suffer from diabetes. Between 120 & 140 million suffer from diabetes Another 35% who have diabetes haven. t yet. t yet. been diagnosed. been diagnosed …
Physical Activity and Diabetes
n n
CDC Diabetes Maps Diabetes Association
http://wwwdiabetesorg/all-abouthttp://wwwdiabetesorg/all-aboutdiabetes/chan_eng/i3/i3p4htm
Diabetes mellitus
n
Symptoms
n n n n
Chronic disease caused by a deficiency in the production of insulin or it use to transport glucose form the blood into other tissues
Results in hyperglycemia: excess glucose in the blood toxic
Excessive urination Persistent thirst Weight loss Chronic fatigue
n
n
Leading cause of adult blindness, end-stage endkidney failure and nontraumatic amputations in the US Increases the risk of CHD, hypertension and stroke 2 - 4 x s
Magnitude of the Problem
n
Magnitude of the Problem
n
MONICA project of the WHO
Between 120 140 million suffer from diabetes mellitus world wide,
n
This number will double by the year 2025 if trends of increasing obesity and inactivity persist WHO 1998
n
US Centers for Disease Control and Prevention
Nearly 17 million Americans have been diagnosed with diabetes Another 35 who have diabetes havent yet haven been diagnosed
n
n
Approximately 800,000 new cases of diabetes are diagnosed annually in the US The N has increased six fold, from 16
million in 1958 to 10 million in 1997 Nations 6th leading killer, responsible for more than 71,000 deaths in the US in 2001
1
Demographics of Diabetes
n
Type 2 Diabetes: Demographics
n
In the US: 98 million women, 69 million men, 151,000 children 20 yo and 70 million older adults 65 yo
Increasing incidence
Elderly and minorities in US African Americans Hispanic Americans Native Americans Asian and Pacific Island Americans
AgeAge-specific Prevalence of Diagnosed Diabetes, by Race/Ethnicity and Sex
30 25
Rate per 100
Age group 0-44 years 45-64 years 65-74 years 75 years
Glucose Diagnostic Criteria
Oral glucose tolerance Blood glucose test test Normal: 140 mg/dl Normal: 110 mg/dl Impaired glucose Impaired glucose tolerance: 140-199 mg/dl tolerance: 110-125 mg/dl 140110Diabetes: 200 mg/dl Diabetes: 126 mg/dl
20 15 10 5 0
White male
White female
Black male
Black female
Hispanic Hispanic male female
Chronic Effect of Exercise on Diabetes
n n n n
Clinical features
n
n n
Lowers circulating insulin Improves glucose tolerance Reduces insulin resistance Increases number of insulin receptors in skeletal muscle in people with type 2 diabetes Increases insulin-like
effect of muscle insulincontraction; increases GLUT4 transporter Increases insulin sensitivity in people with type 2 diabetes
2 principle forms
Type 1 or insulin-dependent diabetes mellitus insulinIDDM or juvenile diabetes
n
Type 1 pancreas fails to produce insulin, which is essential for survival
Common in children PA can help manage blood glucose levels
Type 2 or non-insulin-dependent diabetes non-insulinmellitus NIDDM
n
n
More common, accounts for about 90 of all diabetes cases world wide Occurs mostly in adults over age 40
2
Clinical features
n
Type 2
Results from insulin insensitivity poor transport of insulin from the blood into the cells 1/2 the cases can normalize after weight reduction from increased physical activity and diet The remaining 1/2 can normalize by consumption of foods low on the glycemic index Highly preventable by diet, weight loss and physical activity
n
n
About 80 of diabetes in the US and 90 worldwide are type 2, which results from insensitivity of muscle and fat cells to insulin, leading to high blood glucose levels Increased PA and weight loss can normalize blood glucose in 50 of the cases
Health Burden of
Diabetes
n
CrossCross-Sectional Studies
n
n n n n
Chronic complications of uncontrolled diabetes include coronary heart disease, nerve diseases, blindness, kidney failure, and amputation CVD is 2-4 x s more likely in those with 2diabetes Risk of stroke is 2-4 x s greater 26060-65 of those with diabetes have high BP 6060-70 have mild to severe diabetic nerve damage
Observed whether a decline in PA resulting from naturally occurring changes in culture are associated with increased risk for type 2 diabetes
Kiribati
n
Pima 
Indians
n
n
n
PopulationPopulation-based survey of 2,938 Micronesians living on the Pacific islands of the Republic of Kiribati Found that age-adjusted prevalence of type age2 diabetes was nearly 3x s as high in urban 3x as in rural samples Among women, obesity urbanization and physical inactivity were each independently associated with higher rates of diabetes
Highest known incidence of type 2 diabetes in the US
Current and lifetime leisure plus occupational PA was measured through questionnaire Ages 15 -59 15-
n
Current PA was inversely associated with fasting glucose levels
Active people also had lower BMIs and waist-towaist-tothigh ratios After
adjustment for age BMI and waist-to-thigh waist-toratio, 2-h glucose levels were still lower among 2men who were physically active
3
University of PA Alumni Study
n
Prospective Cohort Studies
n
n
n
6,000 male alumni observed for 14 years Dose dependent reduction in risk of developing type 2 diabetes was associated with higher levels of leisure-time PA leisureAgeAge-adjusted risk of type 2 diabetes decreased by 6 for each 500 kcal/wk increase in leisure-time PA up to 3,500 leisurekcal/wk Risk reduction remained after adjustments for obesity, hypertension, and parental history of diabetes
University of Pennsylvania Alumni Study examining leisure PA with RR for type 2 diabetes
12 1 08 06 04 02 0 500 500 1,000 1,500 2,000 2,500 3,000 3,500 1
Nurses Nurses Health Study
n
094
088
082
076
n
07 064 058
Approximately 87,000 female US nurses observed for eight years 1,300 new cases of type 2 diabetes were confirmed
Women who had engaged in at least one vigorous activity per week had an ageageadjusted RR that was 1/3 lower than women who had not participated in at least one vigorous activity
Leisure PA kcal/wk
USNurses USNurses Health Study: examining vigorous PA with
relative risk for type 2 diabetes
Relative risk for type 2 diabetes
Aerobics Center Longitudinal Study ACLS
n
12 1 08 06 04 02 0
1/wk 1/wk 1/wk BMI adj
n
1/wk 1/wk 1/wk BMI adj
n
Interaction among cardiorespiratory fitness, blood glucose levels and mortality risk was examined in the ACLS 9,000 men observed for approximately eight years Age -adjusted death rates increased with higher initial levels of fasting blood glucose
Vigorous PA
4
Aerobics Center Longitudinal Study ACLS
n
Strength of the Evidence
n
The RR for death was higher in the least fit group compared with the most fit across all levels of fasting blood glucose
64 mmol/L, RR 138 mmol/L, 64-78 mmol/L, RR 161 64mmol/L, 78 mmol/L, RR 192 mmol/L,
n
n
Suggests that the risk of early death increases with less favorable blood glucose levels Improved fitness levels might reduce the allallcause mortality associated with impaired CHO metabolism
Growing number of prospective cohort studies lasting 4-16 years and 4randomized controlled trials lasting 3 mo to 6 yr agree that physical activity reduces risk of type 2 diabetes
Strength of Association
n
Consistency
n
Limited number of prospective cohort studies and
randomized controlled trials consistently agree that regular, vigorous PA is associated with a 252550 reduction in the risk of the development of type 2 diabetes
n
Clinical trial that examined PA and risk of type 2 diabetes included diverse samples There is good agreement that PA reduces the risk of type 2 diabetes in middlemiddle-aged and older men and women, including those who have impaired glucose tolerance, regardless of initial fitness level, race, or ethnic background
Summary
n
n
n
PopulationPopulation-based studies indicate that moderate physical activity is associated with a dose-dependent reduction in the risk of dosedeveloping type 2 diabetes The effect of lowered glucose after acute exercise lasts about 72 h, exercising every two to three days each week may be sufficient to help maintain normalized blood glucose levels Most studies suggest that vigorous PA 223x/wk provides most of the independent benefits of glucose control
5
Source:vegofwa.org
