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emphasize a relatively fixed carbohydrate\nconsumption pattern with respect to both\ntime and amount while considering insulin\naction. Attention to resultant hunger andsatiety cues will also help with nutrientmodifications throughout the day (73,221). | [
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Commercially available automated insulindelivery systems still require basic diabetesmanagement skills, including carbohydrateS84 Facilitating Positive Health Behaviors and Well-being Diabetes Care Volume 47, Supplement 1, January 2024\n©AmericanDiabetesAssociation | [
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counting and understanding of the impact\nof protein and fat on postprandial glucose\nresponse (222).\nProtein\nThere is no evidence that adjusting thedaily level of protein intake (typically1–1.5 g/kg body weight/day or 15 –20% | [
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of total calories) will improve health, andresearch is inconclusive regarding theideal amount of dietary protein to opti-mize either glycemic management orCVD risk (203,223). Therefore, protein in-take goals should be individualized basedon current eating patterns. Some re-search has found successful manage-ment of typ... | [
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has found successful manage-ment of type 2 diabetes with meal plansincluding slightly higher levels of protein(20–30%), which may contribute to in- | [
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creased satiety (224).\nHistorically, low-protein eating plans\nwere advised for individuals with diabetickidney disease (DKD) (with albuminuriaand/or reduced estimated glomerular fil- | [
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tration rate); however, current evidencedoes not suggest that people with DKDneed to restrict protein to less than thegenerally recommended protein intake(73). Reducing the amount of dietaryprotein below the recommended daily al-lowance of 0.8 g/kg is not recommendedbecause it does not alter glycemic meas-ures, cardiov... | [
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does not alter glycemic meas-ures, cardiovascular risk measures, or therate at which glomerular filtration rate de- | [
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clines and may increase risk for malnutri-tion (225 –227).\nStrong evidence suggests higher plant\nprotein intake and replacement of animalprotein with plant protein is associatedwith lower risk of all-cause and cardiovas-cular mortality in the Women ’s Health Ini-\ntiative cohort study (228). A meta-analysisof 13 RCTs... | [
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plant proteins leads to small improve-\nments in A1C and fasting glucose in indi-viduals with type 2 diabetes (229). Plantproteins are lower in saturated fat andsupport planetary health (230).\nFats | [
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Fats\nEvidence suggests that there is not an op-timal percentage of calories from fat forpeople with or at risk for diabetes andthat macronutrient distribution should beindividualized according to the individual ’s | [
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eating patterns, preferences, and meta-bolic goals (73). The type of fats con-sumed is more important than totalamount of fat when looking at metabolicgoals and CVD risk, and it is recom-\nmended that the percentage of total calo-ries from saturated fats should be limited(98,129,231 –233). Multiple RCTs including | [
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people with type 2 diabetes have re-\nported that a Mediterranean eating pat-\ntern (95,129,234 –239) can improve both\nglycemic management and blood lipids.The Mediterranean eating pattern is\nbased on the traditional eating habits in\nthe countries bordering the Mediterra-nean Sea. Although eating styles vary bycount... | [
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of common features, including consump-\ntion of fresh fruits and vegetables, wholegrains, beans, and nuts/seeds; olive oil asthe primary fat source; low to moderateamounts of fish, eggs, and poultry; and\nlimited added sugars, sugary beverages,sodium, highly processed foods, re fined\ncarbohydrates, saturated fats, and f... | [
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carbohydrates, saturated fats, and fatty orprocessed meats.\nEvidence does not conclusively support\nrecommending n-3 (eicosapentaenoicacid and docosahexaenoic acid) supple-ments for all people with diabetes for theprevention or treatment of cardiovascular\nevents (73,240,241). In individuals with | [
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events (73,240,241). In individuals with\ntype 2 diabetes, two systematic reviewswith n-3 and n-6 fatty acids concludedthat the dietary supplements did not im-\nprove glycemic management (203,242). In | [
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prove glycemic management (203,242). In\nthe ASCEND (A Study of CardiovascularEvents iN Diabetes) trial, when comparedwith placebo, supplementation with n-3fatty acids at a dose of 1 g/day did not\nlead to cardiovascular bene fiti np e o p l e\nwith diabetes without evidence of CVD | [
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with diabetes without evidence of CVD\n(243). However, results from the Reduc-tion of Cardiovascular Events With Icosa-\npent Ethyl-Intervention Trial (REDUCE-IT)\nfound that supplementation with 4 g/dayof pure eicosapentaenoic acid signi ficantly\nlowered the risk of adverse cardiovascu-\nlar events. This trial of 8,17... | [
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lar events. This trial of 8,179 participants,\nin which over 50% had diabetes, found a5% absolute reduction in cardiovascularevents for individuals with establishedatherosclerotic CVD taking a preexisting\nstatin with residual hypertriglyceridemia\n(135–499 mg/dL [1.52 –5.63 mmol/L])\n(244). See Section 10, “Cardiovasc... | [
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(244). See Section 10, “Cardiovascular\nDisease and Risk Management, ”for\nmore information. People with diabetesshould be advised to follow the guide-lines for the general population for therecommended intakes of saturated fat,\ndietary cholesterol, and trans fat (98).\nTrans fats should be avoided. In addi- | [
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Trans fats should be avoided. In addi-\ntion, as saturated fats are progressivelydecreased in the diet, they should be re-\nplaced with unsaturated fats and notwith re fined carbohydrates (238).\nSodium\nAs for the general population, peoplewith diabetes are advised to limit theirsodium consumption to <2,300 mg/day | [
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(73). Restriction to <1,500 mg, even for\nthose with hypertension, is generally notrecommended (245 –247). Sodium rec-\nommendations should take into accountpalatability, availability, affordability, andthe dif ficulty of achieving low-sodium\nrecommendations in a nutritionally ade-quate eating plan (248,249).\nMicronut... | [
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Micronutrients and Supplements\nD e s p i t el a c ko fe v i d e n c eo fb e n e fitf r o md i -\netary supplements, consumers continueto take them. Estimates show that up to59% of people with diabetes in the U.S.use supplements (250). Without underly-ing de ficiency, there is no benefi tf r o m | [
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herbal or nonherbal (i.e., vitamin or min-eral) supplementation for people with dia-betes (73,251). Federal law in the U.S.broadly de fines dietary supplements as\nhaving one or more dietary ingredients, in-cluding vitamins, minerals, herbs or otherbotanicals, amino acids, enzymes, tissuesfrom organs or glands, or extra... | [
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Routine antioxidant supplementation\n(such as vitamins E and C) is not recom-mended due to lack of evidence of ef fi-\ncacy and concern related to long-termsafety. Based on the 2022 U.S. Preven-tative Services Task Force statement,the harms of b-carotene outweigh the\nbene fits for the prevention of CVD or\ncancer. b-Car... | [
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cancer. b-Carotene was associated with\nincreased lung cancer and cardiovascu-lar mortality risk (253).\nIn addition, there is insuffi cient evidence\nto support the routine use of herbal sup-plements and micronutrients, such as cin-namon (254), curcumin, vitamin D (255),aloe vera, or chromium, to improve glyce-mia in p... | [
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Although the Vitamin D and Type 2\nDiabetes Study (D2d) prospective RCT andDiabetes Prevention and Active Vitamin D(DPVD) showed no signi ficant bene fito fv i -\ntamin D versus placebo on the progressionto type 2 diabetes in individuals at highrisk (257,258), post hoc analyses andmeta-analyses suggest a potential bene fi... | [
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in speci fic populations (257,259 –261).diabetesjournals.org/care Facilitating Positive Health Behaviors and Well-being S85\n©AmericanDiabetesAssociation | [
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Further research is needed to de fine indi-\nvidual characteristics and clinical indica-\ntors where vitamin D supplementationmay be of bene fit.\nMetformin is associated with vitamin\nB12 de ficiency per a report from the Dia-\nbetes Prevention Program OutcomesStudy (DPPOS), which suggests that peri-odic testing of vitam... | [
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be considered in people taking metfor-\nmin, particularly in those with anemiaor peripheral neuropathy (262,263) (seeSection 9, “Pharmacologic Approaches\nto Glycemic Treatment ”). Consumers can\nconsult the U.S. Food and Drug Adminis-tration (FDA) Dietary Supplement Ingredi-\nent Directory to locate information about | [
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ent Directory to locate information about\ningredients used in dietary supplementsand any action taken by the agency withregard to that ingredient (264).\nFor special populations, including preg-\nnant or lactating individuals, older adults,vegetarians, and people following very-low-calorie or low-carbohydrate diets, a | [
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multivitamin may be necessary (265).\nAlcohol\nModerate alcohol intake ingested with\nfood does not have major detrimentaleffects on long-term blood glucose man-agement in people with diabetes. Risksassociated with alcohol consumptioninclude hypoglycemia and/or delayed hy-poglycemia (particularly for those using in- | [
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sulin or insulin secretagogue therapies),\nweight gain, and hyperglycemia (for thoseconsuming excessive amounts) (73,256).People with diabetes should be educatedabout these risks and encouraged to mon-itor glucose frequently after drinking alco-hol to minimize such risks. People with\ndiabetes can follow the same guide... | [
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diabetes can follow the same guidelines as\nthose without diabetes consistent with Die-tary Guidelines for Americans, 2020 –2025\n(98). The available evidence does not sup-port recommending alcohol consumptioni np e o p l ew h od on o tc u r r e n t l yd r i n k( 2 6 6 ) .\nTo reduce risk of alcohol-related harms, | [
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To reduce risk of alcohol-related harms,\nadults can choose not to drink or to drinkin moderation by limiting intake to #2\ndrinks a day for men or #1d r i n kad a yf o r\nwomen (one drink is equal to a12-oz beer, a 5-oz glass of wine, or 1.5 ozof distilled spirits) (266). There is growing\nevidence for psychoeducation... | [
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evidence for psychoeducational interven-\ntions that may increase knowledge aboutalcohol use and diabetes, may enhanceperceived risks, and may reduce alcoholuse among young people with type 1 dia-\nbetes (267).\nNonnutritive Sweeteners\nThe FDA has approved many nonnutritive | [
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Nonnutritive Sweeteners\nThe FDA has approved many nonnutritive\nsweeteners (NNS) for consumption by thegeneral public, including people with dia-betes (73,268). However, the safety androle of NNS continue to be sources of con-cern and confusion for the public (269).This confusion has been heightened withthe World Heal... | [
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tional recommendation (270) against NNS\nfor weight management, the Cleveland | [
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Clinic study on erythritol and its relation-ship to CVD (271), and the InternationalAgency for Research on Cancer classifyingaspartame as a possible carcinogen to hu-mans (272). It should be noted the sys-tematic analysis that informed the WorldHealth Organization recommendation ex-cluded individuals with diabetes. In ... | [
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ex-cluded individuals with diabetes. In an edito-rial from the Journal of Clinical Investigation , | [
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Nobs and Elinav (273) from the WeizmannInstitute described the impact these recentstudies have had on the public perceptionof safety of NNS: “The burden of proof has | [
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shifted from a need to prove that NNS areunsafe to a necessity of understanding theirpotential scope of effects on humans in or-der to optimize their recommended use bypopulations at risk. ”\nDespite FDA approval and generally rec- | [
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ognized as safe (GRAS) status for NNS, aswell as established acceptable daily intake(ADI), questions remain. Implementationand interpretation of human NNS studiesare inherently challenging. Each of thesweeteners are their own distinct com-pounds with different molecular struc-tures, although they are often consideredto... | [
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although they are often consideredtogether in studies. Issues of duration ofexposure (short or long), different physical | [
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0.0490713... |
forms (packets/powder or in beverages),\ncardiometabolic health of the host, per-sonalized individual response, presence ofother nutrient components, the emergingevidence about the microbiome, and lim-ited RCTs complicate the science (273).\nFor some people with diabetes who are | [
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For some people with diabetes who are\naccustomed to regularly consuming sugar-sweetened products, NNS (containing fewor no calories) may be an acceptable sub-\nstitute for nutritive sweeteners (those | [
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stitute for nutritive sweeteners (those\ncontaining calories, such as sugar, honey,and agave syrup) when consumed in mod-eration (274,275). NNS do not appear tohave a signi ficant effect on glycemic man-\nagement (104,276,277), and they canreduce overall calorie and carbohydrate | [
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intake (104,274) as long as individuals arenot compensating with additional caloriesfrom other food sources (73,278). There is\nmixed evidence from systematic reviews\nand meta-analyses for NNS use with re-gard to weight management, with some\nfinding bene fiti nw e i g h tl o s s( 2 7 9 –281)\nwhile other research sugge... | [
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while other research suggests an associa-\ntion with weight gain (282,283). This may\nbe explained by reverse causality and resid-\nual confounding variables (283). The addi-tion of NNS to eating plans poses nobenefit for weight loss or reduced weight | [
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gain without energy restriction (284). In arecent systematic review and meta-analysisusing low-calorie and no-calorie sweetened\nbeverages as an intended substitute for\nsugar-sweetened beverages, a small im-provement in body weight and cardiome-\ntabolic risk factors was seen without | [
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tabolic risk factors was seen without\nevidence of harm and had a direction ofbenefit similar to that seen with water.\nHealth care professionals should continue\nto recommend water, but people with\noverweight or obesity and diabetes mayalso have a variety of no-calorie or low-\ncalorie sweetened products so that they\... | [
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calorie sweetened products so that they\ndo not feel deprived (285).\nHealth care professionals should con-\ntinue to recommend reductions in sugar\nintake and calories with or without the\nuse of NNS. Assuring people with diabe-tes that NNS have undergone extensive\nsafety evaluation by regulatory agencies | [
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safety evaluation by regulatory agencies\nand are continually monitored can allayunnecessary concern for harm. Healthcare professionals can regularly assess\nindividual use of NNS based on the ac-\nceptable daily intake (amount of a sub-stance considered safe to consume each\nday over a person ’s life) and recommend | [
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day over a person ’s life) and recommend\nmoderation. See the chart from the FDA\non safe levels of sweeteners found at\nfda.gov/food/food-additives-petitions/\naspartame-and-other-sweeteners-food.\nPHYSICAL ACTIVITY\nRecommendations\n5.27 Counsel youth with type 1 dia-\nbetes Cor type 2 diabetes Bto engage\nin 60 min/... | [
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in 60 min/day or more of moderate- or\nvigorous-intensity aerobic activity, with\nvigorous muscle-strengthening and\nbone-strengthening activities at least\n3 days/week.\n5.28 Counsel most adults with type 1\ndiabetes Cand type 2 diabetes Bto en- | [
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0.05... |
diabetes Cand type 2 diabetes Bto en-\ngage in 150 min or more of moderate- toS86 Facilitating Positive Health Behaviors and Well-being Diabetes Care Volume 47, Supplement 1, January 2024\n©AmericanDiabetesAssociation | [
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vigorous-intensity aerobic activity per\nweek, spread over at least 3 days/\nw e e k ,w i t hn om o r et h a n2c o n s e c u -\ntive days without activity. Shorter du-rations (minimum 75 min/week) of\nvigorous-intensity or interval training\nmay be suf ficient for younger and\nmore physically fit individuals.\n5.29 Couns... | [
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5.29 Counsel adults with type 1 diabe-\ntesCand type 2 diabetes Bto engage\nin 2–3 sessions/week of resistance ex-\nercise on nonconsecutive days.\n5.30 Recommend flexibility training\nand balance training 2– 3 times/week\nfor older adults with diabetes. Yoga and\ntai chi may be included based on indi-\nvidual preferenc... | [
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vidual preferences to increase flexibil-\nity, muscular strength, and balance. C\n5.31 For all people with diabetes, eval-\nuate baseline physical activity and time\nspent in sedentary behavior (i.e., quiet\nsitting, lying, and leaning). For people\nwho do not meet activity guidelines,encourage increase in physical acti... | [
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(e.g., walking, yoga, housework, gar-\ndening, swimming, and dancing) above\nbaseline (type 1 diabetes Eand type 2\ndiabetes B). Counsel that prolonged\nsitting should be interrupted every\n30 min for blood glucose bene fits.C\nPhysical activity is a general term that in-\ncludes all movement that increases en-\nergy us... | [
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ergy use and is an important part of the\ndiabetes management plan. Exercise is a\nmore speci fic form of physical activity\nthat is structured and designed to im-prove physical fitness. Both physical activ-\nity and exercise are important. Exercisehas been shown to improve blood glu-\ncose levels, reduce cardiovascular ... | [
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cose levels, reduce cardiovascular risk\nfactors, contribute to weight loss, and\nimprove well-being (286). Physical activ-\nity is as important for those with type 1\ndiabetes as it is for the general popula-\ntion, but its speci fic role in the preven-\ntion of diabetes complications and themanagement of blood glucose... | [
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c l e a ra si ti sf o rt h o s ew i t ht y p e2d i a b e -\ntes. Many individuals with type 2 diabetes\ndo not meet the recommended exercise\nlevel per week (150 min). Objective mea-\nsurement by accelerometer in 871 indi-\nviduals with type 2 diabetes showed that\n44.2%, 42.6%, and 65.1% of White, African | [
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44.2%, 42.6%, and 65.1% of White, African\nAmerican, and Hispanic individuals, respec-tively, met the recommended threshold of\nexercise (287). An RCT in 1,366 individualswith prediabetes combined a physical | [
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activity intervention with text messagingand telephone support, which showedimprovement in daily step count at12 months compared with the control\ngroup. Unfortunately, this was not sus-\ntained at 48 months (288). Another RCT,including 324 individuals with prediabe-tes, showed increased physical activity at\n8 weeks w... | [
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8 weeks with supportive text messages,\nbut by 12 weeks there was no differencebetween groups (289). It is important fordiabetes care management teams to un-\nderstand the diffi c u l t yt h a tm a n yp e o p l e\nhave reaching recommended treatment | [
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have reaching recommended treatment\ngoals and to identify individualized ap-proaches to improve goal achievement,which may need to change over time.\nModerate to high volumes of aerobic | [
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Moderate to high volumes of aerobic\nactivity are associated with substantiallylower cardiovascular and overall mortalityr i s k si nb o t ht y p e1a n dt y p e2d i a b e t e s(290). A prospective observational study\nof adults with type 1 diabetes suggested | [
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of adults with type 1 diabetes suggested\nthat higher amounts of physical activityled to reduced cardiovascular mortalityafter a mean follow-up time of 11.4 years\nfor people with and without chronic kid-\nney disease (291). Additionally, structured\nexercise interventions of at least 8 weeks’duration have been shown t... | [
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by an average of 0.66% in people with\ntype 2 diabetes, even without a signi fi-\ncant change in BMI (292). There are also\nconsiderable data for the health bene fits\n(e.g., increased cardiovascular fitness,\ngreater muscle strength, improved insulin\nsensitivity) of regular exercise for those | [
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sensitivity) of regular exercise for those\nwith type 1 diabetes (293). Exercise train-ing in type 1 diabetes may also improve\nseveral important markers such as triglyc-\neride level, LDL cholesterol, waist circum-\nference, and body mass (294). In adultswith type 2 diabetes, higher levels of exer-\ncise intensity are... | [
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cise intensity are associated with greater\ni m p r o v e m e n t si nA 1 Ca n di nc a r d i o r e s p i r a -toryfitness (295); sustained improvements\nin cardiorespiratory fitness and weight loss\nhave also been associated with a lower risk\nof heart failure (258). Other bene fits in-\nclude slowing the decline in mobil... | [
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clude slowing the decline in mobility among\noverweight people with diabetes (296). TheADA position statement “Physical Activity/\nExercise and Diabetes ”reviews the evi-\ndence for the bene fits of exercise in people\nwith type 1 and type 2 diabetes and offers\nspecifi c recommendations (297). Increased | [
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specifi c recommendations (297). Increased\nphysical activity (soccer training) has alsobeen shown to be bene ficial for improving\noverall fitness in Latino men with obesity,demonstrating feasible methods to increase\nphysical activity in this population (298).\nPhysical activity and exercise should be rec-\nommended and... | [
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ommended and prescribed to all individuals\nwho are at risk for or with diabetes as part\nof management of glycemia and overall\nhealth. Speci fic recommendations and pre-\ncautions will vary by the type of diabetes,\nage, activity, and presence of diabetes-\nrelated health complications. Recommen- | [
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related health complications. Recommen-\ndations should be tailored to meet the spe-cific needs of each individual (297).\nExercise and Youth\nY o u t hw i t hd i a b e t e so rp r e d i a b e t e ss h o u l dbe encouraged to engage in regular physi-\ncal activity, including at least 60 min of | [
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cal activity, including at least 60 min of\nmoderate to vigorous aerobic activity everyday and muscle- and bone-strengtheningactivities at least 3 days per week (299). In\ngeneral, youth with type 1 diabetes bene fit\nfrom being physically active, and meta-\nanalyses have demonstrated a signi ficant\nassociation between ... | [
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association between physical activity and\nlower A1C (300). Thus, an active lifestyle\nshould be recommended to all (301). Youthwith type 1 diabetes who engage in morephysical activity may have better health\noutcomes and health-related quality of life\n(302,303). See Section 14, “Children and\nAdolescents, ”for detail... | [
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Adolescents, ”for details.\nFrequency and Type of Physical\nActivity\nFor all people with diabetes, evaluate\nbaseline physical activity and time spentin sedentary behavior (quiet sitting, lying,\nand leaning). For people who do not | [
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and leaning). For people who do not\nmeet activity guidelines, encourage an in-crease in physical activity (walking, yoga,housework, gardening, swimming, anddancing) above baseline (304). Health\ncare professionals should counsel people | [
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care professionals should counsel people\nwith diabetes to engage in aerobic and re-sistance exercise regularly (240). Aerobicactivity bouts should last at least 10 min,\nwith the goal of /C2430 min/day or more\nmost days of the week for adults with\ntype 2 diabetes. Daily exercise, or at leastnot allowing more than 2 ... | [
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between exercise sessions, is recom-\nmended to decrease insulin resistance,regardless of diabetes type (305,306). Astudy in adults with type 1 diabetes found a\ndose-response inverse relationship between\nself-reported bouts of physical activity perweek and A1C, BMI, hypertension, dyslipi-demia, and diabetes-related c... | [
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such as hypoglycemia, diabetic ketoacidosis,\nretinopathy, and microalbuminuria (307).diabetesjournals.org/care Facilitating Positive Health Behaviors and Well-being S87\n©AmericanDiabetesAssociation | [
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Over time, activities should progress in in-\ntensity, frequency, and/or duration to atleast 150 min/week of moderate-intensityexercise. Adults able to run at 6 miles/h(9.7 km/h) for at least 25 min can bene fit\nsufficiently from shorter durations of vigor- | [
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sufficiently from shorter durations of vigor-\nous-intensity activity or interval training(75 min/week) (297). Many adults, includingmost with type 2 diabetes, may be unable\nor unwilling to participate in such intense\nexercise and should engage in moderateexercise for the recommended duration.Adults with diabetes are ... | [
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engage in 2 –3 sessions/week of resis-\nt a n c ee x e r c i s eo nn o n c o n s e c u t i v ed a y s\n(308). Although heavier resistance trainingwith free weights or weight machinesmay improve glycemia and strength (309),\nresistance training of any intensity is rec- | [
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resistance training of any intensity is rec-\nommended to improve strength, balance,and the ability to engage in activities ofdaily living throughout the life span.\nHealth care professionals should support\npeople with diabetes to set stepwise goalstoward meeting the recommended exer-cise goals. As individuals intensi... | [
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ercise program, medical monitoring may\nbe indicated to ensure safety and evalu-ate the effects on glucose management.(See\nPHYSICAL ACTIVITY AND GLYCEMIC MANAGEMENT ,\nbelow.)\nEvidence supports that all individuals,\nincluding those with diabetes, should beencouraged to reduce the amount of timespent being sedentary ... | [
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with low energy expenditure (e.g., seated\nwork at a computer or watching televi-\nsion)—by breaking up bouts of sedentary\nactivity (> 30 min) by briefl ys t a n d i n g ,\nwalking, or performing other light physical\nactivities (310,311). Participating in leisure- | [
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activities (310,311). Participating in leisure-\ntime activity and avoiding extended seden-tary periods may help prevent type 2 dia-betes for those at risk and may also aid in\nglycemic management for those with dia-\nbetes (312,313).\nA systematic review and meta-analysis\nfound higher frequency of regular lei-sure-ti... | [
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fective in reducing A1C levels (314). A\nwide range of activities, including yoga,tai chi, and other types, can have signi fi-\ncant impacts on A1C, flexibility, muscle\nstrength, and balance (286,315 –317). | [
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strength, and balance (286,315 –317).\nFlexibility and balance exercises may beparticularly important in older adults withdiabetes to maintain range of motion,strength, and balance (297) ( Fig. 5.1 ). | [
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There is strong evidence that exercise inter-ventions in individuals with type 2 diabetesimprove depression, A1C, and overall psy-chosocial well-being (318).\nPhysical Activity and Glycemic\nManagement\nClinical trials have provided strong evi- | [
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Management\nClinical trials have provided strong evi-\ndence for the A1C-lowering value of resis-tance training in older adults with type 2diabetes (297) and for an additive bene fit\nof combined aerobic and resistance exer-cise in adults with type 2 diabetes (319).If not contraindicated, people with type 2diabetes shou... | [
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least two weekly sessions of resistance\nexercise (free weights, machines, elasticbands, or body weight as resistance), witheach session consisting of at least one set\n(group of consecutive repetitive exercise\nmotions) of five or more different resis-\ntance exercises involving the large musclegroups (320).\nFor peopl... | [
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For people with type 1 diabetes, al-\nthough exercise, in general, is associatedwith improvement in disease status, careneeds to be taken in titrating exercise withrespect to glycemic management. Each in-\ndividual with type 1 diabetes has a variable | [
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dividual with type 1 diabetes has a variable\nglycemic response to exercise. This variabil-ity should be taken into considerationwhen recommending the type and dura-\ntion of exercise for a given individual (293).\nIndividuals of childbearing potential with\npreexisting diabetes, particularly type 2 dia- | [
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preexisting diabetes, particularly type 2 dia-\nbetes, and those at risk for or presentingwith gestational diabetes mellitus should\nbe advised to engage in regular moderate\nphysical activity prior to and during theirpregnancies as tolerated (297).\nHigh-Intensity Interval Training\nHigh-intensity interval training (H... | [
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High-intensity interval training (HIIT) is a\nplan that involves aerobic training done be-\ntween 65% and 90% VO 2peak or 75% and\n95% heart rate peak for 10 s to 4 min with12 s to 5 min of active or passive recovery.\nHIIT has gained attention as a potentially\ntime-ef ficient modality that can elicit signif- | [
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... |
time-ef ficient modality that can elicit signif-\nicant physiological and metabolic adapta-tions for individuals with type 1 and type 2\ndiabetes (321,322). Higher intensities of\naerobic training are generally consideredsuperior to low-intensity training (323).HIIT showed reductions in A1C and BMI\nand improvement in fi... | [
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