'Better
to play football than read the Gita'
Mr. Toastmaster, fellow Toastmasters and dear guests, good
evening!
Diabetes is on the rise. No longer a disease of
predominantly rich nations, the prevalence of diabetes is steadily increasing
everywhere, most markedly in the world’s middle-income countries. When diabetes
is uncontrolled, it has dire consequences for health and well-being.
The goal of treatment in type 2 diabetes is to achieve and
maintain optimal BG, lipid, and blood pressure (BP) levels to prevent or delay
chronic complications of diabetes. Many people with type 2 diabetes can achieve
BG control by following a nutritious meal plan and exercise program, losing
excess weight, implementing necessary self-care behaviors, and taking oral
medications, although others may need supplemental insulin.
The maintenance of normal BG at rest and during exercise
depends largely on the coordination and integration of the sympathetic nervous
and endocrine systems. Contracting muscles increase uptake of BG, although BG
levels are usually maintained by glucose production via liver glycogenolysis
and gluconeogenesis and mobilization of alternate fuels, such as free fatty
acids.
Some research findings
Here I have four categories of findings:
A: Randomized, controlled trials (overwhelming data)
1.
PA causes increased glucose uptake into active
muscles balanced by hepatic glucose production, with a greater reliance on
carbohydrate to fuel muscular activity as intensity increases
2.
PA can result in acute improvements in systemic
insulin action lasting from 2 to 72 h
3.
Resistance exercise enhances skeletal muscle
mass
4.
At least 2.5 h/week of moderate to vigorous PA
should be undertaken as part of lifestyle changes to prevent type 2 diabetes
onset in high-risk adults
B: Randomized, controlled trials (limited data)
1.
A combination of aerobic and resistance exercise
training may be more effective in improving BG control than either alone
2.
Both aerobic and resistance training improve
insulin action, BG control, and fat oxidation and storage in muscle
3.
Individuals with type 2 diabetes engaged in
supervised training exhibit greater compliance and BG control than those
undertaking exercise training without supervision
4.
Persons with type 2 diabetes should undertake at
least 150 min/week of moderate to vigorous aerobic exercise spread out during
at least 3 days during the week, with no more than 2 consecutive days between
bouts of aerobic activity
5.
In addition to aerobic training, persons with
type 2 diabetes should undertake moderate to vigorous resistance training at
least 2–3 days/week
6.
Supervised and combined aerobic and resistance
training may confer additional health benefits, although milder forms of PA
(such as yoga) have shown mixed results.
7.
Efforts to promote PA should focus on developing
self-efficacy and fostering social support from family, friends, and health
care providers. Encouraging mild or moderate PA may be most beneficial to
adoption and maintenance of regular PA participation. Lifestyle interventions
may have some efficacy in promoting PA behavior.
C Nonrandomized trials, observational studies
1.
Although moderate aerobic exercise improves BG
and insulin action acutely, the risk of exercise-induced hypoglycemia is
minimal without use of exogenous insulin or insulin secretagogues. Transient hyperglycemia
can follow intense PA
2.
The acute effects of resistance exercise in type
2 diabetes have not been reported, but result in lower fasting BG levels for at
least 24 h postexercise in individuals with IFG
3.
Milder forms of exercise (e.g., tai chi, yoga)
have shown mixed results
4.
Blood lipid responses to training are mixed but
may result in a small reduction in LDL cholesterol with no change in HDL
cholesterol or triglycerides. Combined weight loss and PA may be more effective
than aerobic exercise training alone on lipids
5.
Recommended levels of PA may help produce weight
loss. However, up to 60 min/day may be required when relying on exercise alone
for weight loss
D Panel consensus judgment
·
Individuals with uncontrolled proliferative
retinopathy should avoid activities that greatly increase intraocular pressure
and hemorrhage risk
Exercise plays a major role in the prevention and control of
insulin resistance, prediabetes, GDM, type 2 diabetes, and diabetes-related
health complications. Both aerobic and resistance training improve insulin
action, at least acutely, and can assist with the management of related
symptoms, but exercise must be undertaken regularly to have continued benefits
and likely include regular training of varying types. The inclusion of an
exercise program or other means of increasing overall PA is critical for
optimal health in individuals with type 2 diabetes.
A REPORT ON DIABETES
Definitions
·
Diabetes is a chronic, progressive disease
characterized by elevated levels of blood glucose.
·
Diabetes of all types can lead to complications
in many parts of the body and can increase the overall risk of dying prematurely.
·
Type 1 diabetes is characterized by deficient
insulin production in the body. People with type 1 diabetes require daily
administration of insulin to regulate the amount of glucose in their blood.
·
Type 2 diabetes results from the body’s ineffective
use of insulin. Type 2 diabetes accounts for the vast majority of people with
diabetes around the world
GLOBAL BURDEN
·
Globally,
an estimated 422 million adults were living with diabetes in 2014, compared to
108 million in 1980.
·
Diabetes caused 1.5 million deaths in 2012. Higher-than-optimal
blood glucose caused an additional 2.2 million deaths, by increasing the risks
of cardiovascular and other diseases.
·
Forty-three percent of these 3.7 million deaths
occur before the age of 70 years.
·
The majority of people with diabetes are
affected by type 2 diabetes.
COMPLICATIONS: Diabetes
of all types can lead to complications in many parts of the body and can
increase the overall risk of dying prematurely. Possible complications include
heart attack, stroke, kidney failure, leg amputation, vision loss and nerve
damage. In pregnancy, poorly controlled diabetes increases the risk of fetal
death and other complications.
ECONOMIC IMPACT: Diabetes
and its complications bring about substantial economic loss to people with
diabetes and their families, and to health systems and national economies
through direct medical costs and loss of work and wages.
PREVENTING DIABETES: Type
1 diabetes cannot be prevented with current knowledge. Effective approaches are
available to prevent type 2 diabetes and to prevent the complications and
premature death that can result from all types of diabetes. These include
policies and practices across whole populations and within specific settings
(school, home, workplace) that contribute to good health for everyone,
regardless of whether they have diabetes, such as exercising regularly, eating
healthily, avoiding smoking, and controlling blood pressure and lipids.
MANAGING DIABETES:
·
The starting point for living well with diabetes
is an early diagnosis – the longer a person lives with undiagnosed and
untreated diabetes, the worse their health outcomes are likely to be.
·
For those who are diagnosed with diabetes, a
series of cost-effective interventions can improve their outcomes, regardless
of what type of diabetes they may have. These interventions include blood
glucose control, through a combination of diet, physical activity and, if
necessary, medication; control of blood pressure and lipids to reduce
cardiovascular risk and other complications; and regular screening for damage
to the eyes, kidneys and feet, to facilitate early treatment.
Famous Personalities with Diabetes
Sources/ References
- 1. World Health Statistics 2014. Geneva: World Health Organization; 2014.
- 2. WHO methods for life expectancy and healthy life expectancy. Global health estimates technical paper WHO/HIS/HSI/GHE/2014.5. Geneva: World Health Organization; 2014.
- 3. United Nations Population Division. World population prospects – 2012 revision. New York: United Nations; 2013.
- 4. WHO methods and data sources for country-level causes of death 2000–2012. Global health estimates technical paper WHO/HIS/HSI/GHE/2014.7. Geneva: World Health Organization; 2014.
- 5. Global Burden of Metabolic Risk Factors for Chronic Diseases Collaboration. Cardiovascular disease, chronic kidney disease and diabetes mortality burden of cardiometabolic risk factors from 1980 to 2010: a comparative risk assessment. Lancet Diabetes Endocrinology. 2014;2:(8)634–647.
- 6. Noncommunicable diseases progress monitor, 2015. Geneva: World Health Organization; 2015.
- 7. Mission and Vision. Medford, Massachusettes: Management Sciences for Health; 2015.
- 8. International Drug Price Indicator Guide, 2015. Washington DC: Management Sciences for Health; 2015.
- 9. Measuring medicine prices, availability, affordability and price components Geneva and Amsterdam: World Health Organization and Health Action International; 2008.
