1. WHAT DOES THE LITERATURE REVEAL ABOUT THE INTERVENTION OF EXERCISE IN A DIABETIC PATIENT TO KEY EVALUATION PARAMETERS OF HEMOGLOBIN A1C, LDL, AND INSULIN REQUIREMENTS
Anthony Peltier
Brandon Zolynsky
Darlene D'Arcangelo
Ferris State University
Nursing Research

2. What is Diabetes
A disease in which the body does not produce enough insulin (Type 1) or does not react appropriately to the insulin produced (Type 2)
Insulin is a hormone that allows our cells to absorb glucose
When cells do not absorb glucose excessive amounts accumulate in the blood stream and cause complications

3. What is Diabetes (Cont.)
Diabetes is a prevalent and costly condition associated with substantial morbidity and mortality
Diabetes effects approximately 170 million people worldwide and is increasing
Diabetes is associated with substantial financial impacts

4. Type 1 Diabetes: Diminished Insulin

5. Type 2 Diabetes: Diminished insulin sensitivity

6. Key Health Indicators Hemoglobin A1C LDL Insulin Requirements
Health care providers use three key indicators to help manage the health of individuals with Diabetes:
Hemoglobin A1C
LDL
Insulin Requirements
These three indicators are considered the standard of care for evaluation of blood sugar control and health

7. The three indicators
A review of what the literature reveals about the impacts exercise has on the three key indicators was performed and will be reviewed

8. The three indicators Hemoglobin A1C
Hemoglobin A1C is a test that evaluates glucose attachment to hemoglobin, which is the protein in red blood cells that carries oxygen
A1C testing provides an average of an individual’s blood glucose levels over a three month period
A high A1C percentage means the glucose levels have also been high which can lead to diabetes or contribute to diabetes related negative outcomes
An appropriate A1C is < 5.7

9. Hemoglobin A1C (Cont.)
Research supports the positive impacts exercise has on A1C levels
Research was conducted by comparing studies of an exercise program in which participants exercised more than 150 minutes per week and less than 150 minutes
Diabetics who exercised 150 minutes averaged a 0.89 percent drop in A1C (Umpierre et al., 2011)
Those who exercised less than 150 minutes had only a 0.36 percent reduction in A1C (Umpierre et al., 2011)

10. Low Density Lipoprotein
LDL or low density lipoprotein is commonly referred to as bad cholesterol
LDL is thought to collect in vessels and arteries and contribute to atherosclerosis
Atherosclerosis is the process by which arteries and vessels narrow due to plaque build up and cause an increased risk of Myocardial Infarction

11. Low Density Lipoprotein
Diabetics are at a much higher risk for adverse cardiac events, thus the medical community recommends much tighter control on LDL levels
Less than 70mg/dL is the standard of care
The American Diabetes Association (ADA) has strong recommendations on exercise and the positive impacts exercise can have on lowering LDL levels

12. Low Density Lipoprotein
A study conducted by Huang, Tai, Yang, & Wang, 2012 concluded that “exercise can effectively control HbA1c and lipid levels for patient with diabetes”
The study concluded that “Hba1C, TC, TH, and LDL levels of the experimental group were significantly lower than those of the control group at both the 8th week and 16th week (Huang, Tai, Yang, & Wang, 2012)

13. Insulin Requirements Insulin is a hormone secreted by the pancreas
Insulin helps your body cells take in insulin
Typically in poorly controlled diabetics insulin requirements are very high
Exercise will increase the body's use of excess glucose thus theoretically lower insulin requirements

14. Insulin Requirements
Exercise and remaining physically active is one of the most powerful treatments an insulin dependent diabetic can do to remain healthy and help decrease the amount of insulin needed
Exercise enhances the body’s sensitivity to insulin, particularly if exercise is aerobic (Stratton PhD, Wilson MD, Enderes MD, and Goldstein MD. 1987, p. 592)
When diabetics exercise less insulin is required to control glucose levels (Stratton Phd, Wilson MD, Enderes MD, and Goldstein MD. 1987, p 591)

15. Conclusion
HgbA1c was the indicator was most addressed in the research articles that were used for this study, this tells us that HgbA1c is regarded as the one of the most used indicators when gauging the control of health in diabetics
The indicator with the least amount of identifiable research was insulin requirements and the impact of exercise. This indicates that insulin resistance is not regarded as a highly important indicator when gauging the control of one's diabetic health, that it is not greatly affected by the implementation of an exercise program, or this is an area lacking good research and presents an opportunity for future work

16. References
Tamura, T., Kida, K., Seki, T., Suetsuna, F., & Kasai, N. (2011). Study of the Relationship between Exercise Therapy and Diet Therapy in Type 2 Diabetes Mellitus Patients. Journal of Physical Therapy Science, 23(3),
Stratton, PhD, R., Wilson, MD, D. P., Endres, MD, R. K., & Goldstein, MD, D. E. (1987). Improved Glycemic Control AFter Supervised 8-wk Exercise Program in Insulin-Dependent Adolescents. Diabetes Care, 10(5),
Colberg, PhD, S. R., Zarrabi, MPH, L., Bennington, RN, MSN, CSN, L., Nakave, MD, A., Somma, EdD, C. T., Swain, PhD, D. P., & Sechrist, EdD, S. R. (2009). Postprandial Walking is Better for Lowering the Glycemic Effect of Dinner than Pre-Dinner Exercise in Type 2 Diabetic Individuals. JAMDA, 10,

17. References
Balducci, S., Zanuso, S., Cardelli, P., Salvi, L., Mazzitelli, G., Bazuro, A., Iacobini, C., Nicolucci, A., Pugliese, G.. (2012) Changes in Physical Fitness Predict Improvements in Modifiable Cardiovascular Risk Factors Independently of Body Weight Loss in Subjects With Type 2 Diabetes Participating in the Italian Diabetes and Exercise Study (IDEAS): Diabetes. Diabetes Care, 35: Reterived from: care.diabetesjournals.org
Umpierre, D., Ribeiro, P., Kramer, C., Leitao, C., Zucatti, A., Azevedo, M., Gross, J., Ribeiro, J., Schaan, B. Physical Acitvity Advice only or Structured Exercise Traning and Association with HbA1c levels with Type 2 Diabetics. (2011). Journal of American Medical Association, 305: Reterived from: http//jama.jamanetwork.com
Huang, C., Tai, Y., Yang, Y., Wang, R. Efficacy of Five-Element Gymnastics in Glucose and Lipid Control in Taiwanese Patient with Type 2 Diabetes. (2012). Research in Nursing & Health, 35. DOI: /nur.21480