TYPE II DIABETES

Question 1

NHS Spending on Diabetes

Answer 1

• by 2035 spending will reach £16.9 billion
• 17% of overall budget spent on treating the condition

Question 2

T1D Develops

Answer 2

• when insulin-producing cells in the pancreas have been destroyed because the body has an abnormal reaction triggered by a virus or other infection

Question 3

T2D Develops

Answer 3

• when beta cells slowly decline in function and/or
• body tissues build up a resistance to insulin; cant take in sufficient glucose to fuel body; glucose builds up in the bloodstream

Question 4

Major Complications of Diabetes

Answer 4

• coronary heart disease
• diabetic retinopathy
• neuropathy and consequent amputation
• nephropathy

Question 5

Types of Activity

Answer 5

• active living (light-moderate; daily; minutes even hours; low risk, low benefit)
• activity for health (moderate; about daily; at least 30 min)
• exercise for fitness (moderate-vigorous; 3 times per week; at least 20 min)
• training for sport (strenuous; several times a week; variable; higher risk, high benefit)

Question 6

PA Guidelines for T2D

Answer 6

• moderate intensity aerobic PA for at least 150min/week lasting >30 min on 5+ days
• can be accumulated throughout the week, bouts >10min
• 75 min/week vigorous intensity provides comparable benefits to 150min/week moderate intensity
• can combine moderate and vigorous activity
• muscle strengthening activities on 2+ days/week in addition to 150min/week
• no need to differ for sub-populations based on gender/race etc

Question 7

Plotnikoff et al., 2006 - Most Don’t Meet RDA for PA

Answer 7

• 71.9% didn’t achieve PA levels
• younger age male gender, higher education, higher income, lower BMI and lower level of perceived disability were associated with higher PA levels

Question 8

Ghouri et al., 2013 - Cardiorespiratory Fitness

Answer 8

• lower cardiorespiratory fitness contributes to increased resistance and fasting glycaemia in middle aged south asian compared with European men living in the UK

Question 9

Knowler et al., 2002 - Lifestyle Intervention Programmes

Answer 9

• lifestyle changes and treatment with metformin both reduced the incidence of diabetes in persons at high risk
• lifestyle intervention more effective than metformin

Question 10

Jeon et al., 2007 - Lifestyle Intervention Programme

Answer 10

• 30% risk reduction associated with >= 150 mins/week brisk walking

Question 11

Grontved and Hu, 2011 - Lifestyle Intervention Programme

Answer 11

• 20% risk increase associated with each 2hours/day increase in tv watching

Question 12

Church et al., 2004 - Aerobics Centre Longitudinal Study

Answer 12

• RR all cause mortality was 4.5x greater in least fit quartile vs fittest quartile after adjustment for BMI

Question 13

Chacko et al., 2008 - Appropriate Blood Pressure Control in Diabetes (ABCD)

Answer 13

• delayed post-ex peak HR predictive of cv events in unfit T2D

Question 14

Boule et al., 2001 - HbA1c and Fitness

Answer 14

• greater exercise volume decreases HbA1c

Question 15

Boule et al., 2003 - HbA1c and Fitness

Answer 15

• greater exercise intensity may be more effective than exercise volume

Question 16

Sigal et al., 2007 - HbA1c and Fitness

Answer 16

• Aerobic and/or resistance type exercises effective in reducing HbA1c

Question 17

Tudor-Locke and Schuna, 2012 - Sit Less, Walk More, Exercise

Answer 17

• sit less = avoid taking <5000 steps/day and limit prolonged sitting bouts
• walk more = take >= 7500 steps/day
• exercise = accumulate >= 3000 steps/day at >= 100 steps/min

Question 18

Morton et al., 2010 - Walking, CRF and Fat Burning

Answer 18

• regular walking improves CRF and fat-burning independent of HbA1c
• 19% lipid energy contribution pre-train, 26% post-train
• 56% increase in fat burning rate after 7-8 weeks walking training

Question 19

Gillen et al., 2012 - HIIT and Post-Exercise Glycaemia

Answer 19

• HIIT reduced hyperglycaemia measured as a proportion of time spent above 10mmol/L
• postprandial hyperglycaemia also lower after HIIT vs CON

Question 20

Little et al., 2011 - HIIT

Answer 20

• low volume HIIT can rapidly improve glucose control and induce adaptations in skeletal muscle linked to improved health

Question 21

Schmidt et al., 2013 - Football Improves Glycaemia

Answer 21

• HbA1c reduced from 7.4±1.2% to 7.0±1.1% after 24 weeks football training

Question 22

Sigal et al., 2007 - Strength Training and Glycaemic Control

Answer 22

• resistance training improves glycaemic control
• improvements are greater when RE combined with aerobic training

Question 23

What Should Patients Be Told?

Answer 23

• get more active
• start modestly; progress from easy to moderate
• frequency; 5+ days/week; part of lifestyle not squeezed in
• mode; daily activities - aerobic and resistance
• build motivation that leads to behavioural change in and outside of work