Diabetes mellitus (DM) is an alarming global health problem [1]. The disease is often associated with various comorbidities and secondary complications, which, in addition to the suffering of patients, also leads to a considerable economic burden [2]. According to estimates, approximately 589 million people worldwide were affected in 2024, and this number is expected to rise dramatically in the coming years [3].
In Germany, at least 9 million people currently live with DM [4]. Over 90 % of these patients have type 2 DM. Lifestyle changes can have multiple positive effects for them, including improved glycemic control [5]. In some cases, especially when the disease is not yet advanced, these changes can even lead to remission of the disease [6]. Therefore, a healthy diet and regular exercise are highly recommended as effective treatment methods [7].
Diets and exercise programs
Various diets are being discussed for improving blood sugar control (HbA1c), insulin sensitivity, or beta cell function, including low-carbohydrate diets, low-fat diets, a Mediterranean diet, and various energy-restricted diets. There is still disagreement about which diet is most effective for managing type 2 DM [8]. In addition to changes in dietary habits, regular physical exercise is an established approach to improving the health of people with type 2 DM [9]. The question arises which diets and exercise programs can best be combined to maximize positive health effects in this patient group.
In a recently published systematic review, we included studies that combined different diets with the same exercise program in people with type 2 DM [10].
Energy-restricted low-carb diets with either high-fat or high-protein content showed superior effects in terms of some outcomes (medication dose, lipid profile, well-being) compared to diets with a higher carbohydrate content (in endurance or strength plus endurance training at moderate intensities). Other diets in direct comparison and in combination with exercise still need to be researched. In calorie-restricted diets, as well as in treatment with incretin mimetics for weight loss, targeted exercise interventions (especially strength training programs) can significantly reduce or even prevent the loss of muscle mass (which usually accompanies weight loss through calorie restriction) [11]. This is an important point, especially for people with type 2 DM, because a large proportion of the absorbed glucose is taken up by the muscles. In this case, more muscle mass means a higher likelihood for faster and more effective glucose clearance. Adequate protein intake is also crucial for optimizing the effects of strength training [12]. Another promising approach is the targeted combination of superfood consumption with exercise. For example, the consumption of certain foods, such as those with a high (poly)phenol content and correspondingly strong antioxidant effect (such as aronia berries), can have positive effects on chronic inflammation and glucose homeostasis in people with type 2 DM [13]. When it comes to exercise, timing is crucial.
Exercise-induced transient increases in oxidative stress are important for triggering training adaptations. Consuming foods with strong antioxidant properties too close to the time of exercise could therefore have a negative effect on long-term adaptations [14]. Exercise can also enhance the regeneration-promoting and anabolic effects of some superfoods. In a recent pilot study, we investigated the effects of daily consumption of a red berry juice with a high aronia content during a strength/endurance training intervention in individuals with prediabetes. After just two weeks, benefits for muscle mass were already evident compared to placebo [15].
Conclusion and outlook
For people with type 2 DM, lifestyle interventions that integrate both diet and exercise hold significant potential. Low-carb diets combined with exercise currently promise the most positive effects in direct comparison with classic macronutrient distribution. However, it should be noted that there currently only few studies investigating the combined effects of other diets and exercise in this particular patient group (especially those providing direct comparisons of different diets alongside the same exercise intervention). When aiming for weight loss, dietary or pharmacological measures should be accompanied by strength training to reduce or even prevent the loss of muscle mass. An adequate intake of protein is important in this context. Consuming certain superfoods and exercising can also be particularly effective for some outcomes. Further studies are needed to investigate the combined effects of diet and exercise in people with type 2 DM.
Literature
1 International Diabetes Federation. IDF Diabetes Atlas 11th Edition; International Diabetes Federation: Brussels, Belgium, 2025.
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4 Deutsche Diabetes Gesellschaft. Deutscher Gesundheitsbericht Diabetes 2024—Die Bestandsaufnahme; Deutsche Diabetes Gesellschaft: Berlin, Germany, 2023.
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13 Simeonov SB, Botushanov NP, Karahanian EB, Pavlova MB, Husianitis HK, Troev DM. Effects of Aronia melanocarpa juice as part of the dietary regimen in patients with diabetes mellitus. Folia Med 2002; 44: 20–23.
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15 Valder S, Schick F, Pietsch N, Wagner T, Urban H, Lindemann P, Riemer L, Quenzer S, Herdegen V, Diel P, Isenmann E, Brinkmann C. Effects of two weeks of daily consumption of (poly)phenol-rich red berry fruit juice, with and without high-intensity physical training, on health outcomes in individuals with pre-diabetes mellitus. Nutr Metab Cardiovasc Dis 2025: 104121.
Autoren
ist Sportwissenschaftler und Biologe. Er ist Professor für Fitness und Gesundheit an der IST Hochschule Düsseldorf, Leiter der Arbeitsgruppe „Integrative und experimentelle Sporttherapie bei Diabetes mellitus und Adipositas“ an der Deutschen Sporthochschule Köln (DSHS). Professor Brinkmann forscht zu Lebensstilinterventionen, Stoffwechsel und Wearable Technologien.
(Stand 2025)
