The impact of prolonged walking on fasting plasma glucose in type 2 diabetes: A Randomised controlled crossover study

ABSTRACT Aims In many low-income countries, fasting glucose is the primary measure of glycaemic control used for treatment titration, as HbA1c is often unavailable or unaffordable. Many patients in these countries walk long distances to the clinic, but the impact of walking on fasting glucose in type 2 diabetes is unknown. We aimed to determine whether this prolonged walking affects the reliability of fasting plasma glucose as a measure of glycaemic control. Methods In a randomised crossover trial, the change in glucose from baseline in the fasting state was compared between walking on a treadmill at a predetermined speed of 4.5 km/hour for 1 hour and not walking (resting) in people with type 2 diabetes. The pre-specified primary outcome was glucose at 1 and 2 hours. Results 45 participants were enrolled and all completed both visits. 21/45 (46.7%) were female, and the median age was 51. Glucose during and after walking was similar to glucose while at rest; glucose difference (walking minus rest) was -0.15 (95% CI: -0.55, 0.26) and -0.10 (95% CI: - 0.50, 0.31) mmol/L at 1 and 2 hours respectively, p>0.4 for both). Conclusions Fasting plasma glucose is not meaningfully affected by prolonged walking in participants with type 2 diabetes; therefore, the reliability of fasting glucose for monitoring glycaemic burden is unlikely to be altered in patients who walk to the clinic. Research in context What is already known about this subject? Fasting glucose is widely used to assess glycaemic control in people living with diabetes in low income countries, as HbA1c and home glucose monitoring are unaffordable. In these settings people living with diabetes will often walk long distances to receive healthcare. Little is known on the impact of walking on fasting glucose in people living with diabetes. What is the key question? Is fasting plasma glucose measure affected by a single bout of exercise such as walking in individuals with type 2 diabetes (T2D)? What are the new findings? There was no significant change in fasting glucose at the end of the walking exercise. There was no meaningful change in fasting glucose observed at any point up to 3 hours after commencing exercise. How might this impact on clinical practice in the foreseeable future? Fasting plasma glucose is not meaningfully affected by prolonged walking in participants with type 2 diabetes; therefore, the reliability of fasting glucose for monitoring glycaemic burden is unlikely to be altered in patients who walk to the clinic.