Acute effects of different intensities of exercise in normoalbuminuric/normotensive patients with type 1 diabetes

Psychosocial Determinants of Treatment Adherence in Patients with Type 2 Diabetes - A Review

Less than 50% of patients with diabetes achieve the glycaemic goals recommended by the American Diabetes Association. The set of factors associated with adherence to treatment is very broad. Evidence suggests that psychosocial factors are related to medication adherence of patients with type 2 diabetes. Due to the lack of a clear statement from researchers regarding the relationship of psychosocial factors to adherence, an electronic search was conducted in PubMed, MEDLINE, Academic Search Ultimate, CINAHL Complete, Edition and Health Source: Nursing/Academic Edition using the following keywords "adherence", "diabetes", "social support", "stress", "anxiety and depression", "beliefs about medicine", "communication", "older age", "frailty", "cognitive impairment", "addiction", "acceptance of illness", "sense of coherence" obtaining 2758 results. After a narrowing of searches and reference scanning, 36 studies were qualified. The studies analysed showed negative effects of anxiety, diabetes distress, older age, poor communication with physicians, stress, concerns about medicines and cognitive impairment on levels of self-care and medication adherence. One study did not confirm the association of depression with adherence. Self-efficacy, social and family support, and acceptance of illness had a beneficial effect on medication adherence. In conclusion, the current evidence suggests that the relationship between psychosocial factors and adherence has reliable scientific support.

Review: Helping the athlete with type 1 diabetes

Exercise is a significant physiological challenge with markedly increased cardiac output, respiration and fuel mobilisation. Whilst the cardio-respiratory response to exercise is similar in type 1 diabetes to that seen in non-diabetic subjects, the response to mobilisation of fuel source to support exercise is impaired. This effect, when combined with the difficulties of nutrition and insulin therapy in type 1 diabetes may negatively impact on the performance of the athlete with diabetes. Hypoglycaemia both during and following exercise, is a significant risk. Furthermore, hyperglycaemia prior to and following some types of exercises can also be problematic. The effect on blood glucose of varying sports can be predicted, and therefore, pro-active adjustments of insulin therapy and nutrition can be made. This article outlines the important differences seen with exercise in type 1 diabetes and discusses appropriate strategies to normalise performance and reduce the risk of hypoglycaemia.

Factors affecting levels of urinary albumin excretion in the general population of Spain: the Di@bet.es study

The present study was undertaken to examine the prevalence of urinary ACR (albumin/creatinine ratio) >30 mg/g and the associated clinical and environmental factors in a representative sample of the population of Spain. Di@bet.es study is a national, cross-sectional population-based survey conducted in 2009-2010. Clinical, metabolic, socio-demographic, anthropometric data and information about lifestyle habit were collected. Those subjects without KDM (known diabetes mellitus) were given an OGTT (oral glucose tolerance test). Albumin and creatinine were measured in a urinary sample and ACR was calculated. The population prevalence of ACR >30 mg/g was 7.65% (adjusted for sex and age). The prevalence of ACR >30 mg/g increased with age (P<0.001). Subjects with carbohydrate metabolism disorders had a greater prevalence of ACR >30 mg/g but after being adjusted for age, sex and hypertension, was significant only in those subjects with UKDM (unknown diabetes mellitus) {OR (odd ratio), 2.07 [95% CI (confidence interval), 1.38-3.09]; P<0.001] and KDM [OR, 3.55 (95% CI, 2.63-4.80); P<0.001]. Prevalence of ACR >30 mg/g was associated with hypertension [OR, 1.48 (95% CI, 1.12-1.95); P=0.001], HOMA-IR (homoeostasis model assessment of insulin resistance) [OR, 1.47 (95% CI, 1.13-1.92); P≤0.01], metabolic syndrome [OR, 2.17 (95% CI, 1.72-2.72); P<0.001], smoking [OR, 1.40 (95% CI, 1.06-1.83); P≤0.05], physical activity [OR, 0.68 (95% CI, 0.54-0.88); P≤0.01] and consumption of fish [OR, 0.38 (95% CI, 0.18-0.78); P≤0.01]. This is the first study that reports the prevalence of ACR >30 mg/g in the Spanish population. The association between clinical variables and other potentially modifiable environmental variables contribute jointly, and sometimes interactively, to the explanation of prevalence of ACR >30 mg/g. Many of these risk factors are susceptible to intervention.

Effect of exercise intensity on albuminuria in adolescents with Type 1 diabetes mellitus

AIMS

Exercise may be useful to detect patients with diabetes prone to develop persistent microalbuminuria. We studied the relationship between exercise intensity, measured as maximal oxygen consumption (VO(2)max), and microalbuminuria in patients with Type 1 diabetes mellitus patients.

METHODS

We studied 10 patients, age range 10-18 years, with Type 1 diabetes who were normotensive and normoalbuminuric, with less than 10 years since diagnosis. Patients had normal renal function, without infections or clinical evidence of complications. Metabolic control was intensively adjusted in all patients. They underwent three consecutive physical exercise tests, reaching 100, 80 and 60% of the maximal cardiac frequency response.

RESULTS

Eight patients had adequate to regular metabolic control. All patients had lower than predicted VO(2)max values. At 60%, only three patients showed microalbuminuria in excess of 20 μg/min, two of them had inadequate metabolic control. Post-exercise microalbuminuria exceeded normal values in nine, seven and three patients when submitted to 100, 80 and 60% of exercise intensity, respectively.

CONCLUSIONS

Microalbuminuria increased with exercise intensity. Sex, body composition and VO(2)max were the main factors associated with microalbuminuria. The prognostic significance of albuminuria induced by intense exercise in these subjects with Type 1 diabetes is not yet known.

[Impact of physical activity on metabolic control and the development of chronic complications in patients with type 1 diabetes mellitus]

Together with a balanced diet, regular physical activity is one of the pillars of diabetes mellitus (DM) management. Physical activity theoretically provides the same advantages in people with DM as in the general population and also has some beneficial effects in controlling metabolic factors, such as improving blood glucose levels and insulin sensitivity. In this article, we analyze the main clinical studies published to date that evaluate the impact of physical activity on metabolic control or the development of chronic complications in patients with type 1 diabetes mellitus. In conclusion, most of the evaluated studies show that regular physical activity favorably affects metabolic control in DM (or at least does not have adverse effects). However, there is insufficient information about the impact of physical activity on the development and progression of chronic complications.

Microalbuminuria and heart rate variability in adolescents with diabetes

INTRODUCTION

Limited clinical and research data are available on early renal and cardiovascular complications in youth with diabetes. The possible associations of elevated microalbuminuria to creatinine (MC) ratios with heart rate variability (HRV) were explored in adolescents with type 1 (T1DM) or type 2 (T2DM) diabetes.

METHODS

A descriptive study was conducted with 41 adolescents with diabetes (n = 31 T1DM vs. n = 10 T2DM). Twenty-four hour Holter recordings for determining HRV, urine spot checks for MC ratio, and the most recent measures of glycosylated hemoglobin (A1c) were obtained.

RESULTS

HRV was significantly lower in the T2DM group, while body mass index percentile, triglycerides, and diastolic blood pressure were significantly higher. For the T1DM group, clinical case examples provided evidence of elevated MC ratios (>30 mirog/mg) occurring in two female subjects who also had decreased HRV measures.

DISCUSSION

Although HRV was not significantly associated with MC ratios for the sample, individual clinical findings can be a warning sign for some adolescents with diabetes. Current recommendations for screening of early renal complications and associated treatment are provided.

Albumin excretion rate is not affected by asymptomatic urinary tract infection: a prospective study

OBJECTIVE

The aim of the study was to evaluate whether asymptomatic urinary tract infection (UTI) significantly influences the level of albumin excretion rate (AER) in diabetic patients.

RESEARCH DESIGN AND METHODS

We screened prospectively for UTI and AER in 765 type 2 diabetic subjects. AER was determined before and after antimicrobial therapy in those patients in whom an asymptomatic UTI was diagnosed (n = 59). To interpret the clinical significance of AER changes, the coefficient of biological variation (CVb) of the AER (CVb-AER) was assessed in a control group of type 2 diabetic patients without UTI (n = 56).

RESULTS

AER did not change after antimicrobial treatment either in the whole group of patients with UTI (pre: 13.8 microg/min [0.1-195] vs. post: 8.5 microg/min [0.1-185]; P = 0.1) or in those patients in whom the infection was eradicated (pre: 11.7 microg/min [0.1-195] vs. post: 7.1 microg/min [0.1-185]; NS). The CVb-AER was 64% in the control group and was inversely correlated with AER (r = -0.44; P = 0.001). The decrease of AER after antimicrobial therapy (55%) did not exceed the biological variation of AER (64%). Finally, UTI did not significantly influence the classification of diabetic patients as normo- or microalbuminuric.

CONCLUSIONS

Asymptomatic UTI does not increase AER in type 2 diabetic patients. Therefore, our results suggest that testing for UTI is not necessary when AER is measured in diabetic patients.