Glycemic Control With Physical Training in Insulin-Dependent Diabetes Mellitus

Physical exercise has long been a cornerstone in the management of diabetes mellitus based on its potential to improve metabolic control and to diminish risk factors for atherosclerotic vascular disease common in older diabetic persons.¹⁻³Participation in physical activity may also have psychosocial benefits in improving selfesteem and feelings of well-being, which are especially important in patients with chronic disease.⁴ Efforts to document the physiologic responses to exercise in patients with diabetes mellitus have only recently been successful. The recognition that serum glycosylated hemoglobin (HbA₁) levels provide a valid marker of metabolic control⁵,⁶and the use of euglycemic clamp techniques in determination of insulin sensitivity⁷have allowed new insights into the diabetesexercise relationship. These studies have indicated differences in type 1 (insulin-dependent) and type 2 (adultonset) diabetic patients and have also separated alterations in metabolic status created by short-term exercise from those resulting from physical