College of Health and Human Services. San Diego State University. Portland ..... uc tio n. 0. â10. â20. â30. â40. â50. Deaths. Related to. Diabetes. All-Cause.
Exercise and Type 2 Diabetes
Larry S. Verity, PhD, FACSM School of Exercise & Nutritional Sciences College of Health and Human Services San Diego State University
Characteristics of Type 1 & Type 2 Diabetes Mellitus
Portland 2011 - T2DM
1
Rate of New Cases of Type 1 & Type 2 Diabetes among Youth < 20 yrs
Portland 2011 - T2DM
Estimated Growth in Type 2 Diabetes: US Population From 2000-2050 Type 2 DM
Year Bagust A, et al. Diabetes, 50 [Suppl 2], A205, 2001 Portland 2011 - T2DM
2
Age-adjusted % of U.S. Adults Who Were Obese or Who Had Diagnosed Diabetes Obesity (BMI ≥30 kg/m2) 1994
No Data
26.0%
Diabetes 1994
No Data
2009
2000
9.0%
CDC‟s Division of Diabetes Translation. National Diabetes Surveillance System available at http://www.cdc.gov/diabetes/statistics
Portland 2011 - T2DM
Diabetes Prevalence: Age and Ethnicity 20-39
40-49
50-59
60-74
75+
25
Percentage (%)
20 15 10 5 0 White - NH
Black - NH
Hispanic
Native Am/Al
Portland 2011 - T2DM
3
Natural History of Type 2 Diabetes Years from diagnosis
-10
0
-5
Onset
10
5
15
Diagnosis
Insulin resistance Insulin secretion
Postprandial glucose Fasting glucose
Microvascular complications
Macrovascular complications (65% die of CVD) Pre-diabetes Type 2 diabetes Ramlo-Halsted BA, Edelman SV. Prim Care. 1999;26:771-789; Nathan DM. N Engl J Med. 2002;347:1342-1349
Portland 2011 - T2DM
Stages of Type 2 Diabetes 100
MonoTherapy
75
b-Cell Function (% b)
Combination Oral Therapy
50
Type 2 Diabetes Phase I Type 2 Diabetes Phase II
25
0 -12 -10
-6
-2
0
2
6
Insulin Phase III 10
14
Years From Diagnosis Portland 2011 - T2DM
Based on data of UKPDS 16: Diabetes. 1995.
4
Cardiometabolic Risk - Graphic Overweight / Obesity Age
Genetics
Insulin Resistance Insulin Resistance ? Syndrome Lipids BP Glucose
Abnormal Lipid Metabolism LDL ApoB HDL Trigly.
Cardiometabolic Risk Global Diabetes / CVD Risk
Age, Race, Gender, Family History
Smoking Inflammation Hypercoagulation
Unhealthy Eating Physical Inactivity
Hypertension
Proportion of Patients with Cardiovascular Disease Increases with Duration of Diabetes 48%
29% 21%
24%
15%
≤2
3-5
6-9
10-14
15+
Years after DM Diagnosis Harris, S et al.; Type 2 Diabetes and Associated Complications in Primary Care in Canada: The Impact of Duration of Disease on Morbidity Load. CDA 2003. Portland 2011 - T2DM
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Contemporary Diabetes Care Team Approach Physician(s) Diabetologist
Exercise Professional
Management Team Diabetes Educator
Registered Dietician
Portland 2011 - T2DM
Management of Diabetes Mellitus: Therapeutic Steps in Management • Medical management • Use of medications to manage glucose • oral agents and/or • insulin
Portland 2011 - T2DM
• Frequent monitoring of blood glucose • Proper diet and exercise
6
Mechanisms of Action of Pharmacologic Agents for Diabetes
Portland 2011 - T2DM
Summary of Pharmacologic Incretin Actions on Different Target Tissues Heart
insulin sensitivity of diabetes medications glucose control for type 2 Predictor of successful weight management Aids in managing other Cardiometabolic risks • Hypertension • Dyslipidemia • Obesity, Body weight/fat and morphology
Clinical trials examined prevention of type 2 diabetes LIFESTYLE was very effective Physical activity > 150 mins/wk MNT for diabetes Strategies for success
Is the DPP an effective „model‟ for secondary prevention? Portland 2011 - T2DM
8
Diabetes Incidence Rates by Ethnicity
Cases/100 person-yr
Lifestyle
Metformin
Placebo
12
8
4
0 Caucasian (n=1768)
African American (n=645)
Hispanic (n=508)
American Indian (n=171)
Asian (n=142)
The DPP Research Group, NEJM 346:393-403, 2002
Portland 2011 - T2DM
Diabetes Incidence Rates by BMI Cases/100 person-yr
16
Lifestyle
Metformin
Placebo
12 8 4 0
24 < 30
30 < 35
(n=1045)
(n=995)
> 35 (n=1194)
Body Mass Index (kg/m2) Portland 2011 - T2DM
The DPP Research Group, NEJM 346:393-403, 2002
9
DPP: Weight Loss and Physical Activity Placebo
Metformin
Lifestyle P 1,500 - 2,000 At least 150 mins/wk
Type (aerobic)
Resistance Frequency > 3 d/wk
Intensity
moderate
Repetitions
8-10 per exercise
Sets
> 3 sets per exercise
Type
major muscle groups: 810 exercises
Portland 2011 - T2DM
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Association Between Insulin Sensitivity and Physical Exercise: The IRAS Study
Portland 20112011 - T2DM ACE Mtng
Portland 20112011 - T2DM ACE Mtng
11
Effect of Physical Activity on Glucose Control HbA1c % is lowered
