TYPE II DIABETES Flashcards
NHS Spending on Diabetes
- by 2035 spending will reach £16.9 billion
- 17% of overall budget spent on treating the condition
T1D Develops
- when insulin-producing cells in the pancreas have been destroyed because the body has an abnormal reaction triggered by a virus or other infection
T2D Develops
- 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
Major Complications of Diabetes
- coronary heart disease
- diabetic retinopathy
- neuropathy and consequent amputation
- nephropathy
Types of Activity
- 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)
PA Guidelines for T2D
- 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
Plotnikoff et al., 2006 - Most Don’t Meet RDA for PA
- 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
Ghouri et al., 2013 - Cardiorespiratory Fitness
- lower cardiorespiratory fitness contributes to increased resistance and fasting glycaemia in middle aged south asian compared with European men living in the UK
Knowler et al., 2002 - Lifestyle Intervention Programmes
- lifestyle changes and treatment with metformin both reduced the incidence of diabetes in persons at high risk
- lifestyle intervention more effective than metformin
Jeon et al., 2007 - Lifestyle Intervention Programme
- 30% risk reduction associated with >= 150 mins/week brisk walking
Grontved and Hu, 2011 - Lifestyle Intervention Programme
- 20% risk increase associated with each 2hours/day increase in tv watching
Church et al., 2004 - Aerobics Centre Longitudinal Study
- RR all cause mortality was 4.5x greater in least fit quartile vs fittest quartile after adjustment for BMI
Chacko et al., 2008 - Appropriate Blood Pressure Control in Diabetes (ABCD)
- delayed post-ex peak HR predictive of cv events in unfit T2D
Boule et al., 2001 - HbA1c and Fitness
- greater exercise volume decreases HbA1c
Boule et al., 2003 - HbA1c and Fitness
- greater exercise intensity may be more effective than exercise volume
Sigal et al., 2007 - HbA1c and Fitness
- Aerobic and/or resistance type exercises effective in reducing HbA1c
Tudor-Locke and Schuna, 2012 - Sit Less, Walk More, Exercise
- 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
Morton et al., 2010 - Walking, CRF and Fat Burning
- 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
Gillen et al., 2012 - HIIT and Post-Exercise Glycaemia
- HIIT reduced hyperglycaemia measured as a proportion of time spent above 10mmol/L
- postprandial hyperglycaemia also lower after HIIT vs CON
Little et al., 2011 - HIIT
- low volume HIIT can rapidly improve glucose control and induce adaptations in skeletal muscle linked to improved health
Schmidt et al., 2013 - Football Improves Glycaemia
- HbA1c reduced from 7.4±1.2% to 7.0±1.1% after 24 weeks football training
Sigal et al., 2007 - Strength Training and Glycaemic Control
- resistance training improves glycaemic control
- improvements are greater when RE combined with aerobic training
What Should Patients Be Told?
- 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
