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Kimberlee A. Gretebeck, Caroline S. Blaum, Tisha Moore, Roger Brown, Andrzej Galecki, Debra Strasburg, Shu Chen and Neil B. Alexander

Type 2 diabetes mellitus (T2DM) is a growing epidemic for older adults, affecting 1 in 4 of those aged 65 years and older. 1 Diabetes-related disability occurs in up to two-thirds of older adults with T2DM and is associated with loss of independence, poor quality of life, and increased utilization

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Lise Crinière, Claire Lhommet, Agnès Caille, Bruno Giraudeau, Pierre Lecomte, Charles Couet, Jean-Michel Oppert and David Jacobi

Background:

Increasing physical activity and decreasing sedentary time are cornerstones in the management of type 2 diabetes (T2DM). However, there are few instruments available to measure physical activity in this population. We translated the long version of the International Physical Activity Questionnaire (IPAQ-L) into French and studied its reproducibility and validity in patients with T2DM.

Methods:

Reproducibility was studied by 2 telephone administrations, 8 days apart. Concurrent validity was tested against pedometry for 7 days during habitual life.

Results:

One-hundred forty-three patients with T2DM were recruited (59% males; age: 60.9 ± 10.5 years; BMI: 31.2 ± 5.2 kg/m2; HbA1c: 7.4 ± 1.2%). Intraclass correlation coefficients (95% CI) for repeated administration (n = 126) were 0.74 (0.61−0.83) for total physical activity, 0.72 (0.57−0.82) for walking, and 0.65 (0.51−0.78) for sitting time. Total physical activity and walking (MET-min·week-1) correlated with daily steps (Spearman r = .24 and r = .23, respectively, P < .05). Sitting time (min·week-1) correlated negatively with daily steps in women (r = −0.33; P < .05).

Conclusion:

Our French version of the IPAQ-L appears reliable to assess habitual physical activity and sedentary time in patients with T2DM, confirming previous data in nonclinical populations.

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Nele Huys, Vicky Van Stappen, Samyah Shadid, Marieke De Craemer, Odysseas Androutsos, Jaana Lindström, Konstantinos Makrilakis, Maria S. de Sabata, Luis Moreno, Pilar De Miguel-Etayo, Violeta Iotova, Imre Rurik, Yannis Manios, Greet Cardon and on behalf of the Feel4Diabetes-Study Group

The prevalence of diabetes is increasing rapidly worldwide because of the increase in age-specific prevalence of diabetes, among other factors. This could be attributed to the increase of the main modifiable risk factors (ie, overweight/obesity and physical inactivity). 1 Ogurtsova et al 2

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Vera K. Tsenkova, Chioun Lee and Jennifer Morozink Boylan

Diabetes is a significant problem in the United States and accounts for substantial morbidity and mortality. Currently, 9.3% have diabetes and 37% have milder forms of hyperglycemia such as prediabetes that typically transition to overt diabetes. 1 The economic costs of diabetes are staggering

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Paul A. McAuley, Haiying Chen, Duck-chul Lee, Enrique Garcia Artero, David A. Bluemke and Gregory L. Burke

Background:

The influence of higher physical activity on the relationship between adiposity and cardiometabolic risk is not completely understood.

Methods:

Between 2000–2002, data were collected on 6795 Multi-Ethnic Study of Atherosclerosis (MESA) participants. Self-reported intentional physical activity in the lowest quartile (0–105 MET-minutes/week) was categorized as inactive and the upper three quartiles (123–37,260 MET-minutes/week) as active. Associations of body mass index (BMI) and waist circumference categories, stratified by physical activity status (inactive or active) with cardiometabolic risk factors (dyslipidemia, hypertension, upper quartile of homeostasis model assessment of insulin resistance [HOMA-IR] for population, and impaired fasting glucose or diabetes) were assessed using logistic regression analysis adjusting for age, gender, race/ethnicity, and current smoking.

Results:

Among obese participants, those who were physically active had reduced odds of insulin resistance (47% lower; P < .001) and impaired fasting glucose/diabetes (23% lower; P = .04). These associations were weaker for central obesity. However, among participants with a normal waist circumference, those who were inactive were 63% more likely to have insulin resistance (OR [95% CI] 1.63 [1.24–2.15]) compared with the active reference group.

Conclusions:

Physical activity was inversely related to the cardiometabolic risk associated with obesity and central obesity.

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Kin-Kit Li, Lorna Ng, Sheung-Tak Cheng and Helene H. Fung

. Accordingly, the effects should be validated across different populations and settings. This study examined the framing effect among older adults with type 2 diabetes (T2D). Message Framing in PA Promotion According to prospect theory ( Tversky & Kahneman, 1981 ), decisions are made based on the subjective

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D.S. Blaise Williams III, Denis Brunt and Robert J. Tanenberg

The majority of plantar ulcers in the diabetic population occur in the forefoot. Peripheral neuropathy has been related to the occurrence of ulcers. Long-term diabetes results in the joints becoming passively stiffer. This static stiffness may translate to dynamic joint stiffness in the lower extremities during gait. Therefore, the purpose of this investigation was to demonstrate differences in ankle and knee joint stiffness between diabetic individuals with and without peripheral neuropathy during gait. Diabetic subjects with and without peripheral neuropathy were compared. Subjects were monitored during normal walking with three-dimensional motion analysis and a force plate. Neuropathic subjects had higher ankle stiffness (0.236 N·m/ deg) during 65 to 80% of stance when compared with non-neuropathic subjects (−0.113 N·m/deg). Neuropathic subjects showed a different pattern in ankle stiffness compared with non-neuropathic subjects. Neuropathic subjects demonstrated a consistent level of ankle stiffness, whereas non-neuropathic subjects showed varying levels of stiffness. Neuropathic subjects demonstrated lower knee stiffness (0.015 N·m/deg) compared with non-neuropathic subjects (0.075 N·m/deg) during 50 to 65% of stance. The differences in patterns of ankle and knee joint stiffness between groups appear to be related to changes in timing of peak ankle dorsiflexion during stance, with the neuropathic group reaching peak dorsiflexion later than the non-neuropathic subjects. This may partially relate to the changes in plantar pressures beneath the metatarsal heads present in individuals with neuropathy.

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Andrzej Gawrecki, Aleksandra Araszkiewicz, Agnieszka Szadkowska, Grzegorz Biegański, Jan Konarski, Katarzyna Domaszewska, Arkadiusz Michalak, Bogda Skowrońska, Anna Adamska, Dariusz Naskręt, Przemysława Jarosz-Chobot, Agnieszka Szypowska, Tomasz Klupa and Dorota Zozulińska-Ziółkiewicz

There is limited data concerning the glycemic changes during mass sporting competitions for children and youth with diabetes. In general, aerobic exercise is associated with decreasing glucose values, whereas brief, very high-intensity or anaerobic exercise is related to increasing glucose values

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Brian D. Tran and Pietro Galassetti

The beneficial effects of exercise, including reduction of cardiovascular risk, are especially important in children with type 1 diabetes (T1DM), in whom incidence of lifetime cardiovascular complications remains elevated despite good glycemic control. Being able to exercise safely is therefore a paramount concern. Dysregulated metabolism in T1DM however, causes frequent occurrence of both hypo- and hyperglycemia, the former typically associated with prolonged, moderate exercise, the latter with higher intensity, if shorter, challenges. While very few absolute contraindications to exercising exist in these children, exercise should not be started with glycemia outside the 80–250 mg/dl range. Within this glycemic range, careful adjustments in insulin administration (reduction or infusion rate via insulin pumps, or overall reduction of dosage of multiple injections) should be combined with carbohydrate ingestion before/during exercise, based on prior, individual experience with specific exercise formats. Unfamiliar exercise should always be tackled with exceeding caution, based on known responses to other exercise formats. Finally, gaining a deep understanding of other complex exercise responses, such as the modulation of inflammatory status, which is a major determinant of the cardio-protective effects of exercise, can help determine which exercise formats and which individual metabolic conditions can lead to maximally beneficial health effects.

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Jennifer L Kuk, Shahnaz Davachi, Andrea M. Kriska, Michael C. Riddell and Edward W. Gregg

This article briefly summarizes the “Pre-Diabetes Detection and Intervention Symposium” that described ongoing and past pre-diabetes interventions, and outlined some considerations when deciding to target specific populations with pre-diabetes. The success of type 2 diabetes (T2D) prevention clinical trials provides clear evidence that healthy lifestyle change can prevent the development of T2D in a cost effective manner in high risk individuals. However, who to target and what cut-points should be used to identify individuals who would qualify for these T2D prevention programs are not simple questions. More stringent cut-offs are more efficient in preventing T2D, but less equitable. Interventions will likely need to be adapted and made more economical for local communities and health care centers if they are to be adopted universally. Further, they may need to be adapted to meet the specific needs of certain high-risk populations such as ethnic minorities. The Chronic Disease Management & Prevention Program for Diverse Populations in Alberta and the Pre-diabetes Detection and Physical Activity Intervention Delivery project in Toronto represent 2 examples of specialized interventions that are targeted at certain high risk populations. To reverse the current T2D trends will require continued efforts to develop and refine T2D prevention interventions.