A shared decision-making approach to individualized exercise management enhances glycemic control, self-care behaviors, and quality of life in type 2 diabetes: a retrospective cohort study

Abstract

Objective To evaluate the association between an individualized exercise management program based on shared decision-making (SDM) and short-term glycemic control, self-care behaviors, and quality of life in patients with type 2 diabetes mellitus (T2DM). Methods This retrospective cohort study used data from electronic medical records and a diabetes management platform (January 2019 – December 2023). After propensity score matching (1:1 nearest-neighbor, caliper = 0.02 SD), 178 patients were included (89 in SDM-based intervention group, 89 in routine care control group). The intervention group received an SDM-driven personalized exercise program plus routine care, while controls received routine care alone. Outcomes included HbA1c, fasting plasma glucose (FPG), 2 h postprandial glucose (2hPG), time in range (TIR), mean amplitude of glycemic excursions (MAGE), 6-meter walking speed, medication adherence, Summary of Diabetes Self-Care Activities (SDSCA) score, and Diabetes-Specific Quality of Life (DSQL) score. Assessments were performed at baseline, 1 month, and 2 months. Results At 1 and 2 months, the intervention group showed significantly greater reductions in HbA1c, FPG, 2hPG, and MAGE, and a significantly greater increase in TIR compared to controls (all p < 0.05). At 2 months, TIR was higher (67.72 ± 15.52% vs. 61.65 ± 23.12%, p = 0.004) and MAGE lower (5.35 ± 2.02 vs. 6.22 ± 1.86, p = 0.027) in the intervention group. The 6-meter walking speed also improved more in the intervention group (1.05 ± 0.11 vs. 0.98 ± 0.12 m/s, p = 0.003). Medication adherence across five domains (medication, diet, glucose monitoring, aerobic exercise, daily routine) was significantly better in the intervention group (all p < 0.05). The intervention group had significantly higher SDSCA scores and lower DSQL scores at 2 months (both p < 0.001), indicating enhanced self-management and improved quality of life. Conclusion An individualized exercise management program based on the SDM model was associated with improved short-term glycemic control, treatment adherence, self-management behaviors, and quality of life in T2DM patients. Future prospective randomized studies with longer follow-up are needed to establish causality and determine the sustainability of these improvements.