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Exp Clin Endocrinol Diabetes 2025; 133(07): 343-353
DOI: 10.1055/a-2500-1026
German Diabetes Association: Clinical Practice Guidelines

Diabetes, Sports and Exercise

Katrin Esefeld
1   Preventive and Rehabilitative Sports Medicine, Technical University of Munich, Klinikum rechts der Isar, Munich, Germany
2   German Center for Cardiovascular Research (Deutsches Zentrum für Herzkreislaufforschung – DZHK), partner site Munich Heart Alliance (MHA), Munich, Germany
,
Stephan Kress
3   Diabetes, Sport and Exercise Working Group of the DDG, Berlin, Germany
4   Department of Internal Medicine I, Vinzentius Hospital Landau, Landau, Germany
,
Meinolf Behrens
3   Diabetes, Sport and Exercise Working Group of the DDG, Berlin, Germany
5   Diabetes Center Minden, Minden, Germany
,
Peter Zimmer
3   Diabetes, Sport and Exercise Working Group of the DDG, Berlin, Germany
,
Michael Stumvoll
6   Department of Internal Medicine III, University Hospital Leipzig, Leipzig, Germany
,
Ulrike Thurm
3   Diabetes, Sport and Exercise Working Group of the DDG, Berlin, Germany
,
Bernhard Gehr
3   Diabetes, Sport and Exercise Working Group of the DDG, Berlin, Germany
7   m&i Specialist Hospital Bad Heilbrunn, Bad Heilbrunn, Germany
,
Martin Halle‡
1   Preventive and Rehabilitative Sports Medicine, Technical University of Munich, Klinikum rechts der Isar, Munich, Germany
2   German Center for Cardiovascular Research (Deutsches Zentrum für Herzkreislaufforschung – DZHK), partner site Munich Heart Alliance (MHA), Munich, Germany
3   Diabetes, Sport and Exercise Working Group of the DDG, Berlin, Germany
,
Christian Brinkmann‡
3   Diabetes, Sport and Exercise Working Group of the DDG, Berlin, Germany
8   Institute of Cardiovascular Research and Sport Medicine, German Sport University Cologne, Cologne, Germany
9   IST University of Applied Sciences Düsseldorf, Düsseldorf, Germany
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Notice of update

The DDG clinical practice guidelines are updated regularly during the second half of the calendar year. Please ensure that you read and cite the respective current version.

UPDATES TO CONTENT AND DIFFERENT RECOMMENDATIONS COMPARED TO THE PREVIOUS YEAR’S VERSION

Change 1:

Update of exercise recommendations for an optimum amount of exercise according to the recommendations of the American Diabetes Association (ADA) for the year 2024

Reason:

Recommendations of the newly-published ADA 2024 guidelines are now being considered.

Supporting reference:

[1]

Change 2:

Note that menstrual cycle phases should be taken into account as an additional factor when considering insulin dose/supplemental carbohydrate adjustments in the context of exercise.

Reason:

Studies suggest that glucose dynamics can vary depending on the menstrual cycle in the context of exercise.

Supporting reference:

[2]

Change 3:

Reference to the possibility of using digital health applications (DIGA) for lifestyle modifications

Reason:

Prescription of DIGAs can help people with diabetes make lifestyle changes to improve clinical outcomes. Proof of efficacy has already been provided for some DIGAs.

Supporting reference:

[3]

Change 4:

Update of recommendations for electromyostimulation (EMS) training for people with diabetes mellitus

Reason:

According to the recommendation of a revised consensus report (based on recent studies on the effectiveness and safety of EMS training), diabetes mellitus is no longer considered an absolute, but a relative contraindication for EMS training in a commercial setting.

Supporting reference:

[4]

Change 5:

Advice on the use of “exercise snacks” (movement units of short duration)

Reason:

Some studies suggest that “exercise snacks”, which can be easily integrated into everyday life, can be useful in counteracting the harmful effects of long periods of inactivity and improving the glucose profile.

Supporting reference:

[5] [6]

Change 6:

Advice on the optimum timing of sport and exercise in people with type 2 diabetes mellitus

Reason:

A recent meta-study shows that to reduce postprandial glucose peaks, sport and exercise immediately after eating are more effective than before eating.

Supporting reference:

[7]

For all forms of diabetes mellitus, exercise is one of the most important measures for maintaining good health. Sport and exercise trigger adaptation and repair mechanisms in various organ systems and cells, such as the muscles, nerves, vessels, immune system or brain, which can help ward off diseases [8] [9] [10] [11].

There is no need for maximum physical exercise. Exertion according to the motto “running/walking without panting” already results in good health benefits. In addition to 30 minutes of exercise per day, increasing the opportunities for being active in the context of everyday activities has also been proven to be effective. In addition to the recommendations of the American Diabetes Association (ADA) from 2024, adults with diabetes should exercise for 150 minutes/week or more at moderate intensity. Younger and physically fit patients can also exercise more intensively (minimum recommendation: 75 minutes/week). Exercise should be performed on at least 3 days, with no more than 2 consecutive days of inactivity. In addition, it is recommended to do strength training 2 to 3 times a week, but not on consecutive days. Periods of sitting should be interrupted every 30 minutes. For older people, flexibility and balance training is also recommended 2–3 times a week. Alternative sports such as yoga and tai-chi may also be suitable. For the treatment of obesity, 200–300 minutes of exercise per week and an energy deficit of about 500–750 kcal/day should be aimed for [1]. For children and adolescents, moderate to strenuous exercise of at least 60 minutes duration/day is recommended [1].

This clinical practice guideline is intended to outline therapeutic options for physical activity in the treatment of diabetes mellitus and to provide practical recommendations for implementing these options for type 1 and type 2 patients.



Publication History

Article published online:
10 June 2025

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