The importance of diet and exercise in the management of diabetes

During the latest Alberta Diabetes Institute (ADI) webinar in celebration of the 100th anniversary of insulin discovery, ADI members and experts in nutrition and exercise therapy, Catherine Chan and Norman Boule, discussed the advancements and the important contributions by Alberta researchers and ADI members in this field.

During the latest Alberta Diabetes Institute (ADI) webinar in celebration of the 100th anniversary of insulin discovery, ADI members and experts in nutrition and exercise therapy, Catherine Chan and Norman Boule, discussed the advancements and the important contributions by Alberta researchers and ADI members in this field.

Diet and exercise are two of the main pillars used to manage diabetes. As mentioned by the speakers, using diet to treat diabetes can be traced back to ancient times. In ancient Egypt, a whole-grain diet was prescribed, while exercise has been prescribed worldwide for centuries, alone or in combination with diet. In the 20th century, diabetes was officially recognized as a metabolic disorder, and diet and exercise continue to play an important role in diabetes management.

Here are the main points discussed in this webinar.

Positive effects of lifestyle interventions

Lifestyle-intervention studies show that both nutritional and exercise therapy have a positive effect in reducing blood glycated hemoglobin (HbA1c), which is linked to diabetes complications. The same studies show a reduction in the number of individuals with pre-diabetes developing Type 2 diabetes (T2D) in the future, reduced medication dosage and improved quality of life. Despite challenges such as low adherence, followup studies show a sustained effect of lifestyle interventions in preventing diabetes over the long term.

Alberta-based studies on diet and exercise therapy in diabetes

Alberta-based studies—many funded by the ADI and conducted at the University of Alberta—have made great contributions to the nutritional and physical-activity research in  diabetes. These studies have investigated the impact of different nutrients and food matrix on diabetes; the impact of food substitution on cardiovascular risks and diabetes; and the use of meal plans (such as the  Pure Prairie Eating Plan), in collaboration with the Primary Care Network and Inuit First Nations. On the exercise front, Alberta studies have investigated physical activity in patients who received islets transplantation; the combination of antidiabetic drug metformin  and exercise; and physical activity in gestational diabetes. All these studies are conducted as an attempt to reverse diabetes and improve its management and patients’ quality of life.

Evidence-based recommendations

As contributing authors in the Diabetes Canada Clinical Practice Guidelines, Chan and Boule discussed the evidence-based changes that have occurred in the nutrition and physical activity guidelines.

While the first edition of the nutrition therapy guidelines recommended reducing fat and spacing carbohydrate intake, nowadays the recommendations are focused on the flexibility of macronutrient distribution and not on individual nutrients. In addition, patients’ preferences and goals are now taken into consideration, to increase adherence to the guidelines. While exercise therapy was not originally recommended for Type 1 diabetes (T1D) management, today recommendations suggest general physical activity and less sedentary time  for management of both T1D and T2D. The current guidelines also present strategies to support behaviour changes and reduce risks associated with exercise in patients with diabetes.

A new era of diabetes management 

Precision health is changing the way diseases are treated and precision nutrition holds the promise to improve diabetes management. For example, food design may help, with scientifically designed foods for patients with T2D. Moreover, sustainable food production will have an impact on the future of nutrition guidelines, while new technologies will better support diabetes self-management. 

Although currently much treatment is focused on behavioural changes,  health-care professionals should make sure to consider the impact of factors in the patients’ nonmedical background—mental health, finances and family, for example—when planning treatment.