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Minimal effect of walking before dinner on glycemic responses in type 2 diabetes: outcomes from the multi-site E-PAraDiGM study

Acta Diabetologica volume 56, pages 755–765 (2019)Cite this article

Abstract

Aim

To examine the effect of walking before dinner on 24-h glycemic control in individuals with type 2 diabetes using the standardized multi-site Exercise-Physical Activity and Diabetes Glucose Monitoring (E-PAraDiGM) Protocol.

Methods

Eighty participants were studied under two conditions (exercise vs. non-exercise control) separated by 72 h in a randomized crossover design. Each condition lasted 2 days during which standardized meals were provided. Exercise consisted of 50 min of treadmill walking at 5.0 km/h before the evening meal, while control involved 50 min of sitting. The primary outcome measure was mean glucose during the 24-h period following exercise (or sitting) measured by continuous glucose monitoring.

Results

Of the 80 participants who were initially randomized, 73 completed both exercise and control. Sixty-three participants [29 males, 34 females; age = 64 ± 8 years, body mass index = 30.5 ± 6.5 kg/m2 and HbA1c = 51 ± 8 mmol/mol (6.8 ± 0.7%), mean ± SD] complied with the standardized diets and had complete continuous glucose monitoring data. Exercise did not affect mean 24-h glucose compared to control (0.03 mmol/L; 95% CI − 0.17, 0.22, P = 0.778) but individual differences between conditions ranged from − 2.8 to +1.8 mmol/L. Exercise did not affect fasting glucose, postprandial glucose or glucose variability. Glucose concentrations measured by continuous glucose monitoring were reduced during the 50 min of walking in exercise compared to sitting in control (− 1.56 mmol/L; 95% CI − 2.18, − 0.95, p < 0.001).

Conclusion

Contrary to previous acute exercise studies, 50 min of walking before dinner in the E-PAraDiGM protocol did not affect 24-h glucose profiles. However, highly heterogeneous responses to exercise were observed.

Trial registration: NCT02834689.

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Acknowledgements

We are grateful for the support of Noah Schwabe, Micah Medinski, Jasmine Paquin, Camille Genest, Michele Bisson and Larissa Wilhelm for data collection and analysis.

Funding

The E-PAraDIGM protocol was developed with funding from a Canadian Institutes of Health Research (CIHR) Planning and Dissemination Grant (Application #334972). An investigator-initiated grant awarded to JPL and NGB from Medtronic Canada provided continuous glucose monitors and sensors in-kind and partially supported provision of standardized diets. The authors acknowledge Johnson & Johnson for providing glucometers, test strips and lancets at the Sherbrooke site, as well as Solo GI Nutrition for in-kind provision of SoLo GI bars. JPL is supported by a CIHR New Investigator Salary Award (MSH-141980) and a Michael Smith Foundation for Health Research (MSFHR) Scholar Award (16890). CMP is supported by a CIHR New Investigator Salary Award and the Campus Alberta Research Chair Program. The study sponsors were not involved in the design of the study; the collection, analysis and interpretation of data; writing the report; or the decision to submit the report for publication.

Author information

Authors and Affiliations

  1. Faculty of Kinesiology, Sport, and Recreation, and Alberta Diabetes Institute, University of Alberta, Edmonton, AB, T6G 2H9, Canada

    Jordan L. Rees, Jane E. Yardley & Normand G. Boulé

  2. School of Health and Exercise Sciences, Faculty of Health and Social Development, University of British Columbia - Okanagan, Kelowna, BC, V1V 1V7, Canada

    Courtney R. Chang, Monique E. François, Mary Jung & Jonathan P. Little

  3. Faculty of Physical Activity Sciences, Université de Sherbrooke, Sherbrooke, QC, J1K 2R1, Canada

    Alexis Marcotte-Chénard, Adeline Fontvieille & Eléonor Riesco

  4. Research Center on Aging, CIUSSSE – CHUS, Sherbrooke, QC, J1H 4C4, Canada

    Alexis Marcotte-Chénard, Adeline Fontvieille & Eléonor Riesco

  5. Faculty of Kinesiology and Recreation Management, University of Manitoba, Winnipeg, MB, R3T 2N2, Canada

    Nika D. Klaprat

  6. Augustana Faculty, University of Alberta, Camrose, AB, T4V 2R3, Canada

    Rebecca A. Dyck, Deanna R. Funk, Gary Snydmiller & Jane E. Yardley

  7. Faculty of Kinesiology, University of Calgary, Calgary, AB, T2N 1N4, Canada

    Kent Bastell

  8. Department of Kinesiology, McMaster University, Hamilton, ON, L8S 4K1, Canada

    Florence E. Godkin & Martin J. Gibala

  9. DREAM Research Theme, Children’s Hospital Research Institute of Manitoba, Winnipeg, MB, R3E 3P4, Canada

    Jon M. McGavock

  10. Departments of Medicine, Cardiac Sciences and Community Health Sciences, Faculties of Medicine and Kinesiology, University of Calgary, Calgary, AB, T2N 1N4, Canada

    Ronald J. Sigal

  11. Department of Medicine, Université Laval, Quebec City, QC, G1V 0A6, Canada

    Marie-Christine Dubé & S. John Weisnagel

  12. Department of Agriculture and Food Science, Université Laval, Quebec City, QC, G1V 0A6, Canada

    Marie-Christine Dubé & S. John Weisnagel

  13. Department of Agricultural, Food and Nutritional Science, University of Alberta, Edmonton, AB, T6G 2E1, Canada

    Carla M. Prado

  14. Faculty of Health and Medical Sciences, University of Surrey, Guilford, GU2 7WG, UK

    Ralph Manders

  15. Centre for Health Evaluation and Outcome Sciences, University of British Columbia, Vancouver, BC, V6Z 1Y6, Canada

    Terry Lee & Joel Singer

Authors
  1. Jordan L. Rees
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  2. Courtney R. Chang
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  3. Monique E. François
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  5. Adeline Fontvieille
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  6. Nika D. Klaprat
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  7. Rebecca A. Dyck
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  8. Deanna R. Funk
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  9. Gary Snydmiller
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  10. Kent Bastell
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  11. Florence E. Godkin
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  15. Jane E. Yardley
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  16. Ronald J. Sigal
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  18. S. John Weisnagel
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  19. Carla M. Prado
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  20. Mary Jung
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  21. Ralph Manders
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  22. Terry Lee
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  23. Joel Singer
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  24. Normand G. Boulé
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  25. Jonathan P. Little
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Contributions

JLR, CRC, MEF, AMC, AF, NDK, RAD, DRF, GS, KB, FEG and MCD collected the data. JLR, ER, JMM, JEY, RJS, MJG, JSW, CMP, MJ, RM, NGB and JPL provided substantial contributions to the conception or design of the work. JLR, NGB and JPL drafted the article, and all others revised it critically for important intellectual content. TL and JS designed and performed the statistical analyses. All authors provide final approval of the submitted version and agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

Corresponding authors

Correspondence to Normand G. Boulé or Jonathan P. Little.

Ethics declarations

Conflict of interest

JEY has received in-kind research support from Animas Canada, Dexcom Canada and Abbott Nutrition Canada. JPL is a scientific advisor and shareholder with Metabolic Insights Inc., a start-up company developing a noninvasive metabolic monitoring device. JPL is a volunteer chief scientific officer for the not-for-profit Institute for Personalized Therapeutic Nutrition (www.therapeuticnutrition.org).

Human and animal rights

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee (University of Alberta Health Research Ethics Board: Pro00059779, The University of British Columbia Clinical Research Ethics Board: H1600377, Conjoint Health Research Ethics Board at the University of Calgary: REB16-1049, University of Manitoba Health Research Ethics Board: HS20322, Hamilton Integrated Research Ethics Board: 1695, Comité d’éthique de la recherche du CIUSSS de l’Estrie-CHUS: #MP-31-2017-1601) and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. 

Informed consent

Informed consent was obtained from all individual participants included in the study.

Data availability

The datasets generated during and/or analyzed during the current study are not publicly available as participants did not provide consent to this form of data sharing. Aggregated data and additional analyses are available from the corresponding author on reasonable request.

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Rees, J.L., Chang, C.R., François, M.E. et al. Minimal effect of walking before dinner on glycemic responses in type 2 diabetes: outcomes from the multi-site E-PAraDiGM study. Acta Diabetol 56, 755–765 (2019). https://doi.org/10.1007/s00592-019-01358-x

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