Editorial on the Research Topic
Lifestyle intervention approaches in prediabetes or diabetesIn the therapy and treatment of diabetes mellitus, physical activity, exercise and nutrition play an important role to improve disease-specific outcomes (1-3). In previous research it was shown that those with type 1 diabetes, who are more physically active face lower risk of overweight, obesity and hypertension when compared against their physically inactive counterparts (4). Furthermore, even a short-term moderate-intensity endurance training program was shown to ameliorate glycated hemoglobin (HbA 1c ) levels and functional capacity (5). At the same time, physical activity and exercise increase the risk of acute and post-exercise hypoglycemia (6) based on different pathophysiological factors (7), hindering people with type 1 diabetes to engage in regular physical activity due to the fear of glycaemic disturbances (8). In people with type 2 diabetes, physical activity and exercise where shown to improve glycaemia (9), decrease the risk of complications and comorbidities (1). Furthermore, in people with pre-diabetes, a holistic lifestyle intervention aiming to increase physical activity levels and lower the daily caloric intake, showed a 58% decreased incidence of type 2 diabetes compared with the placebo group, which was even higher than the decrease observed with metformin therapy (31% reduction) (10). In a different study, assessing the efficacy of an lifestyle intervention on improvements of short term type 2 diabetes (<3 years), it was shown that 61% of participants were able to reach disease remission, which was not observed within the standard of care control group (11).Taking this evidence into account, there are clear recommendations from the American Diabetes Association (ADA) in regards to physical activity and exercise in people with diabetes (12): 150 min/weeks of moderate intensity exercise or 75 min/week of high-intensity exercise to improve insulin sensitivity, lung function and cardiac output and to lower the risk of cardiovascular disease; two to three strength training sessions per week to ameliorate body composition, bone mineral density, blood lipid profiles and overall cardiovascular health; flexibility/balance training (2-3 sessions per week, especially for older people with diabetes) to improve the range of motion, balance and gait and reduce the risk of falls. When focusing on nutrition therapy in people with diabetes and pre-diabetes, it is recommended in a consensus report that a variety of eating patterns are acceptable for disease management (13). In more Frontiers in Endocrinology frontiersin.org 01