Nutrition and physical activity
Nutrition education programs can improve metabolic control in ambulatory older people with diabetes (44). Amino acid supplementation may improve glycemic control and insulin sensitivity in these patients, although this is controversial (45,46). Physical training programs can be successfully implemented in older people with diabetes, although comorbid conditions may prevent aerobic physical training in many patients, and increased activity levels may be difficult to sustain. Prior to instituting an exercise program, elderly subjects should be carefully evaluated for underlying CV or musculoskeletal problems that may preclude such programs. Aerobic exercise improves arterial stiffness and baroreflex sensitivity, both surrogate markers of increased CV morbidity and mortality (47,48). While the effects of aerobic exercise programs on glucose and lipid metabolism are inconsistent (49–51), resistance training has been shown to result in modest improvements in glycemic control, as well as improvements in strength, body composition, and mobility (52–56). Exercise programs may reduce the risk of falls and improve balance in patients with neuropathy (57,58). However, it appears difficult to maintain these lifestyle changes outside of a supervised setting (59).