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Diabetes Mellitus Type 2: New Advances & Research

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Presentation on theme: "Diabetes Mellitus Type 2: New Advances & Research"— Presentation transcript:

1 Diabetes Mellitus Type 2: New Advances & Research
Leon Lategan University of Johannesburg South Africa

2 At a Glance Diabetes Complications Current Research
Summary and Take Home Message

3 Diabetes Mellitus (DM)
“Sugar Diabetes” Increased blood glucose concentration Type 1: no insulin produced by the pancreas (10%) Previously “juvenile diabetes” Type 2: insulin resistance at cellular level (90%) Previously “adult-onset diabetes”

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5 Prevalence Africa: 12 million in 2010 projection is 24 million in 2030
App. 347 million people worldwide have diabetes. More than 80% of people with diabetes live in low- and middle-income countries. The WHO projects that diabetes deaths will double between 2005 and 2030. Africa: 12 million in 2010 projection is 24 million in 2030 (WHO)

6 DM in Africa Egypt: 16.5% Sub-Saharan Africa Iran: 10.5%
Gabon: 10% Algeria: 7.5% Cameroon: 6% Kenya: 5% Nigeria: 5% Ghana: 3% Sub-Saharan Africa Mauritius: 15% Botswana: 11% Zimbabwe: 10% South Africa: 7% Zambia: 5% Mozambique: 3%

7 Warning Signs of DM Polydipsia: increased thirst
Polyuria: increased urination Polyphagia: excessive hunger Fatigue Many infections Headaches Blurred vision Dizziness Dehydration Rapid heart rate Unexplained weight loss

8 Diagnosis of DM Fasting glucose test: ≥ 126 mg·dL−1 (7.0 mmol·L−1)
Glucose tolerance test: ≥ 200 mg·dL−1 (11.1 mmol·L−1) HbA1c : ≥ 6.5% or Diabetic emergency: vomiting, dehydration & ketoacidosis, …

9 Thus, DM has to be managed !
Complications of DM Hypo- and hyperglycemia: coma & death Retinopathy: loss of vision / blindness Peripheral neuropathy & gangrene: limb amputation Renal / kidney failure: death Coronary artery disease: myocardial infarction or stroke Thus, DM has to be managed !

10 Current Research Pearls from 2010 – 2014 Warning:
Not a systematic review or Meta-analysis

11 Change in Physical Activity after a Diabetes Diagnosis: Opportunity for Intervention
A disease diagnosis may motivate Pxs to increase their physical activity levels. Primary healthcare practitioners should thus make use of this opportunity/window to educate their Pxs about the role of physical activity. Schneider et al. (2014). Med Sci Sp & Ex, 46(1):84-91

12 Investigating telephone support as a strategy to increase the physical activity levels of people with diabetes 12 Telephone calls: once a week for 20 minutes each “The number of people classified as active increased by 31% and 85% were considered physically active at the end of the intervention.” The results verify the efficacy of telephone support as a strategy to increase physical activity levels in people with diabetes … Zanetti et al. (2014). Journal of Diabetes Nursing, 18(1):p32-36

13 Suggestion Why not Consider DM Education & Motivation to Exercise:
Bulk SMS WhatsApp Twitter FaceBook Etc…

14 Beyond Basic Exercise Guidelines: Is Sitting really the new Smoking?
Sedentary time is closely related to adverse health risks even if individuals perform physical activity on a daily basis. …too much sitting can be detrimental to health … Mary Stenson (College of Saint Benedict, Saint John’s University) Forum Lectures:

15 So what happens when we sit ?

16 Associations of overall sitting time and TV viewing time with fibrinogen and C reactive protein: the AusDiab study Conclusions: Overall sitting time was positively associated with plasma fibrinogen and high sensitivity CRP in men and women. Plasma fibrinogen & CRP are important markers of all-cause mortality and cardio- metabolic disease like DM T2. Howard et al. (2014). Br J Sports Med, 1-5

17 Sitting may make you sick
Conclusion Sitting may make you sick

18 PHARMACOLOGICAL EXERCISE MIMETICS IN THERAPY: DELUSION OR FUTURE?
Recognizing the beneficial effects of physical activity on health researchers have focused on the active substances that mimic or potentiate the effects of exercise and big pharmaceutical companies see a potentially huge market and profit in this However, mimicking exercise by means of drugs can lead to a chronic catabolic state. Vitošević et al. (2013). Acta Medica Medianae, 52(4):58-62

19 High-intensity exercise training for the prevention of type 2 diabetes mellitus
The American Diabetes Association (ADA) recommends that adults with prediabetes engage in ≥ 150 minutes per week of moderate activity and target a 7% weight loss. Although patients can accrue all exercise benefits by performing low intensity or medium intensity activities such as walking, high intensity activities (>70% HRR or RPE) represent a time- efficient alternative to meeting physical activity guidelines. Rynders & Weltman (2014). The Physician and Sportsmedicine, 42(1):7-14

20 One Bout of Exercise Alters Free-Living Postprandial Glycemia in Type 2 Diabetes
One bout of 60 minutes of aerobic exercise at a moderate intensity (70% HRmax) reduced average blood glucose levels for 24 hours The authors concluded that Type 2 diabetics should exercise daily to reap the maximal benefits from exercise. Oberlin et al. (2014). Med Sci Sp & Ex, 46(2):

21 Moderate intensity: 60% - 70% HRmax
Exercise prescription for patients with type 2 diabetes and pre-diabetes: A position statement from Exercise and Sport Science Australia 210 min/week Moderate intensity: 60% - 70% HRmax Combine aerobic & resistance exercise Hordern et al. (2012). Journal of Science and Medicine in Sport, 15: 25–31

22 Why look for a new drug when we have: EXERCISE
Conclusion Why look for a new drug when we have: EXERCISE

23 Exercise is Medicine for Diabetes
Example of an Exercise Programme for a Diabetic Walk / jog / cycle for 30 min Push-ups & Lunges 2 sets of 15 reps Stretch Hamstrings, Calves and Lower back 2 x 30 sec

24 Summary Exercise must form part of DM management
Africa is not immune to DM DM has serious complications Sitting time must be reduced Education & Communication is important Exercise must form part of DM management

25 Questions

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28 Diabetes: Risks during exercise
Hypoglycemia (<4.0 mmol/l) – very rare in DM T2, but should be avoided in Type 1 Pxs Abstain from exercise during acute illness or with fever Peripheral Neuropathy – monitor feet for blisters and wounds that don’t heal Comorbidities: Hypertension, Peripheral vascular disease, Obesity & OA

29 Children Active To Stay Healthy (CASH): Exercise as a Tool for Reducing Inflammation and Cardiovascular Risk in Sedentary, Pubescent Adolescents With Obesity … high intensity interval exercise … may elicit greater improvements to endothelial function … for children with obesity, but also other inflammatory diseases such as diabetes, cancer, and arthritis. Starkoff, Brooke E. (Doctoral Dissertation) The Ohio State University, 2013

30 Cognitive status and foot self care practice in overweight diabetics, engaged in different levels of physical activity Regular physical activity can help promote cognitive status and foot self care practice in overweight patients with type 2 diabetes. Journal of Diabetes & Metabolic Disorders February 2014, 13:31

31 Exercise Dose ? HRPAS = % HRR x duration (min)
Heart Rate Physical Activity Score (HRPAS) HRPAS = % HRR x duration (min) Example: HRPAS = 60% HRR x 20 min = 120 Miller et al. (2014). Med Sci Sp & Ex, 46(1):69-75


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