Low physical activity in patients with type 2 diabetes: The role of obesity

AimsFew studies have described ambulatory activity in free-living individuals with type 2 diabetes mellitus (T2DM) using motion sensors, and none included a control group. For this reason, our study compared the physical-activity levels of outpatients with T2DM with subjects without diabetes, and examined the relationship between body mass index (BMI) and physical-activity parameters.MethodsPhysical-activity levels in 70 outpatients with T2DM and 30 age-, gender- and employment-matched individuals without diabetes were measured using the SenseWear Armband™, a monitoring device validated against doubly labelled water, to assess total energy expenditure. Patients wore the SenseWear Armband™ on their right arm continuously every day for 1 week.ResultsTotal energy expenditure (< 300 kcal/day), number of steps (< 1500/day), physical-activity duration (< 130 min/day) and active energy expenditure/day (< 300 kcal) were all significantly lower (P < 0.05) in patients with T2DM. These measures were inversely correlated with BMI, and remained significant after adjusting for age, gender, employment status and the presence of diabetes.ConclusionOutpatients with T2DM have lower physical-activity levels than their matched controls, a characteristic that is related to their higher BMI.     

The association of physical activity and depression in Type 2 diabetes

Aims Physical inactivity and depressed mood are both associated with a higher likelihood of diabetes‐related complications; the association between physical activity and depressed mood in Type 2 diabetes has not been reviewed previously. We have reviewed (i) the strength of this association and (ii) the impact of depression‐specific management and physical activity interventions on mood and activity levels in overweight adults with Type 2 diabetes. Methods Studies published between January 1996 and September 2007 were identified (Ovid ‐medline , Psych‐ Info and embase ) using pertinent search terms (keyword/title). Results Of the 12 studies included (10 cross‐sectional, two trials), most employed a standardized questionnaire for depressed mood but only one item for physical activity. In adults with Type 2 diabetes, the inactive are 1.72 to 1.75 times more likely to be depressed than the more active; the depressed are 1.22 to 1.9 times more likely to be physically inactive than the non‐depressed. Two randomized trials demonstrated that a depression management programme improved mood, but only one demonstrated increased physical activity. Conclusions Studies to date suggest an association between depressed mood and physical inactivity in adults with Type 2 diabetes, although objective measures of physical activity have not been employed. Depression‐specific management may improve mood and possibly activity. A trial comparing the impact of depression‐specific management compared with exercise intervention on depressed mood and activity in Type 2 diabetes is justified.     

Obstructive sleep apnea and diabetic neuropathy: a novel association in patients with type 2 diabetes

Rationale: Diabetic peripheral neuropathy is common and causes significant morbidity. Obstructive sleep apnea (OSA) is also common in patients with type 2 diabetes. Because OSA is associated with inflammation and oxidative stress, we hypothesized that OSA is associated with peripheral neuropathy in type 2 diabetes. Objectives: To assess the relationship between OSA and peripheral neuropathy in patients with type 2 diabetes. Methods: A cross-sectional study of adults with type 2 diabetes recruited randomly from the diabetes clinic of two UK hospitals. Measurements and Main Results: Peripheral neuropathy was diagnosed using the Michigan Neuropathy Screening Instrument. OSA (apnea-hypopnea index ≥ 5 events/h) was assessed using home-based, multichannel respiratory monitoring. Serum nitrotyrosine was measured by ELISA, lipid peroxide by spectrophotometer, and microvascular function by laser speckle contrast imaging. Two hundred thirty-four patients (mean [SD] age, 57 [12] yr) were analyzed. OSA prevalence was 65% (median apnea-hypopnea index, 7.2; range, 0-93), 40% of which were moderate to severe. Neuropathy prevalence was higher in patients with OSA than those without (60% vs. 27%, P < 0.001). After adjustment for possible confounders, OSA remained independently associated with diabetic neuropathy (odds ratio, 2.82; 95% confidence interval, 1.44-5.52; P = 0.0034). Nitrotyrosine and lipid peroxide levels (n = 102, 74 with OSA) were higher in OSA and correlated with hypoxemia severity. Cutaneous microvascular function (n = 71, 47 with OSA) was impaired in OSA. Conclusions: We describe a novel independent association between diabetic peripheral neuropathy and OSA. We identified increased nitrosative/oxidative stress and impaired microvascular regulation as potential mechanisms. Prospective and interventional studies are needed to assess the impact of OSA and its treatment on peripheral neuropathy development and progression in patients with type 2 diabetes.     

血清对氧磷酯酶活性变化与糖尿病视网膜病变的关系

目的 探讨对氧磷酯酶(PON)活性变化与2型糖尿病视网膜病变(DR)的关系。方法 用分光光度法检测96例DR患者、82例单纯2型糖尿病(DM)患者及58例正常对照者血清PON的活性；用放免法检测血清免疫反应性胰岛素(IRI)、C肽(C—P)的水平。结果 (1)DR患者血清PON活性明显低于DM患者(F＝11．04，P＜0．01)，DM患者血清PON活性低于正常对照者(F＝16．90，P＜0．01)；(2)PON活性与空腹血清胰岛素及C—P水平无明显相关(r＝0.113，P＞0．05，r＝0．109，P＞0．05)；(3)Logistic回归分析表明，PON活性(P＜0．01)是DR的独立变异危险因素。结论 PON活性变化与DR的发病有关。     

Links between adiposity,physical activity and self-reported fatigue in patients with type 2 diabetes mellitus

Fatigue which is modulated by many physiological and psychological factors is a major reason why most patients do not pursue consistent physical activity at recommended levels. Patients with Type 2 Diabetes (T2D) usually have inappropriate adiposity and inadequate physical activity. This study describes the links between adiposity, physical activity and self-reported fatigue in a group of Nigerian patients with T2D. Participants for this cross-sectional survey were a consecutive sample of 122 T2D patients assessed for adiposity (using body mass index and body fat percentage), physical activity (International Physical Activity Questionnaire) and self-reported fatigue (Iowa fatigue Scale). Seventy-seven (63.1 %) of the participants were overweight-to-obese, 50.8 % had very high body fat percentage, 49.2 % presented with a low level of physical activity and 78.6 % reported substantial-to-severe fatigue. Significant associations were found between self-reported fatigue and each of body mass index (χ ²?=?21.076; p?=?0.002), body fat percentage (χ ²?=?19.214; p?=?0.016) and physical activity (χ ²?=?33.332; p?=?0.0001). Adjusted odds ratio for reporting substantial-to-severe fatigue was 2.49 (95 % CI?=?1.99–3.98) for obese patients and 0.52 (95 % CI?=?0.26–0.74) for those with moderate physical activity level. Most of the participants presented with adiposity, low physical activity level, and reported substantial-to-severe fatigue. Self-reported fatigue was significantly linked with adiposity and physical activity. Overweight, obesity, and high body fat percentage increased the risk of reporting substantial-to-severe fatigue while moderate-to-high physical activity level reduced the risk. Commitment to physical activity may help to reduce fatigue in overweight-to-obese T2D patients.     

Self-reported physical activity in community-dwelling adults with diabetes and its association with diabetes complications

Aims

To describe the physical activity levels of an Australian community-based adult population with diabetes, and investigate the interaction between diabetes complications and physical activity.

Clinic-based support to help overweight patients with type 2 diabetes increase physical activity and lose weight

BACKGROUND: Our objective was to test the effect of physicians providing brief health lifestyle counseling to patients with type 2 diabetes mellitus during usual care visits. METHODS: We conducted a randomized controlled trial of a 12-month intervention at 2 large community health centers, enrolling 310 patients with a body mass index (calculated as weight in kilograms divided by height in meters squared) of 25 or greater. In the intervention group, self-management goals for nutrition and physical activity were set using a tailored computer program. Goals were then reviewed at each clinic visit by physicians. The control group received only printed health education materials. The main outcome measures included change in physical activity and body weight. RESULTS: In the intervention group, recommended levels of physical activity increased from 26% at baseline to 53% at 12 months (P< .001) compared with controls (30% to 37%; P= .27), and 32% of patients in the intervention group lost 6 or more pounds at 12 months compared with 18.9% of controls (odds ratio, 2.2; P= .006). CONCLUSION: A brief intervention to increase the dialogue between patients and health care providers about behavioral goals can lead to increased physical activity and weight loss.     

No association of multiple type 2 diabetes loci with type 1 diabetes

Aims/hypothesis  

We used recently confirmed type 2 diabetes gene regions to investigate the genetic relationship between type 1 and type 2 diabetes, in an average of 7,606 type 1 diabetic individuals and 8,218 controls, providing >80% power to detect effects as small as an OR of 1.11 at a false-positive rate of 0.003.     

脂肪炎症因子在2型糖尿病发病中的重要性

胰岛素抵抗和胰岛β细胞功能减退是2型糖尿病发病的两个关键因素，但2型糖尿病的病因和发病机制尚未完全阐明。近年来炎症病因学理论倍受关注。该理论认为，2型糖尿病是一种自然免疫和低度炎症性疾病。由细胞因子介导的急性相反应属于先天性免疫反应，在正常个体该反应能促进遭受破坏的内环境恢复稳态；而在对急性反应高度敏感的个体，这种反应将导致疾病的发生，而非修复。这些细胞因子是导致代谢综合征的主要原因，从而认为炎症是胰岛素抵抗的触发因素。目前炎症因子与2型糖尿病发病密切相关的证据主要来源于临床流行病学研究。美国的一项研究发现，血清C反应蛋白（CRP）升高者2型糖尿病发病率增加2．3倍。另一项前瞻性研究显示，     

Thiazolidinediones plus metformin association on body weight in patients with type 2 diabetes

There are different studies about the efficacy and safety and tolerability of thiazolidinediones added to metformin. The reported improved glycemic control with thiazolidinediones use seems to be associated with an increase in weight with an estimated 2-3 kg weight gain suggesting that maybe thiazolidinediones are not safe for the clinical use. Other authors reported that thiazolidinediones give an improvement in the glycemic without giving weight gain. With our review, we want to evaluate the effects of thiazolidinediones plus metformin combination in diabetic patients on the body weight. From the data emerged from our review we can conclude that even if a small increase in mean body weight was observed in patients treated with thiazolidinediones plus metformin therapy, the weight gain was less than previously reported and it was also considerably less than what might have been expected given the large improvements in glycemic control. For these reasons we can safely say that thiazolidinediones in combination with metformin are effective and well tolerated in patients with type 2 diabetes.     

2型糖尿病与簇蛋白基因关联的初步研究

目的探讨2型糖尿病（T2DM）与簇蛋白（Glu）基因多态性的关联。方法聚合酶链式反应-变性梯度凝胶电泳（PCR-DGGE）和DNA测序技术分析62例T2DM患者及60例正常对照者的Glu基因外显子2和外显子5基因多态性。结果Glu基因外显子2发现1个多态位点：1963（＋A）;外显子5发现3个多态位点：（1）7476（-A）,（2）7534（-C）,（3）7521C→T。结论Glu基因外显子2和外显子5多态性在2型糖尿病组和正常对照组多态性位点基因频率分布差异有统计学意义。因此,Clu基因外显子2和外显子5多态性可能与T2DM易感性有关联。     

Inverse association between plasma homocysteine, sulphonylurea exposure and physical activity: a community-based sample of type 2 diabetes patients in the Skaraborg hypertension and diabetes project

AIM: This study aimed to investigate levels of Homocysteine (tHcy) and folate in a population-based sample of patients with type 2 diabetes. In particular, the study explored modifiable determinants such as treatment for diabetes, life style, glucose control and kidney function. PATIENTS AND METHODS: In a community-based surveillance of patients with type 2 diabetes, 196 men and 191 women were consecutively identified in primary care and characterized by cardiovascular disease (CVD) risk factors focusing on components in the metabolic syndrome. For categorical associations plasma tHcy was dichotomized using the upper 10 percentiles of the distribution. RESULTS: Treatment with sulphonylurea was associated with lower serum levels of tHcy compared to those on diet alone. The association was confined to women [odds ratio 0.14; confidence interval 0.03-0.8] and remained significant when differences in factors related to the metabolic syndrome, life style and previous CVD were accounted for, but was lost when adjusted for HbA1c. There was an inverse dose-related association between physical activity and plasma levels of tHcy (men p = 0.006, women p = 0.034), and a positive association with serum levels of creatinine (men p = 0.004, women p < 0.001). CONCLUSIONS: The association with physical activity might be one contributing explanation for its well-known protective effect on cardiovascular disease. The over risk for vascular complications in diabetic patients with kidney disease may be partially explained by high levels of tHcy and should be further explored. Prospective studies are particularly needed on various treatment for type 2 diabetes and tHcy to explore possible implications for clinical procedures and for public health.