Interventions for Being Active Among Individuals with Diabetes

A Systematic Review of the Literature

Jan Kavookjian, PhD, MBA, Betsy M. Elswick, PharmD and Tara Whetsel, PharmD From the Department of Pharmacy Care Systems, Harrison School of Pharmacy, Auburn, Alabama (Dr Kavookjian), and the Clinical Pharmacy Department, West Virginia University School of Pharmacy, Morgantown (Dr Elswick, Dr Whetsel).

Correspondence to Jan Kavookjian, PhD, MBA, Department of Pharmacy Care Systems, Harrison School of Pharmacy, 128 Miller Hall, Auburn, AL 36849-5501 (kavooja@auburn.edu).

Purpose

The purpose of this systematic review is to assess and summarize evidence and gaps in the literature regarding the intervention for being active (exercise) among individuals with diabetes.

Methods

Twelve electronic databases were searched. Publications eligible for inclusion specifically studied learning, behavioral, clinical, and humanistic outcomes for exercise interventions in adult patients with type 1 and type 2 diabetes.

Results

Seven reviews (2 systematic reviews, 3 meta-analyses, 2 technical reviews) and 34 individual, nonreview studies (18 randomized controlled trials, 16 nonrandomized trials) met inclusion criteria. For type 2 diabetes, findings suggested that exercise had a positive effect on glycemic control and decreased cardiovascular risk, but the impact of exercise on behavioral and humanistic outcomes was unclear; long-term outcomes and adherence to exercise interventions is unknown because most studies were of short duration. The overall impact of varied types of exercise in type 1 diabetes was unclear, especially regarding glycemic control. Potential benefits of exercise in type 1 may include improved cardiovascular health.

Conclusion

The review did not identify specific successful intervention details because of the heterogeneity of studies, subjects, and research gaps. General findings suggest that physical activity is better than no exercise at all; intensive regimens, if tolerated by patients, achieved better clinical outcomes than less intensive regimens. Reviewed studies using structured exercise regimens exhibited a more significant impact on outcomes. Substantial gaps in the literature include studies measuring direct effects of exercise in the US minority populations most affected by type 2 diabetes and economic evaluations of exercise interventions. Interventions must be tailored to individual patient needs to succeed.

Link to full-text version of the review in The Diabetes Educator journal