110

How effective are weight loss and exercise in controlling blood sugar in seniors?

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