type 2 diabetes mellitus is a widely known chronic metabolic disease in nearly all 
 countries that is characterized by an increase in the blood - glucose level resulting from 
 impairment of -cell function relative to insulin sensitivity1 , 2 . it is associated with 
 changes in body mass index ( bmi ) , glycemic control , the quality of life , and the others as 
 well as complications related to the cardiovascular , renal , optic , and neural system2,3,4 . the prevalence of type 2 diabetes has become a leading global factor of mortality and 
 morbidity5 . the population with type 2 
 diabetes would increase worldwide by 11.4% from 366 million in 2011 to 522 million by 2030 , 
 representing about one in 10 adult . in korea , the prevalence rate of diabetes is expected to 
 be similar to the global trend , and the global rate has increased approximately seven - fold , 
 from 1.5 to 9.9% , during the past 40 years6 . in particular , diabetes has become one of the leading causes of 
 death , and the rate of death is the twice as high as that among persons without the 
 disorder3 , 7 . although there has been noticeable development of new treatment 
 modalities for diabetes , many studies have reported that the prevalence of diabetes is 
 expected to double over the next 25 years5 . clinical trials for patients with diabetes are focused on intensive glycemic control to 
 prevent hypoglycemia by multifactorial interventions8 , 
 9 . adjustment of food intake , 
 pharmacological therapy , and exercise are suggested as the three major sources of therapy 
 for type 2 diabetes10 . it has an well - known impact on 
 glycated hemoglobin as well as independent effects on other parameters of cardio - metabolic 
 risk by promoting endothelial function11 . although most guidelines has emphasized the importance of exercise training and numerous 
 studies have demonstrated effects on diabetes in experimental environments , large - scale 
 research of relations between these interventions and diabetes have been lacking until 
 recent years in korea12 . therefore , the 
 aim of present study was to investigate the current evidence for the effect of exercise on 
 glycemic control , the lipid profile , body composition , vascular health , and complications in 
 a number of patients with type 2 diabetes . this study was performed for two months , from march 19 , 2013 , to may 29 , 2013 , at 13 
 general hospitals located in seoul and gyeonggi province , republic of korea . patients over 
 20  year old and registered as having type 2 diabetes , excluding those with type 1 diabetes 
 and those who were unfit on the day they were diagnosed , were invited to participate . based 
 on these criteria , there were 2,626 possible participants who had visited outpatient clinics 
 and received medical care for 6 months . this study was approved by the institutional review 
 board ( irb ) of each participant s hospital . in this study , we surveyed the management of the 
 1,263 type 2 diabetic patients of 13 general hospitals in the republic of korea according to 
 the american diabetes association ( ada ) guidelines8 . using medical records , we investigated socio - economic data , disease - related data , blood 
 sampling tests , prescription drugs , co - morbidities and complications . bmi was calculated as weight ( kg ) divided by height 
 ( m ) squared . to understand the management , we checked the results of angiography and 
 hemoglobin a1c ( hba1c ) , serum lipid , fasting blood sugar , 2-hour postprandial glucose , and 
 microalbuminuria test which are the indexes for blood sugar management . we also investigated 
 behavioral treatment , oral hypoglycemic agents , insulin , insulin with an oral hypoglycemic 
 agent and insulin pumps in the case of diabetes treatment . for comorbid medication , we 
 investigated hypertension drugs , anticoagulation agents and anti - lipidemic agents . we 
 investigated the 1  year results , and if there were no records or the records were one or 
 more years old , the patient was considered to have had no check - up . for the appropriate 
 metabolic control level , we checked the blood sugar level , blood pressure , low - density 
 lipoprotein cholesterol ( ldl - c ) < 100  mg / dl , high - density lipoprotein , and serum lipid 
 level . we followed the target standards of the ada which were the hba1c < 7.0% , blood 
 pressure < 130/80 mmhg , cholesterol ( hdl - c ) > 40  mg / dl ( male ) or 55  mg / dl ( female ) , 
 and triglyceride < 150  mg / dl8 . regarding complications , we included only those diagnosed based on the patients medical 
 records . for complications , we counted cases in which patients had related drug 
 prescriptions even if there was no diagnosis and cases in which there were diseases 
 diagnosed based on the patients medical records . if the patients had received education at 
 other institutions , the education was excluded because of lack of clear records and quality 
 control . when patients were medicated with hypertension- and dyslipidemia - related drugs , we 
 whether or not there were medical records . all statistical analyses were performed using spss for windows ( v. 12.0  k , spss inc . , the results were expressed as the mean  standard deviation ( sd ) and 
 number ( percent ) . the general and clinical characteristics of the patients in the exercise 
 and non - exercise groups , including age , height , weight , and others results , were analyzed 
 with the independent t - test . pearson s correlation coefficients were used to assess the relation between 
 metabolic regulation ( blood pressure , glucose , hba1c , total cholesterol , triglyceride , and 
 hdl and ldl cholesterol ) and exercise in patients with type 2 diabetes . moreover , univariate 
 logistic regression was used to assess the associations between achievement of goals for 
 metabolic regulation of medical characteristics and complications and exercise in patients 
 with type 2 diabetes . the odds ratios for each factor in each model were calculated with 
 wald - type 95% confidence intervals . characteristics of the study population were analyzed ( table 1table 1.general and clinical characteristics of the patients in the exercise and 
 non - exercise groupsvariabletotalexercisenon - exercisemeansdmeansdmeansdn1,263734529age ( yr)60.611.660.411.060.912.5height ( cm)163.19.1163.58.6162.59.7weight ( kg)67.011.466.611.067.611.9bmi ( kg / m)25.13.3 * 24.93.125.53.6onset ( yr)50.111.150.010.650.411.9duration of diabetes ( yr ) 10.58.310.48.010.58.5n ( % ) n ( % ) gendermale734 ( 58.1)440 ( 59.9)294 ( 55.6)female529 ( 41.9)294 ( 40.1)235 ( 44.4)hypertension625 ( 49.5)*342 ( 46.6)283 ( 53.5)hyperlipidemia206 ( 16.3)109 ( 14.9)97 ( 18.3)therapy of diabetesdiet48 ( 3.8)24 ( 3.3)24 ( 4.5)oral agent895 ( 70.9)528 ( 71.9)367 ( 69.4)oral agent+inulin236 ( 18.7)137 ( 18.7)99 ( 18.7)insulin78 ( 6.2)43 ( 5.8)35 ( 6.6)education experience773 ( 61.2)*469 ( 63.9)304 ( 57.5)characteristics of the study population were investigated using medical records 
 including disease - related data and data for blood sampling tests , prescription drugs , 
 comorbidities , and complications . each value is presented as the mean  sd of the 
 values measured during the survey . * p < 0.05 ) . among the 1,263 diabetic participants , 734 routinely performed exercise for 
 management of diabetes . the baseline characteristics of the participants revealed an average 
 age of 60.6  years with a slightly higher proportion of males ( 58.1% ) than females ( 41.9% ) . there were no significant differences in height ( 163.58.6  cm vs. 162.59.7  cm ) , weight 
 ( 66.611.0  kg vs. 67.611.9  kg ) , and duration of diabetes ( 10.48.0  years vs. 
 10.58.5  years ) between the exercise and non - exercise groups . however , there was a 
 significant difference in bmi ( 24.93.1 vs. 25.53.6 ) between the two groups . in the 
 exercise group , 46.6% of the participants had hypertension , 14.9% of the participants had 
 hyperlipidemia , 63.9% of the participants had received education concerning diabetes . in the 
 non - exercise group , 53.5% of the participants had hypertension ( 53.5% ) , 18.3% of the 
 participants had hyperlipidemia , and 57.5% of the participants had received education 
 concerning diabetes . an oral agent was applied for diabetes therapy for most of the 
 participants in the two groups ( 71.9% vs. 69.4% ) . characteristics of the study population were investigated using medical records 
 including disease - related data and data for blood sampling tests , prescription drugs , 
 comorbidities , and complications . each value is presented as the mean  sd of the 
 values measured during the survey . * p < 0.05 the correlation coefficients showed an association between metabolic regulation variables 
 and exercise management . most metabolic regulation variables had associations with exercise , 
 except for diastolic blood pressure ( dbp ) ( table 
 2table 2.the correlation coefficients for metabolic regulation and exercise in patients 
 with type 2 diabetesvariableexercisenon - exercisecorrelation coefficientsmeansdmeansdsbp123.914.0126.114.80.1*dbp74.39.975.110.00.0fasting glucose132.838.0140.945.01.0*postprandial glucose192.169.3210.175.50.1*hba1c7.21.27.61.60.1*total cholesterol162.534.8167.440.10.1*triglyceride131.084.5157.095.10.1*hdl50.114.547.713.10.9*ldl92.530.299.158.70.1*the relations between metabolic regulation ( blood pressure , glucose , hba1c , total 
 cholesterol , triglyceride , and hdl and ldl cholesterol ) and exercise in patients with 
 type 2 diabetes were analyzed . exercise management was associated with a decrease in the levels of systolic 
 blood pressure ( sbp ) , fasting glucose , postprandial glucose , hba1c , total cholesterol , 
 triglyceride , and ldl . the relations between metabolic regulation ( blood pressure , glucose , hba1c , total 
 cholesterol , triglyceride , and hdl and ldl cholesterol ) and exercise in patients with 
 type 2 diabetes were analyzed . p < 0.05 in order to calculate the odds ratio for exercise and achievement of goals for metabolic 
 regulation in patients with type 2 diabetes , univariate logistic regression was performed 
 ( table 3table 3.odds ratio for exercise and achievement of goals for metabolic regulation in 
 patients with type 2 diabetesvariablegoalexercisenon - exerciseodds ratioachievement ( % ) achievement ( % ) blood pressure<130/80384 ( 52.3)242 ( 45.7)1.3*fasting glucose<130372 ( 53.1)222 ( 42.0)1.3*postprandial glucose<180299 ( 40.7)158 ( 29.9)1.5*hba1c<7.0371 ( 50.5)214 ( 40.5)1.5*<6.5199 ( 27.1)114 ( 21.6)1.3*total cholesterol<200597 ( 81.3)394 ( 74.5)1.3triglyceride<150518 ( 70.6)288 ( 54.4)2.0*hdlmen>40295 ( 67.0)163 ( 55.4)1.3*women>50138 ( 46.9)104 ( 44.3)1.3ldl<100399 ( 54.4)274 ( 51.8)1.2bmi18.524.9383 ( 52.2)241 ( 45.6)1.3*odds ratios for exercise and achievement of goals for metabolic regulation in 
 patients with type 2 diabetes were calculated by univariate logistic regression . achievement of goals was decided based on the target standards of the ada , which were 
 the hba1c < 7.0% , blood pressure < 130/80 mmhg , ldl - c < 100  mg / dl , hdl - c > 
 40  mg / dl ( male ) or 55  mg / dl ( female ) , and triglyceride < 150  mg / dl . odds ratios for 
 each factor in each model were calculated with wald - type 95% confidence intervals . regarding achievement of goals for metabolic regulation , significant odds 
 ratios were observed for the effect of exercise treatment on blood pressure , fasting 
 glucose , postprandial glucose , hba1c , triglyceride , hdl in men , and bmi in the patients with 
 type 2 diabetes . odds ratios for exercise and achievement of goals for metabolic regulation in 
 patients with type 2 diabetes were calculated by univariate logistic regression . achievement of goals was decided based on the target standards of the ada , which were 
 the hba1c < 7.0% , blood pressure < 130/80 mmhg , ldl - c < 100  mg / dl , hdl - c > 
 40  mg / dl ( male ) or 55  mg / dl ( female ) , and triglyceride < 150  mg / dl . odds ratios for 
 each factor in each model were calculated with wald - type 95% confidence intervals . * p 
 < 0.05 moreover , the odds ratios for exercise and complication incidence in patients with type 2 
 diabetes were also analyzed ( table 4table 4.odds ratio for exercise and complication incidence in patients with type 2 
 diabetesvariableexercisenon - exerciseodds ratiocomplication incidence ( % ) complication incidence ( % ) neuropathy147 ( 20.0)110 ( 20.8)1.0cerebrovasculopathy64 ( 8.7)65 ( 12.3)0.7*cardiovasculopathy164 ( 22.3)121 ( 22.9)1.0odds ratio for exercise and complication incidence in patients with type 2 diabetes 
 were calculated . univariate logistic regression was used to assess the associations 
 between complications and exercise in type 2 diabetes . odds ratios for each factor in 
 each model were calculated with wald - type 95% confidence intervals . odds ratio for exercise and complication incidence in patients with type 2 diabetes 
 were calculated . univariate logistic regression was used to assess the associations 
 between complications and exercise in type 2 diabetes . odds ratios for each factor in 
 each model were calculated with wald - type 95% confidence intervals . type 2 diabetes mellitus is associated with changes in all organ systems involved in human 
 health including the digestive , cardiovascular , renal , optic , and neural systems . for type 2 diabetes , the three major sources of therapy are adjustment of food intake , pharmacological 
 therapy , and exercise . among them , exercise makes up an important part of diabetes 
 management and ameliorates the health of patients with type 2 diabetes . therefore , the aim 
 of present study was to investigate the current evidence for the effect of exercise on 
 glycemic control , lipid profile , body composition , vascular health , and complications in a 
 number of patients with type 2 diabetes to understand the apparent relations between 
 exercise and health . diabetes affects both body mass and muscle quality , due to poor vascular supply and 
 peripheral neuropathy13 . among the 
 characteristics of the study population , there was a significant difference in only bmi 
 between the exercise and non - exercise groups in the present results . the bmi value 
 represents a highly important risk factor for type 2 diabetes , and exercise adjusts the bmi 
 by reducing visceral fat and increasing the fat - free mass7 , 14 our results showed an association between metabolic regulation variables and exercise 
 management . exercise 
 management was associated with a decrease in sbp , fasting glucose , postprandial glucose , 
 hba1c , total cholesterol , triglyceride , and ldl . furthermore , it is well known that aerobic exercise enhances 
 glycemic control , raising it to a moderate level5 . endurance exercise helps to decrease ldl - c , however , it had no 
 impact on hdl , total cholesterol , and triglycerides16 . moreover , in the present results concerning exercise and achievement of goals for metabolic 
 regulation in patients with type 2 diabetes , significant odds ratios were observed for the 
 effect of exercise treatment on blood pressure , fasting glucose , postprandial glucose , 
 hba1c , triglyceride , hdl in men , and bmi in the patients with type 2 diabetes . these results 
 are related to the effect of exercise through the regulation of energy metabolism in type 2 
 diabetes . exercise induces a change in fuel usage by working muscle from nonesterified fatty 
 acids to a blend of nonesterified fatty acids , glucose , and muscle glycogen10 . during exercise , these changes induce a decrease in insulin secretion and increase in glucagon , 
 catecholamine , and cortisol secretion . moreover , these neural and endocrine changes cause 
 deficits in fuel availability , neural activity from the acting limb , visceral organs , and 
 baroreceptor control of heart rate17 . the 
 exercise - induced increase in glucagon evokes glycogenolysis and gluconeogenesis as well as 
 hepatic amino metabolism and fat oxidation . the exercise - induced increase in endogenous glucose 
 production is important in regulation of whole - body glucose homeostasis10 . meanwhile , in our results concerning exercise and complication incidence in patients with 
 type 2 diabetes , exercise management was associated with decreased occurrence of 
 cerebrovasculopathy . previous studies reported that aerobic exercise had valuable effects on 
 metabolic parameters such as glycemic control , fasting blood glucose level , and the lipid 
 profile , and decreased the risk factors in type 2 diabetes2 . the present study demonstrated that exercise was associated with metabolic regulation of 
 glycemic control , the lipid profile , and body composition , as well as vascular health and 
 complications , in 1,263 korean patients with type 2 diabetes . these results from this 
 large - scale study could explain the apparent relations between exercise and diabetic health . therefore , these facts imply that exercise leads to a more healthy life and reduces 
 disorders and complications in patients with type 2 diabetes . more research related to the 
 importance of exercise in terms of its various beneficial aspects is needed for people with 
 type 2 diabetes in other countries .
[ purpose ] the aim of the present study was to investigate the current evidence for the 
 effect of exercise on glycemic control , the lipid profile , body composition , vascular 
 health , and complications in korean patients with type 2 diabetes . [ subjects and methods ] 
 the subjects were 1,263 patients receiving outpatient care at 13 general hospitals located 
 in seoul and gyeonggido who were subjected to examinations in the areas of blood glucose 
 management , complications management , and diabetes education between march 19 and may 29 , 
 2013 . the relations between exercise and various regulatory factors including patient s 
 general and clinical characteristics , metabolic regulation , achievement of goals for 
 metabolic regulation , and complication incidence in patients with type 2 diabetes were 
 investigated . 
 [ results ] exercise management was associated with a decrease in systolic 
 blood pressure , fasting glucose , postprandial glucose , hemoglobin a1c , total cholesterol , 
 triglyceride , and low - density lipoprotein regarding achievement of goals for metabolic 
 regulation , significant odds ratios were observed for the effect of exercise treatment on 
 blood pressure , fasting glucose , postprandial glucose , hemoglobin a1c , triglyceride , hdl 
 in men , and bmi in patients with type 2 diabetes . 
 moreover , exercise management was 
 associated with decreased occurrence of cerebrovasculopathy . 
 [ conclusion ] in conclusion , 
 exercise induced metabolic regulation of glycemic control , the lipid profile , and body 
 composition , as well as vascular health and complications , in korean patients with type 2 
 diabetes .