Type II Diabetes

Type II Diabetes is a major public health issue and in 2019, it was estimated that around the world more than 4 million deaths in people aged 20-79 were attributable to diabetes and it's complications. On an individual level, it has been estimated that a 50 year old with diabetes has a six year lower life expectancy than a similar person without diabetes.

This page is intended as a learning resource for those interested in the relationship between physical activity and Type II Diabetes.

Study Questions

  • Why is Diabetes a public health priority? (e.g. Seshasi et al, 2011)

  • What are the long-term health complications of hyperglycemia?

  • Describe how blood glucose is regulated.

  • What types of Diabetes exist and how do they vary?

  • What are the modifiable and non-modifiable risk factors for TIID?

  • What is the link between physical activity levels, sedentary lifestyles and the onset of TIID?

  • What are the links between activity levels, Cardiorespiratory fitness and strength and TIID?

  • What are the links between dietary intake and onset of TIID?

  • How can nutritional and physical activity changes impact the management of TIID?

  • What medications are used to manage TIID and how do they work?

  • What is the relationship between excess body fat and TIID? How does this relationship vary across populations and individuals?

  • What is Insulin resistance and how does it link to TIID?

  • How does gender interact with the risk factors for TIID?

  • How does ethnic background interact with the risk factors for TIID?

  • How successful have interventions been in addressing TIID? (e.g. Gong et al, 2019; Lindstrom et al, 2013) How have these worked for different genders and ethnic groups?

Recommended Chapters

Gill, J.M.R. (2021) Type 2 Diabetes. In Stensel, D.J., Hardman, A.E. and Gill, J.M.R. Physical Activity and Health: The Evidence Explained. (3rd Ed) Routledge. [companion website]

Robinson, S. (2022) Diabetes. In Robinson, S. (2021). Priorities for Health Promotion and Public Health. Londen: Routledge.

Further Reading

Ashton, R. E., Tew, G. A., Aning, J. J., Gilbert, S. E., Lewis, L., & Saxton, J. M. (2020). Effects of short-term, medium-term and long-term resistance exercise training on cardiometabolic health outcomes in adults: systematic review with meta-analysis. British journal of sports medicine, 54(6), 341-348. http://dx.doi.org/10.1136/bjsports-2017-098970

Bellou, V., Belbasis, L., Tzoulaki, I., & Evangelou, E. (2018). Risk factors for type 2 diabetes mellitus: An exposure-wide umbrella review of meta-analyses. PloS one, 13(3). doi: 10.1371/journal.pone.0194127

Colberg, S. R., Sigal, R. J., Yardley, J. E., Riddell, M. C., Dunstan, D. W., Dempsey, P. C., ... & Tate, D. F. (2016). Physical activity/exercise and diabetes: a position statement of the American Diabetes Association. Diabetes Care, 39(11), 2065-2079.

Hex, N., Bartlett, C., Wright, D., Taylor, M., & Varley, D. (2012). Estimating the current and future costs of Type 1 and Type 2 diabetes in the UK, including direct health costs and indirect societal and productivity costs. Diabetic Medicine, 29(7), 855-862.

Forouhi, N. G., & Wareham, N. J. (2019). Epidemiology of diabetes. Medicine, 47(1), 22-27. https://doi.org/10.1016/j.mpmed.2018.10.004

Gill, J. M., & Cooper, A. R. (2008). Physical activity and prevention of type 2 diabetes mellitus. Sports Medicine, 38(10), 807-824. https://doi.org/10.2165/00007256-200838100-00002

Gong, Q., Zhang, P., Wang, J., Ma, J., An, Y., Chen, Y., ... & Roglic, G. (2019). Morbidity and mortality after lifestyle intervention for people with impaired glucose tolerance: 30-year results of the Da Qing Diabetes Prevention Outcome Study. The lancet Diabetes & endocrinology, 7(6), 452-461. https://doi.org/10.1016/S2213-8587(19)30093-2

Harmer, A. R., & Elkins, M. R. (2015). Amount and frequency of exercise affect glycaemic control more than exercise mode or intensity. Br J Sports Med, 49(15), 1012-1014. http://dx.doi.org/10.1136/bjsports-2013-093225

Hemmingsen, B., Gimenez‐Perez, G., Mauricio, D., i Figuls, M. R., Metzendorf, M. I., & Richter, B. (2017). Diet, physical activity or both for prevention or delay of type 2 diabetes mellitus and its associated complications in people at increased risk of developing type 2 diabetes mellitus. Cochrane Database of Systematic Reviews, (12). https://doi.org/10.1002/14651858.CD003054.pub4

Igarashi, Y., Akazawa, N., & Maeda, S. (2021). The relationship between the level of exercise and hemoglobin A1c in patients with type 2 diabetes mellitus: a systematic review and meta-analysis. Endocrine, 74(3), 546-558. https://doi.org/10.1007/s12020-021-02817-8

Karstoft, K., & Pedersen, B. K. (2016). Exercise and type 2 diabetes: focus on metabolism and inflammation. Immunology and cell biology, 94(2), 146.

Kirwan, J. P., Sacks, J., & Nieuwoudt, S. (2017). The essential role of exercise in the management of type 2 diabetes. Cleveland Clinic journal of medicine, 84(7 Suppl 1), S15. doi: 10.3949/ccjm.84.s1.03

Kumar, A. S., Maiya, A. G., Shastry, B. A., Vaishali, K., Ravishankar, N., Hazari, A., ... & Jadhav, R. (2019). Exercise and insulin resistance in type 2 diabetes mellitus: A systematic review and meta-analysis. Annals of physical and rehabilitation medicine, 62(2), 98-103. https://doi.org/10.1016/j.rehab.2018.11.001

Lindström, J., Peltonen, M., Eriksson, J. G., Ilanne-Parikka, P., Aunola, S., Keinänen-Kiukaanniemi, S., ... & Tuomilehto, J. (2013). Improved lifestyle and decreased diabetes risk over 13 years: long-term follow-up of the randomised Finnish Diabetes Prevention Study (DPS). Diabetologia, 56(2), 284-293. https://doi.org/10.1007/s00125-012-2752-5

Mendes, R., Sousa, N., Almeida, A., Subtil, P., Guedes-Marques, F., Reis, V. M., & Themudo-Barata, J. L. (2016). Exercise prescription for patients with type 2 diabetes—a synthesis of international recommendations: narrative review. Br J Sports Med, 50(22), 1379-1381. http://dx.doi.org/10.1136/bjsports-2015-094895

Mirahmadizadeh, A., Khorshidsavar, H., Seif, M., & Sharifi, M. H. (2020). Adherence to Medication, Diet and Physical Activity and the Associated Factors Amongst Patients with Type 2 Diabetes. Diabetes Therapy, 1-16. https://doi.org/10.1007/s13300-019-00750-8

Mozaffarian, D., Kamineni, A., Carnethon, M., Djoussé, L., Mukamal, K. J., & Siscovick, D. (2009). Lifestyle risk factors and new-onset diabetes mellitus in older adults: the cardiovascular health study. Archives of internal medicine, 169(8), 798-807.

O’Hagan, C., De Vito, G., & Boreham, C. A. (2013). Exercise Prescription in the Treatment of Type 2 Diabetes Mellitus. Sports Medicine, 43(1), 39-49.[abstract]

Polonsky, K.S. (2012) The Past 200 Years in Diabetes N Engl J Med 367:1332-1340 DOI: 10.1056/NEJMra1110560 [full text]

Qiu, S., Cai, X., Yang, B., Du, Z., Cai, M., Sun, Z., ... & Schumann, U. (2019). Association between cardiorespiratory fitness and risk of type 2 diabetes: A meta‐analysis. Obesity, 27(2), 315-324. https://doi.org/10.1002/oby.22368

Rydén, L., Grant, P. J., Anker, S. D., Berne, C., Cosentino, F., ... & Xuereb, R. G. (2013). ESC Guidelines on diabetes, pre-diabetes, and cardiovascular diseases developed in collaboration with the EASD: the Task Force on diabetes, pre-diabetes, and cardiovascular diseases of the European Society of Cardiology (ESC) and developed in collaboration with the European Association for the Study of Diabetes (EASD). European heart journal, 34(39), 3035-3087. https://doi.org/10.1093/eurheartj/eht108

Sattar, N., & Gill, J. M. (2014). Type 2 diabetes as a disease of ectopic fat?. BMC medicine, 12(1), 1-6. https://doi.org/10.1186/s12916-014-0123-4

Schwarz, P. E., Greaves, C. J., Lindström, J., Yates, T., & Davies, M. J. (2012). Nonpharmacological interventions for the prevention of type 2 diabetes mellitus. Nature Reviews Endocrinology, 8(6), 363-373. https://doi.org/10.1038/nrendo.2011.232

Seshasai, S.R., Kaptoge, S., Thompson, A., Di Angelantonio, E., Gao, P., Sarwar, N., ... & Emerging Risk Factors Collaboration. (2011). Diabetes mellitus, fasting glucose, and risk of cause-specific death. The New England journal of medicine, 364(9), 829-841. https://doi.org/10.1056/NEJMoa1008862

Smith, A. D., Crippa, A., Woodcock, J., & Brage, S. (2016). Physical activity and incident type 2 diabetes mellitus: a systematic review and dose–response meta-analysis of prospective cohort studies. Diabetologia, 59(12), 2527-2545. https://doi.org/10.1007/s00125-016-4079-0

Turner, G., Quigg, S., Davoren, P., Basile, R., McAuley, S. A., & Coombes, J. S. (2019). Resources to guide exercise specialists managing adults with diabetes. Sports medicine-open, 5(1), 1-12. https://doi.org/10.1186/s40798-019-0192-1

Umpierre, D., Ribeiro, P. A., Kramer, C. K., Leitão, C. B., Zucatti, A. T., Azevedo, M. J., ... & Schaan, B. D. (2011). Physical activity advice only or structured exercise training and association with HbA1c levels in type 2 diabetes: a systematic review and meta-analysis. JAMA, 305(17), 1790-1799.

Valabhji, J., Barron, E., Bradley, D., Bakhai, C., Fagg, J., O’Neill, S., ... & Smith, J. (2020). Early outcomes from the English National health service diabetes prevention programme. Diabetes Care, 43(1), 152-160. https://doi.org/10.2337/dc19-1425

Zanuso, S., Jimenez, a, Pugliese, G., Corigliano, G., & Balducci, S. (2010). Exercise for the management of type 2 diabetes: a review of the evidence. Acta Diabetologica, 47(1), 15–22. doi:10.1007/s00592-009-0126-3 [full text]