As a practice, American Diabetes Association (ADA) annually reviews and updates its guidelines at the beginning of each year with a focus on improving the care of people with diabetes.

Recently, ADA published updated recommendations and precautions about physical activity and exercise in people with type 1 diabetes, type 2 diabetes, and gestational diabetes.

The updates refer to few key changes made to the existing document.

The fear of hypoglycemia, loss of glycemic control, and inadequate evidence based recommendations around exercise management of patients with diabetes are some of the major barriers of diabetes care. This article summarizes the important changes and the updates by the ADA for recommending exercise regimens for patients with diabetes.

Health screening and evaluation before exercise

To mitigate the possible complications and obtain the maximum benefits of exercise, certain changes have been made in the pre-exercise health screening and evaluation which are as follows:

• For asymptomatic sedentary individuals, pre-exercise medical clearance is not required to begin low to moderate intensity exercises.
• For adults with diabetes and high risk of cardiovascular disease, pre-exercise clearance from the physician is required to perform high intensity exercises.

Recommendations on physical activity/exercise

Exercise is a more planned and structured form of physical activity which will help in an effective blood glucose management. The risk of hypoglycemiaand other severe consequences can be minimized by monitoring the blood glucose levels regularly and varying the order of activities accordingly.

• Aerobic exercises

Adults with type 1 or type 2 diabetes should consider a moderate to vigorous aerobic activity for at least 150 minutes or more weekly.To maintain higher levels of insulin sensitivity, there should be no elapse of more than 2 days between the activities.Moderately exercising adults with type 2 diabetes can practice High Intensity Interval Training (HIIT) under supervision which results in greater insulin sensitivity.

• Resistance exercises

On non-consecutive days, 2-3 sessions per week of resistance exercise using various strength training modalities can be recommended for all adults.

• Flexibility and balance exercises

Flexibility exercises have been included for all ages to enhance the movement around the joints.And, balance exercises such as lower body and core strengthening exercises have been included for adults to prevent falls and improve gait.
 

Key Updates- ADA Guidelines-2017

The new updates address psychosocial issues in all aspects of diabetes care including self-management, mental health, communication, complications, comorbidities, and life-stage considerations. The revised standards of care made by ADA for 2017 as compared to the previous year are as follows:

• It is recommended that for all diabetic patients, diabetes self management education (DSME) should be provided.
• Diabetic patients should be assessed and addressed for the mental conditions such as depression, anxiety and bipolar disorder.
• The diabetic patients are recommended to avoid prolonged sitting and include short periods of light intensity activities every 30 minutes.
• The significance of physical activities that maintain flexibility and balance in older adults with diabetes has been included.
• It also suggests that sleep assessment should be recommended for the patients with diabetes as an abnormal sleep pattern is associated with a poor glycemic control.
• The new assessment criteria for screening the prediabetes were included.
• Use of insulin instead of metformin and glyburide is recommended in pregnant women with diabetes as there is no evidence of long-term safety data for oral antidiabetics.
• A recommendation has been made on testing for persistent diabetes in women with gestational diabetes after 4 to 12 weeks postpartum.
• In diabetic patients with cardiovascular disease, prescription of empagliflozin or liraglutide should be considered as these drugs have been proved to reduce cardiovascular and all-cause mortality rate.
• For patients with type 2 diabetes, a recommendation has been added on combination injection therapies which include basal insulin plus GLP-1 receptor agonist, and basal insulin plus rapid-acting insulin.
• A recommendation of periodic assessment and supplementation of vitamin B12 levels has been included to overcome metformin induced B12 deficiency.
   

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  Managing health complications

  Postprandial hyperglycemia can be lowered by increasing daily movement. For older adults, increased daily movement should be recommended as it is a good point to start from the lowest possible exercise.Sedentary activities and prolonged sitting should be interrupted by light walking or slight stretching activities to improve the overall glycemic levels.

  Keeping the blood glucose levels in control is essential to prevent numerous complications such as renal failure, nerve pain and electrolyte imbalance.These comprehensive guidelines focusing on the importance of exercise in diabetic people have been framed to help physicians assist the individuals leading a healthy life.