Adults With Type 2 Diabetes:
PT Examination and Treatment
Part II: Outcomes Measures
J. David Taylor PT, Ph.D., CSCS
Note to Participants: There are interactive pop-up questions throughout this lecture. If you choose to pause the
lecture and return at a later time, a natural break time would be after answering the interactive questions.
(You are able to pause at any time and the presentation will “remember” where you were. It’s just a more
natural time to pause after the interactive questions.) For your convenience, this outline reflects where/when
within the lecture the interactive questions occur.
This lecture has 107 slides and is 117 minutes in duration.
I. The A1C test
Notes
A. Physiological basis of the test
1. How glucose binds to hemoglobin
B. Normal vs. abnormal A1C
C. A1C vs. mean plasma glucose
D. Clinical importance of the A1C test
1. The ACCORD trial
2. The ADVANCE trial
3. The VADT
E. Clinically important changes in A1C test results
Interactive Questions – slide 22 @ 25 minutes
E. A1C and complications
1. Increased flux through the polyol pathway
2. Intracellular production of AGE precursors
3. PKC activation
4. Increased hexosamine pathway activity
G. Blood glucose levels
1. Physiology of fasting and non-fasting blood glucose
levels
a. Normal vs. abnormal fasting blood glucose
levels
b. Normal vs. abnormal post-prandial blood
glucose levels
H. A1C vs. blood glucose testing
II. Risk factors in type 2 diabetes
A. Cardiovascular
B. Waist circumference
C. Blood pressure
D. Hematologic
Interactive Questions – slide 57 @ 62 minutes
III. Clinically important physical fitness outcomes
A. Exercise capacity
B. Chronotropic incompetence
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C. Muscle strength
D. Physical function
E. Heart rate recovery
Notes
IV. Exercise testing
A. Maximal graded exercise testing
1. Aerobic Center Longitudinal Study (ACLS)
2. Modified Balke-Ware treadmill protocol
a. Heart rate monitors
3. Bruce treadmill protocol
a. Submaximal graded exercise testing
b. ii. Modified Bruce treadmill protocol
B. Muscle strength testing
1. 1-repetition maximum testing
2. Multiple-repetition testing
C. AHA guidelines for exercise testing
1. Red flags
2. Yellow flags
Interactive Questions – slide 94 @ 106 minutes
V. Physical function and physical performance tests
A. Physical function tests
1. The Patient-Specific Functional Scale (PSFS)
B. Physical performance tests
1. The modified physical performance test
2. TUG procedure
3. 6-minute walk test
Interactive Questions – slide 104 @ 114 minutes
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Bibliography
1. * Standards of medical care in diabetes — 2012. Diabetes Care. 2012 Jan;35 Suppl 1:S11-63.
2. Centers for Disease Control and Prevention. National diabetes fact sheet: national estimates and
general information on diabetes and prediabetes in the United States, 2011. Atlanta, GA: U.S.
Department of Health and Human Services, Centers for Disease Control and Prevention, 2011.
Downloaded from www.cdc.gov/diabetes/pubs/pdf/ndfs_2011.pdf on March 20, 2012.
3. Action to Control Cardiovascular Risk in Diabetes Study Group, Gerstein HC, Miller ME et al.
Effects of intensive glucose lowering in type 2 diabetes. N Engl J Med. 2008 Jun 12;358(24):
2545-59.
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vascular outcomes in patients with type 2 diabetes. N Engl J Med. 2008 Jun 12;358(24):2560-72.
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with type 2 diabetes. N Engl J Med. 2009 Jan 8;360(2):129-39.
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after exercise as a predictor of mortality. N Engl J Med. 1999 Oct 28;341(18):1351-7.
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testing as a predictor of mortality in a cardiovascularly healthy cohort. Ann Intern Med. 2000 Apr
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a predictor of cardiovascular disease and all-cause mortality in men with diabetes. Diabetes Care.
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* These articles are available to download through the tab at the top of this course, as well as from
our library page at www.educata.com/articles.aspx.
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Suggested websites for more information:
1. American Diabetes Association: professional.diabetes.org
2. The Patient-Specific Functional Scale questionnaire:
www.tac.vic.gov.au/upload/patient-specific.pdf
3. Center for Disease Control: Chronic Disease Prevention and Health Promotion: Diabetes:
www.cdc.gov/chronicdisease/resources/publications/aag/ddt.htm.
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