Effect of Physical Activity on Fasting Blood Sugar Level, HbA1c and

Total Cholesterol among Type 2 Diabetes Mellitus Patients in Medan

City, Indonesia

Rina Amelia

, Juliandi Harahap

, Aznan Lelo

Reni Asmara Ariga

, and Novita Sari Harahap

Department of Community Medicine/Public Health, Faculty of Medicine, Universitas Sumatera Utara, Jl. dr. Mansyur

No.5 Kampus USU Medan 20155, Indonesia

Department of Pharmacology and Therapeutics, Faculty of Medicine, Universitas Sumatera Utara, Jl. dr. Mansyur No.5

Kampus USU Medan 20155, Indonesia

Faculty of Nursing, Universitas Sumatera Utara, Jl. Prof. Maas No. 3 Kampus USU Medan 20155, Indonesia

Faculty of Sport Sciences, State University of Medan, Jl. Wilem Iskandar Medan , Indonesia

Keywords: Physical activity, Type 2 Diabetes Meletus, Fasting Blood Glucose level, HbA1C, Total Cholesterol.

Abstract: Physical activity is an important role in diabetic patients. Physical activity done regularly and enough will

help patients to blood sugar control and prevent complications and control the body weight. The aim of this

study was to analyze the effect of physical activity on Fasting Blood Sugar Level, Hba1c and Total

Cholesterol among Type 2 Diabetes Mellitus (T2DM) patients in Medan City. The study design was analytic

with cross sectional approach. The study population was T2DM patients in Medan City with the number of

samples is 87 people who have fulfilled the inclusion and exclusion criteria. Data collection is done by

interviewing and patient blood test. Assessment of physical activity of diabetic patients using a global

questionnaire physical activity instrument that is a valid and reliable questionnaire. Fasting Blood Glucose

Level and Total Cholesterol examination done by Spectrophotometer Colorimeter + Full Automatic and

HbA1c examination using Doronad affinity + Modified HPLC method. The data analyzed using one way

ANOVA statistic test and processed data using SPSS. The results showed there was a relationship of physical

activity to fasting BGL, HbA1C levels and Total cholesterol of Diabetes Mellitus Type 2 patients in Medan

City.

1 INTRODUCTION

The increased prevalence of diabetes mellitus has

influenced by changes in lifestyle and lack of physical

activity. Adults who have less physical activity will

experience an increased risk of death by 20-30%

compared with people who perform enough physical

activity or routine each week (Ricther and

Hargreaves, 2013). Physical exercise is any body

movement produced by skeletal muscle contraction

that increases energy expenditure above the basal

level (Centre for Disease Control and Prevention,

2011). Physical activity is a movement of the body

due to skeletal muscle activity resulting in energy

expenditure, including activities while working,

playing, doing housework, travel, and recreation.

Physical activity is not the same as exercise or

physical exercise, where exercise is a subcategory of

planned, structured, a repetitive physical exercise to

improve and to maintain physical fitness (World

Health Organization, 2015)

Physical activity together with diet and drug

modifications has recommended one of four

components for diabetes therapy, in which the study

found that exercise can reduce hyperglycemia and

body fat and increase protection against the

development of cardiovascular complications

(Indonesia, 2015). Regular physical exercise reduces

dyslipidemia and increases insulin sensitivity. By

increasing the concentration of GLUT-4 receptors on

the plasma membrane or sarcolemma, insulin

resistance affects the transport of glucose into cells.

The glycemic control reduced visceral fat and

decreased plasma triglycerides can be achieved

528

Amelia, R., Harahap, J., Lelo, A., Ariga, R. and Harahap, N.

Effect of Physical Activity on Fasting Blood Sugar Level, HbA1c and Total Cholesterol among Type 2 Diabetes Mellitus Patients in Medan City, Indonesia.

DOI: 10.5220/0010077205280533

In Proceedings of the International Conference of Science, Technology, Engineering, Environmental and Ramiﬁcation Researches (ICOSTEERR 2018) - Research in Industry 4.0, pages

528-533

ISBN: 978-989-758-449-7

without loss of body weight (Kennedy et. al., 2012;

Amelia, 2017). Aerobic exercise increases glucose

uptake of muscle by up to five times through an

insulin-independent mechanism. After exercise,

glucose uptake continues to increase with an insulin-

independent mechanism for 2 hours and insulin-

dependent for up to 48 hours if prolonged exercise

(Colberg et al., 2010; Paramitha, 2014; Ramadhanisa,

2013; Amelia et al., 2017). Structured physical

activity like aerobic exercise, resistance training, or a

combination of both has been shown to decrease

HbA1c levels in diabetic patients; besides, moderate

intensity exercise for more than 150 minutes per week

is also closely related to decreased HbA1c (Cavero-

Redondo et al., 2017). Regular exercise of mild

intensity for more than 150 minutes per week proved

to be more effective than those who exercised less

than 150 minutes per week. This situation is indeed in

line with the theory since HbA1c is a valid glycemic

blood marker in the last three months. Regular

exercise of mild intensity for more than 150 minutes

per week proved to be more effective than those who

exercised less than 150 minutes per week (Cavero-

Redondo et al., 2018; Boniol et al., 2017; Amelia et

al., 2018; Harahap et al., 2018). The aim of this study

was to analyze the effect of physical activity on

glycemic control (FBGL and HbA1C and Total

Cholesterol) of T2DM patients in Medan City.

2 MATERIAL AND METHOD

The study design was analytic with a cross-sectional

approach, in which the assessment of physical activity

and glycemic control has performed at one time only.

After the collection of observational data on diabetes

patients continue to assess the complications

experienced by patients. The conducted data has done

in April-May 2018. The study population was DM

Type 2 patient in Medan City. Sampling is type2

Diabetic patients from several community health

centers in Medan City and General Practice doctors

serving outpatient diabetes patients. Determination of

the sample size done by using the formula of

population proportion estimation by using a single

simple formula for the proportion of population

hypothesis so that the number of samples is 85 people

who have fulfilled the inclusion and exclusion

criteria. The inclusion criteria in this study were:

Patients DMT2 aged 35-55 years, had no

contraindication to doing physical exercise, willing to

follow the research and the patient came

independently to the place of service and independent

in performing daily activities. While Exclusion

Criteria are: Patients with severe complications, type

1 Diabetes mellitus patients, another type, and

gestational, type 2 diabetes mellitus patients

accompanied by other comorbidities.

Data collection is done by interviewing and taking

blood. Before the research, this research protocol has

been approved by the research ethics committee at the

Faculty of Medicine Universitas Sumatera Utara, and

all participants who are willing to participate in the

research have signed written informed consent. The

source of research data is primary data, namely

patient characteristics data, nutritional status, data

physical activity and glycemic control data.

Assessment of the physical activity of diabetic

patients using a global physical activity questionnaire

instrument that is a valid and reliable questionnaire,

for each patient answer will get a predetermined

score, physical activity in diabetes patients divide to

three categories, namely physical activity is less/low,

enough/ excellent and high/excessive. Assessment of

glycemic control includes fasting blood glucose level,

hbA1C levels and Total cholesterol by direct blood

venous removal from diabetes patients. Fasting blood

glucose level ad Total Cholesterol examinations were

done by Spectrophotometer Colorimeter + Full

Automatic and HbA1c examination using Doronad

affinity + Modified HPLC method. After the data

collected then analyzed by using one way ANOVA

statistical test and processed data using SPSS.

3 RESULT AND DISCUSSION

3.1 Baseline Characteristics of T2DM

Patients in Medan City

Table 1: Basic Characteristics of T2DM patients in Medan

City

Characteristics

Frequency

(n)

Percentage

(%)

Gender

Man 16 18.8

Woman 69 81.2

Age Group

Late adolescent (36-

45 years old)

12 14.1

Early elderly (46-55

years old)

73 85.9

Ethnic

Batak 4 4.7

Mandailing 8 9.4

Padang 10 11.8

Jawa 52 61.2

Effect of Physical Activity on Fasting Blood Sugar Level, HbA1c and Total Cholesterol among Type 2 Diabetes Mellitus Patients in Medan

City, Indonesia

529

Melayu 10 11.8

Banjar 1 1.2

Work

Civil Servants 7 8.2

Private Servants 23 27.1

Retired 3 3.5

Policemen 2 2.4

Entrepreneurs 8 9.4

Housewives 42 49.4

Duration of Illness

1-5 years 52 61.2

6-10 years 20 23.5

11-15 years 11 12.9

˃ 15 years 2 2.4

Diabetes History

Father 15 17.6

Mother 15 17.6

Father and Mother 8 9.4

No one 47 55.3

Use of Anti-Diabetic

Drugs

Glibenclamide 68 80.0

Metformin 7 8.2

Combination

(Glikenklamid+

Metformin)

5 5.9

Traditional drug 3 3.5

Use of Insulin

Present 2 2.4

Not Present 83 97.6

BMI

Less Weight 8 9.4

Normal Weight 43 50.6

Obesity 34 40

Blood Pressure

Hypertension 68 80.0

Not Hypertension 17 20.0

Physical Activity (PA)

High PA 19 22.4

Medium PA 13 15.3

Low PA 53 62.4

Table 1 explains that based on gender it is known that

most patients are women (81.2%), based on age

known to most elderly patients are Early elderly (46-

55 years old) (85.9%). Based on the ethnic, majority

is Java as many as 52 people (61.2%). The most

patient work is a housewife as much as 42 people

(49.4%). Based on the duration of diabetes known to

the majority of diabetes for 1-5 years as many as 52

people (61.2%), most patients with diabetes. Based on

the family history known most diabetic patients have

a family history of diabetes suffered by the mother as

much as 47 people (55.3%). The majority of diabetic

patients consume glibenclamide as an anti-diabetic

drug as much as 68 people (80%) and only 2 people

who have a history of using insulin 83 people

(97.6%). Nutritional status of diabetes patients most

normal nutritional status as many as 43 people

(50.5%). The majority of patients experienced an

increase in blood pressure as much as 68 people

(80%). Based on physical activity it is known that the

majority of diabetic patients have a less physical

activity / low as much as 68 people (80%).

3.2 Fasting Blood Glucose Level,

HbA1C, and Total Cholesterol of

T2DM Patients in Medan City

Table 2: Glycemic and Total Cholesterol Control Data of

T2DM Patients

Parameter Mean Median SD Min Max

FBSL

(mg/dl)

249.9 245.0 109.

87.0 600.

HbA1C

(mg/dl)

9.4 9.1 2.8 6.0 15.8

Total

Kolesterol

(mg/dl)

232.5 229.0 196.

110.

456.

Results of Table 2 showed that mean of FBSL was

249.9 mg/dl, and the hbA1C level was 9.4 mg/dl and

the total cholesterol level was 232.5 mg/dl.

3.3 Relationship of Physical Activity

with Fasting Blood Glucose,

HbA1C, and Total Cholesterol in

T2DM Patients in Medan City

Table 3: Relation of Physical Activity with Fasting Blood

Glucose, HbA1C, and Total Cholesterol in T2DM Patients

in Medan City

Parameter Physical Activity

(PA)

F Sig

BGL

(mg/dl)

High PA 3.518

0.025

Medium PA

Low PA

HbA1C

(mg/dl)

High PA 3.403

0.038

Medium PA

Low PA

Total

Kolesterol

(mg/dl)

High PA 3.710 0.045

Medium PA

Low PA

Table 3 is the result of ANOVA test. The results of

table 2 show that there are differences in the average

ICOSTEERR 2018 - International Conference of Science, Technology, Engineering, Environmental and Ramiﬁcation Researches

530

levels of FBGL, HBA1C, and total cholesterol based

on the physical activity of T2DM patients.

Diabetes is one of the metabolic diseases, in the

metabolic syndrome, regular physical exercise will

lower blood sugar, HbA1c, triglycerides, blood

pressure, and insulin resistance. Insulin work on the

muscles and the liver can be modified either by

physical exercise that is acute or physical exercise

regularly (Meenu and Jayendrasinh, 2013; Rusdiana

et al., 2018; Nurmawati and Kusmiyati, 2008).

Accordingly, aerobic exercise increases the uptake of

glucose up to five muscles fold through the insulin-

independent mechanism After exercise, and glucose

uptake continues to rise with a 2-hour insulin-

independent and insulin-dependent mechanism for up

to 48 hours if prolonged exercise (Colberg et al.,

2010). Improvement of insulin work can last up to 24

hours after a short physical exercise (about 20

minutes) if the intensity has increased close to the

maximum. Even low-intensity aerobic exercise can

improve insulin work in obese patients, and insulin

resistance for 24 hours. Increased entry of glucose

into muscle cells lasts for several hours after physical

exercise. Regular or regular physical exercise may

also increase prolonged insulin sensitivity (Guelfi et

al., 2007). During physical exercise, the entry of

glucose into the skeletal muscle will increase. This

situation is due to an increase in the number of

glucose transporters in the muscle cell membrane of

GLUT-4 (glucose transporters-4). In addition to being

found in muscle cells, GLUT-4 is also present in fatty

tissues and other tissues. Physical activity extends the

capillary collateral area of muscle and blood flow,

where the GLUT4 expression (skeletal muscle

glucose transporter protein 4) will increase as well;

increased glucose synthesis, reduced release as well

as increased clearance of free fatty acids. With the

least amount of blood glucose available, the process

of glucose binding to heteroprotein hemoglobin will

reduce so that HbA1c levels are also decreased

(Amelia et al., 2017; Cavero-Redondo et al., 2017;

Boniol and Dragomir, 2017; Amelia et al., 2018).

The rate of reduction of BGL, HbA1C, and Total

cholesterol depends on the type of physical activity

performed. The Surgeon General's Report on Physical

Activity and Health recommends that all adult

individuals should have the moderate physical

activity for at least 30 minutes almost every day of the

week) (Cavero-Redondo et al., 2017; Boniol and

Dragomir, 2017). In general, a physical activity

carried out is aerobic and nonaerobic (resistance

training) and mixed physical exercise between

aerobic and resistance training. Aerobics and

prisoners have their respective advantages and

disadvantages in maintaining BGL and HbA1c levels,

but by doing a combination of both types of physical

activity, it will get better results. One of the famous

trial studies in examining the relationship between

physical activity and HbA1c levels was a trial DARE

(The Diabetes Aerobic and Resistance Exercise

Study) examined and compared the effects of

physical exercise resistance training, aerobic, and a

combination of both for six months. Once examined,

the combination of physical exercise is the most

effective physical activity in controlling HbA1c

compared to a physical activity other singles: were

found to decrease by 0.46% larger in the couch

damping aerobic exercise alone and 0.59% greater

than the resistance exercise only. Besides, it can

presume that participants with baseline HbA1c lower

than 7.5% had only a 'down' effect through

combination physical exercise; participants with

HbA1c levels> 7.5% independent of the type of

physical activity selected, although combination

physical exercise provides more benefits (Byrne et

al., 2017). For good results, physical activity must

meet the requirements that are done at least 3 to 4

times a week with and at least 30 minutes in a

continuous activity for at least eight weeks. The

duration of physical activity affects the fraction of

BGL decrease, HbA1c, and Total Cholesterol.

A prospective study in 16 patients with T2DM

aged 50-54 who underwent aerobic physical exercise

for eight weeks obtained improved blood glucose

control with decreased fasting blood glucose levels

and significant HbA1c levels with value p <0.05

(Maiorana et al., 2001; Huang et al., 2014). In

moderate exercise intensity for more than 150

minutes per week proved to be more effective than

those who exercised less from 150 minutes per week.

HbA1c is a valid glycemic marker of blood in the last

three months. The authors themselves acknowledge

the variation of physical activity intervention is one

of the factors that trigger the variation in quality and

heterogeneity of data in this meta-analysis.

Another study showed that the mean decrease of

blood sugar, HbA1c, cholesterol, LDL, HDL, and

triglyceride levels were found in moderate physical

activity with duration ≥ 150 minutes/week. Besides,

mean BGL, HbA1c, cholesterol, LDL, HDL and

triglyceride levels were found to decrease in intensive

physical activity for ≥ 75 minutes/week and ≥ 150

minutes/week (Carral Fet al., 2013).

Effect of Physical Activity on Fasting Blood Sugar Level, HbA1c and Total Cholesterol among Type 2 Diabetes Mellitus Patients in Medan

City, Indonesia

531

4 CONCLUSIONS

Physical activity has an essential role in controlling

BGL, HbA1 C and total cholesterol in addition to diet

and drug consumption. Education and motivation

need to be given to patients so they can perform the

regular physical activity and continue to avoid

complications of diabetes.

ACKNOWLEDGEMENTS

The authors gratefully acknowledge that the present

research was support by the Directorate of Research

and Community Service of the Directorate General

for Research and Development of the Ministry of

Research, Technology and Higher Education by the

agreement of Funding Research and Community

Service for the Fiscal Year 2018 with the contract

number: 117/UN5.2.3.1/PPM/KP-DRPM/2018

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