The effect of time spent outdoors during summer on daily blood glucose and steps in women with type 2 diabetes
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The effect of time spent outdoors during summer on daily blood glucose and steps in women with type 2 diabetes Molly B. Richardson1 · Courtney Chmielewski2 · Connor Y. H. Wu3 · Mary B. Evans4 · Leslie A. McClure5 · Kathryn W. Hosig1,6 · Julia M. Gohlke1
Received: 1 June 2019 / Accepted: 12 October 2019 © Springer Science+Business Media, LLC, part of Springer Nature 2019
Abstract This study investigated changes in glycemic control following a small increase in time spent outdoors. Women participants with type 2 diabetes (N = 46) wore an iBUTTON temperature monitor and a pedometer for 1 week and recorded their morning fasting blood glucose (FBG) daily. They went about their normal activities for 2 days (baseline) and were asked to add 30 min of time outdoors during Days 3–7 (intervention). Linear mixed effects models were used to test whether morning FBG values were different on days following intervention versus baseline days, and whether steps and/or heat exposure changed. Results were stratified by indicators of good versus poor glycemic control prior to initiation of the study. On average, blood glucose was reduced by 6.1 mg/dL (95% CI − 11.5, − 0.6) on mornings after intervention days after adjusting for age, BMI, and ambient weather conditions. Participants in the
poor glycemic control group (n = 16) experienced a 15.8 mg/ dL decrease (95% CI − 27.1, − 4.5) in morning FBG on days following the intervention compared to a 1.6 mg/dL decrease (95%CI − 7.7, 4.5) for participants in the good glycemic control group (n = 30). Including daily steps or heat exposure did not attenuate the association between intervention and morning FBG. The present study suggests spending an additional 30 min outdoors may improve glycemic control; however, further examination with a larger sample over a longer duration and determination of mediators of this relationship is warranted.
Electronic supplementary material The online version of this article (https://doi.org/10.1007/s10865-019-00113-5) contains supplementary material, which is available to authorized users.
Glycemic control for persons diagnosed with type 2 diabetes is challenging. Building on Thaler and Sustein’s idea of nudge theory (Thaler and Sunstein 2008) where small changes may create a choice architecture that makes the healthy choice easier or the default choice has shown public health promise when applied to obesity research (Arno and Thomas 2016). Since obesity and diabetes are highly correlated (Golay and Ybarra 2005), some approaches found successful in persons with obesity may be effective in persons with diabetes. A nudge-based risk communication intervention providing personalized life expectancy information was shown to be feasible and acceptable for individuals with poor glycemic control (Rouyard et al. 2018). However, the nudge approach related to time spent outdoors for improved glycemic control has largely been unexplored. Small, potentially unnoticeable changes to one’s life may
* Julia M. Gohlke [email protected] 1
Department of Population Hea
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