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Helleputte S, Stautemas J, De Craemer M, Bogaert L, De Backer T, Calders P, Lapauw B. Physical activity and sedentary behaviour in relation to body composition, estimated insulin sensitivity and arterial stiffness in adults with type 1 diabetes. Diabetes Res Clin Pract 2024; 217:111860. [PMID: 39293499 DOI: 10.1016/j.diabres.2024.111860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2024] [Revised: 09/04/2024] [Accepted: 09/13/2024] [Indexed: 09/20/2024]
Abstract
AIMS To examine the association of daily PA levels and sedentary behaviour with body composition, estimated insulin sensitivity, and arterial stiffness in adults with type 1 diabetes (T1D). METHODS Cross-sectional study in adults with T1D (n = 54). PA levels (daily steps, and time in moderate-to-vigorous intensity PA (MVPA)) and sedentary behaviour were measured using accelerometry for 7 days (McRoberts® DynaPort MoveMonitor). Cardiopulmonary exercise test for VO2max. Anthropometrics were collected, and body composition (total and % of fat mass (FMtot, FM%), total and % of lean mass (LMtot, LM%), and estimated visceral adipose tissue (VAT)) volume was assessed with dual energy X-ray-absorptiometry (DXA). Estimates of insulin sensitivity were determined (estimated glucose disposal rate (eGDR) and total daily insulin dose). Arterial stiffness was assessed with carotid-femoral pulse wave velocity (cf-PWV (m/s); SphygmoCor®). RESULTS Lower 10-years HbA1c associated moderately with all PA measures. Favourable moderate associations were also found between PA measures and BMI, waist, VAT but not FM and LM. PA measures were favourably associated with a lower total daily insulin dose and higher eGDR. All PA parameters associated moderately with cf-PWV however not independent from traditional risk factors. VO2max inversely associated with cf-PWV independent of age, T1D duration and 24-hour mean blood pressure. CONCLUSIONS Higher levels of PA, lower sedentary behaviour and greater exercise capacity are favourably associated with long-term glycaemic control, body composition, insulin dosage, estimated insulin sensitivity and arterial stiffness in adults with T1D. Therefore, regular PA and limiting sedentary time should be encouraged to improve metabolic and cardiovascular health in this population. Future longitudinal studies should explore mutual interactions and synergistic effects of PA on these outcomes.
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Affiliation(s)
- Simon Helleputte
- Faculty of Medicine and Health Sciences, Ghent University, Belgium; Fonds Wetenschappelijk Onderzoek (FWO) Vlaanderen, Belgium.
| | - Jan Stautemas
- Faculty of Medicine and Health Sciences, Ghent University, Belgium
| | | | - Lotte Bogaert
- Faculty of Medicine and Health Sciences, Ghent University, Belgium
| | - Tine De Backer
- Faculty of Medicine and Health Sciences, Ghent University, Belgium; Department of Cardiology, Ghent University Hospital, Belgium
| | - Patrick Calders
- Faculty of Medicine and Health Sciences, Ghent University, Belgium
| | - Bruno Lapauw
- Faculty of Medicine and Health Sciences, Ghent University, Belgium; Department of Endocrinology, Ghent University Hospital, Belgium
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Viñals C, Conget I, Granados M, Giménez M, Amor AJ. Evaluation of Cardiovascular Risk in People with Type 1 Diabetes: A Comprehensive and Specific Proposed Practical Approach. Diabetes Ther 2024; 15:1831-1844. [PMID: 38976136 PMCID: PMC11263441 DOI: 10.1007/s13300-024-01616-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2024] [Accepted: 06/25/2024] [Indexed: 07/09/2024] Open
Abstract
People living with type 1 diabetes (T1D) have an increased risk of cardiovascular disease (CVD), and it is the leading cause of morbidity and mortality in this population. CVD risk increases with each uncontrolled risk factor, even in individuals with good glycaemic control. Recommendations for assessing CVD risk in the T1D population are extended from those for type 2 diabetes (T2D) even though the physiopathology and underlying mechanisms of atherosclerosis in T1D are poorly understood and differ from those in T2D. Unlike the assessment of microvascular complications, which is well established in T1D, this is far from being the case for the comorbidities and risk associated with CVD. Aside from classical cardiovascular comorbidities, carotid ultrasound can be useful to stratify CVD risk. The utilization of specific risk scales such as the Steno Type 1 Risk Engine can help to more accurately classify cardiovascular risk in these individuals. The cornerstones of the management of cardiovascular risk in T1D are the promotion of the Mediterranean diet, tight glycaemic control (glycated haemoglobin (HbA1c) < 7%), blood pressure < 130/80 mmHg in most patients, and low-density lipoprotein (LDL) cholesterol < 100 mg/dL in moderate-risk individuals, < 70 mg/dL in high-risk individuals, and < 55 mg/dL in very high-risk individuals. Conventional medical follow-up of patients with T1D should be individualized (approximately 2-3 visits per year), and a carotid ultrasound evaluation is recommended every 5 years in the absence of significant preclinical atherosclerosis or more often in those with severe preclinical atherosclerosis. Antithrombotic therapy is recommended in those receiving secondary prevention, those with stenosis > 50% in any arterial bed, and those with an impaired ankle-brachial index. This document is a proposal of a practical approach for the evaluation, classification, and management of CVD risk in individuals living with T1D.
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Affiliation(s)
- Clara Viñals
- Diabetes Unit, Endocrinology and Nutrition Department, Hospital Clínic Barcelona, Villarroel 170, 08036, Barcelona, Spain.
| | - Ignacio Conget
- Diabetes Unit, Endocrinology and Nutrition Department, Hospital Clínic Barcelona, Villarroel 170, 08036, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
- Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Hospital Clínic, Barcelona, Spain
| | - Montse Granados
- Diabetes Unit, Endocrinology and Nutrition Department, Hospital Clínic Barcelona, Villarroel 170, 08036, Barcelona, Spain
| | - Marga Giménez
- Diabetes Unit, Endocrinology and Nutrition Department, Hospital Clínic Barcelona, Villarroel 170, 08036, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
- Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Hospital Clínic, Barcelona, Spain
| | - Antonio J Amor
- Diabetes Unit, Endocrinology and Nutrition Department, Hospital Clínic Barcelona, Villarroel 170, 08036, Barcelona, Spain.
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Moon JS, Kang S, Choi JH, Lee KA, Moon JH, Chon S, Kim DJ, Kim HJ, Seo JA, Kim MK, Lim JH, Song YJ, Yang YS, Kim JH, Lee YB, Noh J, Hur KY, Park JS, Rhee SY, Kim HJ, Kim HM, Ko JH, Kim NH, Kim CH, Ahn J, Oh TJ, Kim SK, Kim J, Han E, Jin SM, Bae J, Jeon E, Kim JM, Kang SM, Park JH, Yun JS, Cha BS, Moon MK, Lee BW. 2023 Clinical Practice Guidelines for Diabetes Management in Korea: Full Version Recommendation of the Korean Diabetes Association. Diabetes Metab J 2024; 48:546-708. [PMID: 39091005 PMCID: PMC11307112 DOI: 10.4093/dmj.2024.0249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2024] [Accepted: 06/20/2024] [Indexed: 08/04/2024] Open
Affiliation(s)
- Jun Sung Moon
- Department of Internal Medicine, Yeungnam University College of Medicine, Daegu, Korea
| | - Shinae Kang
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Jong Han Choi
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Korea
| | - Kyung Ae Lee
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Jeonbuk National University Hospital, Jeonbuk National University Medical School, Jeonju, Korea
| | - Joon Ho Moon
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Suk Chon
- Department of Endocrinology and Metabolism, College of Medicine, Kyung Hee University, Seoul, Korea
| | - Dae Jung Kim
- Department of Endocrinology and Metabolism, Ajou University Hospital, Ajou University School of Medicine, Suwon, Korea
| | - Hyun Jin Kim
- Department of Internal Medicine, Chungnam National University Hospital, Chungnam National University College of Medicine, Daejeon, Korea
| | - Ji A Seo
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Korea University Ansan Hospital, Korea University College of Medicine, Ansan, Korea
| | - Mee Kyoung Kim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Yeouido St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Jeong Hyun Lim
- Department of Food Service and Nutrition Care, Seoul National University Hospital, Seoul, Korea
| | - Yoon Ju Song
- Department of Food Science and Nutrition, The Catholic University of Korea, Bucheon, Korea
| | - Ye Seul Yang
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Jae Hyeon Kim
- Division of Endocrinology and Metabolism, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - You-Bin Lee
- Division of Endocrinology and Metabolism, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Junghyun Noh
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Inje University Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Korea
| | - Kyu Yeon Hur
- Division of Endocrinology and Metabolism, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jong Suk Park
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Sang Youl Rhee
- Department of Endocrinology and Metabolism, College of Medicine, Kyung Hee University, Seoul, Korea
| | - Hae Jin Kim
- Department of Endocrinology and Metabolism, Ajou University Hospital, Ajou University School of Medicine, Suwon, Korea
| | - Hyun Min Kim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Chung-Ang University College of Medicine, Seoul, Korea
| | - Jung Hae Ko
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Inje University Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Nam Hoon Kim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea
| | - Chong Hwa Kim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Sejong General Hospital, Bucheon, Korea
| | - Jeeyun Ahn
- Department of Ophthalmology, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea
| | - Tae Jung Oh
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Soo-Kyung Kim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Korea
| | - Jaehyun Kim
- Department of Pediatrics, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Eugene Han
- Department of Internal Medicine, Keimyung University School of Medicine, Daegu, Korea
| | - Sang-Man Jin
- Division of Endocrinology and Metabolism, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jaehyun Bae
- Department of Internal Medicine, Hallym University Kangnam Sacred Heart Hospital, College of Medicine, Hallym University, Seoul, Korea
| | - Eonju Jeon
- Department of Internal Medicine, Daegu Catholic University School of Medicine, Daegu, Korea
| | - Ji Min Kim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Chungnam National University College of Medicine, Daejeon, Korea
| | - Seon Mee Kang
- Department of Internal Medicine, Kangwon National University Hospital, Kangwon National University School of Medicine, Chuncheon, Korea
| | - Jung Hwan Park
- Division of Endocrinology & Metabolism, Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea
| | - Jae-Seung Yun
- Division of Endocrinology and Metabolism, Department of Internal Medicine, St. Vincent’s Hospital, College of Medicine, The Catholic University of Korea, Suwon, Korea
| | - Bong-Soo Cha
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Min Kyong Moon
- Department of Internal Medicine, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea
| | - Byung-Wan Lee
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
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Turner LV, Marak MC, Gal RL, Calhoun P, Li Z, Jacobs PG, Clements MA, Martin CK, Doyle FJ, Patton SR, Castle JR, Gillingham MB, Beck RW, Rickels MR, Riddell MC. Associations between daily step count classifications and continuous glucose monitoring metrics in adults with type 1 diabetes: analysis of the Type 1 Diabetes Exercise Initiative (T1DEXI) cohort. Diabetologia 2024; 67:1009-1022. [PMID: 38502241 DOI: 10.1007/s00125-024-06127-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Accepted: 02/16/2024] [Indexed: 03/21/2024]
Abstract
AIMS/HYPOTHESIS Adults with type 1 diabetes should perform daily physical activity to help maintain health and fitness, but the influence of daily step counts on continuous glucose monitoring (CGM) metrics are unclear. This analysis used the Type 1 Diabetes Exercise Initiative (T1DEXI) dataset to investigate the effect of daily step count on CGM-based metrics. METHODS In a 4 week free-living observational study of adults with type 1 diabetes, with available CGM and step count data, we categorised participants into three groups-below (<7000), meeting (7000-10,000) or exceeding (>10,000) the daily step count goal-to determine if step count category influenced CGM metrics, including per cent time in range (TIR: 3.9-10.0 mmol/l), time below range (TBR: <3.9 mmol/l) and time above range (TAR: >10.0 mmol/l). RESULTS A total of 464 adults with type 1 diabetes (mean±SD age 37±14 years; HbA1c 48.8±8.1 mmol/mol [6.6±0.7%]; 73% female; 45% hybrid closed-loop system, 38% standard insulin pump, 17% multiple daily insulin injections) were included in the study. Between-participant analyses showed that individuals who exceeded the mean daily step count goal over the 4 week period had a similar TIR (75±14%) to those meeting (74±14%) or below (75±16%) the step count goal (p>0.05). In the within-participant comparisons, TIR was higher on days when the step count goal was exceeded or met (both 75±15%) than on days below the step count goal (73±16%; both p<0.001). The TBR was also higher when individuals exceeded the step count goals (3.1%±3.2%) than on days when they met or were below step count goals (difference in means -0.3% [p=0.006] and -0.4% [p=0.001], respectively). The total daily insulin dose was lower on days when step count goals were exceeded (0.52±0.18 U/kg; p<0.001) or were met (0.53±0.18 U/kg; p<0.001) than on days when step counts were below the current recommendation (0.55±0.18 U/kg). Step count had a larger effect on CGM-based metrics in participants with a baseline HbA1c ≥53 mmol/mol (≥7.0%). CONCLUSIONS/INTERPRETATION Our results suggest that, compared with days with low step counts, days with higher step counts are associated with slight increases in both TIR and TBR, along with small reductions in total daily insulin requirements, in adults living with type 1 diabetes. DATA AVAILABILITY The data that support the findings reported here are available on the Vivli Platform (ID: T1-DEXI; https://doi.org/10.25934/PR00008428 ).
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Affiliation(s)
- Lauren V Turner
- School of Kinesiology and Health Science, York University, Toronto, ON, Canada
| | | | - Robin L Gal
- Jaeb Center for Health Research, Tampa, FL, USA
| | | | - Zoey Li
- Jaeb Center for Health Research, Tampa, FL, USA
| | - Peter G Jacobs
- Department of Biomedical Engineering, Oregon Health & Science University, Portland, OR, USA
| | | | - Corby K Martin
- Pennington Biomedical Research Center, Louisiana State University, Baton Rouge, LA, USA
| | - Francis J Doyle
- Harvard John A. Paulson School of Engineering and Applied Sciences, Harvard University, Cambridge, MA, USA
| | | | - Jessica R Castle
- Harold Schnitzer Diabetes Health Center, Oregon Health & Science University, Portland, OR, USA
| | - Melanie B Gillingham
- Department of Molecular and Medical Genetics, Oregon Health & Science University, Portland, OR, USA
| | - Roy W Beck
- Jaeb Center for Health Research, Tampa, FL, USA
| | - Michael R Rickels
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Michael C Riddell
- School of Kinesiology and Health Science, York University, Toronto, ON, Canada.
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5
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Murillo S, Brugnara L, Ríos S, Ribas V, Servitja JM, Novials A. People with type 1 diabetes exhibit lower exercise capacity compared to a control population with similar physical activity levels. Diabetes Res Clin Pract 2024; 211:111655. [PMID: 38574895 DOI: 10.1016/j.diabres.2024.111655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2024] [Revised: 03/23/2024] [Accepted: 04/01/2024] [Indexed: 04/06/2024]
Abstract
AIMS We aimed to assess physical activity (PA) levels, adherence to PA guidelines, and fitness capacity in individuals with type 1 diabetes (T1D) and control population. METHODS This cross-sectional study included 232 T1D and 248 controls. PA levels (IPAQ-SF questionnaire), adherence to guidelines (>150 min/week of moderate-to-vigorous PA), fitness capacity (VO2max, maximal incremental test on a cycle ergometer and 1RM test) were assessed, along with other clinical variables. RESULTS Total PA levels (T1D 2202 ± 1839 vs. controls 2357 ± 2189 METs/min/week), adherence (T1D 53.1 % vs controls 53.2 %), and sedentariness (T1D 27.3 % vs. controls 25.1 %) were similar between groups. However, participants with T1D exhibited significantly lower levels of VO2max (29.1 ± 10.5 vs. 32.5 ± 11.5 mlO2/kg/min, p < 0.001), work capacity (2.73 ± 1.03 vs. 3 ± 10 W/kg of body weight, p = 0.004) and strength capacity (2.29 ± 0.53 vs. 2.41 ± 0.79 kg/kg body weight in 1RM, p = 0.01) than controls, after adjusting for sex and age. CONCLUSIONS Individuals with T1D exhibit lower fitness capacity compared to a control population, regardless of age and sex, even when presenting similar levels of total physical activity and adherence to guidelines.
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Affiliation(s)
- Serafín Murillo
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain; Department of Endocrinology, Institut de Recerca Sant Joan de Déu, Hospital Sant Joan de Déu, Barcelona, Spain.
| | - Laura Brugnara
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain; Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Instituto de Salud Carlos III, Madrid, Spain.
| | - Santiago Ríos
- Departament de Genètica, Microbiologia i Estadística, Facultat de Biologia, Universitat de Barcelona, Barcelona, Spain.
| | - Vicent Ribas
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain; Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Instituto de Salud Carlos III, Madrid, Spain.
| | - Joan-Marc Servitja
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain; Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Instituto de Salud Carlos III, Madrid, Spain.
| | - Anna Novials
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain; Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Instituto de Salud Carlos III, Madrid, Spain.
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Pesantez M, Ebekozien O, Vendrame F. Type 1 Diabetes and Cardiovascular Health. Endocrinol Metab Clin North Am 2024; 53:151-163. [PMID: 38272593 DOI: 10.1016/j.ecl.2023.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2024]
Abstract
Type 1 diabetes (T1D) is associated with an increased risk of cardiovascular disease (CVD). CVD occurs much earlier in people with T1D than in the general population, and several risk factors have been identified some of which are modifiable. Risk prediction models and imaging tests to detect early signs of CVD have not been extensively validated. Strategies to promote cardiovascular health (CVH) in T1D include identifying risk factors, early treatment to achieve CVH targets, and improving the education of health care providers and people with T1D.
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Affiliation(s)
- Maria Pesantez
- Jackson Memorial Hospital, 1450 Northwest 10 Avenue, Miami, FL 33136, USA
| | - Osagie Ebekozien
- T1D Exchange, 101 Federal Street Suite 440, Boston, MA 02110, USA
| | - Francesco Vendrame
- Department of Medicine, Division of Endocrinology, Diabetes and Metabolism, University of Miami Miller School of Medicine, 1450 Northwest 10 Avenue, Room 1086, Miami, FL 33136, USA.
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Glyn T, Fourlanos S, Paldus B, Flint S, Armstrong E, Andrews RC, Narendran P, Wentworth J. The Need to Prioritize Education and Resources to Support Exercise in Type 1 Diabetes: Results of an Australian Survey of Adults With Type 1 Diabetes and Health Providers. Can J Diabetes 2024; 48:105-111.e5. [PMID: 38040407 DOI: 10.1016/j.jcjd.2023.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Revised: 11/06/2023] [Accepted: 11/24/2023] [Indexed: 12/03/2023]
Abstract
OBJECTIVES Regular exercise is recommended for people with type 1 diabetes (PWD) to improve their health, but many do not meet recommended exercise targets. Educational resources supporting PWD to exercise exist, but their value is unclear. To determine the need for improved exercise resources in Australia, we surveyed adult PWD and health providers (HPs) about their confidence in managing type 1 diabetes (T1D) around exercise, barriers to exercise, and the adequacy of current resources. METHODS Australian adult PWD and HPs completed surveys to rate the importance of exercise in T1D management, confidence in managing T1D around exercise, barriers to giving and receiving education, resources used, and what form new resources should take. RESULTS Responses were received from 128 PWD and 122 HPs. Both groups considered exercise to be important for diabetes management. PWD cited time constraints (57%) and concern about dysglycemia (43%) as barriers to exercise, and many lacked confidence in managing T1D around exercise. HPs were more confident, but experienced barriers to providing advice, and PWD did not tend to rely on this advice. Instead, 72% of PWD found continuous glucose monitoring most helpful. Both groups desired better resources to support exercise in T1D, with PWD preferring to obtain information through a structured education program and HPs through eLearning. CONCLUSIONS Australian HPs and PWD appreciate the importance of exercise in T1D management and express a clear desire for improved educational resources. Our findings provide a basis for developing a comprehensive package of resources for both adult PWD and HPs, to support exercise in PWD.
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Affiliation(s)
- Tessa Glyn
- Department of Diabetes and Endocrinology, Royal Melbourne Hospital, Parkville, Victoria, Australia.
| | - Spiros Fourlanos
- Department of Diabetes and Endocrinology, Royal Melbourne Hospital, Parkville, Victoria, Australia; Department of Medicine, Royal Melbourne Hospital, University of Melbourne, Parkville, Victoria, Australia; Australian Centre for Accelerating Diabetes Innovations, University of Melbourne, Parkville, Victoria, Australia
| | - Barbora Paldus
- Department of Diabetes and Endocrinology, Royal Melbourne Hospital, Parkville, Victoria, Australia; Department of Medicine, Royal Melbourne Hospital, University of Melbourne, Parkville, Victoria, Australia; Department of Endocrinology and Diabetes, St. Vincent's Hospital, Melbourne, Victoria, Australia
| | - Steve Flint
- Department of Diabetes and Endocrinology, Royal Melbourne Hospital, Parkville, Victoria, Australia; Department of Medicine, Royal Melbourne Hospital, University of Melbourne, Parkville, Victoria, Australia
| | - Emma Armstrong
- Department of Diabetes and Endocrinology, Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - Robert Charles Andrews
- University of Exeter Medical School, Exeter, United Kingdom; Department of Diabetes, Taunton and Somerset NHS Foundation Trust, Taunton, United Kingdom
| | - Parth Narendran
- Department of Diabetes, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom; Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, United Kingdom
| | - John Wentworth
- Department of Diabetes and Endocrinology, Royal Melbourne Hospital, Parkville, Victoria, Australia; Department of Medicine, Royal Melbourne Hospital, University of Melbourne, Parkville, Victoria, Australia; Walter and Eliza Hall Institute of Medical Research, Parkville, Victoria, Australia
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8
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Ahola AJ, Tikkanen-Dolenc H, Harjutsalo V, Groop PH. Clustering of risk behaviours and associations between risk behaviours and cardio-metabolic risk factors in adult individuals with type 1 diabetes. Diabetes Res Clin Pract 2024; 208:111115. [PMID: 38266825 DOI: 10.1016/j.diabres.2024.111115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Revised: 01/17/2024] [Accepted: 01/20/2024] [Indexed: 01/26/2024]
Abstract
AIMS To assess clustering of risk behaviours and their health determinants. METHODS Cross-sectional health behaviour and health data were collected from individuals with type 1 diabetes, in the FinnDiane Study. Clustering of risk behaviours was assessed and associations between behaviours and health variables were investigated. RESULTS Data were available from 956 participants (40 % men, mean age 46 years). Altogether, 4.3 % individuals reported no risk behaviours, while 25.7 %, 37.4 %, 24.7 %, 6.8 %, and 1.0 % reported 1, 2, 3, 4, and 5 risk behaviours, respectively. Reporting ≥4 risk behaviours occurred more frequently than expected by chance. Dietary non-adherence was most frequently reported (84.4 %), followed by low LTPA (54.4 %), poor sleep (41.9 %), high alcohol consumption (15.2 %), and smoking (11.2 %). Adjusted for confounders, relative to ≤1 risk behaviour, reporting ≥2 risk behaviours was associated with higher BMI, waist circumference, and diastolic blood pressure. Having ≥3 risk behaviours was associated with larger waist-hip ratio, and higher HbA1c and triglyceride concentration; ≥4 risk behaviours was associated with higher cholesterol concentration. Of the health behaviours, low LTPA had the highest number of deleterious health associations. CONCLUSIONS Accumulation of risk behaviors increases negative health outcomes. Exhibiting ≥2 risk behaviours or low LTPA was associated with multiple adverse outcomes.
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Affiliation(s)
- Aila J Ahola
- Folkhälsan Institute of Genetics, Folkhälsan Research Center, Helsinki, Finland; Department of Nephrology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland; Research Program for Clinical and Molecular Metabolism, Faculty of Medicine, University of Helsinki, Finland
| | - Heidi Tikkanen-Dolenc
- Folkhälsan Institute of Genetics, Folkhälsan Research Center, Helsinki, Finland; Department of Nephrology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland; Research Program for Clinical and Molecular Metabolism, Faculty of Medicine, University of Helsinki, Finland
| | - Valma Harjutsalo
- Folkhälsan Institute of Genetics, Folkhälsan Research Center, Helsinki, Finland; Department of Nephrology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland; Research Program for Clinical and Molecular Metabolism, Faculty of Medicine, University of Helsinki, Finland; National Institute for Health and Welfare, Helsinki, Finland
| | - Per-Henrik Groop
- Folkhälsan Institute of Genetics, Folkhälsan Research Center, Helsinki, Finland; Department of Nephrology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland; Research Program for Clinical and Molecular Metabolism, Faculty of Medicine, University of Helsinki, Finland; Department of Diabetes, Central Clinical School, Monash University, Melbourne, Victoria, Australia.
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9
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ElSayed NA, Aleppo G, Bannuru RR, Beverly EA, Bruemmer D, Collins BS, Darville A, Ekhlaspour L, Hassanein M, Hilliard ME, Johnson EL, Khunti K, Lingvay I, Matfin G, McCoy RG, Perry ML, Pilla SJ, Polsky S, Prahalad P, Pratley RE, Segal AR, Seley JJ, Stanton RC, Gabbay RA. 5. Facilitating Positive Health Behaviors and Well-being to Improve Health Outcomes: Standards of Care in Diabetes-2024. Diabetes Care 2024; 47:S77-S110. [PMID: 38078584 PMCID: PMC10725816 DOI: 10.2337/dc24-s005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Abstract
The American Diabetes Association (ADA) "Standards of Care in Diabetes" includes the ADA's current clinical practice recommendations and is intended to provide the components of diabetes care, general treatment goals and guidelines, and tools to evaluate quality of care. Members of the ADA Professional Practice Committee, an interprofessional expert committee, are responsible for updating the Standards of Care annually, or more frequently as warranted. For a detailed description of ADA standards, statements, and reports, as well as the evidence-grading system for ADA's clinical practice recommendations and a full list of Professional Practice Committee members, please refer to Introduction and Methodology. Readers who wish to comment on the Standards of Care are invited to do so at professional.diabetes.org/SOC.
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10
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Rák T, Kovács-Valasek A, Pöstyéni E, Csutak A, Gábriel R. Complementary Approaches to Retinal Health Focusing on Diabetic Retinopathy. Cells 2023; 12:2699. [PMID: 38067127 PMCID: PMC10705724 DOI: 10.3390/cells12232699] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Revised: 11/20/2023] [Accepted: 11/20/2023] [Indexed: 12/18/2023] Open
Abstract
Diabetes mellitus affects carbohydrate homeostasis but also influences fat and protein metabolism. Due to ophthalmic complications, it is a leading cause of blindness worldwide. The molecular pathology reveals that nuclear factor kappa B (NFκB) has a central role in the progression of diabetic retinopathy, sharing this signaling pathway with another major retinal disorder, glaucoma. Therefore, new therapeutic approaches can be elaborated to decelerate the ever-emerging "epidemics" of diabetic retinopathy and glaucoma targeting this critical node. In our review, we emphasize the role of an improvement of lifestyle in its prevention as well as the use of phytomedicals associated with evidence-based protocols. A balanced personalized therapy requires an integrative approach to be more successful for prevention and early treatment.
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Affiliation(s)
- Tibor Rák
- Department of Ophthalmology, Clinical Centre, Medical School, University of Pécs, Rákóczi út 2., 7623 Pécs, Hungary; (T.R.)
| | - Andrea Kovács-Valasek
- Department of Neurobiology, University of Pécs, Ifjúság útja 6, 7624 Pécs, Hungary
- János Szentágothai Research Centre, University of Pécs, Ifjúság útja 20, 7624 Pécs, Hungary
| | - Etelka Pöstyéni
- Department of Neurobiology, University of Pécs, Ifjúság útja 6, 7624 Pécs, Hungary
| | - Adrienne Csutak
- Department of Ophthalmology, Clinical Centre, Medical School, University of Pécs, Rákóczi út 2., 7623 Pécs, Hungary; (T.R.)
| | - Róbert Gábriel
- Department of Neurobiology, University of Pécs, Ifjúság útja 6, 7624 Pécs, Hungary
- János Szentágothai Research Centre, University of Pécs, Ifjúság útja 20, 7624 Pécs, Hungary
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11
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Kistkins S, Mihailovs T, Lobanovs S, Pīrāgs V, Sourij H, Moser O, Bļizņuks D. Comparative Analysis of Predictive Interstitial Glucose Level Classification Models. SENSORS (BASEL, SWITZERLAND) 2023; 23:8269. [PMID: 37837098 PMCID: PMC10574913 DOI: 10.3390/s23198269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Revised: 10/02/2023] [Accepted: 10/04/2023] [Indexed: 10/15/2023]
Abstract
BACKGROUND New methods of continuous glucose monitoring (CGM) provide real-time alerts for hypoglycemia, hyperglycemia, and rapid fluctuations of glucose levels, thereby improving glycemic control, which is especially crucial during meals and physical activity. However, complex CGM systems pose challenges for individuals with diabetes and healthcare professionals, particularly when interpreting rapid glucose level changes, dealing with sensor delays (approximately a 10 min difference between interstitial and plasma glucose readings), and addressing potential malfunctions. The development of advanced predictive glucose level classification models becomes imperative for optimizing insulin dosing and managing daily activities. METHODS The aim of this study was to investigate the efficacy of three different predictive models for the glucose level classification: (1) an autoregressive integrated moving average model (ARIMA), (2) logistic regression, and (3) long short-term memory networks (LSTM). The performance of these models was evaluated in predicting hypoglycemia (<70 mg/dL), euglycemia (70-180 mg/dL), and hyperglycemia (>180 mg/dL) classes 15 min and 1 h ahead. More specifically, the confusion matrices were obtained and metrics such as precision, recall, and accuracy were computed for each model at each predictive horizon. RESULTS As expected, ARIMA underperformed the other models in predicting hyper- and hypoglycemia classes for both the 15 min and 1 h horizons. For the 15 min forecast horizon, the performance of logistic regression was the highest of all the models for all glycemia classes, with recall rates of 96% for hyper, 91% for norm, and 98% for hypoglycemia. For the 1 h forecast horizon, the LSTM model turned out to be the best for hyper- and hypoglycemia classes, achieving recall values of 85% and 87% respectively. CONCLUSIONS Our findings suggest that different models may have varying strengths and weaknesses in predicting glucose level classes, and the choice of model should be carefully considered based on the specific requirements and context of the clinical application. The logistic regression model proved to be more accurate for the next 15 min, particularly in predicting hypoglycemia. However, the LSTM model outperformed logistic regression in predicting glucose level class for the next hour. Future research could explore hybrid models or ensemble approaches that combine the strengths of multiple models to further enhance the accuracy and reliability of glucose predictions.
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Affiliation(s)
- Svjatoslavs Kistkins
- Research Institute of Pauls Stradins Clinical University Hospital, LV-1002 Riga, Latvia; (S.K.); (V.P.)
| | - Timurs Mihailovs
- Institute of Smart Computing Technologies, Riga Technical University, LV-1048 Riga, Latvia; (T.M.); (D.B.)
| | - Sergejs Lobanovs
- Research Institute of Pauls Stradins Clinical University Hospital, LV-1002 Riga, Latvia; (S.K.); (V.P.)
| | - Valdis Pīrāgs
- Research Institute of Pauls Stradins Clinical University Hospital, LV-1002 Riga, Latvia; (S.K.); (V.P.)
| | - Harald Sourij
- Interdisciplinary Metabolic Medicine Trials Unit, Division of Endocrinology and Diabetology, Medical University of Graz, 8010 Graz, Austria;
| | - Othmar Moser
- Division of Exercise Physiology and Metabolism, Institute of Sport Science, University of Bayreuth, 95447 Bayreuth, Germany;
| | - Dmitrijs Bļizņuks
- Institute of Smart Computing Technologies, Riga Technical University, LV-1048 Riga, Latvia; (T.M.); (D.B.)
- SIA “R4U”, LV-1016 Riga, Latvia
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12
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Clerc A. Nutrition education to type 1 diabetes patients: few changes over the time. FRONTIERS IN CLINICAL DIABETES AND HEALTHCARE 2023; 4:1243237. [PMID: 37705724 PMCID: PMC10497213 DOI: 10.3389/fcdhc.2023.1243237] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Accepted: 08/10/2023] [Indexed: 09/15/2023]
Affiliation(s)
- Aurélien Clerc
- Nutrition Unit, University Training Hospital, Fribourg, Switzerland
- Department of Nutrition and Dietetics, School of Health Sciences, University of Applied Sciences and Arts Western Switzerland (HES-SO), Geneva, Switzerland
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13
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Zheng L, Qin R, Rao Z, Xiao W. High-intensity interval training induces renal injury and fibrosis in type 2 diabetic mice. Life Sci 2023; 324:121740. [PMID: 37120014 DOI: 10.1016/j.lfs.2023.121740] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Revised: 04/13/2023] [Accepted: 04/24/2023] [Indexed: 05/01/2023]
Abstract
AIMS Previous studies showed that high-intensity interval training (HIIT) improved fasting blood glucose and insulin resistance in type 2 diabetes mellitus (T2DM) mice. However, the effect of HIIT on the kidneys of mice with T2DM has not been examined. This study aimed to investigate the impact of HIIT on the kidneys of T2DM mice. MATERIALS AND METHODS T2DM mice were induced with a high-fat diet (HFD) and one-time 100 mg/kg streptozotocin intraperitoneal injection, and then T2DM mice were treated with 8 weeks of HIIT. Renal function and glycogen deposition were observed by serum creatinine levels and PAS staining, respectively. Sirius red staining, hematoxylin-eosin staining, and Oil red O staining were used to detect fibrosis and lipid deposition. Western blotting was performed to detect the protein levels. KEY FINDINGS HIIT significantly ameliorated the body composition, fasting blood glucose, and serum insulin of the T2DM mice. HIIT also improved glucose tolerance, insulin tolerance, and renal lipid deposition of T2DM mice. However, we found that HIIT increased serum creatinine and glycogen accumulation in the kidneys of T2DM mice. Western blot analysis showed that the PI3K/AKT/mTOR signaling pathway was activated after HIIT. The expression of fibrosis-related proteins (TGF-β1, CTGF, collagen-III, α-SMA) increased, while the expression of klotho (sklotho) and MMP13 decreased in the kidneys of HIIT mice. SIGNIFICANCE This study concluded that HIIT induced renal injury and fibrosis, although it also improved glucose homeostasis in T2DM mice. The current study reminds us that patients with T2DM should be cautious when participating in HIIT.
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Affiliation(s)
- Lifang Zheng
- College of Physical Education, Shanghai University, Shanghai 200444, China; Shanghai Key Lab of Human Performance, Shanghai University of sport, Shanghai 200438, China
| | - Ruiting Qin
- College of Physical Education, Shanghai University, Shanghai 200444, China
| | - Zhijian Rao
- College of Physical Education, Shanghai Normal University, Shanghai 200234, China; Exercise Biological Center, China Institute of Sport Science, Beijing, China.
| | - Weihua Xiao
- Shanghai Key Lab of Human Performance, Shanghai University of sport, Shanghai 200438, China.
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14
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Abstract
Regular physical activity improves cardiometabolic and musculoskeletal health, helps with weight management, improves cognitive and psychosocial functioning, and is associated with reduced mortality related to cancer and diabetes mellitus. However, turnover rates of glucose in the blood increase dramatically during exercise, which often results in either hypoglycaemia or hyperglycaemia as well as increased glycaemic variability in individuals with type 1 diabetes mellitus (T1DM). A complex neuroendocrine response to an acute exercise session helps to maintain circulating levels of glucose in a fairly tight range in healthy individuals, while several abnormal physiological processes and limitations of insulin therapy limit the capacity of people with T1DM to exercise in a normoglycaemic state. Knowledge of the acute and chronic effects of exercise and regular physical activity is critical for the formulation of clinical strategies for the management of insulin and nutrition for active patients with T1DM. Emerging diabetes-related technologies, such as continuous glucose monitors, automated insulin delivery systems and the administration of solubilized glucagon, are demonstrating efficacy for preserving glucose homeostasis during and after exercise in this population of patients. This Review highlights the beneficial effects of regular exercise and details the complex endocrine and metabolic responses to different types of exercise for adults with T1DM. An overview of basic clinical strategies for the preservation of glucose homeostasis using emerging technologies is also provided.
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Affiliation(s)
- Michael C Riddell
- Muscle Health Research Centre, School of Kinesiology and Health Science, York University, Toronto, Ontario, Canada.
- LMC Diabetes and Endocrinology, Toronto, Ontario, Canada.
| | - Anne L Peters
- Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
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15
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Pereira WVC, Vancea DMM, de Andrade Oliveira R, de Freitas YGPC, Lamounier RN, Silva Júnior WS, Fioretti AMB, Macedo CLD, Bertoluci MC, Zagury RL. 2022: Position of Brazilian Diabetes Society on exercise recommendations for people with type 1 and type 2 diabetes. Diabetol Metab Syndr 2023; 15:2. [PMID: 36593495 PMCID: PMC9806892 DOI: 10.1186/s13098-022-00945-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2022] [Accepted: 11/04/2022] [Indexed: 01/03/2023] Open
Abstract
INTRODUCTION For individuals diagnosed with diabetes mellitus, the practice of properly oriented physical exercises brings significant benefits to the individual's health and is considered an indispensable tool for metabolic management. The individualization of exercise routines is an essential aspect for therapeutic success, despite the need to consider some general recommendations. This review is an authorized literal translation of the Brazilian Society of Diabetes (SBD) Guidelines 2021-2022, which is based on scientific evidence and provides guidance on physical activities and exercises aimed at individuals with type 1 and 2 diabetes. METHODS SBD designated 9 specialists from its "Department of Diabetes, Exercise & Sports" to author chapters on physical activities and exercises directed to individuals with type 1 and 2 diabetes. The aim of these chapters was to highlight recommendations in accordance with Evidence Levels, based on what is described in the literature. These chapters were analyzed by the SBD Central Committee, which is also responsible for the SBD 2021-2022 guidelines. Main clinical inquiries were selected to perform a narrated review by using MEDLINE via PubMed. Top available evidence, such as high-quality clinical trials, large observational studies and meta-analyses related to physical activity and exercise advisory, were analyzed. The adopted MeSh terms were [diabetes], [type 1 diabetes], [type 2 diabetes], [physical activity] [physical exercise]. RESULTS 17 recommendations were defined by the members. For this review, it was considered different Evidence Levels, as well as different Classes of Recommendations. As to Evidence Levels, the following levels were contemplated: Level A) More than one randomized clinical trial or a randomized clinical trial meta-analysis with low heterogeneity. Level B) Meta analysis with observational studies, one randomized clinical trial, sizeable observational studies and sub-groups analysis. Level C) Small non-randomized studies, cross-sectional studies, case control studies, guidelines or experts' opinions. In respect to Recommendation Classes, the following criteria were adopted: I. "Recommended": Meaning there was a consent of more than 90% of the panel; IIa. "Must be considered": meaning there is a general preference of the panel which 70-90% agrees; IIb. "Can be considered". 50-70% agrees; III Not recommended: There is a consensus that the intervention should not be performed. CONCLUSION Physical exercise aids on the glycemic control of type 2 diabetes individuals while also decreasing cardiovascular risk in individuals with type 1 and 2 diabetes. Individuals diagnosed with diabetes should perform combined aerobic and resistance exercises in order to manage the disease. In addition, exercises focusing on flexibility and balance should be specially addressed on elderly individuals. Diabetes individuals using insulin as therapeutic treatment should properly monitor glycemia levels before, during and after exercise sessions to minimize health incidents, such as hypoglycemia.
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Affiliation(s)
- William Valadares Campos Pereira
- Research Group on Physical Exercise and Non-Transmissible Chronic Diseases from the Physical Education School of the University of Pernambuco (UPE), Recife, Brazil
| | - Denise Maria Martins Vancea
- Research Group on Physical Exercise and Non-Transmissible Chronic Diseases from the Physical Education School of the University of Pernambuco (UPE), Recife, Brazil
- Physical Education School of the University of Pernambuco (UPE), Avenida Agamenon Magalhães, S/N-Santo Amaro, Recife,, PE CEP 50100-010 Brazil
| | - Ricardo de Andrade Oliveira
- Department of Obesity and Associated Diseases of the Brazilian Obesity Association (ABESO), Board of Directors of the Rio de Janeiro Society of Exercise Medicine and Sports, Rio de Janeiro, Brazil
| | | | | | - Wellington S. Silva Júnior
- Endocrinology Discipline, Department of Medicine I, Faculty of Medicine, Center of Biological Sciences, Federal University of Maranhão (UFMA), Praça Gonçalves Dias, 21, Centro, São Luís, MA CEP 65020-240 Brazil
| | | | | | - Marcello Casaccia Bertoluci
- Internal Medicine Department, Federal University of Rio Grande do Sul (UFRGS), Ramiro Barcelos, 2350 Building 12, 4th Floor, Porto Alegre, RS Brazil
- Endocrinology Division, Hospital de Clínicas de Porto Alegre (HCPA), Ramiro Barcelos, 2350 Building 12, 4th Floor, Porto Alegre, RS Brazil
| | - Roberto Luis Zagury
- Luiz Capriglione State Institute of Diabetes and Endocrinology (IEDE), Rio de Janeiro, Brazil
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16
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ElSayed NA, Aleppo G, Aroda VR, Bannuru RR, Brown FM, Bruemmer D, Collins BS, Hilliard ME, Isaacs D, Johnson EL, Kahan S, Khunti K, Leon J, Lyons SK, Perry ML, Prahalad P, Pratley RE, Seley JJ, Stanton RC, Young-Hyman D, Gabbay RA, on behalf of the American Diabetes Association. 5. Facilitating Positive Health Behaviors and Well-being to Improve Health Outcomes: Standards of Care in Diabetes-2023. Diabetes Care 2023; 46:S68-S96. [PMID: 36507648 PMCID: PMC9810478 DOI: 10.2337/dc23-s005] [Citation(s) in RCA: 146] [Impact Index Per Article: 146.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
The American Diabetes Association (ADA) "Standards of Care in Diabetes" includes the ADA's current clinical practice recommendations and is intended to provide the components of diabetes care, general treatment goals and guidelines, and tools to evaluate quality of care. Members of the ADA Professional Practice Committee, a multidisciplinary expert committee, are responsible for updating the Standards of Care annually, or more frequently as warranted. For a detailed description of ADA standards, statements, and reports, as well as the evidence-grading system for ADA's clinical practice recommendations and a full list of Professional Practice Committee members, please refer to Introduction and Methodology. Readers who wish to comment on the Standards of Care are invited to do so at professional.diabetes.org/SOC.
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17
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Adolfsson P, Taplin CE, Zaharieva DP, Pemberton J, Davis EA, Riddell MC, McGavock J, Moser O, Szadkowska A, Lopez P, Santiprabhob J, Frattolin E, Griffiths G, DiMeglio LA. ISPAD Clinical Practice Consensus Guidelines 2022: Exercise in children and adolescents with diabetes. Pediatr Diabetes 2022; 23:1341-1372. [PMID: 36537529 PMCID: PMC10107219 DOI: 10.1111/pedi.13452] [Citation(s) in RCA: 32] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/07/2022] [Indexed: 12/24/2022] Open
Affiliation(s)
- Peter Adolfsson
- Department of PediatricsKungsbacka HospitalKungsbackaSweden
- Institute of Clinical Sciences, Sahlgrenska AcademyUniversity of GothenburgGothenburgSweden
| | - Craig E. Taplin
- Department of Endocrinology and DiabetesPerth Children's HospitalNedlandsWestern AustraliaAustralia
- Telethon Kids InstituteUniversity of Western AustraliaPerthWestern AustraliaAustralia
- Centre for Child Health ResearchUniversity of Western AustraliaPerthWestern AustraliaAustralia
| | - Dessi P. Zaharieva
- Division of Endocrinology, Department of PediatricsSchool of Medicine, Stanford UniversityStanfordCaliforniaUSA
| | - John Pemberton
- Department of Endocrinology and DiabetesBirmingham Women's and Children's HospitalBirminghamUK
| | - Elizabeth A. Davis
- Department of Endocrinology and DiabetesPerth Children's HospitalNedlandsWestern AustraliaAustralia
- Telethon Kids InstituteUniversity of Western AustraliaPerthWestern AustraliaAustralia
- Centre for Child Health ResearchUniversity of Western AustraliaPerthWestern AustraliaAustralia
| | | | - Jonathan McGavock
- Faculty of Kinesiology and Recreation ManagementUniversity of ManitobaWinnipegManitobaCanada
- Diabetes Research Envisioned and Accomplished in Manitoba (DREAM) ThemeChildren's Hospital Research Institute of ManitobaWinnipegManitobaCanada
- Department of Pediatrics and Child HealthUniversity of ManitobaWinnipegManitobaCanada
- Diabetes Action Canada SPOR NetworkTorontoOntarioCanada
| | - Othmar Moser
- Division Exercise Physiology and Metabolism, Department of Sport ScienceUniversity of BayreuthBayreuthGermany
- Interdisciplinary Metabolic Medicine Trials Unit, Division of Endocrinology and Diabetology, Department of Internal MedicineMedical University of GrazGrazAustria
| | - Agnieszka Szadkowska
- Department of Pediatrics, Diabetology, Endocrinology & NephrologyMedical University of LodzLodzPoland
| | - Prudence Lopez
- Department of PaediatricsJohn Hunter Children's HospitalNewcastleNew South WalesAustralia
- University of NewcastleNewcastleNew South WalesAustralia
| | - Jeerunda Santiprabhob
- Siriraj Diabetes CenterFaculty of Medicine Siriraj Hospital, Mahidol UniversityBangkokThailand
- Division of Endocrinology and Metabolism, Department of PediatricsFaculty of Medicine Siriraj Hospital, Mahidol UniversityBangkokThailand
| | | | | | - Linda A. DiMeglio
- Department of Pediatrics, Division of Pediatric Endocrinology and DiabetologyIndiana University School of Medicine, Riley Hospital for ChildrenIndianapolisIndianaUSA
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18
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Blonde L, Umpierrez GE, Reddy SS, McGill JB, Berga SL, Bush M, Chandrasekaran S, DeFronzo RA, Einhorn D, Galindo RJ, Gardner TW, Garg R, Garvey WT, Hirsch IB, Hurley DL, Izuora K, Kosiborod M, Olson D, Patel SB, Pop-Busui R, Sadhu AR, Samson SL, Stec C, Tamborlane WV, Tuttle KR, Twining C, Vella A, Vellanki P, Weber SL. American Association of Clinical Endocrinology Clinical Practice Guideline: Developing a Diabetes Mellitus Comprehensive Care Plan-2022 Update. Endocr Pract 2022; 28:923-1049. [PMID: 35963508 PMCID: PMC10200071 DOI: 10.1016/j.eprac.2022.08.002] [Citation(s) in RCA: 154] [Impact Index Per Article: 77.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Revised: 08/01/2022] [Accepted: 08/02/2022] [Indexed: 02/06/2023]
Abstract
OBJECTIVE The objective of this clinical practice guideline is to provide updated and new evidence-based recommendations for the comprehensive care of persons with diabetes mellitus to clinicians, diabetes-care teams, other health care professionals and stakeholders, and individuals with diabetes and their caregivers. METHODS The American Association of Clinical Endocrinology selected a task force of medical experts and staff who updated and assessed clinical questions and recommendations from the prior 2015 version of this guideline and conducted literature searches for relevant scientific papers published from January 1, 2015, through May 15, 2022. Selected studies from results of literature searches composed the evidence base to update 2015 recommendations as well as to develop new recommendations based on review of clinical evidence, current practice, expertise, and consensus, according to established American Association of Clinical Endocrinology protocol for guideline development. RESULTS This guideline includes 170 updated and new evidence-based clinical practice recommendations for the comprehensive care of persons with diabetes. Recommendations are divided into four sections: (1) screening, diagnosis, glycemic targets, and glycemic monitoring; (2) comorbidities and complications, including obesity and management with lifestyle, nutrition, and bariatric surgery, hypertension, dyslipidemia, retinopathy, neuropathy, diabetic kidney disease, and cardiovascular disease; (3) management of prediabetes, type 2 diabetes with antihyperglycemic pharmacotherapy and glycemic targets, type 1 diabetes with insulin therapy, hypoglycemia, hospitalized persons, and women with diabetes in pregnancy; (4) education and new topics regarding diabetes and infertility, nutritional supplements, secondary diabetes, social determinants of health, and virtual care, as well as updated recommendations on cancer risk, nonpharmacologic components of pediatric care plans, depression, education and team approach, occupational risk, role of sleep medicine, and vaccinations in persons with diabetes. CONCLUSIONS This updated clinical practice guideline provides evidence-based recommendations to assist with person-centered, team-based clinical decision-making to improve the care of persons with diabetes mellitus.
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Affiliation(s)
| | | | - S Sethu Reddy
- Central Michigan University, Mount Pleasant, Michigan
| | | | | | | | | | | | - Daniel Einhorn
- Scripps Whittier Diabetes Institute, La Jolla, California
| | | | | | - Rajesh Garg
- Lundquist Institute/Harbor-UCLA Medical Center, Torrance, California
| | | | | | | | | | | | - Darin Olson
- Colorado Mountain Medical, LLC, Avon, Colorado
| | | | | | - Archana R Sadhu
- Houston Methodist; Weill Cornell Medicine; Texas A&M College of Medicine; Houston, Texas
| | | | - Carla Stec
- American Association of Clinical Endocrinology, Jacksonville, Florida
| | | | - Katherine R Tuttle
- University of Washington and Providence Health Care, Seattle and Spokane, Washington
| | | | | | | | - Sandra L Weber
- University of South Carolina School of Medicine-Greenville, Prisma Health System, Greenville, South Carolina
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19
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Abstract
Adult-onset autoimmune (AOA) diabetes pathophysiology starts with immune changes, followed by dysglycaemia and overt disease. AOA diabetes can occur as classic type 1 diabetes when associated with severe loss of insulin secretion. More frequently, it is diagnosed as latent autoimmune diabetes in adults, a slowly progressing form with late onset, a long period not requiring insulin, and it is often misdiagnosed as type 2 diabetes. As its clinical presentation varies remarkably and immune markers often lack specificity, it is challenging to classify each case ad hoc, especially when insulin treatment is not required at diagnosis. Proper care of AOA diabetes aims to prevent complications and to improve quality of life and life expectancy. To achieve these goals, attention should be paid to lifestyle factors, with the aid of pharmacological therapies properly tailored to each individual clinical setting. Given the heterogeneity of the disease, choosing the right therapy for AOA diabetes is challenging. Most of the trials testing disease-modifying therapies for autoimmune diabetes are conducted in people with childhood onset, whereas non-insulin diabetes therapies have mostly been studied in the larger population with type 2 diabetes. More randomized controlled trials of therapeutic agents in AOA diabetes are needed.
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20
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He J, Hu S, Xu X, Guo P, Niu Y, Zhang J, Zhang R, Chen S, Ma S, Liu F, Li Q, Li C, Zhang L, Wu Y, Zhang M, Zhang M. Association of long-term exposure to PM 2.5 in workplace with fasting plasma glucose among asymptomatic adults: A multicenter study in North China. ENVIRONMENT INTERNATIONAL 2022; 166:107353. [PMID: 35749995 DOI: 10.1016/j.envint.2022.107353] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Revised: 06/08/2022] [Accepted: 06/13/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND The impacts of long-term high exposure to PM2.5 in workplace on glucose metabolism in asymptomatic working adults (AWAs) have rarely been explored. OBJECTIVES To assess the relationship between long-term exposure to workplace PM2.5 and glucose metabolism in asymptomatic general working adults in heavily polluted regions. METHODS We used the baseline data of the asymptomatic working participants from the Beijing-Tianjin-Hebei Medical Examination Cohort, which recruited adults undergoing medical examinations. A machine learning-based spatial-temporal model was used to estimate daily average PM2.5 concentrations in the participants' workplaces. We assessed the association of long-term PM2.5 concentrations (three years prior to the interview) and fasting plasma glucose (FPG) using generalized linear mixed-effects models (GLMM) with inclusion of potential confounders. Stratified analyses by sex, age, BMI and smoking status, and two pollutant models were further performed. RESULTS A total of 37,619 individuals were interviewed and 28,865 were included in the analyses. The mean FPG was 5.20 (0.96) mmol/L, and the estimated three-year average concentration of PM2.5 exposure was 69.51 (6.92) μg/m3. We detected a significant association of long-term exposure to workplace PM2.5 and FPG, a 10 µg/m3 increase in the long-term workplace PM2.5 exposure was associated with 0.075 (95%CI: 0.050-0.100) mmol/L elevated FPG and 25% (OR = 1.25, 95%CI: 1.05-1.50) elevated odds of abnormal fasting glucose metabolism with control of the potential confounding. The detected association between workplace PM2.5 and FPG metabolism remained significant in males, individuals aged > 44 years, overweight and/or obese people, both smokers and non-smokers, and when NO2, SO2, O3, and CO were included in the model. CONCLUSIONS Long-term exposure to workplace PM2.5 was associated with elevated FPG and/or odds of abnormal glucose metabolism among AWAs. Male, middle-aged, overweight and/or obese AWAs were more susceptible to workplace PM2.5 regardless of smoking status.
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Affiliation(s)
- Jiangshan He
- School of Medicine, Nankai University, Tianjin, China
| | - Songhua Hu
- School of Statistics and Data Science, Nankai University, Tianjin, China.
| | - Ximing Xu
- Big Data Center for Children's Medical Care, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, China.
| | - Pei Guo
- School of Medicine, Nankai University, Tianjin, China
| | - Yujie Niu
- Hebei Key Laboratory of Environment and Human Health, Shijiazhuang, China; Department of Occupational Health and Environmental Health, Hebei Medical University, Shijiazhuang, China.
| | - Jingbo Zhang
- Beijing Physical Examination Center, Beijing, China
| | - Rong Zhang
- Hebei Key Laboratory of Environment and Human Health, Shijiazhuang, China; Department of Occupational Health and Environmental Health, Hebei Medical University, Shijiazhuang, China.
| | - Shuo Chen
- Beijing Physical Examination Center, Beijing, China.
| | - Shitao Ma
- Hebei Key Laboratory of Environment and Human Health, Shijiazhuang, China; Department of Occupational Health and Environmental Health, Hebei Medical University, Shijiazhuang, China
| | - Feng Liu
- Beijing Physical Examination Center, Beijing, China.
| | - Qiang Li
- Beijing Physical Examination Center, Beijing, China
| | - Chunjun Li
- Tianjin People's Hospital, Tianjin, China
| | - Li Zhang
- Tianjin First Central Hospital, Tianjin, China
| | - Ying Wu
- School of Statistics and Data Science, Nankai University, Tianjin, China.
| | - Mianzhi Zhang
- Dongfang Hospital, Beijing University of Chinese Medicine, Beijing, China.
| | - Minying Zhang
- School of Medicine, Nankai University, Tianjin, China.
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21
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McCarthy M, Ilkowitz J, Zheng Y, Vaughan Dickson V. Exercise and Self-Management in Adults with Type 1 Diabetes. Curr Cardiol Rep 2022; 24:861-868. [PMID: 35524882 DOI: 10.1007/s11886-022-01707-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/20/2022] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW The purpose of this review paper is to examine the most recent evidence of exercise-related self-management in adults with type 1 diabetes (T1D). RECENT FINDINGS This paper reviews the benefits and barriers to exercise, diabetes self-management education, the role of the healthcare provider in assessment and counseling, the use of technology, and concerns for special populations with T1D. Adults with T1D may not exercise at sufficient levels. Assessing current levels of exercise, counseling during a clinical visit, and the use of technology may improve exercise in this population.
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Affiliation(s)
- Margaret McCarthy
- Rory Meyers College of Nursing, New York University, New York, NY, USA.
| | - Jeniece Ilkowitz
- Pediatric Diabetes Center, NYU Langone Health, New York, NY, USA
| | - Yaguang Zheng
- Rory Meyers College of Nursing, New York University, New York, NY, USA
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22
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The Therapeutic Role of Exercise and Probiotics in Stressful Brain Conditions. Int J Mol Sci 2022; 23:ijms23073610. [PMID: 35408972 PMCID: PMC8998860 DOI: 10.3390/ijms23073610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 03/14/2022] [Accepted: 03/22/2022] [Indexed: 02/04/2023] Open
Abstract
Oxidative stress has been recognized as a contributing factor in aging and in the progression of multiple neurological disorders such as Parkinson’s disease, Alzheimer’s dementia, ischemic stroke, and head and spinal cord injury. The increased production of reactive oxygen species (ROS) has been associated with mitochondrial dysfunction, altered metal homeostasis, and compromised brain antioxidant defence. All these changes have been reported to directly affect synaptic activity and neurotransmission in neurons, leading to cognitive dysfunction. In this context two non-invasive strategies could be employed in an attempt to improve the aforementioned stressful brain status. In this regard, it has been shown that exercise could increase the resistance against oxidative stress, thus providing enhanced neuroprotection. Indeed, there is evidence suggesting that regular physical exercise diminishes BBB permeability as it reinforces antioxidative capacity, reduces oxidative stress, and has anti-inflammatory effects. However, the differential effects of different types of exercise (aerobic exhausted exercise, anaerobic exercise, or the combination of both types) and the duration of physical activity will be also addressed in this review as likely determinants of therapeutic efficacy. The second proposed strategy is related to the use of probiotics, which can also reduce some biomarkers of oxidative stress and inflammatory cytokines, although their underlying mechanisms of action remain unclear. Moreover, various probiotics produce neuroactive molecules that directly or indirectly impact signalling in the brain. In this review, we will discuss how physical activity can be incorporated as a component of therapeutic strategies in oxidative stress-based neurological disorders along with the augmentation of probiotics intake.
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23
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Wake AD. Protective effects of physical activity against health risks associated with type 1 diabetes: "Health benefits outweigh the risks". World J Diabetes 2022; 13:161-184. [PMID: 35432757 PMCID: PMC8984568 DOI: 10.4239/wjd.v13.i3.161] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2021] [Revised: 12/08/2021] [Accepted: 02/20/2022] [Indexed: 02/06/2023] Open
Abstract
The magnitude of diabetes mellitus (DM) has increased in recent decades, where the number of cases and the proportion of the disease have been gradually increasing over the past few decades. The chronic complications of DM affect many organ systems and account for the majority of morbidity and mortality associated with the disease. The prevalence of type 1 DM (T1DM) is increasing globally, and it has a very significant burden on countries and at an individual level. T1DM is a chronic illness that requires ongoing medical care and patient self-management to prevent complications. This study aims to discuss the health benefits of physical activity (PA) in T1DM patients. The present review article was performed following a comprehensive literature search. The search was conducted using the following electronic databases: "Cochrane Library", Web of Science, PubMed, HINARI, EMBASE, Google for grey literature, Scopus, African journals Online, and Google Scholar for articles published up to June 21, 2021. The present review focused on the effects of PA on many outcomes such as blood glucose (BG) control, physical fitness, endothelial function, insulin sensitivity, well-being, the body defense system, blood lipid profile, insulin resistance, cardiovascular diseases (CVDs), insulin requirements, blood pressure (BP), and mortality. It was found that many studies recommended the use of PA for the effective management of T1DM. PA is a component of comprehensive lifestyle modifications, which is a significant approach for the management of T1DM. It provides several health benefits, such as improving BG control, physical fitness, endothelial function, insulin sensitivity, well-being, and the body defense system. Besides this, it reduces the blood lipid profile, insulin resistance, CVDs, insulin requirements, BP, and mortality. Overall, PA has significant and essential protective effects against the health risks associated with T1DM. Even though PA has several health benefits for patients with T1DM, these patients are not well engaged in PA due to barriers such as a fear of exercise-induced hypoglycemia in particular. However, several effective strategies have been identified to control exercise-induced hypoglycemia in these patients. Finally, the present review concludes that PA should be recommended for the management of patients with T1DM due to its significant health benefits and protective effects against associated health risks. It also provides suggestions for the future direction of research in this field.
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Affiliation(s)
- Addisu Dabi Wake
- Department of Nursing, College of Health Sciences, Arsi University, Asella 193/4, Ethiopia
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24
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Zhang F, Wang H, Wang W, Zhang H. The Role of Physical Activity and Mortality in Hemodialysis Patients: A Review. Front Public Health 2022; 10:818921. [PMID: 35252096 PMCID: PMC8891147 DOI: 10.3389/fpubh.2022.818921] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2021] [Accepted: 01/26/2022] [Indexed: 12/20/2022] Open
Abstract
Available data indicated that physical activity was related to improved outcomes in hemodialysis patients. Multiple observational studies involving different cohorts have reported that increased physical activity level was associated with decreased mortality among hemodialysis patients. Therefore, promoting physical activity has become an increasingly critical and promising approach to improving cardiovascular health and clinical outcomes in hemodialysis patients. This review summarizes the published articles regarding physical activity and hemodialysis patients, focusing on mortality and strategy to promote physical activity.
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Affiliation(s)
- Fan Zhang
- Department of Nephrology, Longhua Hospital Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Hui Wang
- Department of Anorectal, Longhua Hospital Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Weiqiong Wang
- Blood Purification Centre, Longhua Hospital Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Huachun Zhang
- Department of Nursing, Longhua Hospital Shanghai University of Traditional Chinese Medicine, Shanghai, China
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25
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5. Facilitating Behavior Change and Well-being to Improve Health Outcomes: Standards of Medical Care in Diabetes-2022. Diabetes Care 2022; 45:S60-S82. [PMID: 34964866 DOI: 10.2337/dc22-s005] [Citation(s) in RCA: 133] [Impact Index Per Article: 66.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
The American Diabetes Association (ADA) "Standards of Medical Care in Diabetes" includes the ADA's current clinical practice recommendations and is intended to provide the components of diabetes care, general treatment goals and guidelines, and tools to evaluate quality of care. Members of the ADA Professional Practice Committee, a multidisciplinary expert committee (https://doi.org/10.2337/dc22-SPPC), are responsible for updating the Standards of Care annually, or more frequently as warranted. For a detailed description of ADA standards, statements, and reports, as well as the evidence-grading system for ADA's clinical practice recommendations, please refer to the Standards of Care Introduction (https://doi.org/10.2337/dc22-SINT). Readers who wish to comment on the Standards of Care are invited to do so at professional.diabetes.org/SOC.
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26
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Pongrac Barlovic D, Harjutsalo V, Groop PH. Exercise and nutrition in type 1 diabetes: Insights from the FinnDiane cohort. Front Endocrinol (Lausanne) 2022; 13:1064185. [PMID: 36619534 PMCID: PMC9813408 DOI: 10.3389/fendo.2022.1064185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Accepted: 12/05/2022] [Indexed: 12/24/2022] Open
Abstract
Type 1 diabetes is a challenging disease, characterized by dynamic changes in the insulin need during life periods, seasons of the year, but also by everyday situations. In particular, changes in insulin need are evident before, during and after exercise and having meals. In the midst of different life demands, it can be very burdensome to achieve tight glycemic control to prevent late diabetes complications, and at the same time, to avoid hypoglycemia. Consequently, many individuals with type 1 diabetes are faced with diabetes distress, decreasing profoundly their quality of life. Today, the nationwide Finnish Diabetic Nephropathy (FinnDiane) Study, launched in 1997, has gathered data from more than 8,000 well-characterized individuals with type 1 diabetes, recruited from 93 centers all over Finland and has established its position as the world's leading project on studying complications in individuals with type 1 diabetes. Studying risk factors and mechanisms of diabetes complications is inconceivable without trying to understand the effects of exercise and nutrition on glycemic control and the development of diabetes complications. Therefore, in this paper we provide findings regarding food and exercise, accumulated during the 25 years of studying lives of Finnish people with type 1 diabetes.
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Affiliation(s)
- Drazenka Pongrac Barlovic
- University Medical Center Ljubljana, Department of Endocrinology, Diabetes and Metabolic Diseases, Ljubljana, Slovenia
- Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Valma Harjutsalo
- Folkhälsan Institute of Genetics, Folkhälsan Research Center, Helsinki, Finland
| | - Per-Henrik Groop
- Folkhälsan Institute of Genetics, Folkhälsan Research Center, Helsinki, Finland
- Department of Nephrology, Helsinki University Central Hospital, University of Helsinki, Helsinki, Finland
- Research Program for Clinical and Molecular Metabolism, University of Helsinki, Faculty of Medicine, Helsinki, Finland
- Department of Diabetes, Central Clinical School, Monash University, Melbourne, VIC, Australia
- *Correspondence: Per-Henrik Groop,
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27
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Kim J. Handgrip Strength to Predict the Risk of All-Cause and Premature Mortality in Korean Adults: A 10-Year Cohort Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 19:ijerph19010039. [PMID: 35010298 PMCID: PMC8751337 DOI: 10.3390/ijerph19010039] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Revised: 12/19/2021] [Accepted: 12/20/2021] [Indexed: 05/31/2023]
Abstract
The prospective association of muscular weakness with the risk of all-cause and premature mortality in a general population remains unknown. The aim of this study was to investigate the prospective effects of handgrip strength and muscular weakness on risk for all-cause and premature mortality over 10 years using a large nationwide sample of Korean adults. The study participants included 9229 middle and older adults (4131 males and 5098 females), using data from the Korean Longitudinal Study of Ageing 2006-2016. Muscular strength was measured using handgrip strength. Muscle weakness was defined using the sex-specific handgrip strength index based on the Asian Working Group on Sarcopenia in Older People (AWGSOP). The primary outcome was all-cause and premature mortality assessed based on the death certificate. The hazard ratio (HR) for all-cause mortality was negatively associated with level of handgrip strength independent of potential confounding factors (HR: 2.06, 95% confidence interval [CI]: 1.62-2.63 for lowest quartile vs. highest quartile). When examined using muscle weakness defined using the AWGSOP diagnosis, the mortality was 1.56 times higher in the weak group (HR: 1.56, 95% CI: 1.36-1.78). We also found that risk of premature mortality was observed in the lowest quartile (HR: 2.34, 95% CI: 1.80-3.05) and the muscle weakness group (HR: 1.80, 95% CI: 1.52-2.13) in the fully adjusted model. Our 10-year prospective cohort study showed that handgrip strength and muscle weakness are strongly associated with an increased risk of all-cause and premature mortality in healthy middle-aged and older adults.
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Affiliation(s)
- Junghoon Kim
- Sports and Exercise Medicine Laboratory, Korea Maritime and Ocean University, 727 Taejong-ro, Yeongdo-Gu, Busan 49112, Korea
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28
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Holt RIG, DeVries JH, Hess-Fischl A, Hirsch IB, Kirkman MS, Klupa T, Ludwig B, Nørgaard K, Pettus J, Renard E, Skyler JS, Snoek FJ, Weinstock RS, Peters AL. The management of type 1 diabetes in adults. A consensus report by the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD). Diabetologia 2021; 64:2609-2652. [PMID: 34590174 PMCID: PMC8481000 DOI: 10.1007/s00125-021-05568-3] [Citation(s) in RCA: 133] [Impact Index Per Article: 44.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
The American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD) convened a writing group to develop a consensus statement on the management of type 1 diabetes in adults. The writing group has considered the rapid development of new treatments and technologies and addressed the following topics: diagnosis, aims of management, schedule of care, diabetes self-management education and support, glucose monitoring, insulin therapy, hypoglycaemia, behavioural considerations, psychosocial care, diabetic ketoacidosis, pancreas and islet transplantation, adjunctive therapies, special populations, inpatient management and future perspectives. Although we discuss the schedule for follow-up examinations and testing, we have not included the evaluation and treatment of the chronic microvascular and macrovascular complications of diabetes as these are well-reviewed and discussed elsewhere. The writing group was aware of both national and international guidance on type 1 diabetes and did not seek to replicate this but rather aimed to highlight the major areas that healthcare professionals should consider when managing adults with type 1 diabetes. Though evidence-based where possible, the recommendations in the report represent the consensus opinion of the authors. Graphical abstract.
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Affiliation(s)
- Richard I G Holt
- Human Development and Health, Faculty of Medicine, University of Southampton, Southampton, UK.
- Southampton National Institute for Health Research Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK.
| | - J Hans DeVries
- Amsterdam UMC, Internal Medicine, University of Amsterdam, Amsterdam, the Netherlands
- Profil Institute for Metabolic Research, Neuss, Germany
| | - Amy Hess-Fischl
- Kovler Diabetes Center, University of Chicago, Chicago, IL, USA
| | - Irl B Hirsch
- UW Medicine Diabetes Institute, Seattle, WA, USA
| | - M Sue Kirkman
- University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | - Tomasz Klupa
- Department of Metabolic Diseases, Center for Advanced Technologies in Diabetes, Jagiellonian University Medical College, Kraków, Poland
| | - Barbara Ludwig
- University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Kirsten Nørgaard
- Steno Diabetes Center Copenhagen, Gentofte, Denmark
- University of Copenhagen, Copenhagen, Denmark
| | | | - Eric Renard
- Montpellier University Hospital, Montpellier, France
- Institute of Functional Genomics, University of Montpellier, CNRS, Inserm, Montpellier, France
| | - Jay S Skyler
- University of Miami Miller School of Medicine, Miami, FL, USA
| | - Frank J Snoek
- Amsterdam UMC, Medical Psychology, Vrije Universiteit, Amsterdam, the Netherlands
| | | | - Anne L Peters
- Keck School of Medicine of USC, Los Angeles, CA, USA
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29
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Holt RIG, DeVries JH, Hess-Fischl A, Hirsch IB, Kirkman MS, Klupa T, Ludwig B, Nørgaard K, Pettus J, Renard E, Skyler JS, Snoek FJ, Weinstock RS, Peters AL. The Management of Type 1 Diabetes in Adults. A Consensus Report by the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD). Diabetes Care 2021; 44:2589-2625. [PMID: 34593612 DOI: 10.2337/dci21-0043] [Citation(s) in RCA: 217] [Impact Index Per Article: 72.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Accepted: 08/25/2021] [Indexed: 02/03/2023]
Abstract
The American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD) convened a writing group to develop a consensus statement on the management of type 1 diabetes in adults. The writing group has considered the rapid development of new treatments and technologies and addressed the following topics: diagnosis, aims of management, schedule of care, diabetes self-management education and support, glucose monitoring, insulin therapy, hypoglycemia, behavioral considerations, psychosocial care, diabetic ketoacidosis, pancreas and islet transplantation, adjunctive therapies, special populations, inpatient management, and future perspectives. Although we discuss the schedule for follow-up examinations and testing, we have not included the evaluation and treatment of the chronic microvascular and macrovascular complications of diabetes as these are well-reviewed and discussed elsewhere. The writing group was aware of both national and international guidance on type 1 diabetes and did not seek to replicate this but rather aimed to highlight the major areas that health care professionals should consider when managing adults with type 1 diabetes. Though evidence-based where possible, the recommendations in the report represent the consensus opinion of the authors.
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Affiliation(s)
- Richard I G Holt
- Human Development and Health, Faculty of Medicine, University of Southampton, Southampton, U.K. .,Southampton National Institute for Health Research Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton, U.K
| | - J Hans DeVries
- Amsterdam UMC, Internal Medicine, University of Amsterdam, Amsterdam, the Netherlands.,Profil Institute for Metabolic Research, Neuss, Germany
| | | | | | - M Sue Kirkman
- University of North Carolina School of Medicine, Chapel Hill, NC
| | - Tomasz Klupa
- Department of Metabolic Diseases, Center for Advanced Technologies in Diabetes, Jagiellonian University Medical College, Kraków, Poland
| | - Barbara Ludwig
- University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Kirsten Nørgaard
- Steno Diabetes Center Copenhagen, Gentofte, Denmark.,University of Copenhagen, Copenhagen, Denmark
| | | | - Eric Renard
- Montpellier University Hospital, Montpellier, France.,Institute of Functional Genomics, University of Montpellier, CNRS, Inserm, Montpellier, France
| | - Jay S Skyler
- University of Miami Miller School of Medicine, Miami, FL
| | - Frank J Snoek
- Amsterdam UMC, Medical Psychology, Vrije Universiteit, Amsterdam, the Netherlands
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30
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Ahola AJ, Tikkanen-Dolenc H, Forsblom C, Harjutsalo V, Groop PH. Symptoms of depression are associated with reduced leisure-time physical activity in adult individuals with type 1 diabetes. Acta Diabetol 2021; 58:1373-1380. [PMID: 34009436 PMCID: PMC8413160 DOI: 10.1007/s00592-021-01718-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Accepted: 04/05/2021] [Indexed: 01/01/2023]
Abstract
AIMS Here, we investigated the association between depressive symptoms and leisure-time physical activity (LTPA) in type 1 diabetes. METHODS Data from adult individuals with type 1 diabetes without evidence of diabetic kidney disease or macrovascular complications, participating in the Finnish Diabetic Nephropathy Study, were included. Based on a questionnaire, weekly LTPA as metabolic equivalent of task hour was calculated. Activity levels (inactive, moderately active, active), weekly frequencies (< 1, 1-2, > 2), intensities (low, moderate, high), and single session durations (< 30, 31-60, > 60 min) were assessed. Depressive symptomatology was evaluated using the Beck Depression Inventory (BDI). We calculated a continuous BDI score and divided participants into those with (BDI score ≥ 16) and without (BDI score < 16) symptoms of depression. For sensitivity analyses, we additionally defined symptoms of depression with antidepressant agent purchases within a year from the study visit. RESULTS Of the 1339 participants (41.7% men, median age 41 years), 150 (11.2%) reported symptoms of depression. After adjustments, both higher BDI scores and depressive symptomatology were associated with more inactive lifestyle, and lower frequency and intensity of the LTPA. The BDI score was additionally associated with shorter single session duration. For antidepressant purchases, lower odds were observed in those with higher intensity and longer single session duration of LTPA. CONCLUSIONS Depressive mood is harmfully related to LTPA in type 1 diabetes. In order to improve the long-term health of individuals with type 1 diabetes, efforts to increase both mental well-being and physical activity should be taken.
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Affiliation(s)
- Aila J Ahola
- Folkhälsan Research Center, Folkhälsan Institute of Genetics, Helsinki, Finland
- Department of Nephrology, University of Helsinki and Helsinki University Central Hospital, Helsinki, Finland
- Research Program for Clinical and Molecular Metabolism, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Heidi Tikkanen-Dolenc
- Folkhälsan Research Center, Folkhälsan Institute of Genetics, Helsinki, Finland
- Department of Nephrology, University of Helsinki and Helsinki University Central Hospital, Helsinki, Finland
- Research Program for Clinical and Molecular Metabolism, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Carol Forsblom
- Folkhälsan Research Center, Folkhälsan Institute of Genetics, Helsinki, Finland
- Department of Nephrology, University of Helsinki and Helsinki University Central Hospital, Helsinki, Finland
- Research Program for Clinical and Molecular Metabolism, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Valma Harjutsalo
- Folkhälsan Research Center, Folkhälsan Institute of Genetics, Helsinki, Finland
- Department of Nephrology, University of Helsinki and Helsinki University Central Hospital, Helsinki, Finland
- Research Program for Clinical and Molecular Metabolism, Faculty of Medicine, University of Helsinki, Helsinki, Finland
- National Institute for Health and Welfare, Helsinki, Finland
| | - Per-Henrik Groop
- Folkhälsan Research Center, Folkhälsan Institute of Genetics, Helsinki, Finland.
- Department of Nephrology, University of Helsinki and Helsinki University Central Hospital, Helsinki, Finland.
- Research Program for Clinical and Molecular Metabolism, Faculty of Medicine, University of Helsinki, Helsinki, Finland.
- Department of Diabetes, Central Clinical School, Monash University, Melbourne, VIC, Australia.
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31
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Can Resistance Exercise Be a Tool for Healthy Aging in Post-Menopausal Women with Type 1 Diabetes? INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18168716. [PMID: 34444464 PMCID: PMC8393224 DOI: 10.3390/ijerph18168716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Revised: 08/12/2021] [Accepted: 08/15/2021] [Indexed: 11/25/2022]
Abstract
Due to improvements in diabetes care, people with type 1 diabetes (T1D) are living longer. Studies show that post-menopausal T1D women have a substantially elevated cardiovascular risk compared to those without T1D. As T1D may also accelerate age-related bone and muscle loss, the risk of frailty may be considerable for T1D women. Exercise and physical activity may be optimal preventative therapies to maintain health and prevent complications in this population: They are associated with improvements in, or maintenance of, cardiovascular health, bone mineral density, and muscle mass in older adults. Resistance exercise, in particular, may provide important protection against age-related frailty, due to its specific effects on bone and muscle. Fear of hypoglycemia can be a barrier to exercise in those with T1D, and resistance exercise may cause less hypoglycemia than aerobic exercise. There are currently no exercise studies involving older, post-menopausal women with T1D. As such, it is unknown whether current guidelines for insulin adjustment/carbohydrate intake for activity are appropriate for this population. This review focuses on existing knowledge about exercise in older adults and considers potential future directions around resistance exercise as a therapeutic intervention for post-menopausal T1D women.
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32
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Slaght JL, Wicklow BA, Dart AB, Sellers EAC, Gabbs M, Carino M, McGavock JM. Physical activity and cardiometabolic health in adolescents with type 2 diabetes: a cross-sectional study. BMJ Open Diabetes Res Care 2021; 9:9/1/e002134. [PMID: 33990367 PMCID: PMC8127979 DOI: 10.1136/bmjdrc-2021-002134] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Revised: 04/14/2021] [Accepted: 04/25/2021] [Indexed: 12/15/2022] Open
Abstract
INTRODUCTION Youth living with type 2 diabetes display increased risk of cardiovascular disease (CVD). It is unclear if regular physical activity (PA) modifies this risk. RESEARCH DESIGN AND METHODS We compared CVD risk factors in a cross-sectional study of 164 youth with type 2 diabetes stratified according to weekly vigorous-intensity PA. Outcomes were hemoglobin A1c (HbA1c), ambulatory blood pressure (BP; ambulatory 24-hour readings), plasma lipoproteins, and albuminuria. The main exposure, vigorous-intensity PA, was quantified with the Adolescent Physical Activity Recall Questionnaire. RESULTS Youth were 15±3 years, and 78% lived rurally and 68% were female, with a mean body mass index (BMI) Z-score of 2.4±1.1 and a mean HbA1c of 9.6% ±2.6%. Youth who participated in regular vigorous-intensity PA (40%; n=67) achieved nearly twice the dose of PA than peers who did not (62 vs 34 metabolic equivalent score-hour/week, p=0.001). After adjusting for duration of diabetes, BMI Z-score, sex, and smoking, youth who engaged in vigorous-intensity PA displayed lower HbA1c (9.1% vs 9.9%, p=0.052), diastolic BP (70 mm Hg vs 73 mm Hg, p=0.002), diastolic load (20% vs 26%, p=0.023), and mean arterial pressure (87.3 mm Hg vs 90.3 mm Hg, p<0.01), compared with youth who did not. Compared with youth who did not participate in regular vigorous-intensity PA, those who did also displayed lower odds of albuminuria after adjusting for duration of diabetes, sex, smoking, rural residence, and BMI Z-score (adjusted OR: 0.40, 95% CI 0.19 to 0.84). CONCLUSIONS Among youth with type 2 diabetes, participation in vigorous-intensity PA is associated with lower CVD risk.
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Affiliation(s)
- Jana L Slaght
- Pediatrics and Child Health, University of Manitoba Children's Hospital Research Institute of Manitoba, Winnipeg, Manitoba, Canada
- Diabetes Research Envisioned and Accomplished in Manitoba (DREAM) Theme, Children's Hospital Research Institute of Manitoba, Winnipeg, Manitoba, Canada
| | - Brandy Alexandra Wicklow
- Pediatrics and Child Health, University of Manitoba Children's Hospital Research Institute of Manitoba, Winnipeg, Manitoba, Canada
- Diabetes Research Envisioned and Accomplished in Manitoba (DREAM) Theme, Children's Hospital Research Institute of Manitoba, Winnipeg, Manitoba, Canada
- Diabetes Research Envisioned and Accomplished in Manitoba (DREAM) Theme, Pediatric Endocrinology and Metabolism, Department of Paediatrics and Child Health, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Allison B Dart
- Pediatrics and Child Health, University of Manitoba Children's Hospital Research Institute of Manitoba, Winnipeg, Manitoba, Canada
- Diabetes Research Envisioned and Accomplished in Manitoba (DREAM) Theme, Children's Hospital Research Institute of Manitoba, Winnipeg, Manitoba, Canada
| | - Elizabeth A C Sellers
- Pediatrics and Child Health, University of Manitoba Children's Hospital Research Institute of Manitoba, Winnipeg, Manitoba, Canada
- Diabetes Research Envisioned and Accomplished in Manitoba (DREAM) Theme, Children's Hospital Research Institute of Manitoba, Winnipeg, Manitoba, Canada
- Diabetes Research Envisioned and Accomplished in Manitoba (DREAM) Theme, Pediatric Endocrinology and Metabolism, Department of Paediatrics and Child Health, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Melissa Gabbs
- Pediatrics and Child Health, University of Manitoba Children's Hospital Research Institute of Manitoba, Winnipeg, Manitoba, Canada
- Diabetes Research Envisioned and Accomplished in Manitoba (DREAM) Theme, Children's Hospital Research Institute of Manitoba, Winnipeg, Manitoba, Canada
| | - Marylin Carino
- Pediatrics and Child Health, University of Manitoba Children's Hospital Research Institute of Manitoba, Winnipeg, Manitoba, Canada
- Diabetes Research Envisioned and Accomplished in Manitoba (DREAM) Theme, Children's Hospital Research Institute of Manitoba, Winnipeg, Manitoba, Canada
| | - Jonathan M McGavock
- Pediatrics and Child Health, University of Manitoba Children's Hospital Research Institute of Manitoba, Winnipeg, Manitoba, Canada
- Diabetes Research Envisioned and Accomplished in Manitoba (DREAM) Theme, Children's Hospital Research Institute of Manitoba, Winnipeg, Manitoba, Canada
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Goulet-Gélinas L, Saade MB, Suppère C, Fortin A, Messier V, Taleb N, Tagougui S, Shohoudi A, Legault L, Henderson M, Rabasa-Lhoret R. Comparison of two carbohydrate intake strategies to improve glucose control during exercise in adolescents and adults with type 1 diabetes. Nutr Metab Cardiovasc Dis 2021; 31:1238-1246. [PMID: 33632598 DOI: 10.1016/j.numecd.2020.12.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Revised: 12/08/2020] [Accepted: 12/10/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND AND AIMS During aerobic physical activity (PA), hypoglycemia is common in people with type 1 diabetes (T1D). Few studies have compared the effectiveness of different carbohydrate (CHO) intake strategies to prevent PA-induced hypoglycemia. Our objective was to compare the efficacy of two CHO intake strategies, same total amount but different CHO intake timing, to maintain glucose levels in the target range (4.0-10.0 mmol/L) during PA in people with T1D. METHODS AND RESULTS An open-label, randomized, crossover study in 33 participants (21 adults; 12 adolescents). Participants practiced 60 min PA sessions (ergocyle) at 60% VO2peak 3.5 h after lunch comparing an intake of 0.5 g of CHO per kg of body weight applied in a pre-PA single CHO intake (SCI) or in a distributed CHO intake (DCI) before and during PA. The percentage of time spent in glucose level target range during PA was not different between the two strategies (SCI: 75 ± 35%; DCI: 87 ± 26%; P = 0.12). Hypoglycemia (<4.0 mmol/L) occurred in 4 participants (12%) with SCI compared to 6 participants (18%) with DCI (P = 0.42). The SCI strategy led to a higher increase (P = 0.01) and variability of glucose levels (P = 0.04) compared with DCI. CONCLUSIONS In people living with T1D, for a 60 min moderate aerobic PA in the post-absorptive condition, a 0.5 g/kg CHO intake helped most participants maintain acceptable glycemic control with both strategies. No clinically significant difference was observed between the SCI and DCI strategies. ClinicalTrials.gov Identifier: NCT03214107 (July 11, 2017).
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Affiliation(s)
- Lucas Goulet-Gélinas
- Montreal Clinical Research Institute (IRCM), 110 Avenue des Pins Ouest, Montreal, Quebec, Canada; Department of Nutrition, Faculty of Medicine, Université de Montréal, 2405 Chemin de La Côte-Sainte-Catherine, Montreal, Quebec, Canada
| | - Marie-Béatrice Saade
- Montreal Clinical Research Institute (IRCM), 110 Avenue des Pins Ouest, Montreal, Quebec, Canada; Research Center of Centre Hospitalier Universitaire Sainte-Justine, 3175 Chemin de La Côte-Sainte-Catherine, Montreal, Quebec, Canada
| | - Corinne Suppère
- Montreal Clinical Research Institute (IRCM), 110 Avenue des Pins Ouest, Montreal, Quebec, Canada
| | - Andréanne Fortin
- Montreal Clinical Research Institute (IRCM), 110 Avenue des Pins Ouest, Montreal, Quebec, Canada
| | - Virginie Messier
- Montreal Clinical Research Institute (IRCM), 110 Avenue des Pins Ouest, Montreal, Quebec, Canada
| | - Nadine Taleb
- Montreal Clinical Research Institute (IRCM), 110 Avenue des Pins Ouest, Montreal, Quebec, Canada
| | - Sémah Tagougui
- Montreal Clinical Research Institute (IRCM), 110 Avenue des Pins Ouest, Montreal, Quebec, Canada; Department of Nutrition, Faculty of Medicine, Université de Montréal, 2405 Chemin de La Côte-Sainte-Catherine, Montreal, Quebec, Canada
| | - Azadeh Shohoudi
- Altasciences, 1200 Avenue Beaumont, Montreal, Quebec, Canada
| | - Laurent Legault
- Department of Pediatrics, Division of Endocrinology and Metabolism, McGill University Health Centre, 1001, Décarie, Montreal, Quebec, Canada
| | - Mélanie Henderson
- Research Center of Centre Hospitalier Universitaire Sainte-Justine, 3175 Chemin de La Côte-Sainte-Catherine, Montreal, Quebec, Canada; Department of Pediatrics, Faculty of Medicine, Université de Montréal, 3175 Chemin de La Côte-Sainte-Catherine, Montreal, Quebec, Canada
| | - Rémi Rabasa-Lhoret
- Montreal Clinical Research Institute (IRCM), 110 Avenue des Pins Ouest, Montreal, Quebec, Canada; Department of Nutrition, Faculty of Medicine, Université de Montréal, 2405 Chemin de La Côte-Sainte-Catherine, Montreal, Quebec, Canada; Montreal Diabetes Research Center & Endocrinology Division, 900 Rue Saint-Denis, Montreal, Quebec, Canada.
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34
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Myers J, Chan K, Chen Y, Lit Y, Patti A, Massaband P, Kiratli BJ, Tamura M, Chertow GM, Rabkin R. Effect of a Home-Based Exercise Program on Indices of Physical Function and Quality of Life in Elderly Maintenance Hemodialysis Patients. Kidney Blood Press Res 2021; 46:196-206. [PMID: 33774634 DOI: 10.1159/000514269] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Accepted: 12/19/2020] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Patients on maintenance hemodialysis (MHD) exhibit muscle wasting and impaired physical function which can be reversed with regular exercise, but accessibility to exercise programs for this unique population is lacking. We assessed the efficacy of a home-based exercise program on a broad range of indices of physical function, quality of life (QoL), and cognitive decline in patients with MHD. DESIGN AND METHODS Twenty-eight MHD patients, mean age 66 ± 7 years, were randomized to a 12-week home-based, case-managed aerobic and resistance exercise program or to usual care (13 exercise and 15 usual care). Comparisons were made for peak VO2, ventilatory inefficiency, 6-min walk test (6MWT), 1-min sit-to-stand (1STS), muscle strength, body composition, QoL, and cognitive measures. RESULTS Peak VO2 improved significantly in the exercise group (p = 0.01 between groups); exercise time improved by 41 and 36% at the ventilatory threshold and peak exercise, respectively (p < 0.01 between groups), but there were no differences in ventilatory efficiency. Trends for improvements in 6MWT and 1STS in the exercise group were observed, but no differences were observed in strength or body composition. Among measures of QoL, general health determined by the SF-36 improved in the exercise group, but there were no differences between groups in cognitive function. CONCLUSIONS MHD patients improved exercise capacity and some indices of QoL following a 12-week home-based exercise program. Home-based exercise is feasible for patients undergoing MHD and may help to obviate accessibility barriers to regular exercise.
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Affiliation(s)
- Jonathan Myers
- Cardiology Division, Veterans Affairs Palo Alto Health Care System, Palo Alto, California, USA.,Cardiology Division, Stanford University, Stanford, California, USA
| | - Khin Chan
- Cardiology Division, Veterans Affairs Palo Alto Health Care System, Palo Alto, California, USA.,Nephrology Section, Veterans Affairs Palo Alto Health Care System, Stanford, California, USA
| | - Yu Chen
- Cardiology Division, Veterans Affairs Palo Alto Health Care System, Palo Alto, California, USA
| | - Yiming Lit
- Nephrology Section, Veterans Affairs Palo Alto Health Care System, Stanford, California, USA.,Nephrology Division, Stanford University, Stanford, California, USA
| | - Alessandro Patti
- Division of Sports and Exercise Medicine, University of Padova, Padova, Italy
| | - Payam Massaband
- Division of Sports and Exercise Medicine, University of Padova, Padova, Italy
| | - B Jenny Kiratli
- Spinal Cord Injury Center, Veterans Affairs Palo Alto Health Care System, Palo Alto, California, USA
| | - Manju Tamura
- Nephrology Section, Veterans Affairs Palo Alto Health Care System, Stanford, California, USA.,Nephrology Division, Stanford University, Stanford, California, USA
| | - Glenn M Chertow
- Nephrology Division, Stanford University, Stanford, California, USA
| | - Ralph Rabkin
- Nephrology Section, Veterans Affairs Palo Alto Health Care System, Stanford, California, USA.,Nephrology Division, Stanford University, Stanford, California, USA
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35
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Valli G, Minnock D, Tarantino G, Neville RD. Delayed effect of different exercise modalities on glycaemic control in type 1 diabetes mellitus: A systematic review and meta-analysis. Nutr Metab Cardiovasc Dis 2021; 31:705-716. [PMID: 33549457 DOI: 10.1016/j.numecd.2020.12.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 12/02/2020] [Accepted: 12/07/2020] [Indexed: 12/23/2022]
Abstract
BACKGROUND AND AIMS Despite the crucial role of exercise in the prevention of comorbidities and complications in type 1 diabetes mellitus (T1DM), people living with the disease are often insufficiently physically active, mainly due to the fear of hypoglycaemia. Research using continuous glucose monitoring (CGM) devices has shown that exercise affects glycaemic control in T1DM for over 24 h. The aim of this systematic review and meta-analysis is, therefore, to investigate the delayed effects of different exercise modalities on glycaemic control in adults with T1DM. METHODS AND RESULTS The literature search of experimental studies was conducted on PubMed, SPORTDiscus and EMBASE from January 2000 to September 2019. Twelve studies using CGM devices were included. Compared to endurance, intermittent exercise increased the time spent in hypoglycaemia (0.62, 0.07 to 1.18; standardised effect size, 95% CI) and reduced the mean interstitial glucose concentration (-0.88, -1.45 to -0.33). No differences emerged in the time spent in hyperglycaemia (-0.07, -0.58 to 0.45) or in the proportion of exercisers experiencing hypoglycaemic events (0.82, 0.45 to 1.49; proportion ratio, 95% CI) between conditions. The systematic review also found a reduced risk of hypoglycaemia if exercise is performed in the morning rather than in the afternoon, and with a 50% rapid-acting insulin reduction. It was not possible to determine the benefits of resistance exercise. CONCLUSIONS For the first time, we systematically investigated the delayed effect of exercise in adults with T1DM, highlighted undetected effects, shortcomings in the existing literature, and provided suggestions to design future comparable studies.
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Affiliation(s)
- Giacomo Valli
- Neuromuscular Physiology Laboratory, Department of Biomedical Sciences, University of Padova, Italy.
| | - Dean Minnock
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Ireland
| | - Giampiero Tarantino
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Ireland
| | - Ross D Neville
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Ireland
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36
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Cardiac Function is Preserved in Adolescents With Well-Controlled Type 1 Diabetes and a Normal Physical Fitness: A Cross-sectional Study. Can J Diabetes 2021; 45:718-724.e1. [PMID: 33773936 DOI: 10.1016/j.jcjd.2021.01.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2020] [Revised: 01/07/2021] [Accepted: 01/16/2021] [Indexed: 11/23/2022]
Abstract
OBJECTIVES Cardiovascular diseases and exercise intolerance elevate mortality in type 1 diabetes (T1D). Left ventricular systolic and diastolic function are already affected in T1DM adolescents, displaying poor glycemic control (glycated hemoglobin [A1C]>7.5%) and exercise intolerance. We investigated to the extent to which left ventricular function is affected by disease severity/duration and whether this is related to exercise capacity. METHODS Transthoracic echocardiography was performed in 19 T1DM adolescents (14.8±1.9 years old, A1C 7.4±0.9%) and 19 controls (14.4±1.3 years old, A1C 5.3±0.2%), matched for age and Tanner stage. Diastolic and systolic (ejection fraction [EF]) function were assessed. Cardiopulmonary exercise testing was used to evaluate exercise capacity, as measured by peak oxygen uptake (VO2peak). RESULTS VO2peak and left ventricular systolic and diastolic function were similar in both groups. Within the T1D group, EF was negatively associated with disease duration (r=-0.79 corrected for age, standardized body mass index, glucose variability and VO2peak; p=0.011). Regression analyses revealed that 37.6% of the variance in EF could be attributed to disease duration. CONCLUSIONS Although left ventricular systolic and diastolic function are preserved in T1D with adequate exercise capacity, disease duration negatively affects EF. The detrimental effects of T1D seem to be driven by disease duration, rather than by disease severity, at least during adolescence. Young T1D patients may, therefore, benefit from cardiovascular evaluation in order to detect cardiovascular abnormalities early in the disease course, and therefore, improve long-term cardiovascular health.
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37
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5. Facilitating Behavior Change and Well-being to Improve Health Outcomes: Standards of Medical Care in Diabetes-2021. Diabetes Care 2021; 44:S53-S72. [PMID: 33298416 DOI: 10.2337/dc21-s005] [Citation(s) in RCA: 169] [Impact Index Per Article: 56.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
The American Diabetes Association (ADA) "Standards of Medical Care in Diabetes" includes the ADA's current clinical practice recommendations and is intended to provide the components of diabetes care, general treatment goals and guidelines, and tools to evaluate quality of care. Members of the ADA Professional Practice Committee, a multidisciplinary expert committee (https://doi.org/10.2337/dc21-SPPC), are responsible for updating the Standards of Care annually, or more frequently as warranted. For a detailed description of ADA standards, statements, and reports, as well as the evidence-grading system for ADA's clinical practice recommendations, please refer to the Standards of Care Introduction (https://doi.org/10.2337/dc21-SINT). Readers who wish to comment on the Standards of Care are invited to do so at professional.diabetes.org/SOC.
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38
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Eckstein ML, Farinha JB, McCarthy O, West DJ, Yardley JE, Bally L, Zueger T, Stettler C, Boff W, Reischak-Oliveira A, Riddell MC, Zaharieva DP, Pieber TR, Müller A, Birnbaumer P, Aziz F, Brugnara L, Haahr H, Zijlstra E, Heise T, Sourij H, Roden M, Hofmann P, Bracken RM, Pesta D, Moser O. Differences in Physiological Responses to Cardiopulmonary Exercise Testing in Adults With and Without Type 1 Diabetes: A Pooled Analysis. Diabetes Care 2021; 44:240-247. [PMID: 33184152 DOI: 10.2337/dc20-1496] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Accepted: 10/14/2020] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To investigate physiological responses to cardiopulmonary exercise (CPX) testing in adults with type 1 diabetes compared with age-, sex-, and BMI-matched control participants without type 1 diabetes. RESEARCH DESIGN AND METHODS We compared results from CPX tests on a cycle ergometer in individuals with type 1 diabetes and control participants without type 1 diabetes. Parameters were peak and threshold variables of VO2, heart rate, and power output. Differences between groups were investigated through restricted maximum likelihood modeling and post hoc tests. Differences between groups were explained by stepwise linear regressions (P < 0.05). RESULTS Among 303 individuals with type 1 diabetes (age 33 [interquartile range 22; 43] years, 93 females, BMI 23.6 [22; 26] kg/m2, HbA1c 6.9% [6.2; 7.7%] [52 (44; 61) mmol/mol]), VO2peak (32.55 [26.49; 38.72] vs. 42.67 ± 10.44 mL/kg/min), peak heart rate (179 [170; 187] vs. 184 [175; 191] beats/min), and peak power (216 [171; 253] vs. 245 [200; 300] W) were lower compared with 308 control participants without type 1 diabetes (all P < 0.001). Individuals with type 1 diabetes displayed an impaired degree and direction of the heart rate-to-performance curve compared with control participants without type 1 diabetes (0.07 [-0.75; 1.09] vs. 0.66 [-0.28; 1.45]; P < 0.001). None of the exercise physiological responses were associated with HbA1c in individuals with type 1 diabetes. CONCLUSIONS Individuals with type 1 diabetes show altered responses to CPX testing, which cannot be explained by HbA1c. Intriguingly, the participants in our cohort were people with recent-onset type 1 diabetes; heart rate dynamics were altered during CPX testing.
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Affiliation(s)
- Max L Eckstein
- Cardiovascular Diabetology Research Group, Division of Endocrinology and Diabetology, Department of Internal Medicine, Medical University of Graz, Graz, Austria.,Division of Exercise Physiology and Metabolism, Department of Sport Science, University of Bayreuth, Bayreuth, Germany
| | - Juliano Boufleur Farinha
- School of Physical Education, Physiotherapy and Dance, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Olivia McCarthy
- Applied Sport, Technology, Exercise and Medicine Research Centre, College of Engineering, Swansea University, Swansea, U.K
| | - Daniel J West
- Population Health Science Institute, Faculty of Medical Science, Newcastle University, Newcastle upon Tyne, U.K
| | - Jane E Yardley
- Alberta Diabetes Institute, Edmonton, Alberta, Canada.,Augustana Faculty, University of Alberta, Camrose, Alberta, Canada
| | - Lia Bally
- Department of Diabetes, Endocrinology, Nutritional Medicine and Metabolism, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland
| | - Thomas Zueger
- Department of Diabetes, Endocrinology, Nutritional Medicine and Metabolism, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland
| | - Christoph Stettler
- Department of Diabetes, Endocrinology, Nutritional Medicine and Metabolism, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland
| | - Winston Boff
- Institute for Children with Diabetes, Conceição Hospital Group, Porto Alegre, Brazil
| | - Alvaro Reischak-Oliveira
- School of Physical Education, Physiotherapy and Dance, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Michael C Riddell
- School of Kinesiology and Health Science, York University, Toronto, Ontario, Canada
| | - Dessi P Zaharieva
- Department of Pediatric Endocrinology and Diabetes, Stanford University School of Medicine, Stanford, CA
| | - Thomas R Pieber
- Cardiovascular Diabetology Research Group, Division of Endocrinology and Diabetology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Alexander Müller
- Cardiovascular Diabetology Research Group, Division of Endocrinology and Diabetology, Department of Internal Medicine, Medical University of Graz, Graz, Austria.,Exercise Physiology, Training & Training Therapy Research Group, Institute of Sports Science, University of Graz, Graz, Austria
| | - Philipp Birnbaumer
- Exercise Physiology, Training & Training Therapy Research Group, Institute of Sports Science, University of Graz, Graz, Austria
| | - Faisal Aziz
- Cardiovascular Diabetology Research Group, Division of Endocrinology and Diabetology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Laura Brugnara
- CIBERDEM-Spanish Biomedical Research Centre in Diabetes and Associated Metabolic Disorders and IDIBAPS-August Pi i Sunyer Biomedical Research Institute/Hospital Clínic de Barcelona, Barcelona, Spain
| | | | | | | | - Harald Sourij
- Cardiovascular Diabetology Research Group, Division of Endocrinology and Diabetology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Michael Roden
- Institute for Clinical Diabetology, German Diabetes Centre, Leibniz Institute for Diabetes Research, Düsseldorf, Germany.,Division of Endocrinology and Diabetology, Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Peter Hofmann
- Exercise Physiology, Training & Training Therapy Research Group, Institute of Sports Science, University of Graz, Graz, Austria
| | - Richard M Bracken
- Applied Sport, Technology, Exercise and Medicine Research Centre, College of Engineering, Swansea University, Swansea, U.K
| | - Dominik Pesta
- Institute for Clinical Diabetology, German Diabetes Centre, Leibniz Institute for Diabetes Research, Düsseldorf, Germany.,German Center for Diabetes Research, München-Neuherberg, Germany
| | - Othmar Moser
- Cardiovascular Diabetology Research Group, Division of Endocrinology and Diabetology, Department of Internal Medicine, Medical University of Graz, Graz, Austria .,Division of Exercise Physiology and Metabolism, Department of Sport Science, University of Bayreuth, Bayreuth, Germany
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Mehta R, Pichel D, Chen-Ku CH, Raffaele P, Méndez Durán A, Padilla F, Arango Alvarez JJ, Esteban Costa Gil J, Esteban Gómez Mesa J, Giorgi M, Lahsen R, Sposito AC. Latin American Expert Consensus for Comprehensive Management of Type 2 Diabetes from a Metabolic-Cardio-Renal Perspective for the Primary Care Physician. Diabetes Ther 2021; 12:1-20. [PMID: 33325006 PMCID: PMC7843679 DOI: 10.1007/s13300-020-00961-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Accepted: 10/27/2020] [Indexed: 11/29/2022] Open
Abstract
Growing scientific evidence from studies on type 2 diabetes (T2D) has recently led to a better understanding of the associated metabolic-cardio-renal risks. The large amount of available information makes it essential to have a practical guide that summarizes the recommendations for the initial management of patients with T2D, integrating different aspects of endocrinology, cardiology, and nephrology. The expert consensus presented here does not attempt to summarize all the evidence in this regard but rather attempts to define practical summary recommendations for the primary care physician to improve the clinical prognosis and management of patients with T2D, while ensuring economic sustainability of health systems, beyond glycemic control.
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Affiliation(s)
- Roopa Mehta
- Metabolic Diseases Research Unit (UIEM), National Institute of Medical Sciences and Nutrition Salvador Zubirán (INCMNSZ), Vasco De Quiroga 15, Belisario Dominguez, Tlalpan, 14200, Mexico.
| | - Daniel Pichel
- Department of Medicine/Cardiology, Hospital Paitilla, Calle 53, Ave Balboa, Urb. Marbella, Panama City, 00134, Panama
| | - Chih Hao Chen-Ku
- Clínica Los Yoses, San Pedro Montes de Oca, San José, Costa Rica
| | - Pablo Raffaele
- Department of Nephrology, Fundación Favaloro University Hospital, Buenos Aires, 1093, Argentina
| | - Antonio Méndez Durán
- Coordinacion de Planeacion de Infraestructura Medica, Instituto Mexicano del Seguro Social, C.P. 6700, Mexico City, Mexico
| | - Francisco Padilla
- Cardiología Clínica e Intervencionista, 44670, Guadalajara, Jalisco, Mexico
| | | | | | | | - Mariano Giorgi
- Cardiology Section, Cardiovascular Prevention Unit, CEMIC, Buenos Aires, Argentina
| | - Rodolfo Lahsen
- Centro de Diabetes Adultos, Clinica Las Condes, 7591047, Santiago, Chile
| | - Andrei C Sposito
- Department of Cardiology, State University of Campinas (Unicamp), Campinas, Brazil
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40
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Buckley JP, Riddell M, Mellor D, Bracken RM, Ross MK, LaGerche A, Poirier P. Acute glycaemic management before, during and after exercise for cardiac rehabilitation participants with diabetes mellitus: a joint statement of the British and Canadian Associations of Cardiovascular Prevention and Rehabilitation, the International Council for Cardiovascular Prevention and Rehabilitation and the British Association of Sport and Exercise Sciences. Br J Sports Med 2020; 55:bjsports-2020-102446. [PMID: 33361136 DOI: 10.1136/bjsports-2020-102446] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/19/2020] [Indexed: 12/12/2022]
Abstract
Type 1 (T1) and type 2 (T2) diabetes mellitus (DM) are significant precursors and comorbidities to cardiovascular disease and prevalence of both types is still rising globally. Currently,~25% of participants (and rising) attending cardiac rehabilitation in Europe, North America and Australia have been reported to have DM (>90% have T2DM). While there is some debate over whether improving glycaemic control in those with heart disease can independently improve future cardiovascular health-related outcomes, for the individual patient whose blood glucose is well controlled, it can aid the exercise programme in being more efficacious. Good glycaemic management not only helps to mitigate the risk of acute glycaemic events during exercising, it also aids in achieving the requisite physiological and psycho-social aims of the exercise component of cardiac rehabilitation (CR). These benefits are strongly associated with effective behaviour change, including increased enjoyment, adherence and self-efficacy. It is known that CR participants with DM have lower uptake and adherence rates compared with those without DM. This expert statement provides CR practitioners with nine recommendations aimed to aid in the participant's improved blood glucose control before, during and after exercise so as to prevent the risk of glycaemic events that could mitigate their beneficial participation.
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Affiliation(s)
- John P Buckley
- Shrewsbury Centre for Active Living, University of Chester Faculty of Medicine and Life Sciences, Chester, Cheshire West and Chester, UK
- Institute of Sport Exercise and Health, University College London, London, UK
| | - Michael Riddell
- School of Kinesiology and Health Science, York University, Toronto, Ontario, Canada
- LMC Healthcare, Diabetes and Endocrinology, Toronto, Ontario, Canada
| | - Duane Mellor
- Aston Medical School, Aston University, Birmingham, West Midlands, UK
- Sport and Exercise Science, Swansea University College of Engineering, Swansea, Wales, UK
| | - Richard M Bracken
- Sport and Exercise Science, Swansea University College of Engineering, Swansea, Wales, UK
| | - Marie-Kristelle Ross
- Hotel-Dieu de Levis, Laval University Faculty of Medicine, Quebec city, Quebec, Canada
| | - Andre LaGerche
- Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia
- St Vincent's Hospital Melbourne Pty Ltd, Fitzroy, Victoria, Australia
| | - Paul Poirier
- Cardiology, Institut universitaire de cardiologie et de pneumologie de Québec, Quebec City, Quebec, Canada
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Zhang NH, Luo R, Cheng YC, Ge SW, Xu G. Leisure-Time Physical Activity and Mortality in CKD: A 1999-2012 NHANES Analysis. Am J Nephrol 2020; 51:919-929. [PMID: 33207339 DOI: 10.1159/000511685] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2020] [Accepted: 09/15/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND For patients with CKD, evidence on the optimal dose of physical activity and possible harm with excessive exercise is limited. This study aimed to analyze the dose-response association between leisure-time physical activity (LTPA) and mortality in those with CKD and explore the optimal dose or possible harm associated with increased levels of LTPA. METHODS 4,604 participants with CKD from the 1999 to 2012 National Health and Nutrition Examination Surveys with linked mortality data obtained through 2015 were classified into 6 groups: 0, 1-149, 150-299, 300-599, 600-899, and ≥900 min/week based on the total duration of the self-reported LTPA. Multivariable-adjusted Cox proportional hazards models were used to examine dose-response associations between LTPA and mortality. RESULTS During the median follow-up of 114 months, 1,449 (31%) all-cause deaths were recorded. Compared to the inactive group (0 min/week), we observed a 22% lower risk of all-cause mortality (hazard ratio [HR], 0.78; 95% confidence interval [CI], 0.63-0.97) among participants who performed 1-149 min per week for LTPA. The corresponding HRs and 95% CIs for all-cause mortality for 150-299 and 300-599 min/week of LTPA were 0.79 (0.64-0.97) and 0.74 (0.56-0.98). The benefit appeared to reach a threshold of a 43% (HR, 0.57; 95% CI, 0.36-0.91) lower risk of all-cause mortality among individuals performing 600-899 min/week for LTPA. Importantly, for ≥900 min/week of LTPA, the continued benefits were observed (HR, 0.62; 95% CI, 0.44-0.87). CONCLUSION LTPA was associated with lower mortality in those with CKD. The optimal dose was observed at the LTPA level of approximately 600-899 min/week, and there were still benefits rather than the excess risk with LTPA levels as high as ≥900 min/week. Therefore, clinicians should encourage inactive CKD patients to perform LTPA and do not need to discourage CKD patients who already adhere to long-term physical activity.
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Affiliation(s)
- Nan-Hui Zhang
- Division of Internal Medicine, Department of Nephrology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Ran Luo
- Division of Internal Medicine, Department of Nephrology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yi-Chun Cheng
- Division of Internal Medicine, Department of Nephrology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Shu-Wang Ge
- Division of Internal Medicine, Department of Nephrology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China,
| | - Gang Xu
- Division of Internal Medicine, Department of Nephrology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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Francescato MP, Ajčević M, Accardo A. Carbohydrate Requirement for Exercise in Type 1 Diabetes: Effects of Insulin Concentration. J Diabetes Sci Technol 2020; 14:1116-1121. [PMID: 30767503 PMCID: PMC7645145 DOI: 10.1177/1932296819826962] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Physical activity is a keystone of a healthy lifestyle as well as of management of patients with type 1 diabetes. The risk of exercise-induced hypoglycemia, however, is a great challenge for these patients. The glycemic response to exercise depends upon several factors concerning the patient him/herself (eg, therapy, glycemic control, training level) and the characteristics of the exercise performed. Only in-depth knowledge of these factors will allow to develop individualized strategies minimizing the risk of hypoglycemia. The main factors affecting the exercise-induced hypoglycemia in patients with T1D have been analyzed, including the effects of insulin concentration. A model is discussed, which has the potential to become the basis for providing patients with individualized suggestions to keep constant glucose levels on each exercise occasion.
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Affiliation(s)
- Maria Pia Francescato
- Department of Medicine, University of Udine, Udine, Italy
- Maria Pia Francescato, MD, Department of Medicine, University of Udine, p. le M. Kolbe 4, 33100 Udine, Italy.
| | - Miloš Ajčević
- Department of Engineering and Architecture, University of Trieste, Trieste, Italy
| | - Agostino Accardo
- Department of Engineering and Architecture, University of Trieste, Trieste, Italy
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43
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Moser O, Mueller A, Eckstein ML, Ziko H, Aberer F, Treiber G, Unteregger C, Kojzar H, Mader JK, Sourij C, Pferschy P, Obermayer A, Tripolt N, Sourij H. Improved glycaemic variability and basal insulin dose reduction during a running competition in recreationally active adults with type 1 diabetes-A single-centre, prospective, controlled observational study. PLoS One 2020; 15:e0239091. [PMID: 32915897 PMCID: PMC7485886 DOI: 10.1371/journal.pone.0239091] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Accepted: 08/29/2020] [Indexed: 12/30/2022] Open
Abstract
INTRODUCTION To investigate the glycaemic response, macronutrient intake and insulin management in people with type 1 diabetes (T1D) compared to healthy individuals around a running competition. MATERIAL AND METHODS This was a single-centre, prospective, controlled observational study performed in individuals with T1D and healthy people. 24 people (12 T1D) were included in this study (age: T1D 41±12 vs. healthy 38±6 years, females: 3 vs. 6, BMI: 25.53.0 vs. 22.9±2.8 kg/m2). Both groups received an intermittently scanned continuous glucose monitoring (isCGM; FreeStyle Libre 1, Abbott, USA) system to assess glycaemia 24 hours before, during and 24 hours after a running competition. During this period, participants recorded their food intake and insulin administration. Data were analysed via ANOVA and mixed model analyses with post-hoc testing (p≤0.05). RESULTS For overall glycaemic ranges in comparison of groups, significant differences were found for time in range (T1D 63±21% vs. healthy 89±13%, p = 0.001), time above range (TAR) 1 (T1D 21±15% vs. healthy 0±0%, p<0.001) and TAR 2 (T1D 8 [0-16%] vs. healthy 0±0%, p<0.001). When glycaemic variability was assessed, people with T1D had a higher glycaemic variability compared to healthy individuals (p<0.0001). Basal insulin dose was significantly reduced when compared against the regular pre-study basal insulin dose (pre-study 22±6 vs. pre-competition day 11±9 (-50±41%), p = 0.02; competition day 15±5 (-32± 1%)). CONCLUSION People with T1D have impaired glucose responses around a running competition compared to healthy individuals. However, basal insulin dose reductions were sufficient to prevent further dysglycaemia. CLINICAL TRIAL ID drks.de; DRKS00019886.
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Affiliation(s)
- Othmar Moser
- Division of Endocrinology and Diabetology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
- * E-mail:
| | - Alexander Mueller
- Division of Endocrinology and Diabetology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
- Exercise Physiology, Training & Training Therapy Research Group, Institute of Sports Science, University of Graz, Graz, Austria
| | - Max L. Eckstein
- Division of Endocrinology and Diabetology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Haris Ziko
- Division of Endocrinology and Diabetology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Felix Aberer
- Division of Endocrinology and Diabetology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Gerlies Treiber
- Division of Endocrinology and Diabetology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Christina Unteregger
- Division of Endocrinology and Diabetology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Harald Kojzar
- Division of Endocrinology and Diabetology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Julia K. Mader
- Division of Endocrinology and Diabetology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Caren Sourij
- Division of Endocrinology and Diabetology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Peter Pferschy
- Division of Endocrinology and Diabetology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Anna Obermayer
- Division of Endocrinology and Diabetology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Norbert Tripolt
- Division of Endocrinology and Diabetology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Harald Sourij
- Division of Endocrinology and Diabetology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
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Sokolovska J, Ostrovska K, Pahirko L, Varblane G, Krilatiha K, Cirulnieks A, Folkmane I, Pirags V, Valeinis J, Klavina A, Selavo L. Impact of interval walking training managed through smart mobile devices on albuminuria and leptin/adiponectin ratio in patients with type 2 diabetes. Physiol Rep 2020; 8:e14506. [PMID: 32652863 PMCID: PMC7354089 DOI: 10.14814/phy2.14506] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Revised: 06/16/2020] [Accepted: 06/16/2020] [Indexed: 12/13/2022] Open
Abstract
Background Interval walking training has demonstrated more pronounced positive effects on physical fitness and metabolism in type 2 diabetes (T2D), compared to continuous walking. One of the pathogenic mechanisms of T2D is associated with derangements in leptin/adiponectin axis, which might predispose affected individuals to vascular inflammation and albuminuria. The aim of this study was to investigate the effects of interval walking training delivered through smart mobile devices upon albuminuria and leptin/adiponectin ratio in patients with T2D. Methods Patients with T2D aged 35–75 were randomized into control (n = 26) and interval training (IT, n = 14) groups. Patients in IT group had to perform three 60‐min interval walking sessions (3 min intervals of slow and fast walking with the intensity of 40% and 70% of the peak energy expenditure) per week delivered by smartphone application for four months. The adherence to training was monitored remotely. Outcome measures were albuminuria, leptin/adiponectin ratio, obesity indicators, and glycaemic control. Leptin and adiponectin concentration was measured in serum samples by Luminex technology. Results In the IT group compared to control group, we observed a statistically significant decrease in albuminuria (p = .002) and leptin/adiponectin ratio (p = .01), as well as a decrease in HbA1c close to statistical significance (p = .09). In IT group, changes in leptin/adiponectin ratio correlated significantly with changes in hip circumference (p = .024). Conclusion Interval walking training is beneficial for vascular health in T2D via impact on albuminuria and leptin/adiponectin ratio.
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Affiliation(s)
| | | | - Leonora Pahirko
- Faculty of Physics, Mathematics and Optometry, University of Latvia, Riga, Latvia
| | | | | | | | - Inese Folkmane
- Faculty of Medicine, University of Latvia, Riga, Latvia.,Centre of Nephrology, Pauls Stradins University Hospital, Riga, Latvia
| | - Valdis Pirags
- Faculty of Medicine, University of Latvia, Riga, Latvia.,Department of Internal Medicine, Pauls Stradins University Hospital, Riga, Latvia
| | - Janis Valeinis
- Faculty of Physics, Mathematics and Optometry, University of Latvia, Riga, Latvia
| | - Aija Klavina
- Latvian Academy of Sport Education, Riga, Latvia
| | - Leo Selavo
- Faculty of Computing, University of Latvia, Riga, Latvia
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45
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Amaral LSDB, Souza CS, Lima HN, Soares TDJ. Influence of exercise training on diabetic kidney disease: A brief physiological approach. Exp Biol Med (Maywood) 2020; 245:1142-1154. [PMID: 32486850 PMCID: PMC7400720 DOI: 10.1177/1535370220928986] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
IMPACT STATEMENT Diabetic kidney disease (DKD) is associated with increased mortality in diabetic patients and has a negative impact on public health. The identification of potential therapies that help the management of DKD can contribute to the improvement of health and quality of life of patients. Thus, this paper is timely and relevant because, in addition to presenting a concise review of the pathogenesis and major pathophysiological mechanisms of DKD, it addresses the most recent findings on the impact of exercise training on this disease. Thus, since non-pharmacological interventions have gained increasing attention in the fight against chronic diseases, this paper appears as an important tool to increase knowledge and stimulate innovative research on the impact of exercise on kidney disease.
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Affiliation(s)
| | - Cláudia Silva Souza
- Departamento de Fisiologia, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, São Paulo 14049-900, Brazil
| | | | - Telma de Jesus Soares
- Instituto Multidisciplinar em Saúde, Universidade Federal da Bahia, Bahia 45029-094, Brazil
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46
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Difference in the risk of depressive symptoms associated with physical activity in persons with diabetes: Across age, gender, and race/ethnicity. J Affect Disord 2020; 269:108-116. [PMID: 32250863 DOI: 10.1016/j.jad.2020.03.035] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2019] [Revised: 03/16/2020] [Accepted: 03/18/2020] [Indexed: 11/22/2022]
Abstract
BACKGROUND To investigate the link between depressive symptoms and physical activity (PA) by examining their association across genders, age, and race/ethnicity. METHODS Data of the cross-sectional study were from the 2011 and 2015 Behavioral Risk Factor Surveillance System. The Patient Health Questionnaire-8, a well-validated instrument to measure depressive symptoms was used. PA was categorized as active, moderately active, and inactive. A generalized linear model specified with a Poisson distribution and log link was performed to investigate the association between depressive symptoms and PA across population characteristics. RESULTS No significant association between PA and depressive symptoms between genders and across racial/ethnic groups was found. Persons aged 65 years or older showed a significantly lower risk of depressive symptoms than those below 45 years when physically active (Adjusted Prevalence Ratio (APR) 0.36, 95% CI = 0.16-0.82) and moderately active (APR 0.39, 95% CI = 0.16-0.98). LIMITATIONS The study included only leisure-time PA. Well-designed surveys that reflect a wider scope of PA are needed to strengthen the analysis. CONCLUSIONS Compared to younger adults, older adults may gain further health benefits in reducing the risk of depressive symptoms by being physically active. Similar health benefits may be gained from PA between genders and between racial/ethnic groups. The different association between PA and depressive symptoms provides practical implications for the effective management of depressive symptoms in persons with diabetes.
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47
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Tikkanen-Dolenc H, Wadén J, Forsblom C, Harjutsalo V, Thorn LM, Saraheimo M, Elonen N, Hietala K, Summanen P, Tikkanen HO, Groop PH. Frequent physical activity is associated with reduced risk of severe diabetic retinopathy in type 1 diabetes. Acta Diabetol 2020; 57:527-534. [PMID: 31749048 PMCID: PMC7160093 DOI: 10.1007/s00592-019-01454-y] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Accepted: 11/05/2019] [Indexed: 11/17/2022]
Abstract
AIMS The aim of this study was to investigate whether leisure-time physical activity (LTPA) is associated with the development of severe diabetic retinopathy in individuals with type 1 diabetes. METHODS Prospective observational analysis as part of the Finnish diabetic nephropathy (FinnDiane) Study with a mean follow-up time of 10.7 years was performed. A total of 1612 individuals with type 1 diabetes were recruited, and LTPA was assessed at baseline using a validated self-report questionnaire. Severe diabetic retinopathy was defined as the initiation of laser treatment due to severe nonproliferative, proliferative retinopathy or diabetic maculopathy (identified from the Care Register for Health Care). RESULTS A total of 261 patients received laser treatment during the follow-up. Higher frequency of LTPA was associated with a lower incidence of severe diabetic retinopathy (p = 0.024), a finding that remained significant after adjustment for gender, duration, age at onset of diabetes, kidney function, BMI, triglycerides and systolic blood pressure. However, when HbA1c and smoking were added to the Cox regression model the association was no more significant. CONCLUSIONS Frequent LTPA is associated with a lower incidence of severe diabetic retinopathy during the follow-up. The total amount or the other components of LTPA (intensity or duration of a single session) were not associated with severe diabetic retinopathy.
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Affiliation(s)
- Heidi Tikkanen-Dolenc
- Folkhälsan Institute of Genetics, Folkhälsan Research Center, Biomedicum Helsinki, Helsinki, Finland
- Abdominal Center Nephrology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- Research Programs Unit, Diabetes and Obesity, University of Helsinki, Helsinki, Finland
| | - Johan Wadén
- Folkhälsan Institute of Genetics, Folkhälsan Research Center, Biomedicum Helsinki, Helsinki, Finland
- Abdominal Center Nephrology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- Research Programs Unit, Diabetes and Obesity, University of Helsinki, Helsinki, Finland
| | - Carol Forsblom
- Folkhälsan Institute of Genetics, Folkhälsan Research Center, Biomedicum Helsinki, Helsinki, Finland
- Abdominal Center Nephrology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- Research Programs Unit, Diabetes and Obesity, University of Helsinki, Helsinki, Finland
| | - Valma Harjutsalo
- Folkhälsan Institute of Genetics, Folkhälsan Research Center, Biomedicum Helsinki, Helsinki, Finland
- Abdominal Center Nephrology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- Research Programs Unit, Diabetes and Obesity, University of Helsinki, Helsinki, Finland
- The Chronic Disease Prevention Unit, National Institute for Health and Welfare, Helsinki, Finland
| | - Lena M Thorn
- Folkhälsan Institute of Genetics, Folkhälsan Research Center, Biomedicum Helsinki, Helsinki, Finland
- Abdominal Center Nephrology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- Research Programs Unit, Diabetes and Obesity, University of Helsinki, Helsinki, Finland
| | - Markku Saraheimo
- Folkhälsan Institute of Genetics, Folkhälsan Research Center, Biomedicum Helsinki, Helsinki, Finland
- Abdominal Center Nephrology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- Research Programs Unit, Diabetes and Obesity, University of Helsinki, Helsinki, Finland
| | - Nina Elonen
- Folkhälsan Institute of Genetics, Folkhälsan Research Center, Biomedicum Helsinki, Helsinki, Finland
- Abdominal Center Nephrology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- Research Programs Unit, Diabetes and Obesity, University of Helsinki, Helsinki, Finland
| | - Kustaa Hietala
- Department of Ophthalmology, Helsinki University Hospital, Helsinki, Finland
| | - Paula Summanen
- Department of Ophthalmology, Helsinki University Hospital, Helsinki, Finland
| | - Heikki O Tikkanen
- Department of Sports and Exercise Medicine, Institute of Clinical Medicine, University of Helsinki, Helsinki, Finland
- School of Medicine, Institute of Biomedicine, University of Eastern Finland, Kuopio, Finland
| | - Per-Henrik Groop
- Folkhälsan Institute of Genetics, Folkhälsan Research Center, Biomedicum Helsinki, Helsinki, Finland.
- Abdominal Center Nephrology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
- Research Programs Unit, Diabetes and Obesity, University of Helsinki, Helsinki, Finland.
- Department of Diabetes, Central Clinical School, Monash University, Melbourne, VIC, Australia.
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Abstract
Real-time continuous glucose monitoring (CGM) use may lead to behavioral modifications in food selection and physical activity, but there are limited data on the utility of CGM in facilitating lifestyle changes. This article describes an 18-item survey developed to explore whether patients currently using CGM believe the technology has caused them to change their behavior.
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49
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Ambrosetti M, Abreu A, Corrà U, Davos CH, Hansen D, Frederix I, Iliou MC, Pedretti RF, Schmid JP, Vigorito C, Voller H, Wilhelm M, Piepoli MF, Bjarnason-Wehrens B, Berger T, Cohen-Solal A, Cornelissen V, Dendale P, Doehner W, Gaita D, Gevaert AB, Kemps H, Kraenkel N, Laukkanen J, Mendes M, Niebauer J, Simonenko M, Zwisler ADO. Secondary prevention through comprehensive cardiovascular rehabilitation: From knowledge to implementation. 2020 update. A position paper from the Secondary Prevention and Rehabilitation Section of the European Association of Preventive Cardiology. Eur J Prev Cardiol 2020; 28:460-495. [PMID: 33611446 DOI: 10.1177/2047487320913379] [Citation(s) in RCA: 359] [Impact Index Per Article: 89.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Accepted: 02/26/2020] [Indexed: 12/24/2022]
Abstract
Secondary prevention through comprehensive cardiac rehabilitation has been recognized as the most cost-effective intervention to ensure favourable outcomes across a wide spectrum of cardiovascular disease, reducing cardiovascular mortality, morbidity and disability, and to increase quality of life. The delivery of a comprehensive and 'modern' cardiac rehabilitation programme is mandatory both in the residential and the out-patient setting to ensure expected outcomes. The present position paper aims to update the practical recommendations on the core components and goals of cardiac rehabilitation intervention in different cardiovascular conditions, in order to assist the whole cardiac rehabilitation staff in the design and development of the programmes, and to support healthcare providers, insurers, policy makers and patients in the recognition of the positive nature of cardiac rehabilitation. Starting from the previous position paper published in 2010, this updated document maintains a disease-oriented approach, presenting both well-established and more controversial aspects. Particularly for implementation of the exercise programme, advances in different training modalities were added and new challenging populations were considered. A general table applicable to all cardiovascular conditions and specific tables for each clinical condition have been created for routine practice.
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Affiliation(s)
- Marco Ambrosetti
- Department of Cardiac Rehabilitation, ICS Maugeri Care and Research Institute, Italy
| | - Ana Abreu
- Serviço de Cardiologia, Hospital Universitário de Santa Maria/Centro Hospitalar Universitário Lisboa Norte (CHULN), Centro Académico de Medicina de Lisboa (CAML), Centro Cardiovascular da Universidade de Lisboa (CCUL), Faculdade de Medicina, Universidade de Lisboa, Portugal
| | - Ugo Corrà
- Department of Cardiac Rehabilitation, ICS Maugeri Care and Research Institute, Italy
| | - Constantinos H Davos
- Cardiovascular Research Laboratory, Biomedical Research Foundation, Academy of Athens, Greece
| | - Dominique Hansen
- REVAL and BIOMED-Rehabilitation Research Centre, Hasselt University, Belgium
| | | | - Marie C Iliou
- Department of Cardiac Rehabilitation and Secondary Prevention, Hôpital Corentin Celton, Assistance Publique Hopitaux de Paris Centre-Universite de Paris, France
| | | | | | | | - Heinz Voller
- Klinik am See, Rehabilitation Centre for Internal Medicine, Rüdersdorf and Centre of Rehabilitation Medicine, University Potsdam, Germany
| | - Matthias Wilhelm
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Switzerland
| | - Massimo F Piepoli
- Heart Failure Unit, G. da Saliceto Hospital, AUSL Piacenza and University of Parma, Italy
| | - Birna Bjarnason-Wehrens
- Department of Preventive and Rehabilitative Sport Medicine and Exercise Physiology, Institute for Cardiology and Sports Medicine, German Sport University Cologne, Germany
| | | | - Alain Cohen-Solal
- Cardiology Department, Hopital Lariboisiere, Paris University, France
| | | | - Paul Dendale
- Heart Centre, Jessa Hospital Campus Virga Jesse, Belgium
| | - Wolfram Doehner
- Department of Cardiology (Virchow Klinikum), German Centre for Cardiovascular Research (DZHK), Germany.,BCRT - Berlin Institute of Health Centre for Regenerative Therapies, and Centre for Stroke Research Berlin, Charité Universitätsmedizin Berlin, Germany
| | - Dan Gaita
- University of Medicine & Pharmacy 'Victor Babes' Cardiovascular Prevention & Rehabilitation Clinic, Romania
| | - Andreas B Gevaert
- Heart Centre, Jessa Hospital Campus Virga Jesse, Belgium.,Research group Cardiovascular Diseases, GENCOR Department, University of Antwerp, Belgium
| | - Hareld Kemps
- Department of Cardiology, Maxima Medical Centre, The Netherlands
| | - Nicolle Kraenkel
- Charité - University Medicine Berlin, Germany.,German Centre for Cardiovascular Research (DZHK), Germany
| | - Jari Laukkanen
- Central Finland Health Care District Hospital District, Finland
| | - Miguel Mendes
- Cardiology Department, CHLO-Hospital de Santa Cruz, Portugal
| | - Josef Niebauer
- University Institute of Sports Medicine, Prevention and Rehabilitation, Paracelsus Medical University, Austria
| | - Maria Simonenko
- Physiology Research and Blood Circulation Department, Cardiopulmonary Exercise Test SRL, Heart Transplantation Outpatient Department, Federal State Budgetary Institution, 'V.A. Almazov National Medical Research Centre' of the Ministry of Health of the Russian Federation, Russian Federation
| | - Ann-Dorthe Olsen Zwisler
- REHPA-Danish Knowledge Centre for Rehabilitation and Palliative Care, University of Southern Denmark, Odense University Hospital, Denmark
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50
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Abstract
Advances in technologies such as glucose monitors, exercise wearables, closed-loop systems, and various smartphone applications are helping many people with diabetes to be more physically active. These technologies are designed to overcome the challenges associated with exercise duration, mode, relative intensity, and absolute intensity, all of which affect glucose homeostasis in people living with diabetes. At present, optimal use of these technologies depends largely on motivation, competence, and adherence to daily diabetes care requirements. This article discusses recent technologies designed to help patients with diabetes to be more physically active, while also trying to improve glucose control around exercise.
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Affiliation(s)
- Michael C Riddell
- School of Kinesiology and Health Science, York University, Toronto, ON M3J 1P3, Canada; LMC Diabetes & Endocrinology, 1929 Bayview Avenue, Toronto, ON M4G 3E8, Canada; York University, 347 Bethune College, North York, Ontario M3J 1P3, Canada.
| | - Rubin Pooni
- School of Kinesiology and Health Science, York University, Toronto, ON M3J 1P3, Canada; York University, 347 Bethune College, North York, Ontario M3J 1P3, Canada
| | - Federico Y Fontana
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Via Casorati, 43, 37121 Verona, Italy; Team Novo Nordisk Professional Cycling Team, 2144 Hills Avenue NW, Atlanta, 30318 GA, USA. https://twitter.com/FeedYourFlock
| | - Sam N Scott
- Team Novo Nordisk Professional Cycling Team, 2144 Hills Avenue NW, Atlanta, 30318 GA, USA; Department of Diabetes, Endocrinology, Nutritional Medicine and Metabolism, Bern University Hospital, University of Bern, Freiburgstrasse 15, 3010 Bern, Switzerland. https://twitter.com/SamNathanScott
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