Exercise and Type 2 Diabetes

    '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.