All in a day’s work: The importance of 24-hour behaviours in the prevention and management of type 2 diabetes
Article by Dr Joe Henson, Researcher and Lecturer
Lifestyle modifications are important pieces of the puzzle when considering the management of type 2 diabetes mellitus. However, national, and international guidelines have tended to place the emphasis on diabetes medicine(s). For the first time, the latest American Diabetes Association/European Association for The Study of Diabetes (ADA/EASD) consensus guidelines on the management of hyperglycaemia have broken with tradition by incorporating a growing body of evidence linking health outcomes associated with type 2 diabetes to the movement behaviour composition over the whole, 24-hr day.
In this context, a 24-hr day comprises a sequence of movement behaviours distributed on a continuum ranging from limited/no movement to high-intensity activities. The five S’s (sleep, sitting, stepping, sweating, and strengthening) encapsulate these physical behaviours and their inclusion represents an important milestone in bridging the gap between current knowledge around 24-hr behaviours and the management of diabetes. These physical behaviours are all linked and have the potential to impact glycaemic control and overall health.
Of particular note, the importance of sleep as a key lifestyle component in the management of type 2 diabetes is highlighted, placing it on a pedestal, alongside physical activity. Previous sleep research in type 2 diabetes has tended to focus on sleep disorders, but the three overarching constructs outlined in the latest ADA/EASD guidelines: quantity, quality and timing (i.e. chronotype (whether you are typically a morning or evening person) of sleep represent important and under-recognised components of type 2 diabetes management.
Beneficial effects on glycaemic control are seen across the spectrum of human movement (from breaking sitting with light activity through to sweating exercises). Even small, regular changes can make a difference to long term health (as little as 500 steps per day can reduce the risk of all-cause mortality). Strengthening exercises (i.e. any activity that uses your own body weight or works against a resistance) also improves glycaemic control and activities like tai chi and yoga also encompass elements of flexibility and balance. This is important as type 2 diabetes represents a model of accelerated biological ageing, leading to difficulties undertaking activities of daily living. As the frailty phenotype in type 2 diabetes is unique, often encompassing obesity at an earlier age, it is increasingly recognised as a major complication and an important target for management of type 2 diabetes.
Ultimately, individual preferences, motivations and circumstances should inform choice, but by considering physical behaviour over the 24-hr day, it offers a broader spectrum of interventional opportunities to improve glycaemic control and improve various other health outcomes.
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