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Glycemic control with physical training in insulin-dependent diabetes mellitus.

Physical exercise has long been a cornerstone in the management of diabetes mellitus based on its potential to improve metabolic control and to diminish risk factors for atherosclerotic vascular disease common in older diabetic persons.1-3Participation in physical activity may also have psychosocial benefits in improving selfesteem and feelings of well-being, which are especially important in patients with chronic disease.4 Efforts to document the physiologic responses to exercise in patients with diabetes mellitus have only recently been successful. The recognition that serum glycosylated hemoglobin (HbA1) levels provide a valid marker of metabolic control5,6and the use of euglycemic clamp techniques in determination of insulin sensitivity7have allowed new insights into the diabetesexercise relationship. These studies have indicated differences in type 1 (insulin-dependent) and type 2 (adultonset) diabetic patients and have also separated alterations in metabolic status created by short-term exercise from those resulting from physical