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To the Editor: The results of the meta-analysis by Mr Boulé and colleagues¹ support a widely held assumption that exercise improves glycemic control in patients with diabetes. The main outcome of the meta-analysis was a 0.66% reduction in glycosylated hemoglobin (HbA_1c) in the exercise group. This effect is much smaller than the nearly 2-fold reduction in all-cause mortality observed by Wei et al.² Potential reporting flaws in the original data may have led Boulé et al to underestimate the effect.

The authors state that "HbA_1c reflects average blood glucose concentration from the previous 8 to 12 weeks." In Table 1, 10 of the 16 trials lasted 13 weeks or less. It is unlikely that the postintervention HbA_1c reflected the full effect of the intervention. In order for the HbA_1c to capture the intervention' s full effect, the intervention needs adequate time to reach a steady state.³ We have previously . . . [Full Text of this Article]

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