Exercise and HbA1c

It has long been known that exercise can have substantial benefits for people with diabetes — both Type 1 and Type 2. It can increase insulin sensitivity, improve cardiovascular fitness, and help sustain weight loss. A common and desired outcome of exercise programs is a lower HbA1c level — particularly for Type 2 diabetes, in which case exercise alone may reduce blood glucose levels. As the number of people with Type 2 diabetes continues to rise — along with its associated medical costs — exercise programs may be an important and currently underused tool in the service of public health, and public finances. But how can the benefits of exercise be extended to the greatest possible number of people? And what does it take to achieve meaningful HbA1c reductions?


Over the years, different studies have explored the potential benefits of a wide variety of exercise programs in people with Type 2 diabetes. The authors of a clinical review published last week attempted to distill the results of these studies. Published in the Journal of the American Medical Association, the review examined 47 clinical trials from 1980 to the present. Of these 47 studies, 23 measured the impact of assigning participants to a structured exercise program; the other 24 tested the effect of giving out exercise advice (often in combination with other advice). Each study lasted at least 12 weeks. Overall, structured exercise programs won out over exercise advice, with an average HbA1c reduction of 0.67% compared with the control group in each study; exercise advice saw an average drop of 0.43% compared with each control group.

Within structured exercise programs, aerobic exercise programs had the best result, with an average HbA1c reduction of 0.73% compared with control groups; resistance programs saw a 0.57% drop, while programs that combined both cardio and resistance saw only a 0.51% drop. Among all structured exercise programs, those that demanded more than 150 minutes of exercise each week were associated with a 0.89% drop in HbA1c; those that demanded 150 minutes or less led to a 0.36% drop. In the separate category of exercise advice, only exercise advice combined with dietary advice was found to reduce HbA1c, with an average reduction of 0.58%; exercise advice alone had no net effect, leading to the overall 0.43% HbA1c drop associated with exercise advice.

A Reuters article on the review notes that to confirm the superiority of structured exercise programs over exercise advice, there would need to be a study directly comparing the two. Nevertheless, it makes intuitive sense that people would be more likely to exercise under supervision than if left to their own devices. The article also notes that such exercise programs may be able to help slow the growth of health-care costs associated with diabetes and prediabetes, which are projected to rise from $194 billion to almost $500 billion in the United States by the end of the decade.

What do you think — should health insurance plans cover exercise programs as a treatment for Type 2 diabetes or prediabetes? If so — and if they are shown to save money — should they cover exercise programs or gym memberships for everyone, or everyone over a certain age? Should doctors fill out prescriptions for exercise programs, just as they do for drugs? Do you believe you would exercise more if you were enrolled in a supervised program at no cost? Have you already tried a structured exercise program designed to combat diabetes? Leave a comment below!

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  • Marta S

    I absolutely think structured programs would help and therefore should be covered by insurance. If I could cut back on my doctor visits by 50% (for instance, 2x a year to check blood level vs 4x a year) after successfully reducing my A1C, wouldn’t that be helpful to everyone? a win-win for insurance and the insured? And if I was successful, that means my future insurance needs would be lessened for complications of diabetes.

    I read recently that the best exercise is the one you like (and therefore will do), whether it’s walking, dancing, swimming, etc… An Exercise Insurance program could go a step further and assist with a questionnaire to determine a person’s exercise “type” then give the person an allowance that is paid back AFTER the class is accomplished.

  • Pamela Mather

    I absolutely think insurance companies should pay for supervised exercise programs for diabetics, or for anyone with metabolic or vascular disease. The key is supervised: not only would it being supervised help the insurer know that the insured is attending, but also that they are doing so safely. The cost of the membership, if purchased in bulk would be nominal for the insurance company, but the savings in dollars for less needed medication and medical care would be huge, to say nothing of the improved life of those who suffer from the disease. Say yes and let’s go forward.

  • bess harrison

    I do think that exercise programs should be covered, either by medicare or by health insurance plan. I think that in the long run, it would result in fewer complications from diabetes, arthritis, and high blood pressure. I am a 75 year old female who is overweight and struggling with diabetes and arthritis and find it very difficult to exercise as much as i should, with a proscribed regimen, and structured exercise program, I believe that it would be beneficial to myself and others like me.

  • mary etherington

    I have been in a Wellness program for nearly five years.

    This program is developed and monitored by professional staff, is available for daily use and offers a pleasant and safe environment.

    I do believe that this encourages continuing participation which is so essential for maintaining physical health. Without question,
    I would recommend and support a health care plan
    that would offer financial coverage (in part at least) for current “elders”.

  • Elaine

    I have type 2 diabetes. I have controlled mine by diet for the last 9 years. I go to Curves 3 times a week. My health plan does cover the cost of the program. I feel that all health plans should cover the cost. By going to Curves i feel that it really helps me to control my diebetes and my asthma.

  • maryschweiger

    I feel anytime you do things with participation from a group we are more likely to cary through I FIND WHEN I try to do things alone my mind tends to wander toward other things.By having a staff to manage you it is more than likely you will achive success just like anything you learn it takes someone to help you.Therefore Iam very much in favor of insurance helping covering the cost of maintaning physical health for everyone not just for the betterment of us with diabetes but to help others from getting it.I have been a type 2 diabetic for years and had dietitians,read the books tried every thing to loose weight evev a gym membership but getting to the gymis like what to do when you get there.it seems people just stare at you because you are to old and dont know the proper technique so usually you just get in the pool and splasharound awhile.a gym trainer is to expensive.

  • Redneck Angel

    YES! If anyone is serious about lowering the cost of long-term care, they should be looking for incentives to get, & stay, enrolled in some kind of exercise program. Or they could offer to extend the “Golden Sneekers” program to anyone who has diabetes.

  • jim snell

    Excellent comments.

    Exercise was and is critical to me. That said; the healing of my eyes, body and kidneys did not start ( even while exercise was going on) until metformin cut off liver make sugar all the time.
    A1C dropped from 13.3 to 6.9 as a result of testing after eyes healed hemorages.

    Exercise and diet are still key critical but also medical magic needed for serious endocrine miscues. In my approach, attacked diet, exercise and medical issues. Some insulin needed but that just highlighted pancreas/Islet aging. Exercise actually helped smoke out the problems and culprits and somehow helped pancrease to improve.

    While I appreciate this excellent article and comments; we must not loose track of other factors – since in AMerica we are always looking for the silver bullit and one key answer; for diabetes is a complex of key points/issues while disease control requires multipronged efforts in unison in varying blends.

  • Rosemary Porter

    It makes so much sense to have fitness programs covered you wonder why it isn’t done more often.
    Prevention is safer, cheaper and has long term effects – but perhaps it’s too good for most health plans. Although, my supplemental plan supports a “Silver Sneaker” program that reduces dramatically, our local YMCA will not participate in the program. So who’s really intrested in keeping seniors healthy? While we’re at it – how about dental care for diabetics? Oh well, with the current anti-older Americans conservative movement and the lack of real information about how the government has siphoned off all of the SSI money into the general fund, I guess it’s not surprising.

  • Lucille

    I absolutely think gym memberships should be covered by insurance companies-it would save them money in the long; I can’t afford a membership and love to swim…I burn, I don’t tan so I don’t swim outdoors and I am not going to expose myself to the general public in a bathing suit; an indoor gym/pool is ideal-they have small classes I can take in the water and open swim times and lap swim times. It would be a win-win for the insurance company AND me. Otherwise I hate to exercise.

  • Natalie Sera

    I had a coronary artery spasm in 1992, and that made me eligible for cardiac rehab. I went 3 times a week, and continued faithfully for 3 years. Then they cut the times the program was offered, and there were no longer any hours I could attend due to my job. So I stopped. And found that I just couldn’t motivate myself to exercise on my own. There is something about having an appointment and supervision that motivated me, plus the room was relatively small, and it was mostly the same people there all the time, so it was socially rewarding as well a physically rewarding. So if there were a structured program available to me that took into account my individual exercise needs (i.e. not just an aerobics class that I couldn’t keep up with), I would definitely go.

  • Richard Hudzinski

    Yes I am looking for one.

  • Ira Weiss

    I also feel that supervised exercise (personal trainer or class?) should be covered. I have used a gym membership for years and thankfully I can afford the monthly payments but many people cannot. I also do laps in our community pool in the summer but some people would also find that membership cost prohibitive. To quote the Fram oil filter commercial: You can pay me now or you can pay me later. Covering the cost of exercise which reduces medical expenses should be a no brainer.

  • Jim Moore

    My insurence company covered me for two years for exercise classes and my A1C dropped from 8.9 to 5.5 and my weight went down 35 lbs. It not only improved my health but reduced the medication I take for diabetis. THey have stopped covering me this year but must be vert dumb not to realize the benifeits and money they saved by offering this service and how much they would save over the long run.

  • Valerie Harvey

    I would recommend and support a health care plan
    that would offer financial coverage.

  • Janice

    I strongly recommend an exercise program.
    I was taking Metformin and Glyburide. I am
    still on Metformin but I occasionly take a half
    a Gyburide in the evening depending on my blood
    sugar tests before going to bed. I am hoping to
    be able to eliminate the half pill altogether when
    I take a little more weight off.

  • Cheri

    I agree with most that exercise programs should be part of a paid insurance program. Preventative medicine is always cheaper than the cost of treatment and repair. The numbers for diabetes keep going up and prevention keeps going down. Even our young people are getting diabetes as they become more sedentary. With all of the budget cuts to education; even PE is falling by the wayside. We need to put more emphasis on lifestyle changes and ways to support people in the process.

  • GiGi Brakeville

    Military health care will not cover anything in the exercise department – as a military spouse with type 1 for 39 years, I have found that doctors under Tricare do not all care about the exercise as much as the pills. I have had an A1C of 4.0 to 4.5 for the last 5 years (after being approved for an insulin pump. And, after many many tranfers and explaining the type 1 and watching their eye light up and suggest tests (I am not kidding), I have taken matters into my own hands with an exercise regime. It works. What is sad, is that since the doctors cannot find fault with my A1C, they focus on other things and have been pushing pills. I am 44 and only on insulin. I am proud of that and go through battles with doctors over this. “Oh your a diabetic, you NEED to be on cholesterol meds” is what I hear all the time. Excercise should be covered but with military health care we are looking at 20 years from now. They have in the last few years JUST approved chiropractic care!!!!

  • Pat D

    I have been involved in organized exercise for 6 years and I know this is a big reason that my blood sugar is under control and that I have been able to lose weight. It would be nice if my insurance covered this program and I know if I did not go to the gym, I would not be able to maintain this 5 hour a week program.

  • Deborah

    I strongly believe that a program helps a person to stay on track with exercise on a regular basis. I use to walk with a friend almost daily. I stopped that and now exercise by myself. I don’t exercise on a regular routine as I did when I had an appointment to meet someone and felt I needed to keep it for the both our sakes. There are always things that come up and I tend to exercise a little less than half as much as I previously did. My primary doctor always tells me exercise helps with diabetes. I now take more insulin than I did when walking daily. I think it is important to set a specific time to exercise daily or otherwise I choose an alternative with my time allotment and am not as regular. A class is a great way to handle these situations and as you have all stated preventitive medicine is smart for the insurance company ‘s bottom line and our bodies.

  • Darcille Dornbush

    Yes I think ALL health insurance companies should have mandated exercise program coverage especially for those who need it. Such as those w/ diabetes.
    I would enroll & use such a program myself.

  • James Anderson

    You stated percentage changes as 0.89%. That means less than 1% and that was the highest one. That change is almost insignificant. Did you really mean that the change was 89%? Or what?
    Please respond. Thank you.

  • Debbie

    I have been type 1 diabetic for 57 years. I so far have only one complecation, and that is weight gain. I stayed at the same weight for years, then when I got the pump about 5 years ago I gained 75 pounds!! I’ve asked my Dr. to send me to a gym, and he says he can’t. I have no support at home, just remarks. I would definatly go to a gym and have support and be with other people with the same problems.

  • Diane Fennell

    Hi Mr. Anderson,

    Thanks for your question. Those percentages refer to the absolute change in A1C; for someone who began the study with a 7.89% A1C level, the 0.89% change would mean that that person ended up with a 7.00% A1C level.

    Diane Fennell
    Web Editor

  • Pamela Lommel

    I was enrolled in an wonderful exercise program, but moved out of the area. I attempted to get another gym to affiliate with the same program. I paid for the gym for almost six months which rehabilitated my knee after surgery. I later contacted pneumonia and could not continue the regimen of exercises. The gym is now a member of the program, unfortunately I was forced to change my (Advantage) insurance and no longer have the program available. I feel better if I can at least walk on the tread mill, but the 30 second strength training was remarkable.

  • Audrey Monroe

    I definitely would exercise more if I could go to a Gym through a prescription plan witch would be covered by my insurance. I have an exercise bike at home, but it’s too boring by myself. I might do five or 10 minutes on my bike, but that’s not enough. I can’t walk anymore because of my neuropathy and vertigo. I also have a lot of swelling my feet and legs. I have heart disease, too. Everytime that I try to exercise, I seem to overdo it, because I usually end up injuring myself in some way, be it my back, or my neck. Because of my Vertigo, I fall a lot. It would really help if I could have supervised exercise.
    Thanks for letting my share my feelings.

  • CM

    If it is free many will sign up but simply will not USE it. We are already in trouble in this country over the cost of healthcare. Rates will go up for diabetics if it is covered. All a diabetic needs to do is WALK daily if they have no other options. It is FREE TOO.

  • Kim Robertson

    I would most definately exercise more. Our community YMCA cost more than I would like to spend for just myself monthly. The YMCA has great benefits and other programs to help exercise, but the cost is high.