Long-term changes of psychological factors regarding exercise in patients with type 2 diabetes after discharge and the effect of these changes on glycemic control.
Kei Washida, Nobumasa Matsui, Morio Shoji and 2 others
PMID 34873370WHAT IT FOUND
Exercise confidence stayed high for 12 months, but blood sugar control worsened after the initial 3-month drop.
Only diabetes duration predicted long-term control. High exercise confidence did not prevent glycemic decline, so do not assume sustained psychological factors guarantee ongoing metabolic improvement.
Key findings
01Self-efficacy for exercise showed no significant changes over 12 months, with scores of 15.6 at discharge, 14.5 at 3 months, 14.7 at 6 months, and 14.6 at 12 months.
02HbA1c levels decreased significantly at 3 months compared to admission but worsened at 12 months compared to 3 months, showing a loss of initial glycemic control gains.
03The duration of diabetes was the only factor affecting HbA1c levels at 12 months after discharge, with longer illness duration associated with worse control.
STILL TO COME
How it was doneWhat they foundWhat it means for PTs
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What it does not show
The study did not measure the actual amount of exercise performed, only the psychological stage and confidence, so it is unknown if exercise volume decreased over time. Only 29 of the original 85 patients completed the 12-month follow-up, and those who dropped out may have had different outcomes, potentially biasing the results toward better-maintained self-efficacy. Dietary compliance and pharmacotherapy changes were not assessed, so it is unclear if worsening HbA1c was due to non-exercise factors. The sample size is small and single-center, limiting generalizability.
Declared interests
The authors declare no conflicts of interest associated with this manuscript.
The easy way to misread this
Do not conclude that sustained exercise self-efficacy and stage of change are sufficient to maintain long-term glycemic control. The study showed that HbA1c worsened at 12 months despite stable psychological factors, indicating that other variables like disease duration or non-exercise treatments likely drove the metabolic decline.