Can diabetes be reversed?

 What is diabetes?

Diabetes is a chronic health condition which occurs when there is too much glucose within the blood. Either the body is unable to make insulin, make enough insulin or the body is unable to effectively use the insulin that it does make to lower or maintain our blood glucose levels within normal readings. The three different types of diabetes include type II, type I and gestational.

It is currently estimated that more than 415 million individuals around the world have diabetes, with >90% of these individuals having type II. Staggeringly, this number is expected to increase by more than 50% by 2040. However, fortunately research has demonstrated that exercise can be used as an effective tool to assist with the management of diabetes.

Whilst type II diabetes cannot be cured, individuals can have their glucose levels return to non-diabetic range (complete remission) or pre-diabetes glucose levels (partial remission). The main mechanism for achieving remission is by achieving significant weight loss. It is thought that weight loss results in increased insulin sensitivity through a reduction of inflammation, improved adipocyte function, reduced oxidate stress, reduced endoplasmic reticulum stress and improved genetic make-up.

Exercise and diabetes

Traditionally, exercise advice has mainly focused on aerobic activity. Aerobic exercise includes walking, running, swimming, bike riding and rowing. These exercises are of lower-intensity and can therefore be undertaken for longer periods of time, which can contribute to both lowering blood glucose and can increase energy expenditure which can aid in weight loss.

However, more recently, an exercise type known as high-intensity interval training (HIIT) has shown promising benefits for acutely lowering blood glucose levels. High intensity interval training consists of short bursts of high intensity exercise interspersed with recovery periods. A common way of prescribing HIIT is known as the 4:4 method. This method involves completing 4 minutes of aerobic exercise at a low intensity which is then followed by 4 minutes of aerobic exercise at a high intensity. The intensity of exercise is alternated within this manner until a total of 16 minutes of aerobic exercise has been completed.

The recommendations for achieving weight loss through aerobic exercise is to complete 300 minutes per week of moderate intensity activity, or 150 minutes per week of vigorous activity or a combination of both. In addition, exercise durations of greater than 150 minutes per week are associated with a HbA1c reduction of 0.89%, compared to those of less than 150 minutes per week which were only associated with a HbA1c reduction of 0.36%. HbA1c is a measure of your average blood glucose reading over the previous 3 months. For people with diabetes, it is recommended that the HbA1c reading is below 7%.

Furthermore, resistance exercise can also have acute benefits in terms of insulin sensitivity and can increase lean body mass. Resistance exercise can also help to increase functional capacity, which can be important for those wanting to maintain independence. Meeting these recommendations are also linked to improvements in all-cause mortality, reduction in the incidence of breast / colon cancer, reduced blood pressure and improved mood, sleep, and physical function. 

The bottom line
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Ultimately, exercise plays a crucial role in the management of diabetes. Whilst diabetes cannot be reversed there are numerous benefits for those who participate in regular exercise. If people cannot meet the guidelines for exercise and diabetes there is still an abundance of health benefits that can be achieved by working towards these recommendations. 

Author - Rebecca Dostan

References

1. Lumb, A 2014, ‘Diabetes and exercise’, Clinical Medicine (London, England), vol. 14, no. 6, pp. 673–676.
2. Taylor, R 2021, ‘Type 2 diabetes and remission: practical management guided by pathophysiology’, Journal of Internal Medicine, vol. 289, no. 6, pp. 754–770.
3. Wondmkun, YT 2020, ‘Obesity, Insulin Resistance, and Type 2 Diabetes: Associations and Therapeutic Implications’, Diabetes, Metabolic Syndrome and Obesity, vol. 13, pp. 3611–3616.
4. Acala, JJ, Roche-Willis, D & Astorino, TA 2020, ‘Characterizing the Heart Rate Response to the 4 × 4 Interval Exercise Protocol’, International Journal of Environmental Research and Public Health, vol. 17, no. 14, pp. 5103-.
5. Exercise is Medicine 2024, Type 2 Diabetes and exercise, Exercise is Medicine, viewed 18 June 2024, <2014-T2DM-FULL-v2.pdf (secureserver.net)>.