# Effectiveness of Physical Activity Support Combined With Continuous Glucose Monitoring by a Physical Therapist in Preconception Care for a Woman With Type 2 Diabetes Mellitus: A Case Study

## TL;DR

A personalized physical activity program with glucose monitoring improved diabetes control and activity levels in a woman with type 2 diabetes planning for pregnancy.

## Contribution

Combining physical activity support with continuous glucose monitoring by a physical therapist improves preconception care for women with type 2 diabetes.

## Key findings

- Time in range increased from 36.6% to 77% after four months of intervention.
- Daily physical activity rose from 2500 to 9500 steps per day.
- The approach improved glycemic control, treatment satisfaction, and quality of life.

## Abstract

Diabetes mellitus represents a major public health challenge worldwide, with type 2 diabetes mellitus (T2DM) accounting for the majority of cases. Urbanization and lifestyle changes are reportedly contributing to the increasing incidence of T2DM worldwide. The prevalence of T2DM is also increasing among women who wish to become pregnant, owing to the growing overall proportion of women with T2DM, the increasing prevalence of obesity, and the rising average age of childbirth. Preconception care is warranted in this demographic to optimize glycemic control, improve pregnancy outcomes, and reduce the risk of congenital anomalies and perinatal complications. Educational support that includes not only glycemic control but also increased physical activity (PA) and lifestyle modifications is important to delivering effective preconception care.

Herein, we report the case of a woman in her 30s with T2DM, hypertension, and dyslipidemia. Her early glycemic control was suboptimal (glycated hemoglobin: 8.9%, time in range (TIR): 36.6%), her pregnancy preparation was delayed, and a personalized PA program was eventually introduced that included continuous glucose monitoring (CGM) reviewed by a physical therapist. The intervention lasted four months and included continuous feedback and adjustments to the timing, intensity, and activity goals of the patient’s exercise regimen based on her CGM trends. A specific PA target of 8,000-10,000 steps per day was established to promote increased daily movement. The intervention also incorporated a combination of aerobic exercise (walking) and resistance training tailored to the patient’s condition and lifestyle. This intervention led to improvements in her blood glucose markers, treatment satisfaction related to diabetes, health-related quality of life, and independence.

The patient’s TIR increased from 36.6% to 77%, and her PA increased from 2500 to 9500 steps/day. This case study highlights the potential of CGM to promote real-time feedback and behavior modification in patients with T2DM, particularly those attempting pregnancy. PA support combined with CGM can effectively manage blood glucose levels, increase motivation, and improve overall health in ways that are highly beneficial to integrate into preconception care regimens.

This study emphasizes that PA support combined with CGM is effective for increasing glycemic control and PA levels, thus improving lifestyle habits and preparing women with T2DM for pregnancy. We advocate for the wider adoption of PA support interventions combined with CGM by physical therapists as a standard practice in preconception care and emphasize the role of this approach in terms of improving long-term metabolic health prior to conception. Further research is warranted to validate these findings and optimize intervention protocols.