In this podcast, I’m going to talk about the importance of 24-hour physical behaviors for people living with type 2 diabetes, as discussed in a joint consensus report by the American Diabetes Association and the European Association for the Study of Diabetes that covered the management of hyperglycemia in type 2 diabetes and was updated during 2022.
Notably, this consensus recommends that weight loss of at least 5% should be a key initial goal for most individuals living with type 2 diabetes who are also living with overweight or obesity. Moreover, this consensus gives weight loss equal precedence to reducing blood glucose levels for managing type 2 diabetes: a significant shift away from the glucocentric approach to the management of type 2 diabetes over the years.
We are reminded that 5%-10% weight loss confers significant cardiometabolic benefits and that 10%-15% weight loss, especially soon after diagnosis of type 2 diabetes, can have a disease-modifying effect and lead to remission of type 2 diabetes. I am going to focus on the recommendations within the consensus that reinforce that all physical activities within a 24-hour period can have an important impact on improving cardiometabolic health in people living with type 2 diabetes and reduce the risk for complications.
The consensus highlights that breaking up prolonged sitting, stepping, sweating (or moderate-to-vigorous activity), strengthening exercises, and even sleep (the so-called five S’s) all have a positive effect on cardiometabolic health in people living with type 2 diabetes. As I always remind my patients, the first step in healthcare is self-care, and as healthcare professionals, we must educate before we medicate.
Let’s start with sitting or, specifically, breaking up prolonged sitting. The consensus sensibly reminds people living with type 2 diabetes to break up prolonged sitting every 30 minutes with short, regular bouts of slow walking or simple resistance exercises. It’s well established that a sedentary lifestyle is associated with adverse cardiometabolic risk profiles and a higher incidence of type 2 diabetes.
A randomized crossover trial published during 2021 found that, in adults with medication-controlled type 2 diabetes, interrupting prolonged sitting with 6 minutes of simple resistance exercises — such as calf raises or mini squats every 60 minutes — significantly reduced postprandial glucose and insulin responses. Now, many are calling sitting the new smoking. Whilst the evidence base doesn’t quite back this up, it is a snappy way to relay to our patients the harmful effects of a sedentary lifestyle.
Next, sweating or moderate-to-vigorous activity. The consensus encourages over 150 minutes of moderate-intensity physical activity or over 75 minutes of vigorous-intensity activity, per week spread over at least three days a week, with no more than two consecutive days of inactivity. Ideally, this should be supplemented with two to three sessions of resistance, flexibility, or balance exercises.
Now, I appreciate that this will be aspirational for many of our patients, but we are reminded that as little as 30 minutes of moderate-intensity physical activity a week improves cardiometabolic profiles. Even 10 minutes of moderate physical activity three times a week has beneficial effects, which is a much more realistic and achievable initial goal for our patients with more sedentary lifestyles.
Furthermore, a systematic review and network analysis published during 2018 found that regular aerobic exercise training improves glycemic management in adults living with type 2 diabetes, with less daily time in hyperglycemia, 6-8 mmol/mol reductions in A1c, and significant benefits in cardiorespiratory fitness. Regular aerobic exercise has similar glucose-lowering potency, compared with a DPP-4 inhibitor or gliptin: another great sound bite for people living with type 2 diabetes.
Next, stepping. Now, walking 10,000 steps daily is exercise lore and is recommended by many as a core activity to maintain our physical and mental well-being. Wearable fitness trackers are well entrenched in modern society and often routinely set 10,000 steps as a daily activity target. However, did you know this concept of 10,000 daily steps is not evidence-based and was actually created as part of a very successful marketing campaign for a pedometer sold shortly after the Tokyo Olympics back in 1964? The device was called Manpo-Kei, which translates into English as “10,000 step meter.” The Japanese character for 10,000 looks like a person walking, which is thought to be how the number was chosen.
However, a prospective cohort study published during 2022 has now provided an evidence base for the cardiometabolic benefits of 10,000 steps daily and above. Notably, the study also concluded that there is no minimum step count associated with morbidity and mortality benefits, which is an important message to relay to our patients.
Daily step goals should be individualized to ensure that they remain realistic and achievable. What the consensus usefully tells us is that for people living with type 2 diabetes, an increase of just 500 steps per day is associated with a 2%-9% reduced risk of cardiovascular morbidity and all-cause mortality. And even better, a 5- to 6-minute brisk-intensity walk per day equates to around 4 years’ greater life expectancy: yet another great sound bite for people living with type 2 diabetes.
Next, strengthening. The consensus informs us that simple resistance exercises, really any activity that uses the person’s own body weight or works against a resistance, such as a weight or a resistance band, can improve insulin sensitivity and glucose levels. Bicep curls using a pair of light weights or any household items that can be comfortably held in one hand, such as tin cans, are also good strengthening exercises. Bicep curls can also be done standing or sitting. For older individuals or people with mobility issues, chair exercises such as leg lifts can be very effective.
Finally, sleep, the last of the five S’s. An average person incredibly spends around 26 years sleeping throughout their lives, for an activity that takes up to a third of our lives. Sleep receives relatively less attention than it deserves. The adverse cardiometabolic effects of poor-quality sleep and poor-quantity sleep are increasingly being recognized.
The consensus tells us that people living with type 2 diabetes should aim for consistent uninterrupted sleep even on the weekends. Specifically, long sleep duration of over 8 hours and short sleep duration of less than 6 hours can both negatively impact A1c levels. Furthermore, quality of sleep is important.
Irregular sleep also adversely impacts glycemic levels. Poor sleep quality in people living with type 2 diabetes is often due to an increased prevalence of conditions such as insomnia, obstructive sleep apnea-hypopnea syndrome, and restless leg syndrome. These conditions are underdiagnosed in primary care in people living with type 2 diabetes.
Finally, chronotype is important. Now, your chronotype is your natural inclination about when you prefer to go to sleep. This inclination also impacts glycemic levels. Night owls, or those who go to bed late and get up late, are more susceptible to inactivity and suboptimal glycemic levels than early birds, who go to bed early and get up early.
However, sleep problems are increasingly common in the whole population and often linked to the pressures of modern life. I appreciate that it’s just not realistic for many people living with type 2 diabetes to get consistent, uninterrupted sleep due to stress, work commitments such as working late or shift working, or having young families.
In conclusion, we must stress the importance of 24-hour physical behaviors to all people living with type 2 diabetes. The five S’s (breaking up prolonged sitting, stepping, sweating or moderate-to-vigorous activity, strengthening exercises, and sleep) all have a positive effect on cardiometabolic health in people living with type 2 diabetes.
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Any views expressed above are the author's own and do not necessarily reflect the views of WebMD or Medscape.
Cite this: Improving Cardiometabolic Health in Type 2 Diabetes - Medscape - Sep 26, 2025.
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