EXSCI3172 – Exercise Prescription 2
EXSCI3172 – Exercise Prescription 2
Exercise and Type 2 Diabetes
Part I - Pathophysiology
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CRICOS Provider No. 00103D
Epidemiology of diabetes
• Diabetes is the 7th leading cause of death in Australia (and global) in 2017
(www.abs.gov.au)
Epidemiology of diabetes
• Proportion of people with diabetes in indigenous
population compared to non-indigenous is 3 to 1
• Incidence of Type 2 Diabetes Mellitus (T2DM) rises by 0.7-0.8% each year
• T2DM accounts for 90-95% of all cases
• Between 2005-2050, estimated:
• 174% increase in males with T2DM
• 220% increase in females with T2DM
• Up to 58% of T2DM cases can be prevented
• Over half of adults with T2DM are overweight or obese
• 31-34% less likely to engage in PA at recommended levels (Zhao et al.
2011)
(Narayan et al 2006)
• Costs >$3 billion per year (Magliano et. Al, 2008)
• Important cause of blindness, kidney failure, lower limb amputation and other long3
term consequences that impact significantly on quality of life (WHO
2016)
• 3 in 5 people with diabetes have CVD
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EXSCI3172 – Exercise Prescription 2
Normal Glucose homeostasis
• Whole body glucose homeostasis coordinated
by three major metabolic events:
1. Insulin secretion by pancreatic β-cells
2. Regulation of hepatic glucose production
3. Stimulation of glucose uptake by insulinsensitive tissues, primarily muscle
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Definition – Type 1 Diabetes
Definition – Type 2 Diabetes
• Previously known as insulin-dependent diabetes mellitus – IDDM
• Previously known as non-insulin dependent diabetes
mellitus – NIDDM
•
Absolute deficiency of insulin caused by autoimmune destruction of insulin
producing beta cells of the pancreas.
•
Insulin is supplied by injection or pump.
• Accounts for 90% of all diabetes cases
•
Usually occurs < 30 years old.
•
Prone to life threatening ketoacidosis; caused by ketone bodies resulting from
fatty acid breakdown
• Characterized by decreased insulin sensitivity in target
tissues (muscle and fat cells)
• Due to dysfunctional insulin receptor sites on cells
• <10% of all diabetes cases
• Develops gradually
• Elevated blood glucose levels can exist for long
periods without symptoms
• Has multiple risk factors
• ~80-90% of all T2DM cases attributed to lifestyle
factors
Symptoms include:
•
Frequent urination
•
Unusual thirst
•
Extreme hunger
•
Irritability
•
Extreme fatigue
•
Unusual weight loss
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EXSCI3172 – Exercise Prescription 2
Definition – Type 2 Diabetes
Diabetes - Diagnosis
• Therefore:
• Insulin unable to facilitate glucose movement into
cell
• Glucose accumulates in blood stream
• This forces pancreas to produce more insulin to
achieve homeostasis
• Beta cells can begin to fail due to increase demand
• Leads to poorly maintained BGL
• In some patients, insufficient amount of insulin is
produced
• Fasting blood glucose levels (BGL):
• Normal = <6.1 (<110) mmol/l(mg/dl)
• Diabetes = ≥7.0 (≥126) mmol/l(mg/dl)
• HbA1c- glycated haemoglobin
• Normal = <6.0%
• Diabetes = ≥6.5%
• Provides an average of blood glucose level over the
previous 10-12 weeks
• If BGL elevated over extended period of time, sugar
combines with haemoglobin, becoming ‘glycated.’
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References
http://www.abs.gov.au/ausstats/abs@.nsf/Lookup/by%20Subject/3303.0~2017~Main%20Features~Australia's%2
0leading%20causes%20of%20death,%202017~2
Bassuk, S. S., & Manson, J. E. (2005). Epidemiological evidence for the role of physical activity in reducing risk
of type 2 diabetes and cardiovascular disease. Journal of applied physiology, 99(3), 1193-1204.
doi:10.1152/japplphysiol.00160.2005
Castaneda C, Layne JE, Munoz-Orians L, et al. A randomized controlled trial of resistance exercise training to
improve glycemic control in older adults with type 2 diabetes. Diabetes Care 2002; 25:2335–2341.
Colberg SR, Sigal RJ, Yardley JE, et al. Physical activity/exercise and diabetes: a position statement of the
American Diabetes Association. Diabetes Care 2016; 39:2065–2079.
Dunstan DW, Daly RM, Owen N, et al. High-intensity resistance training improves glycemic control in older
patients with type 2 diabetes. Diabetes Care 2002; 25:1729–1736.
Gill, J. M., & Cooper, A. R. (2008). Physical activity and prevention of type 2 diabetes mellitus. Sports Med,
38(10), 807-824.
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References
Laaksonen, D. E., Lindstrom, J., Lakka, T. A., Eriksson, J. G., Niskanen, L., Wikstrom, K., . . . Uusitupa, M. (2005). Physical
activity in the prevention of type 2 diabetes: the Finnish diabetes prevention study. Diabetes, 54(1), 158-165.
Magliano DJ, Barr EL, Zimmet PZ, Cameron AJ, Dunstan DW, Colagiuri S, Jolley D, Owen N, Phillips P, Tapp RJ, Welborn
TA, and Shaw JE. Glucose indices, health behaviors, and incidence of diabetes in Australia: the Australian Diabetes,
Obesity and Lifestyle Study. Diabetes Care. 2008;31(2):267-72.
Narayan KMV, Boyle JP, Geiss LS, Saaddine JB, Thompson TJ. Impact of recent increase in incidence on future diabetes
burden: U.S., 2005–2050. Diabetes Care. 2006;29(9):2114–6.
Ross, R., Dagnone, D., Jones, P. J., Smith, H., Paddags, A., Hudson, R., & Janssen, I. (2000). Reduction in obesity and
related comorbid conditions after diet-induced weight loss or exercise-induced weight loss in men. A randomized,
controlled trial. Ann Intern Med, 133(2), 92-103.
Schwingshackl L, Missbach B, Dias S, König J, Hoffmann G. Impact of different training modalities on glycaemic control and
blood lipids in patients with type 2 diabetes: a systematic review and network meta-analysis. Diabetologia 2014;
57:1789–1797
.
Snowling NJ, Hopkins WG. Effects of different modes of exercise training on glucose control and risk factors for
complications in type 2 diabetic patients: a meta-analysis. Diabetes Care 2006; 29:2518–2527.
Umpierre, D., Ribeiro, P. B., Kramer, C. K., & et al. (2011). Physical activity advice only or structured exercise training and
association with hba1c levels in type 2 diabetes: A systematic review and meta-analysis. Jama, 305(17), 1790-1799.
doi:10.1001/jama.2011.576
Gordon BA, Benson AC, Bird SR, Fraser SF. Resistance training improves metabolic health in type 2 diabetes: a
systematic review. Diabetes Res Clin Pract 2009; 83:157–175.
The World Health Organisation. (2016). Global Report on Diabetes
Jelleyman C, Yates T, O’Donovan G, et al. The effects of high intensity interval training on glucose regulation and
insulin resistance: a meta-analysis. Obes Rev 2015; 16:942–961.
Zhao G, Ford ES, Li C, Balluz LS. Physical activity in U.S. older adults with diabetes mellitus: prevalence and correlates of
meeting physical activity recommendations. J Am Geriatr Soc. 2011;59(1):132–7.
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