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The Role of Exercise in Managing Type 2 Diabetes: A Review of its Effectiveness over Medication
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Type 2 diabetes is one of the most common lifelong diseases which restrict the function of insulin hormone within the body. In simpler terms, type 2 diabetics are insulin resistant. There are different factors which may cause diabetes within a person like genetic disorder, obesity, beta cell damage and different metabolic syndrome. There is no cure to this disease however; proper medication and practices are able to control the outcomes. Apart from continuous medication, physical exercises are often suggested to the T2D patients by the physicians. Considering these fundamentals of diabetes, this literature review is headed to analyse the impact of exercise on managing T2D over glycemic medications and nurses and midwives can play a major role in this case as well. In this regard the following research question has been developed by the researchers here.
"Does exercise improve blood glucose levels in type 2 diabetics more effectively than glycemic medication?”
Prevalence of type 2 diabetes
Type 2 diabetes is considered as a global burden of diseases based on the prevalence of this disease worldwide. This rising burden is developing a major concern for healthcare management globally. As per the forecast of 2017, the prevalence of this disease was 6059 per 100000 people (AIHW, 2020). It was identified that around 462 million individuals globally were affected by this disease which is similar to 6.28% of the world’s population. To be very specific, 4.4% of these people are between 15 to 49 years old, 15% are between 50 to 69 years old and 22% of them are aged more than 70 years (AIHW, 2020). This disease has been identified to be the 9th leading cause of mortality globally causing 1 millions of deaths every year. The prevalence rates are increasing rapidly in developed countries like Western Europe.
In Australia the rate is 7060 per 100000 people. As per the data of 2018, 11% deaths in Australia were caused by Diabetes. 1.2 million Australians, which is 4.9% of the overall population, are suffering from Type 2 Diabetes (AIHW, 2020). In this case, access to treatment and health consultation is a major element as well. It can be seen that the rate of deaths and hospitalisation due to diabetes are two-times higher in remote areas in comparison to the Major cities.
Role of exercise in managing blood glucose levels in comparison to glycemic medication
T2D is one of the major healthcare concerns globally based on the rate of prevalence of this disease. Though this disease is not curable, it has been identified that self management is one of the most important things in case of controlling the outcomes of the disease. The major concern behind T2D treatment is to reduce the blood sugar level. Different types of drugs are prescribed to the patients. Aim of these medications is to stimulate the pancreas so that it can produce and release more insulin which is the key hormone to control blood glucose level (Mayo clinic, 2022). Apart from that, glucose release from the liver is also inhibited by these drugs.
Blocking stomach enzymes to digest carbohydrates, improving cell sensitivity to manage insulin, slowing down the movement of food through the stomach and inhibiting the kidney from re-absorption of glucose are some major roles of glycemic drugs as well (Mayo clinic, 2022). These medications are used for controlling the blood glucose levels within the diabetic patients. However, there are some severe side effects of these medications as well. Some of the common and initial side effects of this treatment are gas, nausea, diarrhoea, bloating, upset stomach and B12 deficiency (Liao, 2022). Metformin is one of the most common medicines for T2D. This case cause lactic acidosis in case of long term intake.
However, on the other hand, one of the most secure and feasible treatments for controlling T2D is physical exercises. As stated by Khan et al., (2020), physical activities are the key aspects to manage and prevent T2D. Participation in daily exercise can control the blood glucose level and it can even prevent from having the disease. Apart from T2D other aspects which may be associated with T2D like, blood pressure, lipid level, quality of life and cardiovascular functions can be managed and controlled through regular exercise. Obesity has been identified as one of the major elements to be associated with T2D. Thus it can be stated that the rate of obesity can be managed through this practice as well. Physical activity is used for weight loss as well. As opined by Wake (2020), weight loss can reduce the risk of T2D by 58% in the case of the population who are at high risk. Effectiveness of exercise has been identified to have acute and chronic improvement of the insulin production and release.
Fuel metabolism: It has been identified that fuel metabolism, muscle glycogenolysis and glucose productions can be managed and controlled by exercise. This practice increases the glucose uptake in the active muscles and is generally balanced by hepatic glucose production. This has a greater resilience in case of carbohydrate to fuel the activities of muscles. Glucose uptake within the muscles can happen through both insulin dependent and insulin independent ways. During the resting period the glucose uptake is generally caused in an insulin dependent way (Karstoft & Pedersen, 2016). On the other hand, during exercise the glucose uptake level increased and it happened through an insulin-independent way. Thus, exercise can help in managing the blood glucose level in lack of insulin in case of T2D as well.
Glycemic control: In case of a normal healthy person, an exercise with moderate intensity influences the peripheral glucose uptake level along with production of hepatic glucose. Thus the blood glucose level do not change if the person is not going through glycogen depleting exercise, in case of type 2 diabetics, if the person is having moderate rate of exercise the muscles start to utilise the blood glucose more and it increase than the formation of hepatic glucose thus the overall glucose level in the blood decreases (Kirwan, Sacks & Nieuwoudt, 2017). On the other hand, in this process the plasma insulin level falls as well.
Insulin resistance: Acute exercise has been identified to change the insulin resistance in the muscle also. Most of the patients with acute exercise have experienced change in their insulin level followed by blood glucose level.
Apart from the acute exercise and training, the chronic exercise also helps in metabolic control, insulin levels and blood glucose levels. In this case aerobic training is suggested to the patients for improving their whole-body insulin level. In this way insulin sensitivity increases without any side effects to the patient. Apart from that, such training increases the storage of lipids in the muscles and fat oxidation capacity as well.
Challenges faced to manage blood glucose level through exercise
There are some factors which should be considered as a challenge for the glycemic patients to go through physical exercise. In most of the cases, patients are suggested with a low to moderate rate of physical exercise. High intensity exercises can lead to acute complications included with hyperglycemia, hypoglycemia and cardiac issues (Pan et al., 2018). However, in the case of a low to moderate rate of exercise these risks are low. Prevention and control of type 2 diabetes can be done best through physical exercise without having any side effects. However, in most of the cases patients are not even aware about the importance of exercise and its impact on diabetes control. Lack of health education is the major issue in this case. Apart from that, if the patient is not doing the exercise properly, it may cause some severe muscle damage having adverse effects (Karstoft & Pedersen, 2016). Hence, slack of guidance and lack of enough healthcare education are some major challenges in case of exercise among the glycemic patients.
Role of nurses and midwives
In the case of healthcare management nurses and midwives can play a major role. In this case healthcare promotion is an important aspect. Nurses are the front figures of healthcare promotion. The three major areas where nurses can contribute to the management of the blood glucose levels are included with coaching techniques, behavioural change therapy and prevention advice (RCN, 2022). Based on the condition of the patients, proper exercise should be suggested to the patients with diabetes. High intensity exercises can be lethal for the patients with high blood pressure or any muscle sores. Hence, the health conditions and other vitals of the patients must be checked before suggesting any exercise for diabetes management. Apart from that, nurses have some major role in providing healthcare education among the diabetic patients. The importance of exercise over medicines can be taught to the patients (Pham & Ziegert, 2016).
They are able to motivate and guide the patients with the right exercise to manage the diabetes level. Self management and self care is effective for managing the outcomes of diabetes as well. This can significantly reduce the mortality rate and global prevalence. Another major reason behind diabetes formation is mental health issues among the patients (RCN, 2022). Nurses can have a significant role in increasing awareness among people regarding mental stress and other mental health conditions. Health care education can be promoted for self screening, prevention and early signs of T2D. Diet and nutrition is a key factor in controlling diabetes among the people. In this regard, nurses can look after the nutritional uptake of the patients and can guide them with proper diet.
Literature gap
The major gap identified in this literature review is included with lack of information regarding the exercise for the patients with type 2 diabetes. All the health conditions are not suitable for physical exercise for managing T2D. Hence, the overall body check-up and checking the vitals of the patients is important before suggesting any exercise as this can be risky in the presence of elath conditions like high blood pressure. Apart from that, there are some other supporting elements like diet to be considered along with exercise to manage T2D, which are missing in this literature review.
Conclusion
This literature review has focused on the impact of exercise instead of glycemic medications in terms of managing the blood glucose level. This literature review has discussed the prevalence of type 2 diabetes globally which has become a global burden of disease. The major focus of this study was on the impact of exercise to manage type 2 diabetes instead of glycemic medication. It has been identified that physical exercises are effective for managing outcomes of type 2 diabetes significantly without any side effects. In this case nurses can play a major role in educating the people and increase self care awareness to manage mortality and hospitalisation rate due to this disease.
