Diagnostic criteria for diabetes and exercise intervention: A comprehensive rehabilitation pathway from blood glucose monitoring to scientific fitness.
There are various methods for testing diabetes, but blood glucose is the only reliable diagnostic indicator. Diagnosing diabetes solely based on urine glucose results without checking blood glucose is inaccurate. Generally, postprandial blood glucose is more sensitive than fasting blood glucose. In diagnosing diabetes, blood glucose 2 hours after a meal is even more important than fasting blood glucose. Therefore, a diagnosis of diabetes cannot be ruled out based solely on a normal fasting blood glucose level.
The process of glucose intolerance can be divided into three stages: the high-risk group stage, the hyperglycemic stage, and the clinical diabetes stage. The high-risk group refers to individuals with normal blood glucose and glucose tolerance who are prone to developing diabetes; they are the key population for diabetes prevention. Hyperglycemia refers to elevated fasting blood glucose, such as impaired fasting glucose (IFG) or elevated 2-hour postprandial blood glucose (IGT), but not meeting the diagnostic criteria for diabetes. This predisposed population is of paramount importance for preventing the onset of diabetes. Clinical diabetes patients, on the other hand, face the challenge of treatment.
Fasting blood glucose testing is crucial, as it reflects blood glucose levels at baseline without dietary intake, indicating the patient's own insulin secretion capacity. Postprandial blood glucose testing provides insight into diabetes control. Compared to fasting blood glucose, postprandial blood glucose testing more easily pinpoints the timing of hyperglycemia, allowing for timely medication and mealtime adherence based on postprandial blood glucose results, and also reflects consistent blood glucose control. Therefore, postprandial and fasting blood glucose testing are equally important for diabetic patients and should be combined.
Comprehensive treatment for diabetes includes appropriate physical exercise, reasonable dietary control, medication, health education, and psychological counseling. Appropriate physical exercise is one of the important measures in treating diabetes.
The effectiveness of exercise intervention in the rehabilitation of type 1 diabetes has been widely debated. Currently, it is believed that exercise intervention is effective for type 1 diabetes patients with well-controlled blood sugar and no significant complications, but care should be taken to prevent hypoglycemia during its implementation. Hypoglycemia is related to factors such as increased muscle utilization of glucose, decreased hepatic glycogen transport capacity, reduced exogenous insulin availability, and decreased sensitivity of insulin receptors in muscles. Furthermore, muscles produce insulin-like peptides during exercise, which can increase the probability of hypoglycemia. Exercise and insulin have a synergistic effect; type 1 diabetes patients can appropriately reduce insulin dosage while slightly increasing their energy intake during exercise.
The effects of exercise intervention on type 2 diabetes are mainly manifested in: regulating glucose metabolism and lowering blood sugar. Studies have confirmed that endurance exercise can increase the utilization of glucose by muscle tissue and increase calorie expenditure. Exercise promotes the direct uptake of blood glucose by skeletal muscle, thus lowering blood sugar. Exercise continuously consumes muscle glycogen and liver glycogen, alleviating hyperglycemia. After exercise, blood glucose is converted into glycogen for storage, resulting in a sustained decrease in blood sugar.
Enhances insulin sensitivity. Type 2 diabetes is often accompanied by obesity, insulin resistance, and hyperinsulinemia. Exercise can reduce weight; in obese patients, insulin secretion decreases during exercise, while insulin binding to receptors increases, improving insulin sensitivity, reducing insulin resistance, and thus improving glucose metabolism. Controls obesity and lowers blood lipids. Increased energy expenditure during exercise can reduce excess body fat and improve abnormally high blood lipids.
Exercise can delay the onset and progression of diabetic complications. During exercise, respiratory and circulatory functions are enhanced, blood flow is accelerated, capillaries dilate, vascular tension decreases, and oxygen supply increases, playing a certain preventive role in the development of diabetic cardiopulmonary complications. In conclusion, the therapeutic effect of exercise intervention on type 2 diabetes has been widely and consistently recognized.