Diabetes Evidence Flashcards
How was the [type 1] diabetes control & complications trial conducted?
- Primary prevention cohort: T1DM for 1-5 years, nil retinopathy, urinary albumin excretion <40mg/24h
- Secondary intervention cohort: T1DM for 1-15 years, mild-mod non-proliferative retinopathy, urinary albumin excretion <200mg/24h
- 711 received insulin >3 injections daily (intensive therapy)
- 730 received 1-2 insulin injections daily (conventional therapy)
What were the conclusions of the [type 1] diabetes control & complications trial?
Primary prevention cohort:
- Fewer pts in in intensive therapy developed retinopathy
Secondary intervention cohort:
- Fewer pts in in intensive therapy had sustained progression of retinopathy
Overall, intensive therapy reduced risk of:
- development & sustained progression of retinopathy by 63%
- severe retinopathy by 47%
- microalbuniuria by 39%
- albuminuria by 54%
- clinical neuropathy at 5 years by 60%
What did the literature review by Sigal et al look at?
Evidence about prescription of exercise for diabetes patients
What recommendations were made by Sigal et al for individuals with diabetes?
- Program of at least 150 min/week of mod-vig PA & a healthful diet with modest energy restriction
- PA distributed over at least 3 days/week with no more than 2 consecutive days without PA
- Increased volumes of AP for increased weight loss
What exercise guidelines were outlined Hordern et al’s statement?
- Minimum of 210 min of mod intensity or 125 min of vig intensity exercise each week.
- Combination of aerobic & resistance training
- Aerobic & resistance training can be combined in one session
- Exercise should be performed on at least 3 days each week with no
more than 2 consecutive days without training
What precautions & CIs were outlined Hordern et al’s statement?
- Hypoglycaemia: self-monitor BGL
- Cardiac risk: screen for risk factors
- Peripheral neuropathy: Footwear, low impact exercises
- Obesity: joint pain
- PVD: may not be able to complete vig aerobic exercises with severe symptoms
What did the study by Mendes et al 2016 look at?
Analysed guidelines & recommendations for exercise prescription for pts with T2DM
What did the study by Mendes et al 2016 conclude?
- 150 minutes (minimum) of accumulated aerobic exercise weekly @ mod-vig intensity (4-6 or 12/13 on the RPE scale) OR
- 90 minutes (minimum) of vig intensity (7-8 or 14-17 on the RPE scale)
- Spread over at least 3/7 with no more than 2 consecutive days off
- Aerobic exercise may be done in 10 minute bouts throughout the day.
- Resistance exercises 2/7
- Flexibility exercises may complement other exercise types.
- Exercise in diabetes improves glycaemic control, insulin sensitivity, body composition, BP and lipid profile while reducing other CV risk factors.
What did the UK prospective diabetes study look at?
- Newly diagnosed pts with T2DM
- Divided into overweight & non-overweight
- Overweight: Randomly assigned intensive treatment with insulin, sulphonylurea or metformin, or conventional treatment with diet
- Non-overweight: Randomly assigned intensive treatment with insulin or sulphonylurea, or conventional treatment with diet
What did the UK prospective diabetes study find?
Conventional: Steady increase in FBG and HbA over 10 yrs
Intensive:
- Initial decrease in FPG & HbA, then increase like conventional
- Lower median HbA
- Increase in weight by ~3.1kg
- Increased risk hypoglycaemia
Both:
- 16% risk reduction for MI
What did the position statement by Inzucchi et al find about therapeutic options for T2DM?
- Sodium-glucose cotransported 2 (SGLT2) inhibitors: Reduces glucose, HbA1c, albuminuria & weight
- Thiazolidinediones: Weight gain, peripheral oedema, heart failure, fractures
- Dipeptidyl peptidase 4 inhibitors: No side effects for CV by possibly for pancreas
- Metformin: CV benefits, low cost, safe
