MONTPELLIER — Studies indicate that physical activity improves glucose metabolism in patients with type 2 diabetes. In addition, other data suggest a reduction in cardiovascular morbidity and mortality thanks to physical activity.
In the consensus report, Management of hyperglycemia in type 2 diabetes, 2022the American Diabetes Association and the European Association for the Study of Diabetes therefore recommend at least 150 minutes per week of moderate-to-vigorous intensity aerobic activity, supplemented by two to three resistance, flexibility or balance per week.
But even when such recommendations are integrated into a therapeutic education program, adherence is often transitory or partial.
In this context, Michael Joubert, MD, PhD, and his team from the University Hospital of Caen wondered about neuromuscular electrical stimulation (NMES), a physical treatment commonly used in functional rehabilitation to improve muscle strength and volume. Could NMES improve glycemic control in patients with type 2 diabetes, and thus constitute an alternative to traditional physical activity?
To answer this question, they conducted a crossover randomized controlled trial called ELECTRODIAB2. The results were presented at the 2023 Congress of the Société Francophone du Diabète.
A few small pilot studies have shown that NMES improves insulin sensitivity and glycemic control; therefore, it could actually be an alternative. The metabolic effect of NMES, however, has not been widely studied.
A total of 40 patients were included in ELECTRODIAB2. Of these participants, 35 were randomly assigned to one of three groups: 6 weeks without NMES (control, no intervention), electrostimulation 3 days a week for 6 weeks (ambulatory bi-quadricipital electrostimulation sessions of 20 minutes) (NMES3) and electrostimulation 5 days a week for 6 weeks (ambulatory bi-quadricipital electrostimulation sessions of 20 minutes) (NMES5). The objective was to assess the glycaemia of sedentary patients with type 2 diabetes during these periods. At each session, NMES was applied at the maximum tolerated intensity.
Data from 32 participants were analyzed. The mean age was 58 ± 10 years and the body mass index was 33.0 ± 4.3 kg/m2. The duration of diabetes was 8.6 ± 5.9 years. Regarding diabetes treatments, 47%, 31%, 9% and 13% of patients were taking 0, 1, 2 and 3 oral hypoglycemic agents or glucagon-like peptide 1 agonists, respectively.
No significant difference in glucose levels was observed between the three groups. The primary outcome was mean blood glucose based on 6-day continuous glucose monitoring (CGM) recording. These levels were 181.4 ± 42.5 mg/dL (control, no intervention), 180.6 ± 45.8 mg/dL (NMES3) and 181.1 ± 48.9 mg/dL (NMES5).
In addition, secondary outcomes (hyperglycaemia and hypoglycaemia rates) did not differ between the three groups.
The researchers concluded that “with respect to the CGM criteria, this crossover randomized controlled trial did not show that the 6-week bi-quadricipital NMES sessions had any benefit.” research on NMES in this population of patients with early-stage diabetes.”
Therefore, at this stage, it does not appear that NMES can be recommended as an alternative to physical activity for sedentary patients with type 2 diabetes.
This article was translated from Medscape French edition.