Are health care professionals advising patients with diabetes or at risk for developing diabetes to exercise more?

Is there a different rating of perceived exertion in men with type 2 diabetes mellitus?

Objective

Studies show that patients with type 2 diabetes mellitus (T2DM) do not engage in regular exercise as often as individuals without T2DM. In addition to numerous barriers to engaging in regular exercise, a different rating of perceived exertion (RPE) during physical activity has been hypothesized to play a role. Therefore, this study investigates whether T2DM affects RPE.

Methods

RPE values (BORG scale ratings) and heart rate (HR) data were analyzed during an endurance step test (25 W + 25 W every 2 min) at different workloads relative to the individual maximum load (50%, 70% and 90% of peak workload (Wpeak)) in patients with T2DM and in non-diabetic control (CON) subjects (n = 12 in each group). Furthermore, in a larger group of overweight patients with T2DM (n = 81), it was investigated whether glycated hemoglobin (HbA1c) levels correlate with RPE values at the different relative loads.

Results

Neither RPE nor HR values significantly differed between T2DM and CON subjects at 50%, 70% or 90% of Wpeak. No significant correlations were identified between HbA1c levels and RPE values.

Conclusion

There is no evidence in our study that T2DM leads to a different perception of physical exertion. Other causes must therefore be responsible for the increased lack of motivation of T2DM patients to engage in regular exercise.

Enabling Adults With Severe Asthma to Exercise: A Qualitative Examination of the Challenges for Patients and Health Care Professionals

BACKGROUND

Adults living with severe asthma have lower physical activity levels, particularly high-intensity physical activity, compared with their healthy peers. Physical inactivity is associated with increased morbidity and mortality.

OBJECTIVE

To understand patient and health care professional attitudes toward exercise and physical activity to inform future strategies for the improvement of healthy lifestyle behaviors, including exercise.

METHODS

Participants recruited from a specialist difficult asthma service were interviewed individually, and health care professionals (HCPs) from primary care, secondary care, and a tertiary center were invited to attend focus groups. Interviews and focus groups were transcribed verbatim. We performed thematic analysis on interviews and focus groups separately, followed by an adapted framework analysis to analyze datasets together.

RESULTS

Twenty-nine people with severe asthma participated in a semi-structured interview. A total of 51 HCPs took part in eight focus groups across the East Midlands, United Kingdom. Final analysis resulted in three major themes: barriers to exercise and exercise counseling - in which patients and HCPs identified disease and non-disease factors affecting those living with severe asthma; attitudes toward HCP support for exercise - highlighting education needs for HCPs and preference for supervised exercise programs; and areas for system improvement in supporting patients and HCPs - challenges exist across health sectors that limit patient support are described.

CONCLUSIONS

Patients identified the important role of HCPs in supporting and advising on lifestyle change. Despite a preference for supervised exercise programs, both patient and HCP barriers existed. To meet patients' varied support needs, improved integration of services is required and HCP skills need extending.

Factors associated with physical activity promotion efforts in individuals with chronic diseases: A systematic review from the perspective of patients

OBJECTIVES

To determine factors associated with healthcare provider physical activity (PA) promotion in individuals with chronic diseases from the perspective of patients.

METHODS

A systematic review of literature was conducted between March and April 2022 by searching five databases. Studies were included if they used survey data, published in English or Chinese, and investigated factors influencing healthcare provider PA promotion in chronic diseases from the perspective of adult patients. Retrieved factors were extracted and mapped to Anderson's Behavioral Model of Health Services Use. Quality of each study was assessed using the NIH Quality Assessment Tool.

RESULTS

Thirteen articles were included for final analysis. The quality of the included studies ranged from fair to good. A series of factors were positively related to healthcare provider PA promotion (e.g., having emotional support or public programs for PA). Conflicting results were found for other factors (e.g., age and gender).

CONCLUSIONS

A series of factors may impact the incorporation of PA promotion into clinical care. More studies with well-designed surveys using primary data collection are suggested to confirm these findings.

PRACTICE IMPLICATIONS

Factors identified from this review provide insights for developing of strategies related to healthcare provider PA promotion for individuals with chronic diseases.

Lifestyle advice for hypertension or diabetes: trend analysis from 2002 to 2017 in England

BACKGROUND

Guidelines recommend that GPs give patients lifestyle advice to manage hypertension and diabetes. Increasing evidence shows that this is an effective and practical treatment for these conditions, but it is unclear whether GPs offer this support.

AIM

To investigate trends in the percentage of patients with hypertension/diabetes receiving lifestyle advice versus medication.

DESIGN AND SETTING

This was a trend analysis of self-reported data from the annual Health Survey for England (HSE) (2003-2017) and GP-recorded data from the QResearch database (2002-2016).

METHOD

The percentage of patients with hypertension or diabetes who received lifestyle advice or medication was calculated in each year. Associations between likelihood of receiving lifestyle advice and characteristics were assessed using multivariable logistic regression.

RESULTS

The percentage of patients receiving lifestyle advice was consistently lower than those receiving medication in both self-reported and medical records. There was consistent evidence of increasing trends in the percentage of patients with hypertension receiving lifestyle advice (HSE 13.8% to 20.1%; Ptrend <0.001; QResearch 11.0% to 22.7%; Ptrend <0.001). For diabetes, there was a non-significant decline in self-reported receipt of lifestyle advice (45.0% to 27.9%; Ptrend = 0.111) and a significant increase in medically recorded delivery of this advice (20.7% to 40.5%; Ptrend <0.001). Patients with hypertension who were overweight or obese were more likely to receive lifestyle advice than those of a healthy weight, whereas the opposite was true for diabetes.

CONCLUSION

Only a minority of patients with diabetes or hypertension report receiving lifestyle advice or have this recorded in their medical records. Interventions beyond guidelines are needed to increase the delivery of behavioural interventions to treat these conditions.

Movement as medicine for cardiovascular disease prevention: A pilot feasibility study of a physical activity promotion intervention for at-risk patients in primary care (Preprint)

Background

Objective

Methods

Results

Conclusions

Trial Registration

Improving Lifestyle Behaviors After Breast Cancer Treatment Among African American Women With and Without Diabetes: Role of Health Care Professionals

BACKGROUND

Little is known about the effect of health professionals' advice on promoting healthy lifestyle behaviors (diet and exercise) among breast cancer patients.

PURPOSE

To identify predictors of receiving lifestyle advice from health professionals and its impact on healthy lifestyle behaviors.

METHODS

We used data from a randomized controlled trial of an interactive, cancer-communication video program using African American breast cancer survivor stories for newly diagnosed African American breast cancer patients (Stages 0-III). Participants completed five interviews over 2 years. This intervention did not significantly affect changes in quality-of-life outcomes. In secondary analysis, we examined differences in baseline variables between women with and without diabetes. Logistic regression models identified independent predictors of receiving advice from "a doctor or other health professional" to improve diet and exercise and of self-reported change in diet and exercise habits at 2 year follow-up.

RESULTS

Of 193 patients included (85% of 228 enrolled), 53 (28%) had diabetes. At 2 year follow-up, a greater proportion of women with (vs. without) diabetes reported receiving advice by a doctor/health professional to improve their diet (73% vs. 57%, p = .04,). Predictors of receiving dietary advice were obesity, diabetes, and breast-conserving surgery (each p < .05). Women receiving dietary advice were 2.75 times more likely to report improving their diet (95% confidence interval: 1.17, 6.46) at follow-up, but receiving physical activity advice was not significantly associated with patients reporting an increase in exercise.

CONCLUSIONS

Although receiving dietary advice predicted dietary improvements, receiving exercise advice did not lead to an increase in physical activity.

CLINICAL TRIAL REGISTRATION

Trial Number NCT00929084.

Lifestyle advice, processes of care and glycaemic control amongst patients with type 2 diabetes in a South African primary care facility

BACKGROUND

The influence of processes of diabetes care on glycaemic control is understudied in primary health care (PHC).

AIM

To explore the influence of lifestyle advice, drug regimen and other processes of care on glycaemic control.

SETTING

Johan Heyns Community Health Centre, Vanderbijlpark, South Africa.

METHODS

In a cross-sectional study involving 200 participants with type-2 diabetes, we collected information on sociodemography, comorbidity, processes of diabetes care, drug regimen and receipt of lifestyle advice. Anthropometric measures and glycosylated haemoglobin (HbA1c) were also determined.

RESULTS

Participants' mean age was 57.8 years and most were black people (88%), females (63%), overweight or obese (94.5%), had diabetes for 10 years (67.9%) and hypertension as comorbidity (98%). Most participants received lifestyle advice on one of diet, exercise and weight control (67%) and had their blood pressure (BP) checked (93%) in the preceding 12 months. However, 2% had any of HbA1c, weight, waist circumference or body mass index checked. Glycaemic control (HbA1c 7%) was achieved in only 24.5% of participants. Exclusive insulin or oral drug was prescribed in 5% and 62% of participants, respectively. Compared to insulin monotherapy, participants on combined metformin and insulin or metformin, sulphonylurea and insulin were less likely to have glycaemic control. Comorbid congestive cardiac failure (CCF) significantly increased the likelihood of glycaemic control.

CONCLUSION

There is substantial shortcomings in the implementation of key processes of diabetes care and glycaemic control. Strategies are needed to prompt and compel healthcare providers to implement evidence-based diabetes guidelines during clinic visits in South African PHC.

Health professionals' perceptions about physical activity promotion in diabetes care within primary health care settings in Oman

Background

As part of formative work to inform an interventional design to increase physical activity (PA) in patients with type 2 diabetes in Oman, this qualitative study aimed to determine health professionals’ perception of barriers and opportunities, personnel responsibilities and plausible PA promotional approaches.

Methods

Four focus group discussions were carried out with groups of health care professionals (family physicians, dieticians and health educators, managers and general practitioners). All discussions were audio recorded and transcribed. Responses were analysed using a thematic analysis.

Results

Barriers to PA reported by participants (n = 29) were identified at three levels: health care system (e.g. deficient PA guidelines); individual (e.g. obstructive social norms) and community (e.g. lack of facilities). Participants felt that a multilevel approach is needed to address perceived barriers and to widen current opportunities. In the presence of various diabetes primary care providers, the potential for dieticians to include individualised PA consultations as part of their role was highlighted. Participants felt that consultations should be augmented by approaches within the community (volunteer support and/or appropriate facilities). However, despite lack of experience with technology supported approaches and motivational tools, the telephone application “WhatsApp” and use of pedometers were considered potentially suitable. The need for training in behaviour change techniques and clearly communicated intervention guidelines was emphasised.

Conclusions

A multi-component approach including PA consultations, possibly led by trained dieticians, technological routes for providing support along with community mapping for resources appear to offer promising approaches for further PA intervention studies within diabetes primary health care.

Diabetes Diagnosis and Screen-Based Sedentary Behavior Among US Adults

Diabetes threatens a patient's health and quality of life, whereas disease diagnosis itself could potentially serve as a teachable moment for initiating behavior change. This study assessed diabetes diagnosis as a possible teachable moment for screen-based sedentary behavior among US adults. The nationally representative sample (n = 3690) came from the 2005-2006 and 2011-2012 National Health and Nutrition Examination Survey. Self-reported hours spent on screen-based sedentary behavior (television/video watching, computer/digital device use) were measured by the Global Physical Activity Questionnaire. Diabetes/prediabetes was identified by fasting plasma glucose and the glycated hemoglobin test. Logistic regressions were conducted to examine the relationship between diabetes diagnosis and screen-based sedentary behavior, adjusting for individual characteristics and sampling design. Compared with those with undiagnosed diabetes, the adjusted values for prevalence of daily television/video watching ≥2 hours (77.45% vs 65.14%), computer/digital device use ≥1 hour (43.20% vs 36.52%), and total screen time (ie, television/video watching plus computer/digital device use) ≥3 hours (66.75% vs 45.78%) were all noticeably higher among adults with diagnosed diabetes, although only the difference in the prevalence of daily total screen time was significant at P < .05. No evidence was found regarding diabetes diagnosis as a teachable moment in reducing screen-based sedentary behavior in US adults.

Changes in Body Weight Among People With Type 2 Diabetes Mellitus in the United States, NHANES 2005-2012

Purpose

To understand weight loss strategies, weight changes, goals, and behaviors in people with type 2 diabetes mellitus (T2DM) and whether these differ by ethnicity.

Methods

T2DM was identified by self-reported diagnosis using the NHANES 2005-2012 data, which also included measured and self-reported current body weight and height, self-reported weight the prior year, and self-reported aspired weight. Nineteen weight loss strategies were evaluated for association with ≥5% weight loss or weight gain versus <5% weight change.

Results

Among people with T2DM, 88.0% were overweight/obese (body mass index [BMI] ≥25 kg/m2) in the prior year and 86.1% the current year. About 60% of the overweight/obese took weight loss actions, mostly using diet-related methods with average weight lost <5%. Two most “effective” methods reported (smoking, taking laxatives/vomiting) are also potentially most harmful. Similar BMI distributions but different goals and behaviors about weight and weight loss were observed across ethnicity. Only physical activity meeting the recommended level and changing eating habits were consistently associated with favorable and statistically significant weight change.

Conclusions

Weight management in T2DM is an ongoing challenge, regardless of ethnicity/race. Among overweight/obese T2DM subjects, recommended level of physical activity and changing eating habits were associated with statistically significant favorable weight change.

Diabetes diagnosis and nutrition facts label use among US adults, 2005-2010

OBJECTIVE

To assess the role of diabetes diagnosis as a potential teachable moment in nutrition facts label use among US adults.

DESIGN

Logistic regression analyses were conducted to examine the relationship between diabetes diagnosis status (diagnosed diabetes, undiagnosed diabetes, diagnosed prediabetes, undiagnosed prediabetes, no diabetes or prediabetes) and self-reported nutrition facts label use, adjusted by individual characteristics and survey design.

SETTING

Study sample came from the National Health and Nutrition Examination Survey 2005-2010 waves.

SUBJECTS

A total of 5110 US adults aged 20 years and older were included in the analyses. Diabetes/prediabetes was identified by fasting plasma glucose and glycated Hb testing.

RESULTS

People with diagnosed diabetes/prediabetes were substantially more likely to report nutrition facts label use when making daily food purchase decisions compared with those with undiagnosed diabetes/prediabetes, whereas the prevalence of nutrition facts label use was similar between people with undiagnosed diabetes/prediabetes and those without diabetes/prediabetes. The adjusted prevalence (95 % CI) of any and regular nutrition facts label use was 85·93 (82·91, 88·95) % and 55·60 (50·04, 61·16) % among those with diagnosed diabetes, respectively, in comparison to 71·50 (59·64, 83·37) % and 32·88 (19·11, 46·65) % among those with undiagnosed diabetes. Analogously, the adjusted prevalence (95 % CI) of any and regular nutrition facts label use was 81·16 (75·27, 87·06) % and 45·28 (37·28, 53·29) % among those with diagnosed prediabetes, respectively, in comparison to 72·83 (68·06, 77·59) % and 39·95 (34·02, 45·89) % among those with undiagnosed prediabetes.

CONCLUSIONS

As a potential teachable moment, diabetes diagnosis may positively impact nutrition facts label use and motivate diabetic patients to manage their condition through making healthier food choices.

An investigation and comparison of the effectiveness of different exercise programmes in improving glucose metabolism and pancreatic β cell function of type 2 diabetes patients

BACKGROUND

Moderately intensive aerobic exercise can improve glucose metabolism and pancreatic β cell function in diabetic patients. To date, there is no evidence to support the long-term effectiveness of home-based exercise interventions on these outcomes.

OBJECTIVE

This study investigated the effectiveness of two moderately intense exercise programmes on glucose metabolism and pancreatic β cell function in type 2 diabetes mellitus (T2DM) patients.

METHODS

A randomised controlled trial of 120 T2DM patients (with a mean age of 55.54 ± 9.09 years) was conducted. Patients were assigned by block randomisation to either an aerobic exercise group (AEG), an accumulated million steps group (AMSG), or a control group (CG); each consisting of 40 patients. Glucose metabolism and pancreatic β cell function of patients were measured at three time intervals for 1 year.

RESULTS

There was no difference in baseline scores, and respective compliance rates for the AEG and AMSG were 94.4% and 99.2%. After generalised estimating equation analysis, the AMSG results for glycated haemoglobin (HbA1c) were significantly lower than those of the CG. The insulinogenic index-acute insulin response (BIGTT-AIR ) of both exercise groups was significantly higher than that of the CG. The AMSG group improved their overall HbA1c and BIGTT-AIR results compared with the AEG group after 3 months exercise programme (T1 ) and 12 months of implementation (T2 ).

CONCLUSION

This study demonstrates that regardless of the type of exercise intervention, it is potentially beneficially effective for glucose metabolism and pancreatic β cell function in T2DM patients. The AMSG had better glucose metabolism and pancreatic β cell function compared with those in the AEG. Nurses can easily integrate exercise interventions into T2DM patient care plans.

Factors influencing primary health care professionals' physical activity promotion behaviors: a systematic review

BACKGROUND

Despite the promising findings related to the efficacy of interventions aimed at promoting physical activity (PA) in primary health care (PHC), the translation of these interventions to PHC practice does not always happen as desired.

PURPOSE

To help understand why efficacious PHC-based PA interventions are not effectively translated to practice, this study systematically reviewed the literature on factors influencing PHC professionals' PA promotion practices.

METHOD

Literature searches were conducted in Web of Science, PubMed, and PsycINFO for peer-reviewed articles published in English from 1990 onwards. Studies were included that met the following criteria: (1) involving PHC-based PA interventions, and (2) reporting factors influencing PHC professionals' PA promotion behaviors. Two researchers independently screened studies and extracted data. A narrative synthesis using thematic analysis was conducted to identify factors.

RESULTS

Of the 4,469 identified articles, 59 were included in the review. Factors were identified by qualitative methods, barrier/facilitator ratings, and the examination of the relationship between factors and PA promotion, and the effectiveness of introduction strategies. Many factors related to the development, delivery, and effects of the innovation, the sociopolitical and organizational culture, resources, and support, patient and PHC professional characteristics, and innovation strategies were identified as potential influences on PHC professionals' PA promotion practices. However, the lack of evidence on the relationship between factors and PA promotion indicated insufficient evidence on PA promotion determinants.

CONCLUSION

This extensive overview of potential factors can inform intervention developers and implementers on which factors may play a role when introducing PA interventions in PHC. Future research should further investigate relationships between factors and PA promotion, which should be guided by qualitative in-depth knowledge on influencing factors.

Provider Advice on Exercise and Diet Among Adults With Comorbid Serious Psychological Distress and Diabetes or Diabetes Risk Factors

Purpose

To examine the lifetime prevalence and correlates of provider advice to increase exercise and reduce dietary fat intake among adults with comorbid serious psychological distress (SPD) and diabetes or diabetes risk factors.

Methods

Study sample (n = 5942) was selected from the Medical Expenditure Panel Survey Household Component (MEPS-HC) series of 2007-2011. SPD was defined as a score of ≥13 on the Kessler Psychological Distress Scale (K6). Multivariate logistic regression was used to examine correlates of lifetime provider advice.

Results

Less than half of adults with SPD had been advised to increase exercise (49.4%) or reduce dietary fat intake (45.6%). The prevalence of receiving provider advice increased in a linear fashion as the number of diabetes risk factors increased and was the highest among those with diabetes. Provision of provider advice was strongly associated with clinical factors rather than individuals’ sociodemographic characteristics and current health behaviors.

Conclusions

Health care providers are missing opportunities to provide exercise and low-fat dietary advice to patients with SPD before they manifest clinical risk factors associated with diabetes. It is important that providers counsel them as early as possible about exercise and nutritional changes that reduce the risks associated with diabetes.

Can physical activity interventions for adults with type 2 diabetes be translated into practice settings? A systematic review using the RE-AIM framework

Despite the strong evidence base for the efficacy of physical activity in the management of type 2 diabetes, a limited number of physical activity interventions have been translated and evaluated in everyday practice. This systematic review aimed to report the findings of studies in which an intervention, containing physical activity promotion as a component, has been delivered within routine diabetes care. A comprehensive search was conducted for articles reporting process data relating to components of the RE-AIM (Reach, Effectiveness, Adoption, Implementation and/or Maintenance) framework. Twelve studies met the selection criteria. Of the nine studies which measured physical activity as an outcome, eight reported an increase in physical activity levels, five of which were significant. Tailoring recruitment, resources and intervention delivery to the target population played a positive role, in addition to the use of external organisations and staff training. Many interventions were of short duration and lacked long-term follow-up data. Findings revealed limited and inconsistent reporting of useful process data.

Exercise prescription in the treatment of type 2 diabetes mellitus : current practices, existing guidelines and future directions

Exercise is an effective treatment for type 2 diabetes mellitus, resulting in stabilization of plasma glucose in the acute phase and improvements in body composition, insulin resistance and glycosylated haemoglobin with chronic exercise training. However, the most appropriate exercise prescription for type 2 diabetes has not yet been established, resulting from insufficient evidence to determine the optimum type, intensity, duration or frequency of exercise training. Furthermore, patient engagement in exercise is suboptimal. There are many likely reasons for low engagement in exercise; one possible contributory factor may be a tendency for expert bodies to prioritize the roles of diet and medication over exercise in their treatment guidelines. Published treatment guidelines vary in their approach to exercise training, but most agencies suggest that people with type 2 diabetes engage in 150 min of moderate to vigorous aerobic exercise per week. This prescription is similar to the established guidelines for cardiovascular health in the general population. Future possibilities in this area include investigation of the physiological effects and practical benefits of exercise training of different intensities in type 2 diabetes, and the use of individualized prescription to maximize the health benefits of training.

The exercise prescription: a tool to improve physical activity

The current epidemic of sedentary behavior is a serious public health issue that requires the attention of the medical community. Although the benefits of physical activity are well established, research indicates that Americans are not heeding the message, and new strategies are warranted to bring about change in this arena. The health care community can and should play a key role in this movement. Patients respect their physicians as credible sources of information and look to them for health-related guidance. Unfortunately, many physicians are not talking to their patients about physical activity and are missing a unique opportunity to raise awareness about its benefits. Exercise needs to be discussed as a serious form of treatment, similar to medication, and should be thoughtfully prescribed to every patient. Physicians need to be familiar with the level of exercise necessary to achieve health benefits as defined by the Physical Activity Guidelines for Americans. Furthermore, they should be competent in their ability to identify a patient's level of risk for starting or increasing exercise and provide guidance on the frequency, intensity, time, and type of activity necessary to safely elicit maximal health benefits. These basic competencies can be easily understood by physicians and incorporated into their practices. Resources have been established to help support physicians in this process. Physiatrists are uniquely positioned to lead the effort for change in this area because they are well-established proponents of exercise and are trained to prescribe therapeutic exercise to address the complex medical issues of their patients. This skill-set should be used for every patient in an effort to reduce the widespread prevalence of the "chronic disease" physical inactivity.

The reporting of previous lifestyle counseling by persons at high risk of Type 2 diabetes

OBJECTIVE

To assess (i) whether the reporting of counseling previously received is associated with high-risk individuals' agreement to participate in lifestyle intervention, (ii) whether the reporting of previous counseling differed within such a high-risk group, and (iii) the associations between lifestyles and previous lifestyle counseling.

METHODS

Cross-sectional data were drawn from 10149 adults at high risk of Type 2 diabetes, who were participating in a Finnish national diabetes prevention project (FIN-D2D). Bivariate analysis and multivariate logistic regression were used.

RESULTS

In relation to the reporting of previous counseling, no difference was found between persons who had agreed and persons who had not agreed to participate in the lifestyle intervention. Persons who were more educated or who had dyslipidemia or diabetes were more likely than the others to report previous counseling. A generally healthy lifestyle, or certain health behaviors (being a non-smoker or eating large amounts of fruit and vegetables) may make the reporting of previous counseling more likely.

CONCLUSION

The results raise questions about the amount and quality of the previously received lifestyle counseling.

PRACTICE IMPLICATIONS

There is a need for sustainable lifestyle counseling structures, within vigorously implemented diabetes prevention projects, if long-lasting lifestyle changes are to be achieved.

Overestimation of physical activity among a nationally representative sample of underactive individuals with diabetes

OBJECTIVES

Using data from the national Health and Retirement Study, we sought to: (a) estimate the proportion of the US adults with diabetes above the age of 50 who do not meet physical activity guidelines but believe they are sufficiently active; and (b) examine demographic and health-related correlates of such "overestimation."

RESEARCH DESIGN

Respondents who were classified as underactive according to a detailed activity inventory but reported exercising at least the "right amount," were designated as overestimating their physical activity. Multiple logistic regression was used to examine the association of demographic and health-related correlates with the odds of overestimation.

RESULTS

Fifty-four percent of the survey sample did not meet physical activity guidelines, and one quarter of this underactive group overestimated their physical activity. The adjusted odds of overestimation were higher among respondents who held the perception that they were about the right weight or underweight [odds ratio (OR)=2.42; 95% confidence interval (CI), 1.49-3.94), who had good or better self-assessed diabetes control (OR=1.84; 95% CI, 1.12-3.04), and who were Black or Hispanic (OR=1.89; 95% CI, 1.13-3.16). Experiencing shortness of breath reduced the odds of overestimation (OR=0.34; 95% CI, 0.19-0.61).

CONCLUSIONS

Overestimation of physical activity is common among adults with diabetes, and is associated with the perceptions that one is about the right weight and that one has good control of diabetes, and with being Black or Hispanic. Clinicians should be aware that these factors may affect their patients' beliefs about how much physical activity is adequate.

Lifestyle counseling in routine care and long-term glucose, blood pressure, and cholesterol control in patients with diabetes

OBJECTIVE

In clinical trials, diet, exercise, and weight counseling led to short-term improvements in blood glucose, blood pressure, and cholesterol levels in patients with diabetes. However, little is known about the long-term effects of lifestyle counseling on patients with diabetes in routine clinical settings.

RESEARCH DESIGN AND METHODS

This retrospective cohort study of 30,897 patients with diabetes aimed to determine whether lifestyle counseling is associated with time to A1C, blood pressure, and LDL cholesterol control in patients with diabetes. Patients were included if they had at least 2 years of follow-up with primary care practices affiliated with two teaching hospitals in eastern Massachusetts between 1 January 2000 and 1 January 2010.

RESULTS

Comparing patients with face-to-face counseling rates of once or more per month versus less than once per 6 months, median time to A1C <7.0% was 3.5 versus 22.7 months, time to blood pressure <130/85 mmHg was 3.7 weeks versus 5.6 months, and time to LDL cholesterol <100 mg/dL was 3.5 versus 24.7 months, respectively (P < 0.0001 for all). In multivariable analysis, one additional monthly face-to-face lifestyle counseling episode was associated with hazard ratios of 1.7 for A1C control (P < 0.0001), 1.3 for blood pressure control (P < 0.0001), and 1.4 for LDL cholesterol control (P = 0.0013).

CONCLUSIONS

Lifestyle counseling in the primary care setting is strongly associated with faster achievement of A1C, blood pressure, and LDL cholesterol control. These results confirm that the findings of controlled clinical trials are applicable to the routine care setting and provide evidence to support current treatment guidelines.

Goal conflict, goal facilitation, and health professionals' provision of physical activity advice in primary care: an exploratory prospective study

Background

The theory of planned behaviour has well-evidenced utility in predicting health professional behaviour, but focuses on a single behaviour isolated from the numerous potentially conflicting and facilitating goal-directed behaviours performed alongside. Goal conflict and goal facilitation may influence whether health professionals engage in guideline-recommended behaviours, and may supplement the predictive power of the theory of planned behaviour. We hypothesised that goal facilitation and goal conflict contribute to predicting primary care health professionals' provision of physical activity advice to patients with hypertension, over and above predictors of behaviour from the theory of planned behaviour.

Methods

Using a prospective predictive design, at baseline we invited a random sample of 606 primary care health professionals from all primary care practices in NHS Grampian and NHS Tayside (Scotland) to complete postal questionnaires. Goal facilitation and goal conflict were measured alongside theory of planned behaviour constructs at baseline. At follow-up six months later, participants self-reported the number of patients, out of those seen in the preceding two weeks, to whom they provided physical activity advice.

Results

Forty-four primary care physicians and nurses completed measures at both time points (7.3% response rate). Goal facilitation and goal conflict improved the prediction of behaviour, accounting for substantial additional variance (5.8% and 8.4%, respectively) in behaviour over and above intention and perceived behavioural control.

Conclusions

Health professionals' provision of physical activity advice in primary care can be predicted by perceptions about how their conflicting and facilitating goal-directed behaviours help and hinder giving advice, over and above theory of planned behaviour constructs. Incorporating features of multiple goal pursuit into the theory of planned behaviour may help to better understand health professional behaviour.

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

Although physical activity (PA) is a key element in the prevention and management of type 2 diabetes mellitus (T2DM), many with this chronic disease do not become or remain regularly active. High-quality studies establishing the importance of exercise and fitness in diabetes were lacking until recently, but it is now well established that participation in regular PA improves blood glucose control and can prevent or delay T2DM, along with positively affecting lipids, blood pressure, cardiovascular events, mortality, and quality of life. Structured interventions combining PA and modest weight loss have been shown to lower T2DM risk by up to 58% in high-risk populations. Most benefits of PA on diabetes management are realized through acute and chronic improvements in insulin action, accomplished with both aerobic and resistance training. The benefits of physical training are discussed, along with recommendations for varying activities, PA-associated blood glucose management, diabetes prevention, gestational diabetes, and safe and effective practices for PA with diabetes-related complications.

Race/Ethnicity and gender differences in health intentions and behaviors regarding exercise and diet for adults with type 2 diabetes: a cross-sectional analysis

Background

Self-management is the cornerstone of diabetes control and prevention of complications; however, it is undetermined whether differences in intention to adopt healthy lifestyles and actual healthy behavior exist across race/ethnic groups. This study evaluated the differences across racial-ethnic groups in self-reported medical advice received and health intentions and behaviors among adults with type 2 diabetes mellitus.

Methods

A cross-sectional analysis of the 2007 SHIELD US survey ascertained self-reported health intentions and behaviors for regular exercise, diet, and weight management among Non-Hispanic Caucasian (n = 2526), Non-Hispanic African-American (n = 706), and Hispanic (n = 179) respondents with type 2 diabetes.

Results

A similar proportion of respondents from each race-gender group (43%-56%) reported receiving healthcare advice to increase their exercise (P = 0.32). Significantly more minorities reported an intention to follow the exercise recommendation compared with Non-Hispanic Caucasians (P = 0.03). More Non-Hispanic African-American (29%) and Hispanic (27%) men reported exercising regularly compared with other race-gender groups (P = 0.02). Significantly more Non-Hispanic Caucasian women (74%) and Hispanic women (79%) reported trying to lose weight compared with other groups (P < 0.0001).

Conclusions

Differences in health intentions and healthy behaviors were noted across race-gender groups. More Non-Hispanic African-American men reported an intention to follow advice on exercising and self-report of exercising regularly was also higher compared with other race-gender groups. More Hispanic men reported high physical activity levels than other groups. Despite an increased willingness to follow healthcare recommendations for diet, >50% of respondents were obese among all race-gender groups.

Accuracy, determinants, and consequences of body weight self-perception in type 2 diabetes: the Fremantle Diabetes Study

OBJECTIVE

To assess the accuracy, determinants, and consequences of body weight self-perception in type 2 diabetes.

METHODS

We studied 1272 community-based patients and a 518-patient overweight/obese subset who returned for ≥4 annual reviews. Multiple logistic regression was used to identify baseline predictors of correct weight self-perception and to determine whether correct weight self-perception predicted future weight loss. Overweight and obesity were defined as body mass indices of 25.0-29.9 and ≥30.0 kg/m(2), respectively.

RESULTS

Of the patients who were overweight (40.0%) or obese (41.8%) at baseline, 52.8% and 83.7%, respectively, correctly self-identified their weight category. Overweight/obese participants who self-identified correctly were more likely to have been informed they were overweight (P<.001), predominantly by their general practitioner (80.1%). Overweight participants had less self-awareness if they were not abdominally obese, did not speak English fluently, were male, or had a low income. Obese participants were more likely to consider themselves overweight if they had better diabetes knowledge and higher educational attainment. Correct weight self-perception did not influence subsequent weight loss.

CONCLUSIONS

Health care professionals can facilitate body weight self-awareness in type 2 diabetes. Education programmes should recognise the impact of gender and socio-demographic variables on accurate weight self-perception.

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

Although physical activity (PA) is a key element in the prevention and management of type 2 diabetes, many with this chronic disease do not become or remain regularly active. High-quality studies establishing the importance of exercise and fitness in diabetes were lacking until recently, but it is now well established that participation in regular PA improves blood glucose control and can prevent or delay type 2 diabetes, along with positively affecting lipids, blood pressure, cardiovascular events, mortality, and quality of life. Structured interventions combining PA and modest weight loss have been shown to lower type 2 diabetes risk by up to 58% in high-risk populations. Most benefits of PA on diabetes management are realized through acute and chronic improvements in insulin action, accomplished with both aerobic and resistance training. The benefits of physical training are discussed, along with recommendations for varying activities, PA-associated blood glucose management, diabetes prevention, gestational diabetes mellitus, and safe and effective practices for PA with diabetes-related complications.

Obesity stigma: a newly recognized barrier to comprehensive and effective type 2 diabetes management

PURPOSE

The purpose of this article is to increase awareness regarding the social problem of obesity stigma and its effects on persons with type 2 diabetes mellitus (T2DM). In addition, practical strategies to dispel stigma and improve diabetes care that nurse practitioners (NPs) can integrate into practice will be introduced.

DATA SOURCES

Thorough review of the literature was conducted including MEDLINE, PsycINFO and CINAHL, spanning the years 1994-2008.

CONCLUSIONS

Obesity and diabetes are both epidemics that demand immediate attention; however, obesity stigma can act as a barrier to ongoing management of both conditions. Obese patients with T2DM may feel responsible not only for their weight but also their diabetes. Therefore, NPs can employ specific counseling strategies that may be beneficial with T2DM obese patients to improve continuity of care while decreasing weight-related stigmatization.

IMPLICATIONS FOR PRACTICE

Negative attitudes toward obesity by healthcare professionals can act as a barrier to diabetes management. Primary care providers including NPs must begin through self-reflection to recognize their own attitudes regarding weight-stigma and how these attitudes may affect their patients. By implementing effective strategies to reduce weight bias, an environment conducive to diabetes and lifestyle modification management may prevent patients from forgoing care.

Patient perspectives on the role of weight management in type 2 diabetes

AIMS

To examine issues of weight misperception, perceived importance of weight management, and patient reports of their HCP's weight-related recommendations among patients with type 2 diabetes.

METHODS

575 overweight adults with type 2 diabetes completed a survey that assessed perceptions about weight management and discussions with HCP's about weight issues.

RESULTS

Among patients with BMI>30, weight misperception was rare (<10%) and perceived importance of weight loss common (>85%). Among overweight patients with BMI<30, weight misperception was more common (47%) and importance of weight loss was endorsed less frequently (68%). Most patients reported that HCP's had advised weight loss (72%) and discussed weight issues at most visits (59%). However, recommendations from HCP's were rarely specific. Few were informed by HCP's that certain diabetes medications might make weight management difficult. Weight misperception was less common, importance of weight loss was more common and weight management efforts were more frequent when HCPs discussed these issues directly.

CONCLUSIONS

Most overweight patients with type 2 diabetes recognize the importance of weight management. Patient reports indicate that HCP's are actively engaged in promoting weight loss and that their recommendations, when specific, are associated with patients' more frequent weight management efforts.

The economic consequences of diabetes and cardiovascular disease in the United States

Diabetes-related care and complications constitute a significant proportion of the United States' (US) health care expenditure. Of these complications, cardiovascular disease (CVD) is a major component. Higher morbidity and mortality rates translate to higher costs of care in patients with diabetes compared to those who do not have the disease. Minorities bear a disproportionate burden of diabetes and CVD. We review this disparity and examine potential etiologies for it in Hispanics and African-Americans, the two largest minority groups in the US. We examine strategies in these populations that may improve outcomes in diabetes and CVD, potentially decreasing health care costs.

Multiple goals and time constraints: perceived impact on physicians' performance of evidence-based behaviours

BACKGROUND

Behavioural approaches to knowledge translation inform interventions to improve healthcare. However, such approaches often focus on a single behaviour without considering that health professionals perform multiple behaviours in pursuit of multiple goals in a given clinical context. In resource-limited consultations, performing these other goal-directed behaviours may influence optimal performance of a particular evidence-based behaviour. This study aimed to investigate whether a multiple goal-directed behaviour perspective might inform implementation research beyond single-behaviour approaches.

METHODS

We conducted theory-based semi-structured interviews with 12 general medical practitioners (GPs) in Scotland on their views regarding two focal clinical behaviours--providing physical activity (PA) advice and prescribing to reduce blood pressure (BP) to <140/80 mmHg--in consultations with patients with diabetes and persistent hypertension. Theory-based constructs investigated were: intention and control beliefs from the theory of planned behaviour, and perceived interfering and facilitating influence of other goal-directed behaviours performed in a diabetes consultation. We coded interview content into pre-specified theory-based constructs and organised codes into themes within each construct using thematic analysis.

RESULTS

Most GPs reported strong intention to prescribe to reduce BP but expressed reasons why they would not. Intention to provide PA advice was variable. Most GPs reported that time constraints and patient preference detrimentally affected their control over providing PA advice and prescribing to reduce BP, respectively. Most GPs perceived many of their other goal-directed behaviours as interfering with providing PA advice, while fewer GPs reported goal-directed behaviours that interfere with prescribing to reduce BP. Providing PA advice and prescribing to reduce BP were perceived to be facilitated by similar diabetes-related behaviours (e.g., discussing cholesterol). While providing PA advice was perceived to be mainly facilitated by providing other lifestyle-related clinical advice (e.g., talking about weight), BP prescribing was reported as facilitated by pursuing ongoing standard consultation-related goals (e.g., clearly structuring the consultation).

CONCLUSION

GPs readily relate their other goal-directed behaviours with having a facilitating and interfering influence on their performance of particular evidence-based behaviours. This may have implications for advancing the theoretical development of behavioural approaches to implementation research beyond single-behaviour models.

Limited English proficiency is a barrier to receipt of advice about physical activity and diet among Hispanics with chronic diseases in the United States

The prevalence of obesity, diabetes, and cardiovascular disease is reaching epidemic proportions among Hispanics in the United States. Health care providers play an important role in motivating patients to make healthful lifestyle changes to reduce the burden of such conditions. Data from the US 2000 National Health Interview Survey was analyzed to determine differences in report of physician-provided physical activity and/or dietary advice by level of English proficiency among obese Hispanics or those who reported having diabetes or cardiovascular disease and who contacted a physician during the past year (n=1,186). Only one third of the sample reported receiving advice to increase their physical activity or to improve their dietary habits; one fifth reported receipt of advice about both. English-proficient Hispanics were about 50% more likely to report receiving advice on physical activity (adjusted odd ratio [AOR]=1.5; 95% confidence interval [CI]: 1.1 to 2.1), diet (AOR=1.5; 95% CI: 1.1 to 2.2) or both (AOR=1.6; 95% CI: 1.1 to 2.3), as compared with limited English-proficient Hispanics, after controlling for health insurance coverage and number of visits to a physician during the last year. Sex, age, region of residence, level of education, annual family income, and smoking status were not significantly associated with receiving physical activity and/or dietary advice. In order to address racial health disparities, and lower the burden of chronic illness, culturally sensitive strategies must be implemented to enhance delivery of effective health-promotion messages by physicians, particularly among at-risk communities.

Physical activity advice to manage chronic conditions for adults with arthritis or hypertension, 2007

OBJECTIVE

To describe the prevalence and characteristics of persons with arthritis or hypertension who received advice from their health-care professional to manage their condition.

METHODS

Data from 9 states were obtained from the 2007 Behavioral Risk Factor Surveillance System. Two modules (Arthritis Management and Actions to Control High Blood Pressure) were analyzed (sample sizes: arthritis 29,698, hypertension 29,783).

RESULTS

Fifty-five percent of persons with arthritis and 75.8% of persons with hypertension reported that their health-care professional ever suggested physical activity or exercise to help manage their condition. Correlates for being less likely to receive advice were lower levels of education, longer time since last routine doctor visit, being physically inactive, and having lower body mass index. Among inactive, normal weight persons, 43.0% (95% CI: 38.7, 47.4) with arthritis and 50.0% (95% CI: 44.4, 55.6) with hypertension reported receiving advice; among inactive, obese patients, 59.1% (95% CI: 55.8, 62.3) with arthritis and 74.0% (95% CI: 70.5, 77.3) with hypertension reported receiving advice.

CONCLUSIONS

Findings suggest that health-care professionals may base physical activity counseling more on body mass index than a patient's activity level. To manage chronic health conditions, health-care professionals should assess patient's physical activity and offer all patients appropriate counseling.

Understanding physical activity intentions among French Canadians with type 2 diabetes: an extension of Ajzen's theory of planned behaviour

BACKGROUND

Regular physical activity is considered a cornerstone for managing type 2 diabetes. However, in Canada, most individuals with type 2 diabetes do not meet national physical activity recommendations. When designing a theory-based intervention, one should first determine the key determinants of physical activity for this population. Unfortunately, there is a lack of information on this aspect among adults with type 2 diabetes. The purpose of this cross-sectional study is to fill this gap using an extended version of Ajzen's Theory of Planned Behavior (TPB) as reference.

METHODS

A total of 501 individuals with type 2 diabetes residing in the Province of Quebec (Canada) completed the study. Questionnaires were sent and returned by mail.

RESULTS

Multiple hierarchical regression analyses indicated that TPB variables explained 60% of the variance in intention. The addition of other psychosocial variables in the model added 7% of the explained variance. The final model included perceived behavioral control (beta = .38, p < .0001), moral norm (beta = .29, p < .0001), and attitude (beta = .14, p < .01).

CONCLUSION

The findings suggest that interventions aimed at individuals with type 2 diabetes should ensure that people have the necessary resources to overcome potential obstacles to behavioral performance. Interventions should also favor the development of feelings of personal responsibility to exercise and promote the advantages of exercising for individuals with type 2 diabetes.

[Physical activity in prevention and treatment of diabetes]

Effects and mechanisms of a single bout of physical load and of the regular exercise (training) on the carbohydrate and fat metabolism are reviewed. During exercise and in the following couple of hours sugar utilization improves, "activity functions like insulin". Proper exercise contributes to using up the fat reserves, and slimmer body, fat reduction can be maintained by the combination of exercise and diet-control. Instructions in "exercise for everybody" and particularly for both type diabetics are detailed. In prevention of cardio-metabolic pathologies the most important measure were avoiding the overweight state by rational alimentation and regular physical activity.

Self-reported diagnosis of heart disease: results from the SHIELD study

OBJECTIVE

This study evaluated the self-reported method of diagnosis of heart disease (HD) to elucidate whether diagnosis is occurring at early, presymptomatic stages as recommended by the prevention guidelines.

METHODS

Respondents to the 2006 survey in the US population-based Study to Help Improve Early evaluation and management of risk factors Leading to Diabetes (SHIELD) reported whether a physician told them that they had HD, including heart attack, angina, heart failure, angioplasty or heart bypass surgery. Self-report of age at diagnosis, specialty of physician who made the diagnosis and whether the diagnosis was made after having symptoms, during routine screening or while being treated for another health problem were assessed. Year of diagnosis was categorised into 3-year intervals from 1985 to 2006. Individuals with HD diagnosis with and without type 2 diabetes mellitus (T2DM) were compared using chi-square tests.

RESULTS

Of 1573 respondents reporting a diagnosis of HD, > 87% were white, > 49% were men and 38% had T2DM. Approximately 19% of respondents reported that their HD diagnosis was made during routine screening. A significantly greater percentage of HD respondents with T2DM reported the diagnosis being made based on symptoms (54%) and while being treated for another health problem (22%) compared with respondents without diabetes (48% symptoms and 15% other health problem, p > 0.05). HD was diagnosed primarily by cardiologists (> 60%) and family doctors (> 25%).

CONCLUSION

There remains a missed opportunity to diagnose HD at earlier stages through routine screening or during treatment of other health conditions such as diabetes, as many individuals were not diagnosed until they were symptomatic.

Diabetes and associated risk factors in patients referred for physical therapy in a national primary care electronic medical record database

OBJECTIVE

The prevalence of diabetes (type 2) in the general population has increased dramatically over the last decade, yet patients with diabetes are rarely referred for physical therapy management of their condition. The majority of patients referred for outpatient physical therapy have musculoskeletal-related conditions. Secondary conditions, such as diabetes, may be prevalent in this population, and physical therapists need to be aware of this to adjust interventions and treatment. The purpose of this article is to describe the prevalence of diabetes and the associated risk factors in adults referred for physical therapy in a primary care outpatient setting.

SUBJECTS AND METHODS

Patients aged 18 years or older referred for physical therapy were identified from the Centricity Electronic Medical Records database during the period of December 13, 1995, to June 30, 2007. Patients were evaluated on the basis of clinical (height, weight, blood pressure, laboratory values), treatment (prescriptions), and diagnostic (ICD-9 codes) criteria to identify the presence of diabetes or associated risk factors (eg, hypertension, elevated triglycerides, low high-density lipoprotein, body mass index, and prediabetes).

RESULTS

There were 52,667 patients referred for physical therapy, the majority of whom were referred for a musculoskeletal-related condition. Approximately 80% of the total study population had diabetes, prediabetes, or risk factors associated with diabetes. The prevalence of diabetes in the study population was 13.2%. Of the diabetes-associated risk factors evaluated, hypertension was the most prevalent (70.4%), and less than half (39.1%) of the study population had an elevated body mass index. Only 20% of the study population had values within normal limits for all clinical, treatment, and diagnostic criteria. Clinical and treatment measurements available to physical therapists identified the majority of associated risk factors.

CONCLUSIONS

Although not the primary indications for referral, diabetes and associated risk factors were identified in a high proportion of the study population. The evaluation of associated conditions in the outpatient orthopedic setting needs to be considered for treatment planning adjustments and to optimize care.

Leisure time physical activity in individuals with screen-detected type 2 diabetes compared to those with known type 2 diabetes

AIMS

To investigate whether leisure time physical activity (LTPA) characteristics differ between individuals with previously undiagnosed (screen-detected) and those with previously diagnosed (known) type 2 diabetes.

METHODS

A population-based random sample of 1364 (participation rate 61%) men and 1461 (65%) women aged 45-74 years participated in a cross-sectional health examination including an oral glucose tolerance test and physical activity assessment by a self-administered questionnaire.

RESULTS

Women with screen-detected type 2 diabetes (n=110) were physically less active than those with known type 2 diabetes (n=68) with differences in the duration of physical activity sessions (multivariate-adjusted P=0.041) and the number of moderate to high intensity exercise sessions per week (multivariate-adjusted P=0.007). In men no differences in LTPA were observed between individuals with screen-detected (n=126) and with known type 2 diabetes (n=109).

CONCLUSIONS

This study supplies indirect evidence that in women, but not in men, with diagnosed type 2 diabetes exercise counselling or other treatment related factors produces the desired increase in LTPA.

Evaluation of a diabetes management system based on practice guidelines, integrated care, and continuous quality management in a Federal State of Germany: a population-based approach to health care research

OBJECTIVE

The aim of this study was to evaluate the Saxon Diabetes Management Program (SDMP), which is based on integrated practice guidelines, shared care, and integrated quality management. The SDMP was implemented into diabetes contracts between health insurance providers, general practitioners (GPs), and diabetes specialized practitioners (DSPs) unified in the Saxon association of Statutory Health Insurance Physicians.

RESEARCH DESIGN AND METHODS

The evaluation of the SDMP in Germany represents a real-world study by using clinical data collected from participating physicians. Between 2000 and 2002 all DSPs and about 75% of the GPs in Saxony participated. Finally, 291,771 patients were included in the SDMP. Cross-sectional data were evaluated at the beginning of 2000 (group A1) and at the end of 2002 (group A2). A subcohort of 105,204 patients was followed over a period of 3 years (group B).

RESULTS

The statewide implementation of the SDMP resulted in a change in therapeutic practice and in better cooperation. The median A1C at the time of referral to DSPs decreased from 8.5 to 7.5%, and so did the overall mean. At the end, 78 and 61% of group B achieved the targets for A1C and blood pressure, respectively, recommended by the guidelines compared with 69 and 50% at baseline. Patients with poorly controlled diabetes benefited the most. Preexisting regional differences were aligned.

CONCLUSIONS

Integrated care disease management with practicable integrated quality management including collaboration between GPs and specialist services is a significant innovation in chronic care management and an efficient way to improve diabetes care continuously.

Raising diabetes awareness in the public domain

Type 2 diabetes mellitus (T2DM) is a chronic, debilitating and costly disease associated with severe complications, and has been recognised as such by the United Nations (UN). But despite being a leading cause of death and serious disability worldwide, the public often perceive T2DM as a relatively mild condition. Furthermore, many people do not know that T2DM is preventable and that steps can be taken to minimise the risk of developing the disease. Improved public awareness of T2DM and its link with obesity and physical inactivity is critical, not only to prevention but also management of diabetes. Recognising this need, the UN has issued a resolution calling on member states to observe World Diabetes Day and implement education and mass media initiatives to raise public awareness of diabetes and its complications. This article reviews selected local, national and international public awareness campaigns to illustrate the range of initiatives that together can work towards the goals of the UN Resolution. By building understanding of diabetes, changing beliefs and attitudes and promoting positive behaviours, such initiatives can help combat the global diabetes epidemic and improve the health and wellbeing of people.

Exercise: the brittle cornerstone of type 2 diabetes treatment

Regular exercise has been recommended for diabetes patients for many years; however, it is not widely used clinically. This may be because of high costs, lack of reimbursement, low compliance and/or absence of proper infrastructure. Alternatively, structured exercise therapy may be underutilised because current guidelines do not include detailed information on the preferred type and intensity of exercise that should be applied to maximise the benefits of exercise for different subgroups of patients with type 2 diabetes. Based on available evidence and our own clinical research experience this article proposes that exercise therapy in type 2 diabetes might be more effective if (1) cardiac rehabilitation programmes served as a model for 'pre-cardiac diabetes rehabilitation'; (2) resistance exercise were prescribed for sarcopenic or severely deconditioned type 2 diabetes patients; and (3) a multidisciplinary approach and continued exercise training under personal supervision became standard therapy. Nevertheless, more clinical research is warranted to establish the efficacy of an approach that takes into account type 2 diabetes subpopulations at different stages of the disease and with different levels of comorbidity.

Does home-based exercise improve body mass index in patients with type 2 diabetes? Results of a feasibility trial

AIMS

This feasibility trial evaluated the use, safety, and short-term benefits of a home-based exercise intervention designed to increase physical activity among adults with diabetes.

METHODS

Participants with type 2 diabetes in a group practice were recruited and randomly assigned to the home-based exercise intervention or usual care. Participants were given diabetes self-management education, instructed to exercise 30 min 5 days/week, and were followed for 3 months. The intervention contained three exercise routines (aerobic and resistance exercises). Outcomes included changes from baseline at 3 months between groups in body mass index (BMI), quality of life, A1C, and blood pressure.

RESULTS

Seventy-six sedentary adults completed the study: 49% intervention group, 68% women, 47% black, mean age 56.6+/-9.6 years. Using intention to treat analysis, a trend towards improvement between groups for BMI (mean change -0.4 versus 0.1, respectively; P=0.06) was identified. Thirty-eight percent of the intervention group adhered to 80% of the exercise recommendation and significantly improved BMI (-1.07; P<0.05). No other differences were detected between groups.

CONCLUSIONS

Home-based exercise interventions have potential to reduce BMI in patients with diabetes. The results provide variance estimates necessary to power a larger study of longer duration.

Adiposity, inflammation and hyperglycaemia in rural and urban Indian men: Coronary Risk of Insulin Sensitivity in Indian Subjects (CRISIS) Study

AIMS/HYPOTHESIS

The aim of this study was to investigate whether the higher prevalence of insulin resistance and glucose intolerance in urban compared with rural Indian men is related to their higher adiposity (percentage body fat) and the associated inflammatory state.

METHODS

We studied 149 rural, 142 urban slum and 150 urban middle-class male residents (age 30-50 years), who were selected by stratified random sampling. We measured body fat (bioimpedance), waist circumference, glucose tolerance (75 g OGTT), insulin resistance [homeostasis model assessment (HOMA-IR)], beta cell function (insulinogenic index) and inflammatory markers (total leucocyte count, IL-6, TNF-alpha and C-reactive protein).

RESULTS

Adiposity, waist circumference, HOMA-IR, insulinogenic index and both fasting and 120 min plasma glucose concentrations increased progressively from rural through to urban slum and urban middle-class men. Inflammatory markers were higher in urban than in rural men. Adiposity was strongly related to HOMA-IR (r = 0.57, p < 0.001) and to insulinogenic index and glycaemic parameters (r = 0.25, p < 0.001 for both). Adiposity explained approximately two thirds of the difference in HOMA-IR between the urban middle-class men and the rural and slum residents, but its contribution to the difference in insulinogenic index and 120 min plasma glucose concentration was not significant. Inclusion of C-reactive protein, IL-6 and total leucocyte count in the models did not further explain these results, nor did the inclusion of waist circumference. There was a significant residual difference after these adjustments.

CONCLUSIONS/INTERPRETATION

Adiposity is a major contributor to the difference in insulin resistance between rural and urban Indian men; there was no additional contribution from inflammation or central obesity. Other unmeasured factors also seem to contribute to the metabolic differences between rural and urban men.