Exercise and type 2 diabetes: the American College of Sports Medicine and the American Diabetes Association: joint position statement

Effects of traditional Chinese mind-body exercise-Baduanjin for type 2 diabetes on psychological well-being: A systematic review and meta-analysis

Background

Type 2 diabetes is considered one of the most psychologically demanding chronic conditions. Patients suffering from this disease often have poor psychological well-being due to emotional stress. Baduanjin exercises, a traditional Chinese mind-body exercise, are used in the management of type 2 diabetes, especially for mental health. However, the effect of Baduanjin exercises on psychological well-being of patients with type 2 diabetes maintains controversial. Therefore, this systematic review was conducted to evaluate the effects on psychological well-being of Baduanjin exercises for type 2 diabetes.

Methods

Six electronic databases were searched from their inception to March 2022 for randomized controlled trials of Baduanjin exercises for type 2 diabetes. Two reviewers independently extracted data and assessed methodological quality based on PEDro scale. The subgroup analysis was conducted based on different control interventions. The Cochran Q statistic and I² were applied to assess the heterogeneity.

Results

Twenty-seven studies between 2005 and 2019 were included in our review. Most of them exceeded the cutoff score 6 based on the PEDro scale. In psychological well-being, the aggregated results indicated that Baduanjin exercises showed positive effects in psychological well-being (SMD, 0.96; 95% CI, 0.57 to 1.36; p < 0.00001), depression (SMD, 1.03; 95% CI, 0.08 to 1.97; p = 0.03), anxiety (SMD, 0.88; 95% CI, 0.30 to 1.46; p = 0.003), and mental health (SMD, 0.72; 95% CI, 0.42 to 1.02; p < 0.00001). In glycemic control, Baduanjin exercises showed better improvements in FBG (SMD, 0.53; 95% CI, 0.34 to 0.72; p < 0.00001), HbA1c (SMD, 0.58; 95% CI, 0.41 to 0.75; p < 0.00001), and 2-hPBG (SMD, 0.56; 95% CI, 0.08 to 1.03; p = 0.02) compared with usual care/education. However, Baduanjin exercises only showed better improvements in HbA1c when compared with other exercises.

Conclusions

The traditional Chinese mind-body exercise-Baduanjin is a beneficial comprehensive therapy for type 2 diabetes, especially in promoting psychological well-being.

Systematic review registration

https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=110034.

Exercise, Physical Activity, and Cardiometabolic Health: Insights into the Prevention and Treatment of Cardiometabolic Diseases

Physical activity (PA) and exercise are widely recognized as essential components of primary and secondary cardiovascular disease (CVD) prevention efforts and are emphasized in the health promotion guidelines of numerous professional societies and committees. The protean benefits of PA and exercise extend across the spectrum of CVD, and include the improvement and reduction of risk factors and events for atherosclerotic CVD (ASCVD), cardiometabolic disease, heart failure, and atrial fibrillation (AF), respectively. Here, we highlight recent insights into the salutary effects of PA and exercise on the primary and secondary prevention of ASCVD, including their beneficial effects on both traditional and nontraditional risk mediators; exercise "prescriptions" for ASCVD; the role of PA regular exercise in the prevention and treatment of heart failure; and the relationships between, PA, exercise, and AF. While our understanding of the relationship between exercise and CVD has evolved considerably, several key questions remain including the association between extreme volumes of exercise and subclinical ASCVD and its risk; high-intensity exercise and resistance (strength) training as complementary modalities to continuous aerobic exercise; and dose- and intensity-dependent associations between exercise and AF. Recent advances in molecular profiling technologies (ie, genomics, transcriptomics, proteomics, and metabolomics) have begun to shed light on interindividual variation in cardiometabolic responses to PA and exercise and may provide new opportunities for clinical prediction in addition to mechanistic insights.

Physical exercise improves mitochondrial function in ovariectomized rats

Estrogen deficiency causes metabolic disorders in humans and rodents, including in part due to changes in energy expenditure. We have shown previously that skeletal muscle mitochondrial function is compromised in ovariectomized (Ovx) rats. Since physical exercise is a powerful strategy to improve skeletal muscle mitochondrial content and function, we hypothesize that exercise training would counteract the deficiency-induced skeletal muscle mitochondrial dysfunction in Ovx rats. We report that exercised Ovx rats, at 60-65% of maximal exercise capacity for 8 weeks, exhibited less fat accumulation and body weight gain compared with sedentary controls. Treadmill exercise training decreased muscle lactate production, indicating a shift to mitochondrial oxidative metabolism. Furthermore, reduced soleus muscle mitochondrial oxygen consumption confirmed that estrogen deficiency is detrimental to mitochondrial function. However, exercise restored mitochondrial oxygen consumption in Ovx rats, achieving similar levels as in exercised control rats. Exercise-induced skeletal muscle peroxisome proliferator-activated receptor-γ coactivator-1α expression was similar in both groups. Therefore, the mechanisms by which exercise improves mitochondrial oxygen consumption appears to be different in Ovx-exercised and sham-exercised rats. While there was an increase in mitochondrial content in sham-exercised rats, demonstrated by a greater citrate synthase activity, no induction was observed in Ovx-exercised rats. Normalizing mitochondrial respiratory capacity by citrate synthase activity indicates a better oxidative phosphorylation efficiency in the Ovx-exercised group. In conclusion, physical exercise sustains mitochondrial function in ovarian hormone-deficient rats through a non-conventional mitochondrial content-independent manner.

Aerobic exercise-mediated changes in the expression of glucocorticoid responsive genes in skeletal muscle differ across the day

Glucocorticoids are released in response to acute aerobic exercise. The objective was to define changes in the expression of glucocorticoid target genes in skeletal muscle in response to acute aerobic exercise at different times of day. We identified glucocorticoid target genes altered in skeletal muscle by acute exercise by comparing data sets from rodents subjected to acute aerobic exercise in the light or dark cycles to data sets from C2C12 myotubes treated with glucocorticoids. The role of glucocorticoid receptor signaling and REDD1 protein in mediating gene expression was assessed in exercised mice. Changes to expression of glucocorticoid genes were greater when exercise occurred in the dark cycle. REDD1 was required for the induction of genes induced at both times of day. In all, the time of day at which aerobic exercise is conducted dictates changes to the expression of glucocorticoid target genes in skeletal muscle with REDD1 contributing to those changes.

Non-pharmacological interventions for the prevention of type 2 diabetes in low-income and middle-income countries: a systematic review of randomised controlled trials

OBJECTIVE

Diabetes poses serious health threats and economic burdens to patients, especially in low-income and middle-income countries (LMICs). This systematic review searches for non-pharmacological interventions for the prevention of type-2 diabetes mellitus (T2DM) among patients who are non-diabetic and pre-diabetic from LMICs.

SETTINGS

LMICs.

PARTICIPANTS

Adult population aged over 18 years without having diabetes.

PRIMARY AND SECONDARY OUTCOMES

Primary outcome is to measure the change in the incidence of T2DM. The secondary outcome is to measure changes in glycated haemoglobin (HbA1c) level, weight/body mass index (BMI), fasting glucose level and 2-hour glucose from baseline of the included randomised controlled trials.

METHODS

This review has been conducted following the standard systematic review guidelines. A total of six electronic databases including MEDLINE, Embase, the Cochrane Library, Web of Science, ClinicalTrials.gov and International Clinical Trials Registry Platform were searched in February 2021 using a comprehensive search strategy.Two sets of independent reviewers performed screening, risk of bias (ROB) assessment using the Cochrane ROB tool and data extraction. Narrative coalescence of selected articles was demonstrated using tables. No meta-analysis was performed due to the lack of homogenous intervention strategies and study settings.

RESULT

A total of five studies were included for the review with a combined population of 1734 from three countries. Three of the studies showed a significant reduction in T2DM incidence after the intervention of physical training and dietary modifications. Four of the studies also demonstrated a significant reduction of different secondary outcomes like weight, BMI, fasting and 2-hour plasma glucose and HbA1c. All the studies demonstrated a low ROB in most of the bias assessment domains with some unclear results in allocation concealments.

CONCLUSIONS

Emphasising non-pharmacological interventions for T2DM prevention can improve health outcomes and lessen the economic burdens, which will be of paramount importance in LMICs.

SYSTEMATIC REVIEW REGISTRATION NUMBER

CRD42020191507.

LitKDM2 study: the impact of health Literacy and knowledge about the disease on the metabolic control of type 2 diabetes mellitus

AIMS

Diabetes mellitus (DM) is a common chronic disease with serious individual and socioeconomic consequences. Low health literacy (HL) has been associated with higher morbimortality. Health knowledge about DM (HK-DM) may also influence individual health. We aimed to assess HL and HK-DM in patients with type 2 DM and their associations with metabolic control.

METHODS

Our sample comprised 194 diabetic patients from a primary care health centre. We collected clinical and demographic data and applied two validated questionnaires, the Newest Vital Sign (NST) and Diabetes Knowledge Test (DKT), to assess HL and HK-DM, respectively. Metabolic control was defined as HbA1c < 7.0%. Participants were classified according to the NST as having "high likelihood of limited HL" (HLL-HL), "possibility of limited HL" (PL-HL), or "adequate HL" (A-HL) and by the DKT as having "low", "average" and "good" HK. Statistical analysis included logistic regression models, using p < 0.05 as a cut-off for statistical significance.

RESULTS

Overall, 72.7 and 34.7% of participants had HLL-HL and low HK-DM, respectively. A-HL (OR = 6.02; 95% CI: 1.691-21.450) and PL-HL (OR = 4.78; 95% CI: 1.350-16.899) were significantly associated with better metabolic control than HLL-HL. We did not find a significant association between HK-DM and metabolic control.

CONCLUSIONS

HL seems to be associated with better metabolic control. We also found a high prevalence of illiteracy and scarce knowledge about DM. Primary care physicians should promote HL to help patients achieve better metabolic control.

Downregulated hs-CRP and MAD, upregulated GSH and TAC, and improved metabolic status following combined exercise and turmeric supplementation: a clinical trial in middle-aged women with hyperlipidemic type 2 diabetes

Background

Aerobic training (AT) and Turmeric Supplementation (TS) are known to exert multiple beneficial effects including metabolic status and Oxidative Stress. To our knowledge, data on the effects of AT and TS on metabolic status and oxidative stress biomarkers related to inflammation in subjects with Hyperlipidemic Type 2 Diabetes Mellitus (HT2DM) are scarce.

Objectives

This study was conducted to evaluate the effects of AT and TS on metabolic status and oxidative stress biomarkers related to inflammation in subjects with HT2DM.

Methods

This randomized single-blinded, placebo-controlled trial was conducted among 42 subjects with HT2DM, aged 45-60 years old. Participants were randomly assigned to four groups; AT+TS (n = 11), AT+placebo (AT; n = 10), TS (n = 11), and Control+placebo (C; n = 10). The AT program consisted of 60-75% of Maximum heart rate (HRmax), 20-40 min/day, three days/week for eight weeks. The participants in the TS group consumed three 700 mg capsules/day containing turmeric powder for eight weeks. Metabolic status and oxidative stress biomarkers were assessed at baseline and end of treatment. The data were analyzed through paired t-test and one-way analysis of variance (ANOVA) and Bonferroni post hoc test at the signification level of P < 0.05.

Results

After eight weeks, significant improvements were observed in metabolic status, oxidative stress biomarkers and high-sensitivity C-reactive protein (hs-CRP) in the AT+TS, TS, and AT compared to C. Additionally, a significant decrease of Metabolic Syndrome (MetS) Z scores (p = 0.001; p = 0.011), hs-CRP (p = 0.028; p = 0.041), Malondialdehyde (MAD) (p = 0.023; p = 0.001), and significantly higher Glutathione (GSH) (p = 0.003; p = 0.001), and Total Antioxidant Capacity (TAC) (p = 0.001; p = 0.001) compared to the AT and TS groups. The results also revealed a significant difference in terms of MetS Z scores (p = 0.001), hs-CRP (p = 0.018), MAD (p = 0.011), GSH (p = 0.001) and TAC (p = 0.025) between the AT and TS.

Conclusions

The findings suggest that AT+TS improves metabolic status, oxidative stress biomarkers, and hs-CRP more effectively compared to TS or AT in middle-aged females with T2DM and hyperlipidemia.

Effectiveness of a personal health coaching intervention (diabetescoach) in patients with type 2 diabetes: protocol for an open-label, pragmatic randomised controlled trial

INTRODUCTION

The widespread prevalence of type 2 diabetes (T2D) not only influences patients' daily lives but also has an economic impact on society. Increasing physical activity and a healthy diet can delay the progression of T2D. Although there are evidence-based recommendations on diet and physical activity, patients with T2D have difficulties implementing them. An appropriate lifestyle intervention can address this problem.

METHODS AND ANALYSIS

This study is based on the need to develop an intervention that helps patients to establish behavioural changes in order to achieve glycaemic control. The intervention will be evaluated in a monocentric, open-label, pragmatic, two-arm randomised controlled trial with a sample ratio of 1:1 and a parallel design. This superiority study will be conducted in Switzerland. All enrolled patients (n=90) will receive the standard medical treatment for T2D. The intervention group will receive personal health coaching by telephone and access to a smartphone and web application for 1 year. The control group will receive access to the application for 1 year and a one-time written diet and exercise recommendation. The primary outcomes are objectively measured physical activity and glycated haemoglobin. Secondary outcomes are self-reported physical activity, nutrition, cognitive mediators of changes in sport-related behaviour, blood values, medication and nutritional supplements, anthropometric data, quality of life, neuropathy and cost-effectiveness. All outcomes will be measured at baseline, at 27 weeks after inclusion and at 54 weeks after inclusion. The recruitment of participants and the measurements will be completed after 2 years. Linear mixed-effects models will be applied for each outcome variable to analyse the intervention effects.

ETHICS AND DISSEMINATION

This study was approved by the Ethics Committee North-western and Central Switzerland in February 2021 (ref: 2020-02755). All participants will be required to provide written informed consent. The results will be published in international peer-reviewed journals.

TRIAL REGISTRATION NUMBER

ISRCTN79457541.

Prognostic value of a novel dNLR-PNI score in patients with acute coronary syndrome undergoing percutaneous coronary intervention

There is currently limited information on the prognostic value of the dNLR-PNI (the combination of the derived neutrophil-to-lymphocyte ratio [dNLR] and prognostic nutritional index [PNI]) score for patients with acute coronary syndrome (ACS). We aimed to explore the predictive value of a dNLR-PNI score on the long-term prognosis of patients with ACS undergoing percutaneous coronary intervention (PCI). A total of 1773 patients with ACS who underwent PCI were consecutively enrolled from January 2016 to December 2018. The cutoff values of dNLR and PNI to predict major adverse cardiovascular events (MACE) were calculated using receiver operating characteristic curves. The patients were divided into three groups based on the dNLR-PNI score, and Kaplan-Meier curves and Cox regression models were used for survival analysis. The endpoints were MACE, including all-cause mortality and rehospitalisation for severe heart failure during follow-up. A total of 1542 patients with ACS who underwent PCI were included. Kaplan-Meier curves showed that a higher level of dNLR, PNI, or dNLR-PNI score was associated with a higher risk of MACE (allp < .001). In multivariate Cox regression models, the dNLR-PNI two score (hazard ratio 3.049, 95% confidence interval 1.503-6.184, p = .002) was found to be an independent predictor of all-cause mortality and rehospitalization for severe heart failure. A high dNLR-PNI score was independently associated with a higher risk of developing MACE in patients with ACS undergoing PCI. The dNLR-PNI score may be a useful prognostic parameter for identifying high-risk ACS patients after PCI.

The experiences of patients with diabetes and strategies for their management during the first COVID-19 lockdown: a qualitative study

BACKGROUND

During the pandemic, primary care systems prioritised attention to COVID-19 patients; chronically ill patients, such as people with Type 2 Diabetes were obliged to take more responsibility for their own care. We aimed to analyse the experiences of patients with Type 2 Diabetes Mellitus during the stay-at-home order that was in place during the first wave of the COVID-19 pandemic and identify the strategies and resources used in managing their care.

METHOD

We conducted a qualitative descriptive study. The participants were ten patients with type 2 Diabetes Mellitus who experienced strict lockdown during the first wave of the COVID-19 pandemic in Catalonia, Spain, selected using intentional sampling. We recorded semi-structured interviews with the participants and conducted thematic analysis.

RESULTS

We identified 14 subthemes, which we then grouped into three overarching themes: 1) anxiety, fear, and vulnerability (anxiety, fear, vulnerability, rethinking life, loneliness, sadness), 2) insufficient diabetes monitoring by the health system (health care received, glycaemic control, view of treatment by health providers) and proactive self-care (changes in daily routine, diet, physical activity, medication, personal protective equipment & social distancing).

CONCLUSION

Despite the exceptional nature of the situation and the stress, worry, and changes in their daily lives, many respondents reported that they had successfully modified their lifestyles. Self-care was effective during confinement and was based on a process of adaptation using the resources available, without face-to-face contact with primary care health staff.

RELEVANCE TO CLINICAL PRACTICE

These results can help to guide the design and implementation of self-care-focused strategies and also to explore new ways of empowering patients without access to health care personnel.

Foot-ankle therapeutic exercise program can improve gait speed in people with diabetic neuropathy: a randomized controlled trial

This study sought to determine whether a foot–ankle therapeutic exercise program can improve daily physical activity (i.e. number of steps) and fast and self-selected gait speed in people with diabetic peripheral neuropathy (DPN). In this single-blind randomized controlled trial and intention-to-treat analysis, 78 volunteers with DPN were allocated into a control group, which received usual care, and an intervention group (IG), which received usual care plus a 12-week foot–ankle exercise program. The adherence at 12 weeks rate in the IG was 92.3% (36 participants) and the dropout was 5.1% in the control group (2 participants). The number of steps and self-selected gait speed did not change significantly in either group (p > 0.05), although a 1,365-step difference between groups were observed at 1-year followup. The 12-week foot–ankle therapeutic exercises improved significantly fast-gait speed (primary outcome) (p = 0.020), ankle range of motion (p = 0.048), and vibration perception (secondary outcomes) (p = 0.030), compared with usual-care at 12 weeks. At 24 weeks, the IG showed better quality of life than controls (p = 0.048). At 1-year, fast-gait speed and vibration perception remained higher in the IG versus controls. Overall, the program may be a complementary treatment strategy for improving musculoskeletal and functional deficits related to DPN.

Trial registration ClinicalTrials.gov NCT02790931 (06/06/2016).

Low Levels of Tumor Necrosis Factor-α will Prevent Periodontitis Exacerbation in Type 2 Diabetes Mellitus

OBJECTIVES

 Diabetes mellitus (DM) is a major risk factor for periodontitis. Susceptibility to periodontitis increases approximately three times in people with DM. There is a clear relationship between the degree of hyperglycemia and the severity of periodontitis. This study aimed to analyze the reduction of tumor necrosis factor-α (TNF-α) in diabetics who came for periodontitis examination to prevent exacerbations.

MATERIALS AND METHODS

 This was an analytic observational study using a cross-sectional approach at health centers in Surabaya, Indonesia. Measurement of periodontal status used the community periodontal index of treatment needs by measuring bleeding at probing and pocket depth. TNF-α was measured using enzyme-linked immunosorbent assay, and behavior and lifestyle using a questionnaire.

STATISTICAL ANALYSIS

 The Kolmogorov-Smirnov test was performed to identify data normality (p < 0.05). A nonparametric test was used to measure the degree of association between different characteristics and the incidence of periodontitis in type 2 DM patients with and without periodontitis. Spearman's test was done to examine the correlation between TNF-α level and severity of periodontitis in diabetics. The significant level was at p <0.05.

RESULTS

 There was a correlation between age, predisposing factors, reinforcing factors, drug consumption, and TNF-α levels in patients with type 2 DM and the incidence of periodontitis.

CONCLUSIONS

 Poor glycemic control can induce oxidative stress on the gingiva, thereby aggravating damage to periodontal tissue. An important factor in preventing periodontitis for type 2 DM patients is controlling blood sugar levels through regular consumption of drugs and regular maintenance of oral cavity health. Knowledge is a predisposing factor that affects adherence of people with type 2 DM to consuming drugs regularly, which can be strengthened by family support. These will ultimately play a role in reducing TNF-α levels.

Managing weight and glycaemic targets in people with type 2 diabetes—How far have we come?

Introduction

As the vast majority of people with type 2 diabetes (T2D) are also overweight or obese, healthcare professionals (HCP) are faced with the task of addressing both weight management and glucose control. In this narrative review, we aim to identify the challenges of reaching and maintaining body weight targets in people with T2D and highlight current and future treatment interventions.

Methods

A search of the PubMed database was conducted using the search terms “diabetes” and “weight loss.”

Results

According to emerging evidence, treating obesity may be antecedent to the development and progression of T2D. While clinical benefits typically set in upon achieving a weight loss of 3–5%, these benefits are progressive leading to further health improvements, and weight loss of >15% can have a disease‐modifying effect in people with T2D, an outcome that up to recently could not be achieved with any blood glucose‐lowering pharmacotherapy. However, advanced treatment options with weight‐loss effects currently in development including the dual GIP/GLP‐1 receptor agonists may enable simultaneous achievement of individual glycemic and weight goals.

Conclusion

Despite considerable therapeutic progress, there is still a large unmet medical need in patients with T2D who miss their individualized glycemic and weight‐loss targets. Nonetheless, it is to be expected that development of future therapies and their use will favourably change the scenario of weight and glucose control in T2D.

Aerobic training reduces pancreatic fat content and improves β-cell function: A randomized controlled trial using IDEAL-IQ magnetic resonance imaging

AIMS

To explore the effects of six months of moderate-intensity aerobic exercise on pancreatic fat content and its impact on β-cell function.

MATERIALS AND METHODS

A total of 106 patients with type 2 diabetes mellitus were randomized to either a moderate-intensity aerobic training group (three times a week, including 5 min warm-up, 50 min aerobic dancing, and 5 min relaxation, n = 53) or control group (n = 53) with 6-month intervention. The primary endpoint was change in pancreatic fat content. An intention-to-treat analysis was conducted.

RESULTS

Eighty-six patients completed the study with 43 patients in the aerobic training group. The average age, HbA1c, and pancreatic fat content for all participants (106 patients) were 66.39 ± 5.59 years, 7.05 ± 1.24%, and 10.35 ± 9.20%, respectively. Nearly half (49.06%) of patients were males. Subjects in the aerobic training group saw a significant reduction in pancreatic fat content when compared to controls (p = 0.001). In logistic regression models containing age, diabetes duration, change in BMI, smoking/drinking status, changes in lipid indices, and other abdominal fat content, only reduction in pancreatic fat content (p < 0.05) was an independent protective factor for β-cell function and HbA1c.

CONCLUSIONS

Six months of moderate-intensity aerobic training significantly reduced the pancreatic fat content. The reduction of pancreatic fat content was an independent protective factor for β-cell function and HbA1c.

The associations between health-related physical fitness and fasting blood glucose in war veterans: a population-based study

The main purpose of the study was to analyze the associations between health-related physical fitness and fasting blood glucose in war veterans. In this cross-sectional study, we recruited 764 men and women aged 45-75 years, who were part of the Homeland War between 1990 and 1995 (33.5% women). Health-related physical fitness included: (1) fat mass and fat-free mass (body composition), (2) push-ups in 30 s (muscular dynamic endurance of upper extremities), (3) sit-ups in 30 s (repetitive upper body strength), (4) chair-stands in 30 s (lower body strength), (5) sit-and-reach test (flexibility) and (6) the 2-min step test (cardiorespiratory function). Laboratory measurement of fasting blood glucose was performed according to standardized procedures in resting seated position after a 12-h overnight fast. Generalized estimating equations with multiple regression models were used to calculate the associations between health-related physical fitness and fasting blood glucose. In men, fasting blood glucose was significantly correlated with fat-free mass (β = - 0.25, p < 0.001), push-ups in 30 s (β = - 0.55, p < 0.001), chair-stands in 30 s (β = - 0.50, p < 0.001), sit-ups in 30 s (r = - 0.45, p < 0.001), the sit-and reach test (r = - 0.46, p < 0.001) and the 2-min step test (r = - 0.19, p < 0.001), while fat mass was positively correlated with fasting blood glucose (β = 0.14, p = 0.004). In women, fasting blood glucose was significantly correlated with fat mass (β = 0.20, p = 0.002), fat-free mass (β = - 0.15, p = 0.014), push-ups in 30 s (β = - 0.49, p < 0.001), chair-stands in 30 s (β = - 0.43, p < 0.001), sit-ups in 30 s (β = - 0.52, p < 0.001), the sit-and reach test (β = - 0.40, p < 0.001) and the 2-min step test (β = - 0.35, p < 0.001). This study shows that fasting blood glucose may be predicted by health-related physical fitness test in war veterans.

Bibliometric and Visualized Analysis of 2011-2020 Publications on Physical Activity Therapy for Diabetes

Background

This study was designed to investigate the global emerging trends of physical activity therapy for diabetes based on a bibliometric analysis of the publications.

Methods

Publication papers from 2011 to 2020 were retrieved from the database of "Web of Science Core Collection" with the topic search. A number of papers, citations, authors, countries, institutions, and references were extracted. CiteSpace was used to analyze co-citation on authors, collaborations between countries and institutions, and detect the emerging trends of burst keywords and references.

Results

A total of 2651 publications were recruited in this study and showed an upward trend of annual publications. Diabetes obesity & metabolism (journal), the United States (country), Harvard University (institution), and Kaku K (author) published the most papers in this research field. "Impaired glucose tolerance" (2011-2012) was the highest strength burst keyword, while "cardiovascular outcome" (2017-2020) was the most burst keyword in the last 5 years. Moreover, "Standards of medical care in diabetes - 2014" was the strongest burst reference.

Conclusion

"Physical activity therapy for diabetes" has been accepted remarkably over the last 10 years. The keywords of "impaired glucose tolerance," "Cardiovascular outcome," "improves glycemic control," "Self-management," and exercise type including "Aerobic exercise, muscle strength" may be the latest research frontiers.

Effects of a Home-Based Physical Activity Programme on Blood Biomarkers and Health-Related Quality of Life Indices in Saudi Arabian Type-2 Diabetes Mellitus Patients: Protocol for a Randomised Controlled Trial

The Kingdom of Saudi Arabia is renowned for its high incidence of type-2 diabetes mellitus, with a prevalence rate of around 33%, which is expected to increase to 45.8% by 2030. Engagement in regular physical activity has been shown to significantly attenuate non-communicable diseases including type-2 diabetes. However, the overall rate of physical inactivity among Saudi Arabian adults is currently 80.5%, owing to time pressures, high-density traffic, poor air quality, lack of suitable exercise places/sports facilities, lack of social/friends support, gender, cultural barriers, low self-confidence, lack of time and environmental factors. Previous analyses have shown that home-based activity interventions can be effective. Therefore, given the aforementioned barriers to physical activity in Saudi Arabia; a home-based physical activity may be an ideal solution in type-2 diabetic patients. This manuscript describes the study protocol for a randomized control trial, examining the effects of a home-based physical activity intervention in Saudi Arabian adults with type-2 diabetes. The study will recruit 62 individuals with type-2 diabetes from the Jazan region of the Kingdom of Saudi Arabia, who will be individually randomized to either a physical activity or control group. This 24-week investigation will involve 12-weeks of physical activity in the physical activity group and feature three examination points i.e., baseline, 12-weeks and 24-weeks (follow-up). The primary study outcome is the between-group difference in blood HbA1c levels relative to controls. Secondary outcomes measures will be between-group differences in anthropometric, blood lipid, physical fitness, and patient-reported quality of life outcomes pertinent to type-2 diabetes. Statistical analysis will be conducted on an intention-to-treat basis. The trial has been granted ethical approval by Jazan University, Health Research Ethics Committee (REF: 2177) and formally registered as a trial (NCT04937296). We expect dissemination of the study findings from this investigation to be through publication in a leading peer-reviewed journal.

The impact of high-intensity interval training on postprandial glucose and insulin: A systematic review and meta-analysis

AIMS

We performed a systematic review and meta-analysis to investigate the effects of high-intensity interval training (HIIT) on postprandial glucose (PPG) and insulin (PPI) versus non-exercise control and moderate-intensity continuous training (MICT) in participants with both normal and impaired glucose.

METHODS

The PubMed, Scopus, and Web of Science electronic databases were searched up to October 2021 for randomized trials evaluating HIIT versus control and/or versus MICT on glucose and insulin AUC using oral glucose tolerance testing. Subgroup analyses based on intervention duration (short-duration < 8 weeks, moderate-duration ≥ 8 weeks), baseline glucose levels (normal glucose and impaired glucose) and type of HIIT (L-HIIT and SIT) were also conducted across included studies.

RESULTS

A total of 25 studies involving 870 participants were included in the current meta-analysis. HIIT effectively reduced glucose [-0.37 (95% CI -0.60 to -0.13), p = 0.002] and insulin [-0.36 (95% CI -0.68 to -0.04), p = 0.02] AUC when compared with a CON group. Reductions in glucose AUC were significant for those with impaired glucose at baseline (p = 0.03), but not for those with normal glucose levels (p = 0.11) and following moderate-duration (p = 0.01), but not short-duration interventions (p = 0.18). However, there were no differences in glucose (p = 0.76) or insulin (p = 0.43) AUC between HIIT and MICT intervention arms.

CONCLUSIONS

Our results demonstrated that both HIIT and MICT are effective for reducing postprandial glycemia and insulinemia, particularly by moderate-duration interventions, and in those with impaired glucose.

Effects of progressive resistance training in individuals with type 2 diabetic polyneuropathy: a randomised assessor-blinded controlled trial

AIMS/HYPOTHESIS

The aim of this study was to evaluate the effects of progressive resistance training (PRT) on muscle strength, intraepidermal nerve fibre density (IENFD) and motor function in individuals with type 2 diabetic polyneuropathy (DPN) and to compare potential adaptations to those of individuals with type 2 diabetes without DPN and healthy controls.

METHODS

This was an assessor-blinded trial conducted at the Neurology department, Aarhus University Hospital. Adults with type 2 diabetes, with and without DPN and healthy control participants were randomised to either supervised PRT or non-PRT for 12 weeks. Allocation was concealed by a central office unrelated to the study. The co-primary outcomes were muscle strength in terms of the peak torque of the knee and ankle extensors and flexors, and IENFD. Secondary outcome measures included the 6 min walk test (6MWT), five-time sit-to-stand test (FTSST) and postural stability index obtained by static posturography.

RESULTS

A total of 109 individuals were enrolled in three groups (type 2 diabetes with DPN [n = 42], type 2 diabetes without DPN [n = 32] and healthy control [n = 35]). PRT resulted in muscle strength gains of the knee extensors and flexors in all three groups using comparative analysis (DPN group, PRT 10.3 ± 9.6 Nm vs non-PRT -0.4 ± 8.2 Nm; non-DPN group, PRT 7.5 ± 5.8 Nm vs non-PRT 0.6 ± 8.8 Nm; healthy control group, PRT 6.3 ± 9.0 Nm vs non-PRT -0.4 ± 8.4 Nm; p<0.05, respectively). Following PRT the DPN group improved the 6MWT (PRT 34.6 ± 40.9 m vs non-PRT 2.7 ± 19.6 m; p=0.001) and the FTSST (PRT -1.5 ± 2.2 s vs non-PRT 1.5 ± 4.6 s; p=0.02). There was no change in IENFD following PRT in any of the groups.

CONCLUSIONS/INTERPRETATION

PRT improved muscle strength of the knee extensors and flexors and motor function in individuals with type 2 diabetic polyneuropathy at levels comparable with those seen in individuals with diabetes without DPN and healthy control individuals, while no effects were observed in IENFD.

TRIAL REGISTRATION

ClinicalTrials.gov NCT03252132 FUNDING: Research reported in this paper is part of the International Diabetic Neuropathy Consortium (IDNC) research programme, supported by a Novo Nordisk Foundation Challenge Program grant (grant no. NNF14OC0011633) and Aarhus University.

Does Androgen Deprivation for Prostate Cancer Affect Normal Adaptation to Resistance Exercise?

BACKGROUND

Loss of muscle mass and muscle function is a common side effect from androgen deprivation therapy (ADT) for prostate cancer (PCa). Here, we explored effects of heavy-load resistance training (RT) on lean body mass and muscle strength changes reported in randomized controlled trials (RCTs) among PCa patients on ADT and in healthy elderly men (HEM), by comparison of results in separate meta-analysis.

METHODS

RCTs were identified through databases and reference lists.

RESULTS

Seven RCTs in PCa patients (n = 449), and nine in HEM (n = 305) were included. The effects of RT in lean body mass change were similar among PCa patients (Standardized mean difference (SMD): 0.4, 95% CI: 0.2, 0.7) and HEM (SMD: 0.5, 95% CI: 0.2, 0.7). It is noteworthy that the within group changes showed different patterns in PCa patients (intervention: 0.2 kg; control: -0.6 kg) and HEM (intervention: 1.2 kg; control: 0.2 kg). The effects of RT on change in muscle strength (measured as 1 RM) were similar between PCa patients and HEM, both for lower body- (PCa: SMD: 1.9, 95% CI: 1.2, 2.5; HEM: SMD: 2.2, 95% CI: 1.0, 3.4), and for upper body exercises (PCa: SMD: 2.0, 95% CI: 1.3, 2.7; HEM: SMD: 1.9, 95% CI: 1.3, 2.6).

CONCLUSIONS

The effects of RT on lean body mass and 1 RM were similar in PCa patients on ADT and HEM, but the mechanism for the intervention effect might differ between groups. It seems that RT counteracts loss of lean body mass during ADT in PCa patients, as opposed to increasing lean body mass in HEM.

Adherence to physical exercise recommendations among type 2 diabetes patients during the COVID-19 pandemic

Background

In the era of the COVID-19 pandemic, nonadherence to the recommended physical exercise for diabetic patients is a difficult issue. Regular physical exercise is critical for reducing further complications of diabetes mellitus and the COVID-19 pandemic. The purpose of this study was to determine the predictors of type 2 adult diabetes patients’ exercise recommendations during the COVID-19 pandemic.

Methods

An institution-based cross-sectional study was conducted among 576 diabetes mellitus patients from August 1, 2020, to September 28, 2020. A systematic random sampling technique was used to select the study participants. An interviewer-administered questionnaire was used to collect the data. Frequency tables and percentages were used to explain the study variables. A binary logistic regression was used to investigate the relationship between the dependent and independent variables.

Result

A total of 576 diabetes mellitus patients participated in the study, with a response rate of 99.3%. The overall prevalence of exercise adherence was 26.4%, whereas 73.6% were non-adherents to exercise recommendations. Rural residency (AOR = 1.95, 95% CI: 1.16–3.27) and COVID-19 related knowledge (AOR = 9.95, 95% CI: 41.14–5.24) were both strongly associated with exercise recommendations.

Conclusion

In this study, only one-fourth of patients had exercised adherence during the era of the COVID-19 pandemic. Knowledge about COVID-19 was one of the factors that was strongly associated with adherence to exercise recommendations for diabetes patients. During the COVID-19 pandemic, encouraging home-based exercises can improve adherence to exercise recommendations.

Stability of extemporaneously prepared sitagliptin phosphate solution

Sitagliptin is a dipeptidyl peptidase-4 (DPP-4) inhibitor that is used orally in conjunction with diet and exercise to control sugar levels in type 2 Diabetes Mellitus patients. This study aimed to extemporaneously prepare SiP solution (1% w/v) using pure Sitagliptin phosphate (SiP) powder and assess its stability according to pharmaceutical regulatory guidelines. Four SiP solutions, coded T1, T2, T3, and T4, were extemporaneously prepared using pure SiP powder as a source of API. The most suitable one, in terms of general organoleptic properties, was selected for further investigations, including stability studies. For this last purpose, samples of the T4 solution were kept under two storage conditions, room temperature (25˚C and 60% Relative Humidity) and accelerated stability conditions (40˚C and 75% Relative Humidity). Assay, pH, organoleptic properties, related substances, and microbial contamination were evaluated for 4 consecutive weeks. A High-Performance Liquid Chromatography (HPLC) analytical method was developed and validated to be used for the analysis and quantification of SiP in selected solution formulation. The adopted formula had a pH on the average of 3 to 4. During the stability tests, all pH values remained constant. Furthermore, after 4 weeks of storage under both conditions, the SiP concentration was close to 100%. A stable SiP extemporaneous solution was successfully prepared using pure SiP powder. Patients with swallowing problems who use feeding tubes and are unable to take oral solid dosage forms may benefit from this research. Community pharmacists can prepare the solution using sitagliptin powder as the source of the active ingredient.

Executive summary of evidence and consensus-based Clinical Practice Guidelines for management of obesity and overweight in midlife women: An AIIMS-DST initiative

BACKGROUND AND AIMS

Weight gain is an independent risk factor for decline in cardiometabolic and overall health-related quality of life in midlife women. The AIIMS-DST initiative aims to develop and validate stepwise recommendations specific for weight management in midlife women.

METHODS

The key clinical questions specific to weight management in midlife women were finalised with the help of a multidisciplinary team of experts in the guideline development group (GDG). Phase I included a systematic and/or narrative review to gather evidence, grading of evidence and expert opinion was sought to develop clinical practice recommendations for each clinical question. Phase II focused on validation of clinical practice recommendations using the peer-review, Delphi method and GRADE approach.

RESULTS

-The guidelines provide clinical practice points to address challenges encountered by midlife women in their attempts to manage obesity via lifestyle modification techniques. The initiation of discussion would help the healthcare provider to identify the weight management needs of the women, educate women on different modalities of weight management, and empower them to incorporate corrective lifestyle behaviours. Before initiating the management, a comprehensive assessment of clinical and lifestylerelated parameters should be completed. A personalised behavioural lifestyle modification program addressing the midlife specific barriers for optimal metabolic, musculoskeletal, and mental health should be planned. A consistent follow-up is required for maintenance of corrective eating and activity habits by addressing midlife specific barriers for sustenance of healthy weight.

CONCLUSION

These recommendations will be useful in opportunistic screening and management of obesity in midlife women across healthcare settings.

The effects of high-intensity functional training on cardiometabolic risk factors and exercise enjoyment in men and women with metabolic syndrome: study protocol for a randomized, 12-week, dose-response trial

Background

Individuals with metabolic syndrome (MetS) are at a greater risk for developing atherosclerotic cardiovascular disease (ASCVD) than those without MetS, due to underlying endothelial dysfunction, dyslipidemia, and insulin resistance. Exercise is an effective primary and secondary prevention strategy for MetS; however, less than 25% of adults meet the minimum stated public recommendations. Barriers often identified are lack of enjoyment and lack of time. High-intensity functional training (HIFT), a time-efficient modality of exercise, has shown some potential to elicit positive affectivity and elicit increased fitness and improved glucose metabolism. However, the effects of HIFT on dyslipidemia and endothelial dysfunction have not been explored nor have the effects been explored in a population with MetS. Additionally, no studies have investigated the minimal dose of HIFT per week to see clinically meaningful changes in cardiometabolic health. The purpose of this study is to (1) determine the dose-response effect of HIFT on blood lipids, insulin resistance, and endothelial function and (2) determine the dose-response effect of HIFT on body composition, fitness, and perceived enjoyment and intention to continue the exercise.

Methods/design

In this randomized, dose-response trial, participants will undergo a 12-week HIFT intervention of either 1 day/week, 2 days/week, or 3 days/week of supervised, progressive exercise. Outcomes assessed at baseline and post-intervention will be multiple cardiometabolic markers, and fitness. Additionally, the participant’s affective response will be measured after the intervention.

Discussion

The findings of this research will provide evidence on the minimal dose of HIFT per week to see clinically meaningful improvements in the risk factors of MetS, as well as whether this modality is likely to mitigate the barriers to exercise. If an effective dose of HIFT per week is determined and if this modality is perceived positively, it may provide exercise specialists and health care providers a tool to prevent and treat MetS.

Trial registration

ClinicalTrials.gov NCT05001126. August 11, 2021.

Physical Exercise in the Context of Air Pollution: An Emerging Research Topic

Physical exercise (PE) brings physiological benefits to human health; paradoxically, exposure to air pollution (AP) is harmful. Hence, the combined effects of AP and PE are interesting issues worth exploring. The objective of this study is to review literature involved in AP-PE fields to perform a knowledge-map analysis and explore the collaborations, current hotspots, physiological applications, and future perspectives. Herein, cluster, co-citation, and co-occurrence analysis were applied using CiteSpace and VOSviewer software. The results demonstrated that AP-PE domains have been springing up and in rapid growth since the 21st century. Subsequently, active countries and institutions were identified, and the productive institutions were mainly located in USA, China, UK, Spain, and Canada. Developed countries seemed to be the major promoters. Additionally, subject analysis found that environmental science, public health, and sports medicine were the core subjects, and multidimensional communications were forming. Thereafter, a holistic presentation of reference co-citation clusters was conducted to discover the research topics and trace the development focuses. Youth, elite athletes, and rural population were regarded as the noteworthy subjects. Commuter exposure and moderate aerobic exercise represented the common research context and exercise strategy, respectively. Simultaneously, the research hotspots and application fields were elaborated by keyword co-occurrence distribution. It was noted that physiological adaptations including respiratory, cardiovascular, metabolic, and mental health were the major themes; oxidative stress and inflammatory response were the mostly referred mechanisms. Finally, several challenges were proposed, which are beneficial to promote the development of the research field. Molecular mechanisms and specific pathways are still unknown and the equilibrium points and dose-effect relationships remain to be further explored. We are highly confident that this study provides a unique perspective to systematically and comprehensively review the pieces of AP-PE research and its related physiological mechanisms for future investigations.

A Metformin Pharmacogenetic Study of Patients with Type 2 Diabetes Mellitus and SLC22A1 Gene Mutation

Background: The purpose of this study was to determine the profiles of patients with type 2 diabetes (T2DM) and an SLC22A1 gene mutation in order to evaluate the effect of metformin pharmacogenetics. Methods: To assess the effect of pharmacogenetics, a mutation of the SLC22A1 gene in T2DM patients receiving metformin was investigated. Blood samples were taken from 50 diabetics of Minangkabau ethnicity who met the inclusion criteria, and SNP genotyping and blood glucose levels were determined. DNA is extracted and purified from blood samples using DNAzol® Genomic DNA Kits (Thermofischer Scientific) reagents. The Chi-square test and Independent sample T test were used to analyze the data. A statistically significant association was defined as a p-value < 0.05. Finally, the GraphPad Prism 7.00 program was used to gather and analyze data. Results: The adjusted odds ratio for inadequate fasting blood glucose was 1.48 (95% CI 1.18-1.95) in this study, while the adjusted odds ratio for diet discipline was 1.23 (95% CI 1.18-1.95). The adjusted odds ratio for low physical activity was 1.18. (95% CI 1.05-1.81). According to the sequencing data, the proportion of mutants is high at exon 2 rs683369 (G> C), while the percentage of wildtype and heterozygous mutants is the same at introns rs4646272 (T> G). Conclusion: Obesity, diet discipline, and low physical activity were all found to increase the likelihood of insufficient fasting blood glucose in T2DM patients. Exon 2 rs683369 (G> C) has a high proportion of mutants, but introns rs4646272 (T> G) have the same percentage of wildtype and heterozygous mutants.

Association between physical activity & sedentary time on frailty status in males and females living with diabetes mellitus: A cross-sectional analysis

BACKGROUND

Physical activity (PA) is a cornerstone for the prevention and the treatment of diabetes mellitus (DM) and frailty. However, no consensus exists on which intensities and types of PA are associated with frailty status among individuals living with DM. To investigate the association between different intensities and types of PA on frailty status in males and females living with DM.

METHODS

A cross-sectional analysis of the 2003-2006 cycles from the National Health and Nutrition Examination Survey (NHANES) was performed in 711 participants living with DM. Frailty status was measured using the 43-item deficit model and DM was self-reported. Weekly PA levels were measured by accelerometer, while resistance training (RT) was measured via questionnaire. Linear and logistic regressions were performed to investigate the associations between different intensities and types of PA and frailty status.

RESULTS

Total time spent performing light PA was associated with a better frailty status in males (ß - 0.041 ± 0.012; p < 0.001) and females (ß - 0.070 ± 0.010; p < 0.0001), while total moderate-to-vigorous PA (MVPA) was associated with a better frailty status in females only (ß-0.235 ± 0.061; p < 0.05). However, once fully adjusted, the different intensities and types of PA were associated more with frailty status for female. When investigating whether different intensities and types of PA were associated with being considered frail, total time spent at MVPA and light PA were associated with higher odds along with total sedentary time for female (all p < 0.01).

CONCLUSION

Each minute engaged in PA was associated with a better frailty status in males and females living with DM, although RT does not appear associated with a better frailty status in adults with DM. Replacing sedentary time with PA is important, especially for females living with DM to have a better frailty status. These results are important as they provide insights into the prevention and the management of frailty in individuals living with DM.

Height-adjusted lean body mass and its associations with physical activity and kidney function in pediatric kidney transplantation

BACKGROUND

Although LBM is positively associated with health outcomes, studies assessing determinants for the accrual of ht-LBM, such as physical activity, are limited. This study aimed to assess ht-LBM levels in pediatric kidney transplant recipients and test its association with baseline and contemporaneous variables, including physical activity.

METHODS

A retrospective cross-sectional review was performed on 46 pediatric kidney transplant recipients, and a longitudinal review was performed on a subset of recipients with serial post-transplant (n = 21) and pre/post-transplant (n = 11) ht-LBM measurements. Ht-LBM measurements were obtained using DXA scans.

RESULTS

This cohort was 16.0 (IQR 12.3, 17.7) years old, 56.5% male and 46 ± 45 months post-transplant with a mean ht-LBM of 15.1 ± 2.5 kg/m² . A median ht-LBM increase of 1.6 kg/m² (IQR - 0.1, 2.6 kg/m² ; p < .01) was observed, over 29.2 ± 12.0 months from the earliest post-transplant scan obtained at 46 ± 25 months post-transplant until the most recent post-transplant scan. A 1.7 ± 1.4 kg/m² (p < .01) increase was observed between pre- and post-transplant DXA scans which were taken at 12 ± 11 months pre-transplant and 13 ± 6 months post-transplant, respectively. In separate adjusted models, lower physical activity questionnaire scores (n = 17, beta = 1.55, p = .02), faster rate of estimated glomerular filtration rate decline (beta = 0.05, p < .048) adjusted for annualized change in BSA, and younger age at scan (beta = 0.32, p < .01) were each significant predictors of lower ht-LBM.

CONCLUSIONS

Physical activity and kidney function may influence ht-LBM in the pediatric kidney transplant population.

Exercise/Physical Activity in Individuals with Type 2 Diabetes: A Consensus Statement from the American College of Sports Medicine

ABSTRACT

This consensus statement is an update of the 2010 American College of Sports Medicine position stand on exercise and type 2 diabetes. Since then, a substantial amount of research on select topics in exercise in individuals of various ages with type 2 diabetes has been published while diabetes prevalence has continued to expand worldwide. This consensus statement provides a brief summary of the current evidence and extends and updates the prior recommendations. The document has been expanded to include physical activity, a broader, more comprehensive definition of human movement than planned exercise, and reducing sedentary time. Various types of physical activity enhance health and glycemic management in people with type 2 diabetes, including flexibility and balance exercise, and the importance of each recommended type or mode are discussed. In general, the 2018 Physical Activity Guidelines for Americans apply to all individuals with type 2 diabetes, with a few exceptions and modifications. People with type 2 diabetes should engage in physical activity regularly and be encouraged to reduce sedentary time and break up sitting time with frequent activity breaks. Any activities undertaken with acute and chronic health complications related to diabetes may require accommodations to ensure safe and effective participation. Other topics addressed are exercise timing to maximize its glucose-lowering effects and barriers to and inequities in physical activity adoption and maintenance.

The impact of concurrent training and antioxidant supplementation on the factors associated with the ocular lens opacity in diabetic rats

The current study was aimed to investigate the protective effect of vitamins C and E (VCE) supplementation, exercise, and their concurrent application against cataract incidence in the diabetic rats. The obtained results indicated that different supplementation and training treatments were capable to preserve the lens transparency in the diabetic rats. Also, upon applying different supplementation and training treatments, the level of glutathione (GSH) and activity of antioxidant enzymes in the diabetic rats was preserved approximately close to their control levels. In addition, different treatments were capable to maintain the structural integrity of the lens proteins in diabetic rats. Moreover, VCE supplementation, exercise and their simultaneous application prevented lens crystallins of diabetic rats against fibrillation and formation of the increased oligomeric sizes. The results of this study signify the importance of antioxidant supplementation and exercise in reducing the detrimental effects of hyperglycemia on the eye lenses.

Technology-based and supervised exercise interventions for individuals with type 2 diabetes: Randomized controlled trial

AIMS

The purpose of this study was to estimate, for people with type 2 diabetes (T2D), the extent to which glycemic control was affected by a 12-week program using mobile app and wearable smartwatch in comparison to supervised exercise training.

METHODS

This study was a stratified, randomized, assessor-blind, controlled, pragmatic trial with three parallel groups which were supervised, mobile app and wearable smartwatch. Individually tailored exercise regimens delivered through a supervisor, mobile app and wearable smartwatch. Programs consisted of aerobic, resistance exercises, calisthenic, flexibility, balance, and coordination exercises. Primary outcome was change in glycemic control (HbA1c); secondary outcome was Six Minute Walk Test; and explanatory outcomes were exercise behaviour, muscle function, and physical capacity. The groups were contrasted for change in HbA1c and absolute reduction of ≥0.5% (Minimal Important Change). Linear and logistic regressions were used to compare the groups and generalized estimated equations were used to analyze the explanatory outcomes.

RESULTS

In total, 90 people were randomized, 6 were lost over 12 weeks, leaving 84 with outcome data. The difference in HbA1c did not differ between the supervised and the technology groups combined and between the mobile app and smartwatch group. Proportions of people achieving a clinically meaningful difference on HbA1c between the supervised and technology groups were similar (46% vs 43%) and the associated OR was 0.87 (95%CI:0.34-2.28). Within the two technology groups, proportions of people achieving a clinically meaningful difference in HbA1c were 48% in the mobile app and 38% in the smartwatch groups and the associated OR was 0.65 (95%CI:0.21-2.03). The groups did not differ on secondary and explanatory outcomes.

CONCLUSIONS

The results of our trial provide evidence that all outcomes have improved in all groups regardless of the exercise delivery method. Considering the supervised programs are not available for everybody, technological options are crucial to implement to help individuals self-manage most aspects of their diabetes.

Exploring New Drug Targets for Type 2 Diabetes: Success, Challenges and Opportunities

There are substantial shortcomings in the drugs currently available for treatment of type 2 diabetes mellitus. The global diabetic crisis has not abated despite the introduction of new types of drugs and targets. Persistent unaddressed patient needs remain a significant factor in the quest for new leads in routine studies. Drug discovery methods in this area have followed developments in the market, contributing to a recent rise in the number of molecules. Nevertheless, troubling developments and fresh challenges are still evident. Recently, metformin, the most widely used first-line drug for diabetes, was found to contain a carcinogenic contaminant known as N-nitroso dimethylamine (NDMA). Therefore, purity and toxicity are also a big challenge for drug discovery and development. Moreover, newer drug classes against SGLT-2 illustrate both progress and difficulties. The same was true previously in the case of glucagon-like peptide-1 receptor agonists and dipeptidyl peptidase-4 inhibitors. Furthermore, researchers must study the importance of mechanistic characteristics of novel compounds, as well as exposure-related hazardous aspects of current and newly identified protein targets, in order to identify new pharmacological molecules with improved selectivity and specificity.

Determinants in Tailoring Antidiabetic Therapies: A Personalized Approach

Diabetes has become a pandemic as the number of diabetic people continues to rise globally. Being a heterogeneous disease, it has different manifestations and associated complications in different individuals like diabetic nephropathy, neuropathy, retinopathy, and others. With the advent of science and technology, this era desperately requires increasing the pace of embracing precision medicine and tailoring of drug treatment based on the genetic composition of individuals. It has been previously established that response to antidiabetic drugs, like biguanides, sulfonylureas, dipeptidyl peptidase-4 (DPP-4) inhibitors, glucagon-like peptide 1 (GLP-1) agonists, and others, depending on variations in their transporter genes, metabolizing genes, genes involved in their action, etc. Responsiveness of these drugs also relies on epigenetic factors, including histone modifications, miRNAs, and DNA methylation, as well as environmental factors and the lifestyle of an individual. For precision medicine to make its way into clinical procedures and come into execution, all these factors must be reckoned with. This review provides an insight into several factors oscillating around the idea of precision medicine in type-2 diabetes mellitus.

The Effects of COVID-19 Lockdown on Glycaemic Control and Lipid Profile in Patients with Type 2 Diabetes: A Systematic Review and Meta-Analysis

The impact of the COVID-19 lockdown on glycaemic control and other metabolic parameters in patients with type 2 diabetes is still evolving. Aim: This systematic review and meta-analysis aims to examine the effects of COVID-19 lockdown on glycaemic control and lipid profile in patients with type 2 diabetes. Methods: The PRISMA framework was the method used to conduct the systematic review and meta-analysis, and the search strategy was based on the population, intervention, control and outcome (PICO) model. The Health Sciences Research databases was accessed via EBSCO-host, and EMBASE were searched for relevant articles. Searches were conducted from inception of the databases until 17 September 2021. Results: The results identified three distinct areas: glycaemic control, lipid parameters and body mass index. It was found that COVID-19 lockdown led to a significant (p < 0.01) increase in the levels of glycated haemoglobin (%) compared with pre-COVID group (gp) with a mean difference of 0.34 (95% CI: 0.30, 0.38). Eleven studies contributed to the data for glycated haemoglobin analysis with a total of 16,895 participants (post-COVID-19 lockdown gp, n = 8417; pre-COVID gp, n = 8478). The meta-analysis of fasting plasma glucose (mg/dL) also showed a significant (p < 0.05) increase in levels of post-COVID-19 lockdown gp compared with pre-COVID gp, with a mean difference of 7.19 (95% CI: 5.28, 9.10). Six studies contributed to fasting plasma glucose analysis involving a total of 2327 participants (post-COVID-19 lockdown, n = 1159; pre-COVID gp, n = 1168). The body mass index (BMI) (kg/m²) analysis also demonstrated that post-COVID-19 lockdown gp had a significantly (p < 0.05) higher BMI than the pre-COVID gp with a mean difference of 1.13 (95% CI: 0.99; 1.28), involving six studies and a total of 2363 participants (post-COVID-19 lockdown gp, n = 1186; pre-COVID gp, n = 1177). There were significantly (p < 0.05) lower levels of total cholesterol (mmol/L), triglyceride (mmol/L) and LDL cholesterol (mmol/L), and higher levels of HDL cholesterol (mg/dL) in the post-COVID-19 lockdown gp compared with pre-COVID gp, although these results were not consistent following sensitivity analysis. Conclusion: The findings of the systematic review and meta-analysis have demonstrated that COVID-19 lockdown resulted in a significant increase (p < 0.05) in the levels of glycated haemoglobin, fasting glucose and body mass index in patients with type 2 diabetes. In contrast, the effect of the lockdown on lipid parameters, including total cholesterol, triglycerides, LDL and HDL cholesterol was not consistent.

Reactive Oxygen Species (ROS) and Antioxidants as Immunomodulators in Exercise: Implications for Heme Oxygenase and Bilirubin

Exercise is commonly prescribed as a lifestyle treatment for chronic metabolic diseases as it functions as an insulin sensitizer, cardio-protectant, and essential lifestyle tool for effective weight maintenance. Exercise boosts the production of reactive oxygen species (ROS) and subsequent transient oxidative damage, which also upregulates counterbalancing endogenous antioxidants to protect from ROS-induced damage and inflammation. Exercise elevates heme oxygenase-1 (HO-1) and biliverdin reductase A (BVRA) expression as built-in protective mechanisms, which produce the most potent antioxidant, bilirubin. Together, these mitigate inflammation and adiposity. Moderately raising plasma bilirubin protects in two ways: (1) via its antioxidant capacity to reduce ROS and inflammation, and (2) its newly defined function as a hormone that activates the nuclear receptor transcription factor PPARα. It is now understood that increasing plasma bilirubin can also drive metabolic adaptions, which improve deleterious outcomes of weight gain and obesity, such as inflammation, type II diabetes, and cardiovascular diseases. The main objective of this review is to describe the function of bilirubin as an antioxidant and metabolic hormone and how the HO-1-BVRA-bilirubin-PPARα axis influences inflammation, metabolic function and interacts with exercise to improve outcomes of weight management.

Associations between weight loss history and factors related to type 2 diabetes risk in the Stop Diabetes study

Background

Frequent weight loss attempts are related to maladaptive eating behaviours and higher body mass index (BMI). We studied associations of several type 2 diabetes (T2D) risk factors with weight loss history, defined as the frequency of prior weight loss attempts, among Finnish adults at increased risk for T2D.

Methods

This study (n = 2684, 80% women) is a secondary analysis of the 1-year StopDia lifestyle intervention with digital intervention group, digital intervention + face-to-face counselling group, or control group. The frequency of prior weight loss attempts was categorized into five groups: no attempts/no attempts to lose weight, but trying to keep weight stable/1–2 attempts/3 or more attempts/ continuous attempts. Data on emotional eating and social/emotional nutrition self-efficacy were collected with a digital questionnaire. We assessed baseline differences between categories of weight loss history as well as the intervention effects.

Results

Altogether 84% of participants had attempted weight loss. Those with one or more weight loss attempts had higher BMI, larger waist circumference, and more emotional eating compared to ‘no attempts’ and ‘no attempts to lose weight, but trying to keep weight stable’ categories. The ‘no attempts’ category had the highest baseline fasting insulin, whereas it showed the largest decrease in this measure with the intervention. This change in fasting insulin in the ‘no attempts’ category was significantly different from all the other categories. Emotional nutrition self-efficacy slightly improved in the ‘no attempts’ category, which was significantly different from its concomitant decrease in the categories ‘1-2 attempts’ and ‘3 or more attempts’. The intervention group assignment did not affect the results.

Conclusions

Multiple attempts to lose weight may unfavourably affect T2D risk factors as well as lifestyle intervention outcomes. More research is needed on how weight loss frequency could affect T2D risk factors and how to design lifestyle interventions for individuals with frequent previous weight loss attempts.

Metabolite Signature of Physical Activity and the Risk of Type 2 Diabetes in 7271 Men

Large population-based studies investigating the association of physical activity (PA) with the metabolite signature contribute significantly to the understanding of the effects of PA on metabolic pathways associated with the risk of type 2 diabetes. Our study included 8749 Finnish men without diabetes at baseline recruited from the Metabolic Syndrome in Men (METSIM) cohort. We used a questionnaire to measure leisure-time PA. Metabolites were measured in 7271 men as a part of Metabolon’s untargeted Discovery HD4 platform using ultrahigh-performance liquid chromatography–tandem mass spectrometry. We found 198 metabolites significantly associated with PA. Several of these metabolites were novel including especially steroids, amino acids, imidazoles, carboxylic acids, and hydroxy acids. Increased PA was significantly associated with high levels of choline plasmalogens, lysophosphatidylcholines, polyunsaturated fatty acids, carotenoids, long chain acylcarnitines, imidazoles, bilirubins, aryl sulfates, hydroxy acids, indolepropionate, and indolelactate. Several of these metabolites have been previously associated with a decreased risk of type 2 diabetes and with a healthy diet. Our population-based study shows that the metabolite signature of increased PA includes multiple metabolic pathways and is associated with better adherence to a healthy lifestyle.

The Effects of Saffron (Crocus sativus L.) in conjunction with Concurrent Training on body composition, glycemic status, and inflammatory markers in obese men with type 2 diabetes mellitus: a randomized double-blind clinical trial

AIM

Chronic inflammation is one of the major challenges in the management of obesity and type 2 diabetes mellitus (T2DM). Our primary aim was to assess the anti-inflammatory effects of Saffron (Crocus sativus L.) supplementation and concurrent training in obese men with T2DM.

METHODS

Sixty obese men with T2DM (age = 39 ± 5 years; body mass = 93.9 ± 6 kg) were randomly assigned to four groups; concurrent training + placebo (CT; n = 15), saffron supplementation (S; n = 15), concurrent training + saffron supplementation (CTS; n = 15), or control (CON; n = 15). The participants in the CT group performed concurrent training (resistance + aerobic) three times per week for 12 weeks and received daily one pill of placebo (maltodextrin); the participants in the S group supplemented with one pill of 100 mg of saffron daily, and the participants in the CTS group participated in both saffron and training intervention while CON group continued regular lifestyle (no training or no supplementation). Inflammatory markers, body composition (evaluated by a multi-frequency bioelectrical impedance device; Jawon X-Contact 356), and metabolic profile were evaluated before and after interventions.

RESULTS

All three interventions significantly (p<0.05) decreased TNF-α (CT = -4.22, S = -1.91, CTS = -9.69 pg/mL), hs-CRP (CT = -0.13, S = -0.1, CTS = -0.32 ng/mL), IL-6 (CT = -6.84, S = -6.36, CTS = -13.55 pg/mL), IL-1β (CT = -8.85, S = -6.46, CTS = -19.8 pg/mL), FBG (CT = -6.97, S = -2.45, CTS = -13.86 mg/dL), insulin (CT = -0.13, S = -0.03, CTS = -0.21 mU/L), HOMA-IR (CT = -0.12, S = -0.04, CTS = -0.21), HbA1c (CT = -0.17, S = -0.11, CTS = -0.26 %), and increased IL-10 (CT = 1.09, S= 0.53, CTS = 2.27 pg/mL) concentrations. There was a positive correlation between changes in BFP with hs-CRP, IL-6, IL-1β, and TNF-α, and IL-10 concentrations across the intervention groups. Additionally, significant differences were observed between the changes for all variables in the CTS group compared to CT, S, and CON groups (p<0.05) CONCLUSION: It seems that an interactive of saffron supplementation and concurrent training has more efficient effects on the anti-inflammatory status compared to the saffron supplementation or concurrent training alone.

The 10-week of aerobic-functional training improves fasting blood sugar, insulin resistance, and lipid profile in patients with diabetic peripheral neuropathy: A randomized controlled trial

Study aim: This study aimed to investigate the effect of a 10-week of combined training course on concentrations of blood sugar, Insulin Resistance (HOMA-IR), and lipid profile in patients with diabetic peripheral neuropathy.

Materials and methods: This clinical trial was performed in diabetic neuropathy women and men (30–60 years old). Participants were randomly assigned to two groups: exercise (EG; n = 10) and control (CG; n = 10). The EG performed 10-week programme with one session of aerobic exercises (40% to 70% of HRReserve) and one session of functional exercises (60–90 min/ day) at the same day for four days/week and the CG performed their daily activities. The Blood glucose, IR, and lipid profile were measured initially and after the intervention.

Results: Repeated-measures ANOVA showed significant decrease in fasting blood sugar (p < 0.01) and HOMA-IR (p < 0.01), and greater improvements in TG (p < 0.05) and LDL (p < 0.05) in EG than CG, but. HDL concentration did not show significant changes.

Conclusion: The 10-week of aerobic-functional training improves fasting blood sugar, IR, and lipid profile in patients with diabetic neuropathy.

A randomized controlled trial of a structured program combining aerobic and resistance exercise for adults with type 2 diabetes in Japan

BACKGROUND

We assessed the effect of supervised, combined aerobic and resistance exercise on diabetic parameters in Japanese patients with type 2 diabetes mellitus (T2DM).

METHODS

This 12-week, multicenter (17 medical institutions), open-label, parallel-group study (clinicaltrials.jp; JapicCTI-184002), randomized (1:1) Japanese patients aged 20-75 years with T2DM and hemoglobin A1c (HbA1c) of 7.0-10.0% to supervised exercise (n = 113) or standard therapy (n = 115). The supervised exercise group undertook supervised aerobic (30 min) and resistance exercise 3 times/week (20 designated gyms). Primary endpoint was change in HbA1c from baseline at week 13. Secondary endpoints were change in fasting blood glucose (FBG), glycoalbumin, fasting insulin, homeostatic model assessment of insulin resistance (HOMA-IR), and HOMA-β at week 13.

RESULTS

Of 228 randomized patients, 97 (85.8%) in the supervised exercise group and 108 (93.9%) in the standard therapy group completed the study. Supervised exercise significantly lowered HbA1c at week 13 versus standard therapy (estimated difference in change from baseline [95% confidence interval]: - 0.44% [- 0.61, - 0.28], p < 0.001). Supervised exercise also significantly decreased FBG (estimated difference: - 13.0 [- 19.2, - 6.7] mg/dL) and glycoalbumin (estimated difference:  - 1.52% [- 2.10, - 0.93]) compared with standard therapy. Fasting insulin (- 0.5 µIU/mL) and HOMA-IR (- 0.3) decreased with supervised exercise, but group differences were not significant. Treatment-emergent adverse events were more frequent in the supervised exercise group (42.5%) than in the standard therapy group (29.6%); however, no major safety concerns were identified.

CONCLUSIONS

A structured, supervised, aerobic and resistance exercise program improved HbA1c and was well accepted among patients with T2DM.

SUPPLEMENTARY INFORMATION

The online version contains supplementary material available at 10.1007/s13340-021-00506-5.

A single bout of cycling exercise induces nucleosome repositioning in the skeletal muscle of lean and overweight/obese individuals

AIM

To compare the molecular and metabolic effects of a single exercise bout in the skeletal muscle between lean and overweight/obese (Ov/Ob) individuals.

MATERIALS AND METHODS

Participants recruited were men, aged 19-30 years, who were either lean (body mass index [BMI] < 25, 18.5-24.1 kg/m² ; n = 15) or Ov/Ob (BMI ≥ 25, 25.5-36.9 kg/m² ; n = 15). Four hours after a high-carbohydrate breakfast (7 kcal/kg; 60% carbohydrate, 25% fat, 15% protein), participants performed a cycling exercise (50% VO₂ max, expending ~650 kcal). Muscle biopsies and peripheral blood samples were collected 30 minutes before the meal and immediately after exercise. Blood analysis, and muscle acylcarnitine profiles, transcriptomics, and nucleosome mapping by micrococcal nuclease digestion with deep sequencing were performed.

RESULTS

A single exercise bout improved blood metabolite profiles in both lean and Ov/Ob individuals. Muscle long-chain acylcarnitines were increased in Ov/Ob compared with lean participants, but were not altered by exercise. A single exercise bout increased the mRNA abundance of genes related to mitochondria and insulin signalling in both lean and Ov/Ob participants. Nucleosome mapping by micrococcal nuclease digestion with deep sequencing revealed that exercise repositioned the -1 nucleosome away from the transcription start site of the PGC1a promoter and of other mitochondrial genes, but did not affect genes related to insulin signalling, in both lean and Ov/Ob participants.

CONCLUSION

These data suggest that a single exercise bout induced epigenetic alterations in skeletal muscle in a BMI-independent manner.

The association between gender-related characteristics and type 2 diabetes risk in a multi-ethnic population: The HELIUS study

BACKGROUND AND AIMS

Men and women have different type 2 diabetes mellitus (T2DM) risks, which have been reported across populations of different ethnicity. Where differences in T2DM risk for sex (biological) have been studied, research on gender (socio-cultural) and T2DM risk is lacking. We explored, in a multi-ethnic population, the association of six gender-related characteristics with incident T2DM over 3 years, and the mediation by known risk factors for T2DM.

METHODS AND RESULTS

We included 9605 women and 7080 men of the multi-ethnic HELIUS study (Amsterdam, the Netherlands). We studied associations between gender-related characteristics and incident T2DM, using Cox regression. After a median of 3.0 years (IQR 2.0; 4.0), 198 (2.1%) women and 137 (1.9%) men developed T2DM. A lower T2DM risk was observed in those not being the primary earner (HR 0.67; 95% CI 0.47; 0.93) and a higher desired level of social support (HR 0.62; 95% CI 0.44; 0.87). Hours spent on household work, home repairs, type of employment and male- or female-dominated occupation were not associated with T2DM incidence. No evidence for effect modification by biological sex or ethnicity was found. Known risk factors of T2DM did not mediate the observed associations.

CONCLUSION

Gender-related characteristics, not being the primary earner and a higher desired social support were associated with reduced T2DM risk, and this was not mediated by known risk factors for T2DM.