EXERCISE AND DIABETES - NEW INSIGHTS AND THERAPEUTIC GOALS

Exercise is frequently recommended in the treatment of diabetes mellit us. Recent studies have improved our understanding of the acute and lo ng-term metabolic and hormonal effects of physical activity in both he althy controls and in people with diabetes, In insulin dependent diabe tes mellitus (IDDM), exercise, in and of itself, does not have a signi ficant effect on overall glycemic control and should be encouraged pri marily for its nonglycemic benefits. Hypoglycemia is the predominant r isk associated with exercise in individuals with IDDM and can be reduc ed by adjusting the insulin and diet prescription in response to infor mation obtained from frequent self-monitoring of blood glucose. In con trast, in non insulin-dependent diabetes mellitus (NIDDM), exercise im proves one of the most prominent basic pathophysiologic features of th is condition, namely insulin resistance, and as a consequence, is an i mportant component of management along with diet and/or drug therapy. In addition to the positive effects on overall glycemic control, exerc ise in NIDDM also results in nonglycemic benefits in these patients. T he subgroup of NIDDM individuals who have mild to moderately impaired glucose tolerance appears most likely to benefit from exercise. Howeve r, 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, appropri ate medical screening and patient education before starting on an exer cise program are mandatory to achieve the best quality of life respons es and metabolic effects. Exercise remains an important component of t he management of diabetes, but its role in the therapy for NIDDM and I DDM is clearly distinct.