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Although our meta-analysis had a limited sample size, increasing exercise intensity safely accentuated reductions in HbA1c in some people with type 2 diabetes. Different approaches have been used to increase exercise intensity (i.e., some used interval training, whereas others used higher-intensity continuous exercise). However, at this time, it is unclear which form, if any, leads to the most favorable results.

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BackgroundBetter understanding of the relationship between obesity and postsurgical adverse outcomes is needed to provide quality and efficient care. We examined the relationship of obesity with the incidence of early adverse outcomes and in‐hospital length of stay following coronary artery bypass grafting surgery.Methods and ResultsWe analyzed data from 7560 patients who underwent coronary artery bypass grafting. Using body mass index (BMI; in kg/m2) of 18.5 to 24.9 as a reference, the associations of 4 BMI categories (25.0–29.9, 30.0–34.9, 35.0–39.9, and ≥40.0) with rates of operative mortality, overall early complications, subgroups of early complications (ie, infection, renal and pulmonary complications), and length of stay were assessed while adjusting for clinical covariates. There was no difference in operative mortality; however, higher risks of overall complications were observed for patients with BMI 35.0 to 39.9 (adjusted odds ratio 1.35, 95% CI 1.11–1.63) and ≥40.0 (adjusted odds ratio 1.56, 95% CI 1.21–2.01). Subgroup analyses identified obesity as an independent risk factor for infection (BMI 30.0–34.9: adjusted odds ratio 1.60, 95% CI 1.24–2.05; BMI 35.0–39.9: adjusted odds ratio 2.34, 95% CI 1.73–3.17; BMI ≥40.0: adjusted odds ratio 3.29, 95% CI 2.30–4.71). Median length of stay was longer with BMI ≥40.0 than with BMI 18.5 to 24.9 (median 7.0 days [interquartile range 5 to 10] versus 6.0 days [interquartile range 5 to 9], P=0.026).Conclusions BMI ≥40.0 was an independent risk factor for longer length of stay, and infection was a potentially modifiable risk factor. Greater perioperative attention and intervention to control the risks associated with infection and length of stay in patients with BMI ≥40.0 may improve patient care quality and efficiency.

Exercise has repeatedly been shown to improve glycemic control as assessed by glycated hemoglobin. However, changes in glycated hemoglobin do not provide information regarding which aspects of glycemic control have been altered. The purpose of this systematic review was to examine the effect of exercise as assessed by continuous glucose monitoring systems (CGMS) in type 2 diabetes. Databases (PubMed, Medline, EMBASE) were searched up to February 2013. Eligible studies had participants with type 2 diabetes complete standardized exercise protocols and used CGMS to measure changes in glycemic control. Randomized controlled trials, crossover trials and studies with pre-post designs were included. Average glucose concentration, daily time spent in hyperglycemia or hypoglycemia, and fasting glucose concentration were compared between exercise and control conditions. Eleven studies met the inclusion criteria and were included in the review. Eight studies had short-term (≤2 weeks) exercise interventions, whereas three studies had a longer-term intervention (all >2 months). The types of exercises utilized included aerobic, resistance and a combination of the two. The eight short-term studies were included in quantitative analysis. Exercise significantly decreased average glucose concentrations (-0.8 mmol/L, p < 0.01) and daily time spent in hyperglycemia (-129 minutes, p < 0.01), but did not significantly affect daily time spent in hypoglycemia (-3 minutes, p = 0.47) or fasting glucose (-0.3 mmol/L, p = 0.13). The four randomized crossover trials had similar findings compared to studies with pre-post designs. Exercise consistently reduced average glucose concentrations and time spent in hyperglycemia despite not significantly affecting outcomes such as fasting glucose and hypoglycemia.

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Aim. To explore the factors associated with exercise-induced acute capillary glucose (CapBG) changes in individuals with type 2 diabetes (T2D). Methods. Fifteen individuals with T2D were randomly assigned to energy-matched high intensity interval exercise (HI-IE) and moderate intensity continuous exercise (MI-CE) interventions and performed a designated exercise protocol 5 days per week for 12 weeks. The duration of exercise progressed from 30 to 60 minutes. CapBG was measured immediately before and after each exercise session. Timing of food and antihyperglycemic medication intake prior to exercise was recorded. Results. Overall, the mean CapBG was lowered by 1.9 mmol/L (P < 0.001) with the change ranging from −8.9 to +2.7 mmol/L. Preexercise CapBG (44%; P < 0.001), medication (5%; P < 0.001), food intake (4%; P = 0.043), exercise duration (5%; P < 0.001), and exercise intensity (1%; P = 0.007) were all associated with CapBG changes, explaining 59% of the variability. Conclusion. The greater reduction in CapBG seen in individuals with higher preexercise CapBG may suggest the importance of exercise in the population with elevated glycemia. Lower blood glucose can be achieved with moderate intensity exercise, but prolonging exercise duration and/or including brief bouts of intense exercise accentuate the reduction, which can further be magnified by performing exercise after meals and antihyperglycemic medication. This trial is registered with ClinicalTrial.gov NCT01144078.