How can counselling affect pancreatic beta-cell function in patients with type 2 diabetes?

This study analyzed the long-term effect of behavioral counseling on increasing daily physical activity (PA) and reducing sedentary (SED) time on changes in beta-cell (β-cell) function and glucose control in patients with type 2 diabetes (T2D). The authors concluded that increasing moderate-to-vigorous-intensity physical activity (MVPA) and reducing SED time can effectively preserve the β-cell function of the pancreas and improve glucose control in these patients.

β-cells are a type of cells found in the pancreas. They produce and secrete the hormone insulin. Insulin controls blood glucose levels. Patients with T2D have impaired β-cell function, reduced insulin sensitivity, and a progressive decline in the ability to maintain normal glucose levels. It is important to ensure the protection of β-cells and reduce their decline in function.

Evidence suggests that supervised exercise can result in increased β-cell function, depending on duration and intensity. However, routine implementation in clinical practice can be challenging. Based on study results, behavioral counseling may offer a better approach since it involves a sustained change made by patients. There is a need to assess the long-term effects of behavioral counseling on physical activity (PA) or SED-time in relation to β-cell function and glucose control in patients with T2D.

This study involved 300 patients that had T2D for at least 1 year. Patients randomly received once-monthly theoretical and practical exercise counseling for 3 years or standard care. Standard care included general physician recommendations for increasing PA while reducing SED-time. All patients were given dietary prescriptions to achieve targets based on blood glucose, blood pressure, fats, and body weight. The Homeostatic Model Assessment-2 (HOMA-2) was used to assess β-cell function (HOMA-B%), insulin sensitivity (HOMA-S%), insulin resistance (HOMA-IR), light-intensity physical activity (LPA), and MVPA.

β-cell function (HOMA-B%) decreased for patients given standard care. Patients that received behavioral counseling had stable β-cell function (HOMA-B%). Significant differences were observed between treatment groups for insulin sensitivity and secretion.

The study showed that patients with T2D that had sustained increases in MVPA may have long-term maintenance of β-cell function with better glucose control if there is a decrease in SED time and a switch to LPA.

The study only used the HOMA-2 method for assessing β-cell function and insulin sensitivity. Many patients were lost to follow-up. This may affect the results.