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Bhatnagar A, Ting DSW, Weng CY. Treatment Options for Diabetic Macular Edema. Int Ophthalmol Clin 2024; 64:57-69. [PMID: 38146881 DOI: 10.1097/iio.0000000000000518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2023]
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Barańska A, Błaszczuk A, Polz-Dacewicz M, Kanadys W, Malm M, Janiszewska M, Jędrych M. Effects of Soy Isoflavones on Glycemic Control and Lipid Profile in Patients with Type 2 Diabetes: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Nutrients 2021; 13:nu13061886. [PMID: 34072748 PMCID: PMC8229139 DOI: 10.3390/nu13061886] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Revised: 05/25/2021] [Accepted: 05/28/2021] [Indexed: 12/30/2022] Open
Abstract
The aim of the report was to investigate the impact of soy protein and isoflavones on glucose homeostasis and lipid profile in type 2 diabetes. The studies used in this report were identified by searching through the MEDLINE and EMBASE databases (up to 2020). Meta-regression and subgroup analyses were performed to explore the influence of covariates on net glycemic control and lipid changes. Weighted mean differences and 95% confidence intervals (CI) were calculated by using random-effect models. Changes in the lipid profile showed statistically significant decreases in total cholesterol and LDL-C concentrations: ‒0.21 mmol/L; 95% CI, ‒0.33 to ‒0.09; p = 0.0008 and ‒0.20 mmol/L; 95% CI, ‒0.28 to ‒0.12; p < 0.0001, respectively, as well as in HDL-C (−0.02 mmol/L; 95% CI, −0.05 to 0.01; p = 0.2008 and triacylglycerols (−0.19 mmol/L; 95% CI, −0.48 to 0.09; p = 0.1884). At the same time, a meta-analysis of the included studies revealed statistically insignificant reduction in fasting glucose, insulin, HbA1c, and HOMA-IR (changes in glucose metabolism) after consumption of soy isoflavones. The observed ability of both extracted isoflavone and soy protein with isoflavones to modulate the lipid profile suggests benefits in preventing cardiovascular events in diabetic subjects. Further multicenter studies based on larger and longer duration studies are necessary to determine their beneficial effect on glucose and lipid metabolism.
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Affiliation(s)
- Agnieszka Barańska
- Department of Medical Informatics and Statistics with E-Learning Lab, Medical University of Lublin, 20-090 Lublin, Poland; (M.M.); (M.J.); (M.J.)
- Correspondence:
| | - Agata Błaszczuk
- Department of Virology with SARS Laboratory, Medical University of Lublin, 20-093 Lublin, Poland; (A.B.); (M.P.-D.)
| | - Małgorzata Polz-Dacewicz
- Department of Virology with SARS Laboratory, Medical University of Lublin, 20-093 Lublin, Poland; (A.B.); (M.P.-D.)
| | | | - Maria Malm
- Department of Medical Informatics and Statistics with E-Learning Lab, Medical University of Lublin, 20-090 Lublin, Poland; (M.M.); (M.J.); (M.J.)
| | - Mariola Janiszewska
- Department of Medical Informatics and Statistics with E-Learning Lab, Medical University of Lublin, 20-090 Lublin, Poland; (M.M.); (M.J.); (M.J.)
| | - Marian Jędrych
- Department of Medical Informatics and Statistics with E-Learning Lab, Medical University of Lublin, 20-090 Lublin, Poland; (M.M.); (M.J.); (M.J.)
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Soltanipour S, Hasandokht T, Soleimani R, Mahdavi-Roshan M, Jalali MM. Systematic Review and Meta-Analysis of the Effects of Soy on Glucose Metabolism in Patients with Type 2 Diabetes. Rev Diabet Stud 2019; 15:60-70. [PMID: 31648293 PMCID: PMC6946090 DOI: 10.1900/rds.2019.15.60] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Revised: 10/10/2019] [Accepted: 10/10/2019] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVE This study aimed to assess the effects of soy consumption on glucose metabolism in patients with type 2 diabetes. METHODS A systematic review was performed in accordance with the Preferred Reporting Items for Systematic Review (PRISMA) principles. Literature published between 1990 and 2019 was searched. Primary outcomes were the effect of soy on fasting plasma glucose (FPG), insulin, and HbA1c. The data were pooled using random effects models. Heterogeneity was assessed using Cochran's Q and I2 statistics. Also, the Cochrane Collaboration's tool for assessing risk of bias was used, and sensitivity analysis and meta-regression were conducted. Publication bias was evaluated using Egger and Begg tests. RESULTS Sixteen randomized clinical trials (RCTs) with a total of 471 participants were regarded as eligible and included in the study. Soy consumption had no significant effects on FPG, insulin, and HbA1c. After the "trim-and-fill" method was applied, soy revealed a significant effect size on FPG (adjusted Cohen's d: -0.18; p = 0.03). Also, subgroup analyses using studies with parallel design showed a significant improvement (moderate effect size) in FPG and insulin. Sensitivity analysis indicated the robustness of our findings. Among secondary outcomes, the results showed a significant effect of soy on HOMA-IR and total cholesterol levels. CONCLUSIONS Although this systematic review and meta-analysis indicated no beneficial effects of soy consumption on FPG, insulin, and HbA1c in patients with type 2 diabetes, pooling of parallel studies showed different results from crossover studies. The quality of evidence revealed low levels of confidence for primary outcomes. Therefore, further research is recommended.
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Affiliation(s)
- Soheil Soltanipour
- School of Medicine, Guilan University of Medical Sciences, Rasht, Guilan, Iran
| | - Tolou Hasandokht
- School of Medicine, Guilan University of Medical Sciences, Rasht, Guilan, Iran
| | - Robabeh Soleimani
- Kavosh Cognitive Behavior Sciences and Addiction Research Center, School of Medicine, Shafa Hospital, Guilan University of Medical Sciences, Rasht, Guilan, Iran
| | | | - Mir Mohammad Jalali
- Otorhinolaryngology Research Center, School of Medicine, Amiralmomenin Hospital, Guilan University of Medical Sciences, Rasht, Guilan, Iran
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Støa EM, Meling S, Nyhus LK, Glenn Strømstad, Mangerud KM, Helgerud J, Bratland-Sanda S, Støren Ø. High-intensity aerobic interval training improves aerobic fitness and HbA1c among persons diagnosed with type 2 diabetes. Eur J Appl Physiol 2017; 117:455-467. [PMID: 28160083 DOI: 10.1007/s00421-017-3540-1] [Citation(s) in RCA: 56] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2016] [Accepted: 01/09/2017] [Indexed: 12/16/2022]
Abstract
PURPOSE It remains to be established how high-intensity aerobic interval training (HAIT) affects risk factors associated with type 2 diabetes (TD2). This study investigated effects of HAIT on maximal oxygen uptake (VO2max), glycated Hemoglobin type A1C (HbA1c), insulin resistance (IR), fat oxidation (FatOx), body weight (BW), percent body fat (%BF), lactate threshold (LT), blood pressure (BP), and blood lipid profile (BLP) among persons with T2D. Results were compared to the effects after a moderate-intensity training (MIT) program. METHODS Thirty-eight individuals with T2D completed 12 weeks of supervised training. HAIT consisted of 4 × 4 min of walking or running uphill at 85-95% of maximal heart rate, and MIT consisted of continuous walking at 70-75% of maximal heart rate. RESULTS A 21% increase in VO2max (from 25.6 to 30.9 ml kg-1 min-1, p < 0.001), and a reduction in HbA1c by -0.58% points (from 7.78 to 7.20%, p < 0.001) was found in HAIT. BW and body mass index (BMI) was reduced by 1.9% (p < 0.01). There was a tendency towards an improved FatOx at 60% VO2max (14%, p = 0.065). These improvements were significant different from MIT. Both HAIT and MIT increased velocity at LT, and reduced %BF, waist circumference, hip circumference, and BP, with no significant differences between the two groups. Correlations were found between change in VO2max and change in HbA1c when the two intervention groups were combined (R = -0.52, p < 0.01). CONCLUSION HAIT is an effective exercise strategy to improve aerobic fitness and reduce risk factors associated with T2D.
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Affiliation(s)
- Eva Maria Støa
- Department of Sports, Physical Education and Outdoor Life Studies, University College of Southeast Norway, Bø, Porsgrunn, Norway.
| | - Sondre Meling
- Department of Endocrinology, Stavanger University Hospital, Former Hospital of Telemark, Stavanger, Norway
| | - Lill-Katrin Nyhus
- Department of Sports, Physical Education and Outdoor Life Studies, University College of Southeast Norway, Bø, Porsgrunn, Norway
| | - Glenn Strømstad
- Department of Sports, Physical Education and Outdoor Life Studies, University College of Southeast Norway, Bø, Porsgrunn, Norway
| | - Karl Magnus Mangerud
- Department of Sports, Physical Education and Outdoor Life Studies, University College of Southeast Norway, Bø, Porsgrunn, Norway
| | - Jan Helgerud
- Department of Sports, Physical Education and Outdoor Life Studies, University College of Southeast Norway, Bø, Porsgrunn, Norway.,Department of Circulation and Medical Imaging, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway.,Hokksund Medical Rehabilitation Center, Hokksund, Norway
| | - Solfrid Bratland-Sanda
- Department of Sports, Physical Education and Outdoor Life Studies, University College of Southeast Norway, Bø, Porsgrunn, Norway
| | - Øyvind Støren
- Department of Sports, Physical Education and Outdoor Life Studies, University College of Southeast Norway, Bø, Porsgrunn, Norway
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Khoshpey B, Djazayeri S, Amiri F, Malek M, Hosseini AF, Hosseini S, Shidfar S, Shidfar F. Effect of Royal Jelly Intake on Serum Glucose, Apolipoprotein A-I (ApoA-I), Apolipoprotein B (ApoB) and ApoB/ApoA-I Ratios in Patients with Type 2 Diabetes: A Randomized, Double-Blind Clinical Trial Study. Can J Diabetes 2016; 40:324-8. [PMID: 27026221 DOI: 10.1016/j.jcjd.2016.01.003] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2015] [Revised: 01/06/2016] [Accepted: 01/22/2016] [Indexed: 12/11/2022]
Abstract
OBJECTIVES Type 2 diabetes is the most common metabolic disorder worldwide. Evidence supports a role for royal jelly (RJ) in reduction of serum glucose and lipids in animals and healthy subjects. The purpose of this study was to determine the effect of RJ intake on serum glucose, apolipoprotein A-I (ApoA-I), apolipoprotein B (ApoB) and ApoB/ApoA-I ratios in patients with type 2 diabetes. METHODS Fifty patients with type 2 diabetes participated in a double-blind, placebo-controlled study. The participants were randomly divided into RJ and placebo groups and were given doses of 1000 mg royal jelly or placebo 3 times a day for 8 weeks, respectively. Weight, height, fasting blood glucose, ApoA-I and ApoB were measured at baseline and endpoint. RESULTS There were no significant differences in baseline characteristics and dietary intakes between groups. The mean difference in glucose concentrations decreased in the RJ group (-9.4 mg/dL vs. 4 mg/dL; p=0.011). The mean difference in ApoA-I concentrations increased in the RJ group (34.4 mg/dL vs. -1.08 mg/dL; p=0.013). There was a significant decrease in mean difference of ApoB/ApoA-I in the RJ group compared with the placebo group (0.008 vs. 0.13; p<0.044), respectively. CONCLUSIONS These data suggest that RJ intake may have desirable effects on serum glucose, Apo-A-I concentrations and ApoB/ApoA-I ratios in people with type 2 diabetes.
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Affiliation(s)
- Basemeh Khoshpey
- Department of Nutrition, School of Public Health, Iran University of Medical Sciences, Tehran, Iran
| | - Shima Djazayeri
- Department of Nutrition, School of Public Health, Iran University of Medical Sciences, Tehran, Iran
| | - Fatemehsadat Amiri
- Department of Nutrition, School of Public Health, Iran University of Medical Sciences, Tehran, Iran
| | - Mojtaba Malek
- Endocrine Research Center, Institute of Endocrinology and Metabolism, Firouzgar Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Agha Fateme Hosseini
- Department of Statistics, School of Public Health, Iran University of Medical Sciences, Tehran, Iran
| | - Sharieh Hosseini
- Department of Applied Chemistry, Faculty of Pharmaceutical Chemistry, Pharmaceutical Sciences Branch, Islamic Azad University, Tehran, Iran
| | - Shahrzad Shidfar
- Worcester Memorial Hospital, University of Massachusetts, Worcester, Massachusetts, USA
| | - Farzad Shidfar
- Department of Nutrition, School of Public Health, Iran University of Medical Sciences, Tehran, Iran.
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Visram S, Bremner AS, Harrington BE, Hawthorne G. Factors affecting uptake of an education and physical activity programme for newly diagnosed type 2 diabetes. ACTA ACUST UNITED AC 2015. [DOI: 10.1002/edn.97] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Heden TD, Winn NC, Mari A, Booth FW, Rector RS, Thyfault JP, Kanaley JA. Postdinner resistance exercise improves postprandial risk factors more effectively than predinner resistance exercise in patients with type 2 diabetes. J Appl Physiol (1985) 2014; 118:624-34. [PMID: 25539939 DOI: 10.1152/japplphysiol.00917.2014] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Abnormally elevated postprandial glucose and triacylglycerol (TAG) concentrations are risk factors for cardiovascular disease in type 2 diabetes. The most effective time to exercise to lower postprandial glucose and TAG concentrations is unknown. Thus the aim of this study was to determine what time is more effective, either pre- or postdinner resistance exercise (RE), at improving postprandial risk factors in patients with type 2 diabetes. Thirteen obese patients with type 2 diabetes completed three trials in a random order in which they consumed a dinner meal with 1) no RE (NoRE), 2) predinner RE (RE → M), and 3) postdinner RE beginning 45 min after dinner (M → RE). Clinical outcome measures included postprandial glucose and TAG concentrations. In addition, postprandial acetaminophen (gastric emptying), endocrine responses, free fatty acids, and β-cell function (mathematical modeling) were measured to determine whether these factors were related to changes in glucose and TAG. The TAG incremental area under the curve (iAUC) was ∼92% lower (P ≤ 0.02) during M → RE compared with NoRE and RE → M, an effect due in part to lower very-low-density lipoprotein-1 TAG concentrations. The glucose iAUC was reduced (P = 0.02) by ∼18 and 30% during the RE → M and M → RE trials, respectively, compared with NoRE, with no difference between RE trials. RE → M and M → RE reduced the insulin iAUC by 35 and 48%, respectively, compared with NoRE (P < 0.01). The glucagon-like peptide-1 iAUC was ∼50% lower (P ≤ 0.02) during M → RE compared with NoRE and RE → M. Given that predinner RE only improves postprandial glucose concentrations, whereas postdinner RE improves both postprandial glucose and TAG concentrations, postdinner RE may lower the risk of cardiovascular disease more effectively.
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Affiliation(s)
- Timothy D Heden
- Department of Nutrition and Exercise Physiology, University of Missouri, Columbia, Missouri
| | - Nathan C Winn
- Department of Nutrition and Exercise Physiology, University of Missouri, Columbia, Missouri
| | - Andrea Mari
- Institute of Biomedical Engineering, National Research Council, Padova, Italy
| | - Frank W Booth
- Department of Nutrition and Exercise Physiology, University of Missouri, Columbia, Missouri; Department of Biomedical Sciences, University of Missouri, Columbia, Missouri
| | - R Scott Rector
- Department of Nutrition and Exercise Physiology, University of Missouri, Columbia, Missouri; Medicine Division of Gastroenterology and Hepatology, University of Missouri, Columbia, Missouri; and Research Service, Harry S. Truman Memorial Veterans Affairs Hospital, University of Missouri, Columbia, Missouri
| | - John P Thyfault
- Department of Nutrition and Exercise Physiology, University of Missouri, Columbia, Missouri; Medicine Division of Gastroenterology and Hepatology, University of Missouri, Columbia, Missouri; and Research Service, Harry S. Truman Memorial Veterans Affairs Hospital, University of Missouri, Columbia, Missouri
| | - Jill A Kanaley
- Department of Nutrition and Exercise Physiology, University of Missouri, Columbia, Missouri;
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Heden TD, Winn NC, Mari A, Booth FW, Rector RS, Thyfault JP, Kanaley JA. Postdinner resistance exercise improves postprandial risk factors more effectively than predinner resistance exercise in patients with type 2 diabetes. JOURNAL OF APPLIED PHYSIOLOGY (BETHESDA, MD. : 1985) 2014. [PMID: 25539939 DOI: 10.1152/japplphysiol.00917] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Abnormally elevated postprandial glucose and triacylglycerol (TAG) concentrations are risk factors for cardiovascular disease in type 2 diabetes. The most effective time to exercise to lower postprandial glucose and TAG concentrations is unknown. Thus the aim of this study was to determine what time is more effective, either pre- or postdinner resistance exercise (RE), at improving postprandial risk factors in patients with type 2 diabetes. Thirteen obese patients with type 2 diabetes completed three trials in a random order in which they consumed a dinner meal with 1) no RE (NoRE), 2) predinner RE (RE → M), and 3) postdinner RE beginning 45 min after dinner (M → RE). Clinical outcome measures included postprandial glucose and TAG concentrations. In addition, postprandial acetaminophen (gastric emptying), endocrine responses, free fatty acids, and β-cell function (mathematical modeling) were measured to determine whether these factors were related to changes in glucose and TAG. The TAG incremental area under the curve (iAUC) was ∼92% lower (P ≤ 0.02) during M → RE compared with NoRE and RE → M, an effect due in part to lower very-low-density lipoprotein-1 TAG concentrations. The glucose iAUC was reduced (P = 0.02) by ∼18 and 30% during the RE → M and M → RE trials, respectively, compared with NoRE, with no difference between RE trials. RE → M and M → RE reduced the insulin iAUC by 35 and 48%, respectively, compared with NoRE (P < 0.01). The glucagon-like peptide-1 iAUC was ∼50% lower (P ≤ 0.02) during M → RE compared with NoRE and RE → M. Given that predinner RE only improves postprandial glucose concentrations, whereas postdinner RE improves both postprandial glucose and TAG concentrations, postdinner RE may lower the risk of cardiovascular disease more effectively.
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Affiliation(s)
- Timothy D Heden
- Department of Nutrition and Exercise Physiology, University of Missouri, Columbia, Missouri
| | - Nathan C Winn
- Department of Nutrition and Exercise Physiology, University of Missouri, Columbia, Missouri
| | - Andrea Mari
- Institute of Biomedical Engineering, National Research Council, Padova, Italy
| | - Frank W Booth
- Department of Nutrition and Exercise Physiology, University of Missouri, Columbia, Missouri; Department of Biomedical Sciences, University of Missouri, Columbia, Missouri
| | - R Scott Rector
- Department of Nutrition and Exercise Physiology, University of Missouri, Columbia, Missouri; Medicine Division of Gastroenterology and Hepatology, University of Missouri, Columbia, Missouri; and Research Service, Harry S. Truman Memorial Veterans Affairs Hospital, University of Missouri, Columbia, Missouri
| | - John P Thyfault
- Department of Nutrition and Exercise Physiology, University of Missouri, Columbia, Missouri; Medicine Division of Gastroenterology and Hepatology, University of Missouri, Columbia, Missouri; and Research Service, Harry S. Truman Memorial Veterans Affairs Hospital, University of Missouri, Columbia, Missouri
| | - Jill A Kanaley
- Department of Nutrition and Exercise Physiology, University of Missouri, Columbia, Missouri;
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Kim HJ, Jung TS, Jung JH, Kim SK, Lee SM, Kim KY, Kim DR, Seo YM, Hahm JR. Improvement of glycemic control after re-emphasis of lifestyle modification in type 2 diabetic patients reluctant to additional medication. Yonsei Med J 2013; 54:345-51. [PMID: 23364966 PMCID: PMC3575963 DOI: 10.3349/ymj.2013.54.2.345] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
PURPOSE The aim of this study is to observe glycemic changes after emphasizing the importance of lifestyle modification in patients with mild or moderately uncontrolled type 2 diabetes. MATERIALS AND METHODS We examined 51 type 2 diabetic patients with 7.0-9.0% hemoglobin A1c (HbA1c) who preferred to change their lifestyle rather than followed the recommendation of medication change. At the enrollment, the study subjects completed questionnaires about diet and exercise. After 3 months, HbA1c levels were determined and questionnaires on the change of lifestyle were accomplished. We divided the study subjects into 3 groups: improved (more than 0.3% decrease of HbA1c), aggravated (more than 0.3% increase of HbA1c) and not changed (-0.3% <HbA1c change <0.3%). RESULTS Among the total 51 subjects, 18 patients (35.3%) showed the decreased levels of HbA1c after 3 months with mean change of -0.74±0.27%, and HbA1c values of 11 patients (21.5%) were less than 7%. In addition, the HbA1c level was significantly reduced in patients who reportedly followed the lifestyle modification such as diet and exercise for 3 months, compared with the one obtained from patients who refused this lifestyle change (p=0.002). CONCLUSION In this study, 35.3% of the patients with mild or moderately uncontrolled type 2 diabetes showed the significant improvement of HbA1c levels after 3 months by simply regulating their daily diet and exercise without change of medication. This suggests that the lifestyle modification is significantly associated with the improvement of glucose control.
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Affiliation(s)
- Hee Jin Kim
- Department of Internal Medicine, Gyeongsang National University School of Medicine, Jinju, Korea
| | - Tae Sik Jung
- Department of Internal Medicine, Gyeongsang National University School of Medicine, Jinju, Korea
- Institute of Health Science, Gyeongsang National University School of Medicine, Jinju, Korea
| | - Jung Hwa Jung
- Department of Internal Medicine, Gyeongsang National University School of Medicine, Jinju, Korea
- Institute of Health Science, Gyeongsang National University School of Medicine, Jinju, Korea
| | - Soo Kyoung Kim
- Department of Internal Medicine, Gyeongsang National University School of Medicine, Jinju, Korea
- Institute of Health Science, Gyeongsang National University School of Medicine, Jinju, Korea
| | - Sang Min Lee
- Department of Internal Medicine, Gyeongsang National University School of Medicine, Jinju, Korea
| | - Kyong Young Kim
- Department of Internal Medicine, Gyeongsang National University School of Medicine, Jinju, Korea
| | - Deok Ryong Kim
- Department of Biochemistry, Gyeongsang National University School of Medicine, Jinju, Korea
- Institute of Health Science, Gyeongsang National University School of Medicine, Jinju, Korea
| | - Yeong Mi Seo
- Nursing Department of Dongseo University, Busan, Korea
| | - Jong Ryeal Hahm
- Department of Internal Medicine, Gyeongsang National University School of Medicine, Jinju, Korea
- Institute of Health Science, Gyeongsang National University School of Medicine, Jinju, Korea
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Hansen E, Landstad BJ, Gundersen KT, Torjesen PA, Svebak S. Insulin Sensitivity After Maximal and Endurance Resistance Training. J Strength Cond Res 2012; 26:327-34. [DOI: 10.1519/jsc.0b013e318220e70f] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Abstract
An active lifestyle increases general health and is protects from a number of different conditions, including exercise and obesity. There is emerging evidence that exercise by itself exerts clinically beneficial effects in both lean and obese subjects, even in the absence of effects on weight.1 Recent results have brought an increasing understanding of the molecular mechanisms underlying the beneficial effects of exercise at the level of metabolism and changes in gene expression. There is a significant dose-response to the effect of exercise, and the current guidelines regarding exercise amount may need to be revised upwards. Furthermore, this treatment option should not be overlooked.
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Affiliation(s)
- Donal J O'Gorman
- School of Health and Human Performance, Dublin City University, Dublin, Ireland
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Balhara YPS, Sagar R. Correlates of anxiety and depression among patients with type 2 diabetes mellitus. Indian J Endocrinol Metab 2011; 15:S50-S54. [PMID: 21847456 PMCID: PMC3152186 DOI: 10.4103/2230-8210.83057] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
CONTEXT Research has established the relation between diabetes and depression. Both diabetes and anxiety/depression are independently associated with increased morbidity and mortality. AIMS The present study aims at assessing the prevalence of anxiety/depression among outpatients receiving treatment for type 2 diabetes. SETTINGS AND DESIGN The study was conducted in the endocrinology outpatient department of an urban tertiary care center. MATERIALS AND METHODS The instruments used included a semi-structured questionnaire, HbA1c levels, fasting blood glucose and postprandial blood glucose, Brief Patient Health Questionnaire, and Hospital Anxiety and Depression Scale (HADS). STATISTICAL ANALYSIS USED Analysis was carried out using the SPSS version 16.0. Pearson's correlation coefficient was calculated to find out the correlations. ANOVA was carried out for the in between group comparisons. RESULTS There was a significant correlation between the HADS-Anxiety scale and Body Mass Index (BMI) with a correlation coefficient of 0.34 (P = 0.008). Also, a significant correlation existed between HADS-Depression scale and BMI (correlation coefficient, 0.36; P = 0.004). Significant correlation were observed between the duration of daily physical exercise and HADS-Anxiety (coefficient of correlation, -0.25; P = 0.04) scores. HADS-Anxiety scores were found to be related to HbA1c levels (correlation-coefficient, 0.41; P = 0.03) and postprandial blood glucose levels (correlation-coefficient, 0.51; P = 0.02). CONCLUSIONS Monitoring of biochemical parameters like HbA1c and postprandial blood glucose levels and BMI could be a guide to development of anxiety in these patients. Also, physical exercise seems to have a protective effect on anxiety in those with type 2 diabetes mellitus.
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Affiliation(s)
- Yatan Pal Singh Balhara
- Departments of Psychiatry, Lady Harding Medical College and Associated Hospitals, New Delhi, India
| | - Rajesh Sagar
- Departments of Psychiatry, All India Institute of Medical Sciences (AIIMS), New Delhi, India
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Teixeira-Lemos E, Nunes S, Teixeira F, Reis F. Regular physical exercise training assists in preventing type 2 diabetes development: focus on its antioxidant and anti-inflammatory properties. Cardiovasc Diabetol 2011; 10:12. [PMID: 21276212 PMCID: PMC3041659 DOI: 10.1186/1475-2840-10-12] [Citation(s) in RCA: 124] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2011] [Accepted: 01/28/2011] [Indexed: 12/22/2022] Open
Abstract
Diabetes mellitus has emerged as one of the main alarms to human health in the 21st century. Pronounced changes in the human environment, behavior and lifestyle have accompanied globalization, which resulted in escalating rates of both obesity and diabetes, already described as diabesity. This pandemic causes deterioration of life quality with high socio-economic costs, particularly due to premature morbidity and mortality. To avoid late complications of type 2 diabetes and related costs, primary prevention and early treatment are therefore necessary. In this context, effective non-pharmacological measures, such as regular physical activity, are imperative to avoid complications, as well as polymedication, which is associated with serious side-effects and drug-to-drug interactions. Our previous work showed, in an animal model of obese type 2 diabetes, the Zucker Diabetic Fatty (ZDF) rat, that regular and moderate intensity physical exercise (training) is able, per se, to attenuate insulin resistance and control glycaemia, dyslipidaemia and blood pressure, thus reducing cardiovascular risk, by interfering with the pathophysiological mechanisms at different levels, including oxidative stress and low-grade inflammation, which are key features of diabesity. This paper briefly reviews the wide pathophysiological pathways associated with Type 2 diabetes and then discusses in detail the benefits of training therapy on glycaemic control and on cardiovascular risk profile in Type 2 diabetes, focusing particularly on antioxidant and anti-inflammatory properties. Based on the current knowledge, including our own findings using an animal model, it is concluded that regular and moderate intensity physical exercise (training), due to its pleiotropic effects, could replace, or at least reduce, the use of anti-diabetic drugs, as well as of other drugs given for the control of cardiovascular risk factors in obese type 2 diabetic patients, working as a physiological "polypill".
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Affiliation(s)
- Edite Teixeira-Lemos
- Unit of Therapeutics, Laboratory of Pharmacology and Experimental Therapeutics, IBILI, Medicine Faculty, University of Coimbra, Portugal
| | - Sara Nunes
- Unit of Therapeutics, Laboratory of Pharmacology and Experimental Therapeutics, IBILI, Medicine Faculty, University of Coimbra, Portugal
| | - Frederico Teixeira
- Unit of Therapeutics, Laboratory of Pharmacology and Experimental Therapeutics, IBILI, Medicine Faculty, University of Coimbra, Portugal
| | - Flávio Reis
- Unit of Therapeutics, Laboratory of Pharmacology and Experimental Therapeutics, IBILI, Medicine Faculty, University of Coimbra, Portugal
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Franz MJ, Powers MA, Leontos C, Holzmeister LA, Kulkarni K, Monk A, Wedel N, Gradwell E. The evidence for medical nutrition therapy for type 1 and type 2 diabetes in adults. ACTA ACUST UNITED AC 2011; 110:1852-89. [PMID: 21111095 DOI: 10.1016/j.jada.2010.09.014] [Citation(s) in RCA: 173] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2009] [Accepted: 05/06/2010] [Indexed: 12/12/2022]
Abstract
This article reviews the evidence and nutrition practice recommendations from the American Dietetic Association's nutrition practice guidelines for type 1 and type 2 diabetes in adults. The research literature was reviewed to answer nutrition practice questions and resulted in 29 recommendations. Here, we present the recommendations and provide a comprehensive and systematic review of the evidence associated with their development. Major nutrition therapy factors reviewed are carbohydrate (intake, sucrose, non-nutritive sweeteners, glycemic index, and fiber), protein intake, cardiovascular disease, and weight management. Contributing factors to nutrition therapy reviewed are physical activity and glucose monitoring. Based on individualized nutrition therapy client/patient goals and lifestyle changes the client/patient is willing and able to make, registered dietitians can select appropriate interventions based on key recommendations that include consistency in day-to-day carbohydrate intake, adjusting insulin doses to match carbohydrate intake, substitution of sucrose-containing foods, usual protein intake, cardioprotective nutrition interventions, weight management strategies, regular physical activity, and use of self-monitored blood glucose data. The evidence is strong that medical nutrition therapy provided by registered dietitians is an effective and essential therapy in the management of diabetes.
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Affiliation(s)
- Marion J Franz
- Nutrition Concepts by Franz, Inc, Minneapolis, MN 55439, USA.
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15
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Abstract
Structured exercise is considered an important cornerstone to achieve good glycemic control and improve cardiovascular risk profile in Type 2 diabetes. Current clinical guidelines acknowledge the therapeutic strength of exercise intervention. This paper reviews the wide pathophysiological problems associated with Type 2 diabetes and discusses the benefits of exercise therapy on phenotype characteristics, glycemic control and cardiovascular risk profile in Type 2 diabetes patients. Based on the currently available literature, it is concluded that Type 2 diabetes patients should be stimulated to participate in specifically designed exercise intervention programs. More attention should be paid to cardiovascular and musculoskeletal deconditioning as well as motivational factors to improve long-term treatment adherence and clinical efficacy. More clinical research is warranted to establish the efficacy of exercise intervention in a more differentiated approach for Type 2 diabetes subpopulations within different stages of the disease and various levels of co-morbidity.
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Affiliation(s)
- Stephan F E Praet
- Department of Rehabilitation Medicine, Erasmus University Medical Center, 3000 CA, Rotterdam, The Netherlands.
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Pipe EA, Gobert CP, Capes SE, Darlington GA, Lampe JW, Duncan AM. Soy protein reduces serum LDL cholesterol and the LDL cholesterol:HDL cholesterol and apolipoprotein B:apolipoprotein A-I ratios in adults with type 2 diabetes. J Nutr 2009; 139:1700-6. [PMID: 19605528 DOI: 10.3945/jn.109.109595] [Citation(s) in RCA: 66] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Type 2 diabetes is highly prevalent in North America and is associated with increased risk of cardiovascular disease (CVD). Evidence supports a role for soy protein in the reduction of serum lipids related to CVD risk; however, few studies have focused on adults with type 2 diabetes who are not on lipid-lowering medications and/or do not have diabetic complications. The purpose of this study was to determine the effect of soy protein isolate (SPI) consumption on serum lipids in adults with diet-controlled type 2 diabetes. Using a double-blind, randomized, crossover, placebo-controlled intervention study design, adults with diet-controlled type 2 diabetes (n = 29) consumed SPI (80 mg/d aglycone isoflavones) or milk protein isolate (MPI) for 57 d each separated by a 28-d washout period. Twenty-four-hour urine samples were collected on d 54-56 of each treatment for analysis of isoflavones and blood was collected on d 1 and 57 of each treatment and analyzed for serum lipids and apolipoproteins. SPI consumption increased urinary isoflavones compared with MPI. SPI consumption reduced serum LDL cholesterol (P = 0.04), LDL cholesterol:HDL cholesterol (P = 0.02), and apolipoprotein B:apolipoprotein A-I (P = 0.05) compared with MPI. SPI did not affect serum total cholesterol, HDL cholesterol, triacylglycerol, apolipoprotein B, or apolipoprotein A-I. These data demonstrate that consumption of soy protein can modulate some serum lipids in a direction beneficial for CVD risk in adults with type 2 diabetes.
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Affiliation(s)
- Elizabeth A Pipe
- Department of Human Health and Nutritional Sciences, University of Guelph, Guelph, ON, Canada N1G 2W1
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17
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Abstract
Evidence from observational, animal and human studies supports a role for soya protein and its isoflavones in the improvement of glycaemic control in type 2 diabetes. The objective of the present study was to determine the effect of isoflavone-rich soya protein on markers of glycaemic control in adults with type 2 diabetes. Using a randomised, crossover, double-blind, placebo-controlled design, adults with diet-controlled type 2 diabetes (n 29) consumed soya protein isolate (SPI) and milk protein isolate (MPI) for 57 d each separated by a 4-week washout. Blood was collected on days 1 and 57 of each treatment period for analysis of fasting HbA1C, and fasting and postprandial glucose, insulin and calculated indices of insulin sensitivity and resistance. Urine samples of 24 h were collected at the end of each treatment period for analysis of isoflavones. Urinary isoflavone excretion was significantly greater following consumption of SPI compared with MPI, and 20.7 % of the subjects (n 6) were classified as equol excretors. SPI consumption did not significantly affect fasting or postprandial glucose or insulin, fasting HbA1C, or indices of insulin sensitivity and resistance. These data do not support a role for soya protein in the improvement of glycaemic control in adults with diet-controlled type 2 diabetes and contribute to a limited literature of human studies on the effects of soya protein on the management of type 2 diabetes.
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Gobert CP, Duncan AM. Consumption, perceptions and knowledge of soy among adults with type 2 diabetes. J Am Coll Nutr 2009; 28:203-18. [PMID: 19828906 DOI: 10.1080/07315724.2009.10719772] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
OBJECTIVE A large body of evidence supports a role for soy in the management of type 2 diabetes. However, little is known about the current consumption, perceptions and knowledge of soy among those living with type 2 diabetes. The purpose of this research was to explore the consumption, perceptions and knowledge of soy among adults with type 2 diabetes. METHODS A total of 202 adults with type 2 diabetes completed a detailed questionnaire designed to gather data about soy consumption, motivations for consuming soy, purchase locations for soy, methods of obtaining information about soy, barriers to soy consumption, as well as general health/lifestyle, medical and demographic information. RESULTS Soy consumers were significantly more likely to be vegetarian, lactose intolerant and avoid cow's milk and significantly less likely to take medications, when compared to soy non-consumers. There were no significant differences between soy consumers and soy non-consumers in factors related to diabetes management. The prevalence of soy consumption was 19% and the majority of soy was consumed on a weekly basis and most often at breakfast. The three most commonly consumed soy products were soy beverage, tofu and roasted soy nuts and they were purchased most often from the grocery store. Soy consumers were significantly more aware of soy's potential health benefits, compared to soy non-consumers. More than half (63.8%) of soy non-consumers had consumed soy in the past and the top reason for no longer consuming soy was 'dislike taste, texture or appearance'. The most commonly reported barriers to soy consumption were being unsure of how to prepare soy, taste and texture. CONCLUSIONS Although soy consumption was not predictive of factors related to diabetes management, valuable information was generated regarding patterns of soy consumption, motivations for and barriers to soy consumption, beliefs and knowledge about soy, and most common sources of information about soy. This information will be useful to numerous stakeholders including those who produce, market and sell soy, as well as those who disseminate health information about soy.
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Affiliation(s)
- Colleen P Gobert
- Department of Human Health and Nutritional Sciences, University of Guelph, Guelph, Ontario, Canada, N1G 2W1
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Abstract
Lifestyle intervention programs encompassing exercise and healthy diets are an option for the treatment and management of obesity and type 2 diabetes and have long been known to exert beneficial effects on whole-body metabolism, in particular leading to enhanced insulin-sensitivity. Obesity is associated with increased risk of several illnesses and premature mortality. However, physical inactivity is itself associated with a number of similar risks, independent of body-mass index, and is an independent risk factor for more than 25 chronic diseases, including type 2 diabetes and cardiovascular disease. This article addresses the debate regarding the relative effects of physical exercise itself and the effect of exercise-induced weight loss.
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Affiliation(s)
- Donal J O'Gorman
- School of Health and Human Performance, Dublin City University, Dublin, Ireland
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Earnest CP. Exercise interval training: An improved stimulus for improving the physiology of pre-diabetes. Med Hypotheses 2008; 71:752-61. [DOI: 10.1016/j.mehy.2008.06.024] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2008] [Revised: 04/22/2008] [Accepted: 06/23/2008] [Indexed: 10/21/2022]
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Evaluation of a diabetes management program in China demonstrated association of improved continuity of care with clinical outcomes. J Clin Epidemiol 2008; 61:932-9. [DOI: 10.1016/j.jclinepi.2007.12.013] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2007] [Revised: 12/29/2007] [Accepted: 12/30/2007] [Indexed: 01/07/2023]
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Abstract
Type 2 diabetes mellitus (T2DM) has dramatically increased throughout the world in many ethnic groups and among people with diverse social and economic backgrounds. This increase has also affected the young such that over the past decade, the increase in the number of children and youth with T2DM has been labeled an 'epidemic'. Before the 1990s, it was rare for most pediatric centers to have significant numbers of patients with T2DM. However, by 1994, T2DM patients represented up to 16% of new cases of diabetes in children in urban areas and by 1999, depending on geographic location, the range of percentage of new cases because of T2DM was 8-45% and disproportionately represented among minority populations. Although the diagnosis was initially regarded with skepticism, T2DM is now a serious diagnostic consideration in all young people who present with signs and symptoms of diabetes in the USA.
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Affiliation(s)
- Orit Pinhas-Hamiel
- Pediatric Endocrinology and Diabetes Unit, Safra Children's Hospital, Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel
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Arao T, Oida Y, Maruyama C, Mutou T, Sawada S, Matsuzuki H, Nakanishi Y. Impact of lifestyle intervention on physical activity and diet of Japanese workers. Prev Med 2007; 45:146-52. [PMID: 17599400 DOI: 10.1016/j.ypmed.2007.05.004] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2006] [Revised: 05/03/2007] [Accepted: 05/08/2007] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To evaluate the effectiveness of the Life Style Modification Program for Physical Activity and Diet (LiSM-PAN) in comparison to a conventional healthcare program. METHOD Subjects with risk factor(s) for chronic disease were allocated as a cluster to the LiSM group (n=92) or the Control group (n=85). The LiSM-PAN program consisted of counseling plus social and environment support, and the Control program consisted of written feedback for changing physical activity and dietary practice. Intervention was conducted for 6 months during 2001-2002 and with data analysis during 2003-2004 in Tokyo, Japan. The main outcomes were leisure time exercise energy expenditure (L.E.E.E.), maximum oxygen uptake (VO2max), dietary habits, body mass index (BMI), blood pressure, blood glucose, and lipid parameters. RESULTS The LiSM group showed a significantly greater increase in L.E.E.E. than the Control group at the end of the intervention (mean inter-group difference: 400.6 kcal/week, 95% CI: 126.1, 675.0 kcal/week). No significant mean inter-group differences were observed in dietary habits. The LiSM group showed significantly greater decreases in BMI, systolic blood pressure, and LDL-cholesterol than the Control group. CONCLUSION The LiSM-PAN program produced greater positive changes in L.E.E.E., dietary habits, and risk factors for cardiovascular diseases in high-risk middle-aged male workers compared to the Control program.
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Affiliation(s)
- Takashi Arao
- Physical Fitness Research Institute, Meiji Yasuda Life Foundation of Health and Welfare, Tokyo, Japan.
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Nielsen PJ, Hafdahl AR, Conn VS, Lemaster JW, Brown SA. Meta-analysis of the effect of exercise interventions on fitness outcomes among adults with type 1 and type 2 diabetes. Diabetes Res Clin Pract 2006; 74:111-20. [PMID: 16735074 DOI: 10.1016/j.diabres.2006.03.033] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2006] [Accepted: 03/16/2006] [Indexed: 12/13/2022]
Abstract
This review applied meta-analytic procedures to integrate primary research that examined exercise fitness outcomes among adults with type 1 or type 2 diabetes. We used extensive literature searching strategies to locate published and unpublished intervention studies that tested exercise interventions. We conducted meta-analytic procedures using both fixed- and random-effects models. Analyses were conducted separately for type 1 and type 2 diabetes and separately for two-group and single-group data under two assumptions about pre-post fitness outcomes association: no association and a strong positive association (0.80). Codable data were extracted from 35 reports with 1074 subjects. The type 1 diabetes overall weighted mean effect size for two-group comparisons was 0.65. For treatment group pretest versus post-test, the effect was 0.62. The effect size among adults with type 2 diabetes for two-group comparisons was 0.35. The treatment group pretest versus post-test comparison effect was 0.37. Effect sizes among control group participants were not statistically different from 0. For type 2 diabetes two-group comparisons, larger effect sizes were associated with exercise prescription, fitness testing, supervised exercise, group sessions, and recommendations for longer duration exercise sessions. HbA1c, age, body mass index, and gender distribution were unrelated to fitness outcomes.
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Affiliation(s)
- Paul J Nielsen
- Biochemistry Department, University of Missouri, Columbia, MO, United States
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Fritz T, Krämer DK, Karlsson HKR, Galuska D, Engfeldt P, Zierath JR, Krook A. Low-intensity exercise increases skeletal muscle protein expression of PPARdelta and UCP3 in type 2 diabetic patients. Diabetes Metab Res Rev 2006; 22:492-8. [PMID: 16752430 DOI: 10.1002/dmrr.656] [Citation(s) in RCA: 91] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND Physical exercise provides health benefits for people with type 2 diabetes mellitus, partly by enhancing skeletal muscle insulin action. We tested the hypothesis that changes in expression of key genes in skeletal muscles relate to exercise-induced improvements in type 2 diabetic patients. METHODS We determined mRNA expression of 20 selected genes following a self-supervised program of walking (> 150 min per week) over a 4-month period. RESULTS This level of physical activity improved clinical parameters in approximately half the participants, as determined by reduced hypertension and enhanced insulin sensitivity (defined by reduced plasma-insulin levels and improved homeostasis model assessment (HOMA)). Skeletal muscle mRNA expression of Cbl-associated protein (CAP), diacylglycerol kinase (DGK)delta, uncoupling protein (UCP) 3, nuclear respiratory factor (NRF)-1, and peroxisome proliferator-activated receptor (PPAR)delta tended to increase in type 2 diabetic patients with an improved clinical profile. Skeletal muscle protein expression of PPARdelta and UCP3 was increased significantly after physical exercise in patients with an improved clinical profile, but were unchanged in patients who did not show exercise-mediated improvements in clinical parameters. CONCLUSIONS This study provides clinical evidence that improvements in insulin sensitivity can be achieved in type 2 diabetic patients after individually executed low-intensity exercise training. Moreover, the positive clinical response to exercise is correlated with changes in skeletal muscle proteins involved in the regulation of mitochondrial biogenesis and metabolism. These changes in skeletal muscle gene expression offer a possible molecular explanation for the improvements in clinical outcomes.
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Affiliation(s)
- Tomas Fritz
- Centre of Family Medicine, Karolinska University Hospital, Karolinska Institutet, 171 11 Stockholm, Sweden
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Fritz T, Wändell P, Aberg H, Engfeldt P. Walking for exercise--does three times per week influence risk factors in type 2 diabetes? Diabetes Res Clin Pract 2006; 71:21-7. [PMID: 16005099 DOI: 10.1016/j.diabres.2005.06.002] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/16/2005] [Indexed: 11/26/2022]
Abstract
In order to assess the effects of regular walking on metabolic control and cardiovascular risk factors in type 2 diabetes 26 patients from one primary care clinic, aged 60.0+/-7.3 years, participated in a walking program during 4 months. Prescribed exercise was walking for 45-60 min three times weekly. A control group of 26 patients from a neighboring primary care clinic, aged 59.3+/-6.2 years, received no exercise instructions. Thus, randomization was not performed. There were no improvements of blood pressure, body mass index, physical fitness, glycated hemoglobin A1c, fasting plasma glucose or insulin by intention-to-treat analysis. Seventeen patients in the intervention group increased their physical activity and improved systolic blood pressure; -7.6 mmHg (-15 to -0.2), diastolic blood pressure; -4.3 mmHg (-7.4 to -1.2), body mass index; -0.6 kg/m2 (-1.1 to -0.1) and total plasma cholesterol; -0.6 mmol/l (-0.9 to -0.3), (mean difference, with 95% CI). We could observe no effects on glucose metabolism in either group. Our results suggest that an increase of regular physical activity equivalent to 45 min of walking 3 days/week may suffice to improve systolic and diastolic blood pressure, lipid metabolism and BMI in patients with type 2 diabetes.
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Affiliation(s)
- Tomas Fritz
- Center of Family Medicine, Karolinska Institutet, Alfred Nobels Allé 12, SE 141 83 Huddinge, Sweden.
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Trento M, Passera P, Borgo E, Tomalino M, Bajardi M, Brescianini A, Tomelini M, Giuliano S, Cavallo F, Miselli V, Bondonio P, Porta M. A 3-year prospective randomized controlled clinical trial of group care in type 1 diabetes. Nutr Metab Cardiovasc Dis 2005; 15:293-301. [PMID: 16054554 DOI: 10.1016/j.numecd.2004.12.005] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2004] [Revised: 11/30/2004] [Accepted: 12/16/2004] [Indexed: 11/15/2022]
Abstract
BACKGROUND AND AIMS We showed that continuing education can be embedded into routine diabetes care by seeing patients in small groups rather than individually. Group care was cost-effective in improving quality of life, knowledge of diabetes, health behaviours and clinical outcomes in people with type 2 diabetes. The aim of this study was to verify if group care can also be applied to type 1 diabetes. METHODS AND RESULTS Randomized, controlled clinical trial comparing 31 patients managed by group care with 31 managed by traditional one-to-one care. A syllabus was built and later remodulated with the patients in a series of focus-group meetings. The primary end-point was changes in quality of life. Secondary end-points were: knowledge of diabetes, health behaviours, HbA1c and circulating lipids. Differential costs to the Italian National Health System and to the patients were also calculated. After 3 years, quality of life improved among patients on group care, along with knowledge and health behaviours (p<0.001, all). Knowledge added its effects to those of group care by independently influencing behaviours (p=0.004) while quality of life changed independently of either (p<0.001). Among controls, quality of life worsened (p<0.001) whereas knowledge and behaviours remained unchanged. HDL cholesterol increased among patients on group care (p=0.027) and total cholesterol decreased in the controls (p<0.05). HbA1c decreased, though not significantly, in both. Direct costs for group and one-to-one care were Euros 933.19 and Euros 697.10 per patient, respectively, giving a cost-effectiveness ratio of Euros 19.42 spent per point gained in the quality of life scale. CONCLUSIONS Group care is applicable and also cost-effective in type 1 diabetes. It improves quality of life, knowledge and behaviours. Future programme adjustments should strive to impact more on metabolic control.
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Affiliation(s)
- M Trento
- Department of Internal Medicine, University of Turin, Corso AM Dogliotti 14, I-10126 Torino, Italy.
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Pinhas-Hamiel O, Zeitler P. Advances in epidemiology and treatment of type 2 diabetes in children. Adv Pediatr 2005; 52:223-59. [PMID: 16124343 DOI: 10.1016/j.yapd.2005.03.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Affiliation(s)
- Orit Pinhas-Hamiel
- Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel
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Affiliation(s)
- Judith G Regensteiner
- Department of Medicine, Program for Women's Health Research, Section of Vascular Medicine, Divisions of Internal Medicine and Cardiology, University of Colorado Health Sciences Center, Denver, CO 80262, USA.
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Current literature in diabetes. Diabetes Metab Res Rev 2003; 19:248-55. [PMID: 12789659 DOI: 10.1002/dmrr.348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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