MANAGEMENT OF ATHLETES WITH TYPE 2 DIABETES – THERAPEUTIC AND EDUCATIONAL STRATEGIES IN CLINICAL PRACTICE
Abstract
Purpose of the study: The aim of this literature review is to synthesize current knowledge on the clinical management of athletes with T2DM, focusing on pharmacological strategies, exercise recommendations, nutritional interventions, self-monitoring technologies, and interdisciplinary education to ensure safety and performance optimization.
Materials and methods: A literature review was conducted using databases such as PubMed, Google Scholar, and Scopus. Articles published between 2000 and 2024 were included if they addressed physical activity, training strategies, medication management, or patient education in individuals with T2DM—particularly in athletic or physically active populations. Key publications included guidelines from the American College of Sports Medicine (ACSM), American Diabetes Association (ADA), and peer-reviewed reviews from Diabetes Spectrum, MDPI Sports, and Medical Sciences Sports Exercise.
Results: The reviewed literature confirms that regular physical activity improves insulin sensitivity and glycemic control in patients with T2DM. However, exercise regimens must be personalized to avoid glycemic complications. Pharmacotherapy should consider the risk of hypoglycemia and dehydration, especially when using insulin or SGLT2 inhibitors. Nutritional strategies, such as pre-exercise carbohydrate intake and hydration protocols, are critical. Technological tools like continuous glucose monitoring (CGM) enhance real-time decision-making. Multidisciplinary education increases adherence and safety in diabetes care among athletes.
Conclusions: Athletes with T2DM can achieve excellent glycemic control and high levels of performance if therapeutic strategies are personalized, evidence-based, and supported by education and technology. Further clinical studies are needed to develop sport-specific recommendations for this unique population.
References
Colberg, S. R., Sigal, R. J., Yardley, J. E., Riddell, M. C., Dunstan, D. W., Dempsey, P. C., ... Tate, D. F. (2016). Physical activity/exercise and diabetes: A position statement of the American Diabetes Association. Diabetes Care, 39(11), 2065–2079. https://doi.org/10.2337/dc16-1728
American College of Sports Medicine. (2022). Exercise/physical activity in individuals with type 2 diabetes: A consensus statement. Medicine & Science in Sports & Exercise, 54(2), 353–368. https://doi.org/10.1249/MSS.0000000000002800
Yardley, J. E., & Sigal, R. J. (2015). Exercise strategies for hypoglycemia prevention in individuals with type 1 diabetes. Diabetes Spectrum, 28(1), 32–38. https://doi.org/10.2337/diaspect.28.1.32
Riddell, M. C., Scott, S. N., Fournier, P. A., Colberg, S. R., Gallen, I. W., ... Taplin, C. E. (2005). Management of competitive athletes with diabetes: A review. Diabetes Spectrum, 18(2), 102–107. https://doi.org/10.2337/diaspect.18.2.102
Dube, J. J., Allison, K. F., Roussel, M., Goodpaster, B. H., & Toledo, F. G. S. (2020). Exercise in individuals with diabetes and prediabetes. Sports, 5(4), 83. https://doi.org/10.3390/sports5040083
Praet, S. F., & van Loon, L. J. (2009). Exercise therapy in type 2 diabetes. Acta Diabetologica, 46(4), 263–278. https://doi.org/10.1007/s00592-009-0126-1
Little, J. P., Gillen, J. B., Percival, M. E., Safdar, A., Tarnopolsky, M. A., Punthakee, Z., & Gibala, M. J. (2011). Low-volume high-intensity interval training reduces hyperglycemia and increases muscle mitochondrial capacity in patients with T2DM. Journal of Applied Physiology, 111(6), 1554–1560. https://doi.org/10.1152/japplphysiol.00921.2011
Reynolds, A. N., Mann, J. I., Williams, S., Venn, B. J., & Weatherall, M. (2016). Advice to walk after meals is more effective for lowering postprandial glycemia in type 2 diabetes than advice that does not specify timing: A randomized crossover study. Diabetologia, 59(12), 2572–2578. https://doi.org/10.1007/s00125-016-4085-2
Dunstan, D. W., Kingwell, B. A., Larsen, R., Healy, G. N., Cerin, E., Hamilton, M. T., ... Owen, N. (2012). Breaking up prolonged sitting reduces postprandial glucose and insulin responses. Diabetes Care, 35(5), 976–983. https://doi.org/10.2337/dc11-1931
Riddell, M. C., Gallen, I. W., Smart, C. E., Taplin, C. E., Adolfsson, P., Lumb, A. N., ... Colberg, S. R. (2017). Exercise management in type 1 diabetes: A consensus statement. The Lancet Diabetes & Endocrinology, 5(5), 377–390. https://doi.org/10.1016/S2213-8587(17)30014-1
Bailey, C. J., & Turner, R. C. (1996). Metformin. The New England Journal of Medicine, 334(9), 574–579. https://doi.org/10.1056/NEJM199602293340906
Zinman, B., Wanner, C., Lachin, J. M., Fitchett, D., Bluhmki, E., Hantel, S., ... Inzucchi, S. E. (2015). Empagliflozin, cardiovascular outcomes, and mortality in type 2 diabetes. The New England Journal of Medicine, 373(22), 2117–2128. https://doi.org/10.1056/NEJMoa1504720
Kelly, A. S., Auerbach, P., Barrientos-Perez, M., Gies, I., Hale, P. M., Marcus, C., ... Arslanian, S. (2022). A randomized trial of semaglutide in adolescents with obesity. The New England Journal of Medicine, 387(24), 2245–2257. https://doi.org/10.1056/NEJMoa2203240
Yardley, J. E., Kenny, G. P., Perkins, B. A., Riddell, M. C., Malcolm, J., Boulay, P., ... Sigal, R. J. (2013). Resistance versus aerobic exercise: Acute effects on glycemia in type 1 diabetes. Diabetes Care, 36(3), 537–542. https://doi.org/10.2337/dc12-0703
Zaharieva, D. P., & Riddell, M. C. (2017). Prevention of exercise-associated dysglycemia: A case study–based approach. Current Diabetes Reports, 17(12), 130. https://doi.org/10.1007/s11892-017-0955-7
Umpierre, D., Ribeiro, P. A. B., Kramer, C. K., Leitão, C. B., Zucatti, A. T. N., Azevedo, M. J., ... Schaan, B. D. (2011). Physical activity advice only or structured exercise training and association with HbA1c levels in type 2 diabetes: A systematic review and meta-analysis. JAMA, 305(17), 1790–1799. https://doi.org/10.1001/jama.2011.576
Dunstan, D. W., Daly, R. M., Owen, N., Jolley, D., De Courten, M., Shaw, J., & Zimmet, P. (2002). High-intensity resistance training improves glycemic control in older patients with type 2 diabetes. Diabetes Care, 25(10), 1729–1736. https://doi.org/10.2337/diacare.25.10.1729
American Diabetes Association. (2022). Exercise and type 2 diabetes. Diabetes Care, 45(Suppl 1), S77–S85. https://doi.org/10.2337/dc22-S006
Thomas, D. T., Erdman, K. A., & Burke, L. M. (2016). Position of the Academy of Nutrition and Dietetics, Dietitians of Canada, and the American College of Sports Medicine: Nutrition and athletic performance. Journal of the Academy of Nutrition and Dietetics, 116(3), 501–528. https://doi.org/10.1016/j.jand.2015.12.006
Jenkins, D. J. A., Kendall, C. W. C., Augustin, L. S. A., Franceschi, S., Hamidi, M., Marchie, A., ... Axelsen, M. (2002). Glycemic index: Overview of implications in health and disease. The American Journal of Clinical Nutrition, 76(1), 266S–273S. https://doi.org/10.1093/ajcn/76.1.266S
Ivy, J. L. (2001). Dietary strategies to promote glycogen synthesis after exercise. Canadian Journal of Applied Physiology, 26(S1), S236–S245. https://doi.org/10.1139/h01-019
Sawka, M. N., Burke, L. M., Eichner, E. R., Maughan, R. J., Montain, S. J., & Stachenfeld, N. S. (2007). American College of Sports Medicine position stand: Exercise and fluid replacement. Medicine & Science in Sports & Exercise, 39(2), 377–390. https://doi.org/10.1249/mss.0b013e31802ca597
Maughan, R. J., Burke, L. M., Dvorak, J., Larson-Meyer, D. E., Peeling, P., Phillips, S. M., ... Meeusen, R. (2018). IOC consensus statement: Dietary supplements and the high-performance athlete. British Journal of Sports Medicine, 52(7), 439–455. https://doi.org/10.1136/bjsports-2018-099027
American Diabetes Association. (2022). 7. Diabetes technology: Standards of medical care in diabetes—2022. Diabetes Care, 45(Suppl 1), S97–S112. https://doi.org/10.2337/dc22-S007
Battelino, T., Danne, T., Bergenstal, R. M., Amiel, S. A., Beck, R., Biester, T., ... Heller, S. R. (2019). Clinical targets for continuous glucose monitoring data interpretation: Recommendations from the international consensus on time in range. Diabetes Care, 42(8), 1593–1603. https://doi.org/10.2337/dci19-0028
Zaharieva, D. P., Turksoy, K., Hughson, R. L., Samadi, S., Feng, J., Daskalaki, E., ... Cinar, A. (2018). Integrated artificial pancreas with adaptive exercise detection: In silico and real-world testing. Journal of Diabetes Science and Technology, 12(6), 1170–1179. https://doi.org/10.1177/1932296818793948
Greenwood, D. A., Gee, P. M., Fatkin, K. J., & Peeples, M. (2017). A systematic review of reviews evaluating technology-enabled diabetes self-management education and support. Journal of Diabetes Science and Technology, 11(5), 1015–1027. https://doi.org/10.1177/1932296817713506
Powers, M. A., Bardsley, J., Cypress, M., Duker, P., Funnell, M. M., Fischl, A. H., ... Vivian, E. (2020). Diabetes self-management education and support in adults with type 2 diabetes: A consensus report. The Diabetes Educator, 46(4), 350–369. https://doi.org/10.1177/0145721720930959
Kutz, M. R. (2018). Sport and exercise psychology: A case-based approach. Jones & Bartlett Learning.
Tricco, A. C., Ivers, N. M., Grimshaw, J. M., Moher, D., Turner, L., Galipeau, J., ... Straus, S. E. (2014). Effectiveness of quality improvement strategies for coordination of care to reduce use of health care services: A systematic review and meta-analysis. CMAJ: Canadian Medical Association Journal, 186(15), E568–E578. https://doi.org/10.1503/cmaj.140289
Views:
24
Downloads:
12
Copyright (c) 2025 Adam Żuczek, Olga Żuczek, Kinga Dyndał, Marcelina Broda, Patrycja Jędrzejewska-Rzezak, Katarzyna Urbańska, Izabela Szczap, Anna Hawryluk, Kamil Marzec, Aleksandra Mokrzycka
This work is licensed under a Creative Commons Attribution 4.0 International License.
All articles are published in open-access and licensed under a Creative Commons Attribution 4.0 International License (CC BY 4.0). Hence, authors retain copyright to the content of the articles.
CC BY 4.0 License allows content to be copied, adapted, displayed, distributed, re-published or otherwise re-used for any purpose including for adaptation and commercial use provided the content is attributed.
