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Diabetes Mellitus Type 2: New Advances & Research
Leon LateganUniversity of Johannesburg
South Africa
At a Glance
Diabetes
Complications
Current Research
Summary and Take Home Message
Diabetes Mellitus (DM)
“Sugar Diabetes”
Increased blood glucose concentration
Type 1: no insulin produced by the pancreas (10%)
Previously “juvenile diabetes”
Type 2: insulin resistance at cellular level (90%)
Previously “adult-onset diabetes”
Prevalence
App. 347 million people worldwide have diabetes.
More than 80% of people with diabetes live in low- and middle-income countries.
The WHO projects that diabetes deaths will double between 2005 and 2030.
Africa: 12 million in 2010 projection is 24 million in 2030
(WHO)
DM in Africa
Sub-Saharan Africa
• Mauritius: 15%
• Botswana: 11%
• Zimbabwe: 10%
• South Africa: 7%
• Zambia: 5%
• Mozambique: 3%
• Egypt: 16.5%
• Iran: 10.5%
• Gabon: 10%
• Algeria: 7.5%
• Cameroon: 6%
• Kenya: 5%
• Nigeria: 5%
• Ghana: 3%
Warning Signs of DM
Polydipsia: increased thirst
Polyuria: increased urination
Polyphagia: excessive hunger
Fatigue
Many infections
Headaches
Blurred vision
Dizziness
Dehydration
Rapid heart rate
Unexplained weight loss
Diagnosis of DM
Fasting glucose test: ≥ 126 mg·dL−1 (7.0 mmol·L−1)
Glucose tolerance test: ≥ 200 mg·dL−1 (11.1 mmol·L−1)
HbA1c : ≥ 6.5%
or
Diabetic emergency: vomiting, dehydration & ketoacidosis, …
Complications of DM Hypo- and hyperglycemia: coma & death
Retinopathy: loss of vision / blindness
Peripheral neuropathy & gangrene: limb amputation
Renal / kidney failure: death
Coronary artery disease: myocardial infarction or stroke
Thus, DM has to be managed !
Current Research
Pearls from 2010 – 2014
Warning:
Not a systematic review or Meta-analysis
Change in Physical Activity after a Diabetes Diagnosis: Opportunity for
Intervention
A disease diagnosis may motivate Pxs to increase their physical activity levels.
Primary healthcare practitioners should thus make use of this opportunity/window to educate their Pxs about the role of physical activity.
Schneider et al. (2014). Med Sci Sp & Ex, 46(1):84-91
Investigating telephone support as a strategy to increase the physical activity levels of
people with diabetes
12 Telephone calls: once a week for 20 minutes each
“The number of people classified as active increased by 31% and 85% were considered physically active at the end of the intervention.”
The results verify the efficacy of telephone support as a strategy to increase physical activity levels in people with diabetes …
Zanetti et al. (2014). Journal of Diabetes Nursing, 18(1):p32-36
Suggestion
Why not Consider DM Education & Motivation to Exercise:
Bulk SMS
Etc…
Beyond Basic Exercise Guidelines: Is Sitting really the new Smoking?
Sedentary time is closely related to adverse health risks even if individuals perform physical activity on a daily basis.
…too much sitting can be detrimental to health …
Mary Stenson (College of Saint Benedict, Saint John’s University) Forum Lectures: 2-6-2014
So what happens when we sit ?
Associations of overall sitting time and TV viewing time with fibrinogen and C reactive protein: the
AusDiab study
Conclusions: Overall sitting time was positively associated with plasma fibrinogen and high sensitivity CRP in men and women.
Plasma fibrinogen & CRP are important markers of all-cause mortality and cardio-metabolic disease like DM T2.
Howard et al. (2014). Br J Sports Med, 1-5
Conclusion
Sitting may make you
sick
PHARMACOLOGICAL EXERCISE MIMETICS IN THERAPY: DELUSION OR FUTURE?
Recognizing the beneficial effects of physical activity on health researchers have focused on the active substances that mimic or potentiate the effects of
exercise and big pharmaceutical companies see a potentially huge market and profit in this
However, mimicking exercise by means of drugs can lead to a chronic catabolic state.
Vitošević et al. (2013). Acta Medica Medianae, 52(4):58-62
High-intensity exercise training for the prevention of type 2 diabetes mellitus
The American Diabetes Association (ADA) recommends that adults with prediabetes engage in ≥ 150 minutes per week of moderate activity and target a 7% weight loss.
Although patients can accrue all exercise benefits by performing low intensity or medium intensity activities such as walking, high intensity activities (>70% HRR or 14-16 RPE) represent a time-efficient alternative to meeting physical activity guidelines.
Rynders & Weltman (2014). The Physician and Sportsmedicine, 42(1):7-14
One Bout of Exercise Alters Free-Living Postprandial Glycemia in Type 2
Diabetes
One bout of 60 minutes of aerobic exercise at a moderate intensity (70% HRmax) reduced average blood glucose levels for 24 hours
The authors concluded that Type 2 diabetics should exercise daily to reap the maximal benefits from exercise.
Oberlin et al. (2014). Med Sci Sp & Ex, 46(2):232-238
Exercise prescription for patients with type 2 diabetes and pre-diabetes: A position statement from Exercise
and Sport Science Australia
210 min/week
Moderate intensity: 60% - 70% HRmax
Combine aerobic & resistance exercise
Hordern et al. (2012). Journal of Science and Medicine in Sport, 15: 25–31
Conclusion
Why look for a new drug when we have:
EXERCISE
Exercise is Medicinefor Diabetes
Example of an Exercise Programme for a Diabetic
Walk / jog / cycle for 30 min
Push-ups & Lunges 2 sets of 15 reps
Stretch Hamstrings, Calves and
Lower back 2 x 30 sec
Summary
Africa is not immune to DM
DM has serious complications
Sitting time must be reduced
Education & Communication is important
Exercise must form part of DM management
Questions
Diabetes:Risks during exercise
Hypoglycemia (<4.0 mmol/l) – very rare in DM T2, but should be avoided in Type 1 Pxs
Abstain from exercise during acute illness or with fever
Peripheral Neuropathy – monitor feet for blisters and wounds that don’t heal
Comorbidities: Hypertension, Peripheral vascular disease, Obesity & OA
Children Active To Stay Healthy (CASH): Exercise as a Tool for
Reducing Inflammation and Cardiovascular Risk in Sedentary,
Pubescent Adolescents With Obesity
… high intensity interval exercise … may elicit greater improvements to endothelial function … for children with obesity, but also other inflammatory diseases such as diabetes, cancer, and arthritis.
Starkoff, Brooke E. (Doctoral Dissertation)
The Ohio State University, 2013
Cognitive status and foot self care practice in overweight diabetics,
engaged in different levels of physical activity
Regular physical activity can help promote cognitive status and foot self care practice in overweight patients with type 2 diabetes.
Journal of Diabetes & Metabolic Disorders
February 2014, 13:31
Exercise Dose ?
Heart Rate Physical Activity Score (HRPAS)
HRPAS = % HRR x duration (min)
Example:
HRPAS = 60% HRR x 20 min
= 120
Miller et al. (2014). Med Sci Sp & Ex, 46(1):69-75