Lifestyle approach for type 2 diabetes and metabolic syndrome

Recent changes in lifestyle, including physical inactivity and unhealthy diets, are likely to have played an important role in the global epidemic of obesity, type 2 diabetes, and metabolic syndrome. Implementation of a healthier lifestyle, with an increase in physical activity and a reduction of body weight, based on the regulation of calories and fat intake, are the basis for the prevention and treatment of both type 2 diabetes and metabolic syndrome. Intervention studies based on changes in lifestyle in individuals at risk found that diabetes incidence was reduced by 42% to 63%. Similarly, intensive lifestyle changes in patients with the metabolic syndrome have been shown to reduce the prevalence of the syndrome by 20% to 48%. Reduction of body weight, improvement of the quality of diet, and promotion of physical activity are the main approaches to prevent and treat patients with type 2 diabetes or metabolic syndrome.     

Cardiovascular risk: prevention and treatment of the metabolic syndrome

The metabolic syndrome is a cluster of metabolic abnormalities, including impaired glucose metabolism, hypertension, dyslipidemia and abdominal obesity. It is a precursor to type 2 diabetes and a powerful independent risk factor for cardiovascular disease. Lifestyle changes, such as a diet high in saturated fats and a lack of physical exercise, have contributed to a worldwide increase in the prevalence of the metabolic syndrome and its associated complications. Identification and effective management of patients with the metabolic syndrome is important to reduce their risk of subsequent disease. Lifestyle modifications are an essential first step, and lipid-lowering therapy may also be required to achieve the lipid goals set out in current treatment guidelines. Statins are the most effective class of lipid-lowering drugs. Recent studies in patients with type 2 diabetes or the metabolic syndrome have shown that rosuvastatin was more effective than atorvastatin, simvastatin or pravastatin in reducing low-density lipoprotein cholesterol and enabling patients to reach lipid goals.     

Eingeschr?nkte Fitness vs. Adipositas

The prevalence of metabolic syndrome and type?2 diabetes mellitus is increasing worldwide, resulting in premature cardiovascular mortality. This has been attributed to the increasing prevalence of obesity. However, multiple clinical and epidemiologic studies have also shown that high levels of cardiorespiratory fitness protect against the development of these metabolic disorders and at the same time reduce cardiovascular mortality. When comparing both parameters, cardiorespiratory fitness has been shown to be a more powerful parameter in the prevention of metabolic syndrome, type?2 diabetes, and cardiovascular disease than obesity. Thus, to prevent cardiovascular disease, it is mandatory to promote physical activity that will increase physical fitness. An English fulltext version of this article is available under Springerlink as supplemental material.     

Exercise, fitness, and cardiovascular disease risk in type 2 diabetes and the metabolic syndrome

This article highlights research supporting the concept that increased physical activity and cardiorespiratory fitness attenuate risk of cardiovascular disease, type 2 diabetes, and the metabolic syndrome. Increased activity and fitness also attenuate risk of developing cardiovascular disease in persons who have type 2 diabetes or the metabolic syndrome. Although controversial, relationships between physical activity/physical fitness and type 2 diabetes/metabolic syndrome are largely independent of body weight. Thus, physical inactivity and poor cardiorespiratory fitness are not only important determinants of cardiovascular and metabolic diseases, but they can also be considered common features of these conditions, much like traditional risk factors such as obesity and insulin resistance.     

Hypertension in the metabolic syndrome

Increased blood pressure is considered an important component of metabolic syndrome. More than 85% of those with metabolic syndrome, even in the absence of diabetes, have elevated blood pressure (BP) or hypertension. The association of elevated BP with the metabolic syndrome is strongly linked through the causative pathway of obesity. Hypertension is the leading metabolic syndrome risk factor that predisposes to increased cardiovascular morbidity and mortality, and is additionally an important risk factor for development of chronic kidney disease in the presence of obesity, the metabolic syndrome, and microalbuminuria. Control of blood pressure in persons with the metabolic syndrome may prevent a significant number of coronary heart disease events. The primary modality of treatment is lifestyle intervention with reduced caloric intake and increased physical activity. Pharmacologic intervention is indicated on the basis of the severity of BP elevation, associated cardiovascular risk factors, and the presence of target organ damage.     

Metabolic syndrome as a predictor of type 2 diabetes,and its clinical interpretations and usefulness

Metabolic syndrome is defined as a cluster of glucose intolerance, hypertension, dyslipidemia and central obesity with insulin resistance as the source of pathogenesis. Although several different combinations of criteria have been used to define metabolic syndrome, a recently published consensus recommends the use of ethnic‐specific criteria, including waist circumference as an indicator of central obesity, triglyceride and high‐density lipoprotein (HDL) cholesterol as indicators of dyslipidemia, and blood pressure greater than 130/85 mmHg. The definition of dysglycemia, and whether central obesity and insulin resistance are essential components remain controversial. Regardless of the definition, the prevalence of metabolic syndrome is increasing in Western and Asian countries, particularly in developing areas undergoing rapid socioenvironmental changes. Numerous clinical trials have shown that metabolic syndrome is an important risk factor for cardiovascular disease (CVD), type 2 diabetes mellitus and all‐cause mortality. Therefore, metabolic syndrome might be useful as a practical tool to predict these two major metabolic disorders. Comprehensive management of risk factors is very important to the improvement of personal and public health. However, recent studies have focused on the role metabolic syndrome plays as a risk factor for CVD; its importance in the prediction of incident diabetes is frequently overlooked. In the present review, we summarize the known evidence supporting metabolic syndrome as a predictor for type 2 diabetes mellitus and CVD. Additionally, we suggest how metabolic syndrome might be useful in clinical practice, especially for the prediction of diabetes.     

Androgens, insulin resistance and vascular disease in men

Type 2 diabetes mellitus is increasing globally and is an established risk factor for the development of atherosclerotic vascular disease. Insulin resistance is the hallmark feature of type 2 diabetes and is also an important component of the metabolic syndrome. There is evidence to suggest that testosterone is an important regulator of insulin sensitivity in men. Observational studies have shown that testosterone levels are low in men with diabetes, visceral obesity (which is strongly associated with insulin resistance), coronary artery disease and metabolic syndrome. Short-term interventional studies have also demonstrated that testosterone replacement therapy produces an improvement in insulin sensitivity in men. Thus hypotestosteronaemia may have a role in the pathogenesis of insulin-resistant states and androgen replacement therapy could be a potential treatment that could be offered for improvements in glycaemic control and reduction in cardiovascular risk, particularly in diabetic men.     

Obesity and type 2 diabetes: which patients are at risk?

An estimated 72.5 million American adults are obese, and the growing US obesity epidemic is responsible for substantial increase in morbidity and mortality, as well as increased health care costs. Obesity results from a combination of personal and societal factors, but is often viewed as a character flaw rather than a medical condition. This leads to stigma and discrimination towards obese individuals and decreases the likelihood of effective intervention. Conditions related to obesity are increasingly common, such as metabolic syndrome, impaired fasting glucose (IFG) and impaired glucose tolerance (IGT), all of which indicate high risk for type 2 diabetes (T2DM). This paper reviews the progression from obesity to diabetes, identifying physiological changes that occur along this path as well as opportunities for patient identification and disease prevention. Patients with prediabetes (defined as having IFG, IGT or both) and/or metabolic syndrome require interventions designed to preserve insulin sensitivity and β-cell function, both of which start to deteriorate prior to T2DM diagnosis. Lifestyle modification, including both healthy eating choices and increased physical activity, is essential for weight management and diabetes prevention. Although sustained weight loss is often considered by patients and physicians as being impossible to achieve, effective interventions do exist. Specifically, the Diabetes Prevention Program (DPP) and programs modelled along its parameters have shown repeated successes, even with long-term maintenance. Recent setbacks in the development of medications for weight loss further stress the importance of lifestyle management. By viewing obesity as a metabolic disorder rather than a personal weakness, we can work with patients to address this increasingly prevalent condition and improve long-term health outcomes.     

Lifestyle intervention, glucose tolerance, and risk of developing type 2 diabetes mellitus

Diabetes mellitus is rapidly becoming one of the main health issues in the 21st century. Environmental factors such as lifestyle habits (i.e., physical inactivity and dietary intake) and obesity may act as initiating factors or progression factors for type 2 diabetes. Therefore, changes in lifestyle (i.e., diet and physical activity) should have the potential to postpone or prevent the development of type 2 diabetes mellitus in subjects at high risk (for example, those with impaired glucose tolerance [IGT]). Several independent and well-controlled randomized studies have shown the beneficial impact of a lifestyle intervention program on glucose tolerance, insulin resistance, and diabetes risk in populations at risk for developing type 2 diabetes mellitus. After 2 years of a combined diet and physical activity intervention program, according to general public health guidelines, the Study on Lifestyle-intervention and IGT Maastricht (SLIM) revealed an improved glucose tolerance in the intervention group compared to a further deterioration in the control group. The Finnish Diabetes Prevention Study (DPS) and the US Diabetes Prevention Program (DPP) both observed a 58% reduction in diabetes risk after 3 years of intervention in a high-risk population. Although other intervention strategies can reduce the incidence of diabetes, lifestyle changes are the most effective mean of delaying or preventing the development of type 2 diabetes mellitus. For a successful implementation of a diabetes prevention program in a primary healthcare setting, both patients and healthcare professionals should be aware of the (clinical) significance of impaired glucose tolerance and the effectiveness of lifestyle interventions to prevent or postpone type 2 diabetes mellitus and its complications.     

Komplexe diätetische und Pharmakotherapie beim metabolischen Syndrom

Metabolic syndrome is characterized by a group of risk factors (obesity, glucose metabolism disorders, dyslipidemia and hypertension) which appear to be caused by obesity related mechanisms of cellular metabolism and the systemic energy balance. A fibre poor diet rich in fat combined with lack of physical activity are important causative factors. A suitable change in diet combined with regular physical exercise and a moderate weight loss of about 5% leads to a massive reduction in the consequential disease diabetes type 2 by 60% in pre-diabetics and reduces the risk factors for metabolic syndrome. Pharmacological therapies using metformin or acarbose were about half as effective in reducing new cases of diabetes, while thiazolidinedione also led to a 60% reduction in new diabetes cases in pre-diabetics in spite of a weight increase. A sensible and realizable change in lifestyle provides a highly efficient therapy of metabolic syndrome, in addition to effective pharmacological options.     

Diabetes in the hispanic or latino population: Genes,environment, culture,and more

The Hispanic or Latino population is the largest minority group in the United States, currently representing 13.7% of the total U.S. population. Hispanics or Latinos usually suffer from higher rates of type 2 diabetes, obesity, metabolic syndrome, and their multiple vascular complications. Inadequate nutrition and reduced physical activity in the setting of an increased genetic predisposition to type 2 diabetes have contributed to the inexorable rise in metabolic abnormalities in Hispanics in the United States, which now affect many children and adolescents. It is evident that multiple medical, cultural, and socioeconomic factors influence the development of diabetes, its course, and its consequences. Our health care system is barely prepared to face the challenge of managing diabetes in this high-risk group. Culturally oriented clinical care, education, outreach and research programs are needed to better identify the challenges to create opportunities to improve the lives of Hispanics or Latinos with diabetes or at risk for the disease.     

Low birth weight and delayed risk of type 2 diabetes and metabolic syndrome

Low birth weight is according to many studies associated with later incidence of type 2 diabetes, hypertension and in lower degree with obesity and hypertriacylglycerolemia. Detection of history of low birth weight could have some importance in detection of persons with metabolic syndrome and cardiovascular risk. In the pathogenesis can be involved fetal selection of thrifty genes which are later unable to overcome low physical activity and overfeeding in adult age. More probable is that low birth weight is primary of genetic origin. The same genetic origin can be involved in BMI rebound in childhood, development of insulin resistance, weight gain and later incidence of metabolic syndrome and type 2 diabetes. Detection of all these phenomena is important in selecting patients in diabetes and cardiovascular risk for preventive intervention.     

Mechanisms,screening modalities and treatment options for individuals with non-alcoholic fatty liver disease and type 2 diabetes

Non-alcoholic fatty liver disease (NAFLD) exists as a spectrum of disease ranging from excessive accumulation of fat within the liver (simple steatosis), inflammation (non-alcoholic steatohepatitis) through to fibrosis, cirrhosis and end-stage liver disease. There is also an increased risk of hepatocellular carcinoma. The principal risk factor for NAFLD is overweight or obesity, along with type 2 diabetes, and NAFLD itself is also a risk factor for incident type 2 diabetes. Overweight/obesity is synergistic with alcohol consumption in causing progressive and insidious liver damage. Recent consensus advocates a change in nomenclature from NAFLD to ‘metabolic associated fatty liver disease’ (MAFLD), reflective of the associated metabolic abnormalities (insulin resistance/type 2 diabetes and metabolic syndrome components). Additional extra-hepatic manifestations of NAFLD include cardiovascular disease, chronic kidney disease and certain cancers. Unlike other micro- and macrovascular complications of type 2 diabetes, systematic screening or surveillance protocols have not been widely adopted in routine diabetes care to assess for presence/severity of NAFLD. Various screening tools are available (non-invasive tests and biochemical indices) combined with imaging techniques (e.g. transient elastography) to detect steatosis and more importantly advanced fibrosis/cirrhosis to facilitate appropriate surveillance. Liver biopsy may be sometimes necessary. Treatment options for type 2 diabetes, including lifestyle interventions (dietary change and physical activity), glucose-lowering therapies and metabolic surgery, can modulate hepatic steatosis and to a lesser extent fibrosis. Awareness of the impact of liver disease on the choice of glucose-lowering medications in individuals with type 2 diabetes is also critical.     

Obesity and metabolic syndrome in Korea

In Korea, a person with a body mass index (BMI) ≥25 kg/m(2) is considered obese, and a person with a BMI ≥30 kg/m(2) is classified as severely obese. Central obesity is defined as a waist circumference ≥90 cm for Korean men and ≥85 cm for Korean women. Recent epidemiologic data show that the prevalence of severe obesity and metabolic syndrome is steadily increasing. These epidemics increased morbidity and mortality of type 2 diabetes, cardiovascular diseases, and obesity-related cancers such as breast, colorectal, and other cancers in Korea. Decreased physical activity, increased fat and alcohol consumption, heavy smoking, and stress/depressed mood are the primary modifiable life-style risk factors for Koreans. Recently, public health interventions to encourage life-style changes have shown promising results in reducing the prevalence of severe obesity and metabolic syndrome.     

Diabetes and dementia: Clinical perspective,innovation, knowledge gaps

The world faces a pandemic-level prevalence of type 2 diabetes. In parallel with this massive burden of metabolic disease is the growing prevalence of dementia as the population ages. The two health issues are intertwined. The Lancet Commission on dementia prevention, intervention, and care was convened to tackle the growing global concern of dementia by identifying risk factors. It concluded, along with other studies, that diabetes as well as obesity and the metabolic syndrome more broadly, which are frequently comorbid, raise the risk of developing dementia. Type 2 diabetes is a modifiable risk factor; however, it is uncertain whether anti-diabetic drugs mitigate risk of developing dementia. Reasons are manifold but constitute a critical knowledge gap in the field. This review outlines studies of type 2 diabetes on risk of dementia, illustrating key concepts. Moreover, it identifies knowledge gaps, reviews strategies to help fill these gaps, and concludes with a series of recommendations to mitigate risk and advance understanding of type 2 diabetes and dementia.     

Physical activity-induced improvements in markers of insulin resistance in overweight and obese children and adolescents

Childhood obesity is a significant, worldwide, public health problem. Coinciding with the increasing prevalence of obesity in youth, Type 2 diabetes has emerged as a critical health condition in this population. In the U.S. alone, approximately 215,000 U.S. youth under the age of 20 were diagnosed with diabetes, with the majority of 10-19 years old diagnosed with Type 2 diabetes. Additionally, the exact number of youth that may have Type 2 diabetes yet remain undiagnosed is unknown. Increasing physical activity to encourage weight loss among youth may reduce the incidence of Type 2 diabetes in youth; however, several recent studies reported positive associations between physical activity and components of Type 2 diabetes without weight loss in youth. These findings support previous studies in adults which observed physical activity-induced improvements in insulin dynamics without changes in body fat. The purpose of this review was to identify studies which examined the effect of physical activity without dietary intervention on markers of insulin resistance in overweight and obese youth. These studies provide strong evidence that physical activity alone, without dietary intervention, can have a positive, significant impact on insulin resistance risk and potentially prevent the development of type 2 diabetes in overweight and obese youth. The studies reviewed provide support for future interventions to shift the focus from reducing obesity to increasing physical activity for the prevention of type 2 diabetes in obese youth.     

Preventing diabetes by treating aspects of the metabolic syndrome

The metabolic syndrome often develops into and is usually present in type 2 diabetes in association with premature cardiovascular disease. Treating diabetes can prevent some of its devastating consequences, but it does not eliminate them all. With the goal to eliminate all the adverse consequences of the syndrome, the optimal approach would be through its prevention. Insulin resistance appears to be pivotal to development of the syndrome complex that includes features such as intra-abdominal or visceral obesity, hypertension, impaired glucose homeostasis, dyslipidemia with elevated triglycerides and low highdensity lipoprotein without elevations of low-density lipoprotein, a procoagulant state, and impaired vascular function. Improving the insulin resistance needs to be the primary target of the therapy. Hyperglycemia, which is one feature of the metabolic syndrome, may range from impaired glucose tolerance (IGT) to overt diabetes. The risk of progression of the disease from IGT to diabetes is increased with time and the presence of various risk factors. Diabetes is a disease of serious concern because of the associated complication of the disease and the huge impact on the health care costs. Many short- and longer-term trials have shown promise in the prevention of diabetes and its metabolic and cardiovascular consequences.     

A scientific review: the role of chromium in insulin resistance

Chromium is an essential mineral that appears to have a beneficial role in the regulation of insulin action and its effects on carbohydrate, protein and lipid metabolism. Chromium is an important factor for enhancing insulin activity. Studies show that people with type 2 diabetes have lower blood levels of chromium than those without the disease. Insulin resistance is the common denominator in a cluster of cardiovascular disease risk factors. One out of every five Americans has metabolic syndrome. It affects 40% of people in their 60s and 70s. Insulin resistance, with or without the presence of metabolic syndrome, significantly increases the risk of cardiovascular disease. Insulin resistance is present in two serious health problems in women; polycystic ovarian syndrome (PCOS) and gestational diabetes. Several studies have now demonstrated that chromium supplements enhance the metabolic action of insulin and lower some of the risk factors for cardiovascular disease, particularly in overweight individuals. Chromium picolinate, specifically, has been shown to reduce insulin resistance and to help reduce the risk of cardiovascular disease and type 2 diabetes. Dietary chromium is poorly absorbed. Chromium levels decrease with age. Supplements containing 200-1,000 mcg chromium as chromium picolinate a day have been found to improve blood glucose control. Chromium picolinate is the most efficacious form of chromium supplementation. Numerous animal studies and human clinical trials have demonstrated that chromium picolinate supplements are safe.     

Metabolically healthy obesity: Definitions, determinants and clinical implications

Obesity is associated with increased risk of developing metabolic syndrome (MetS), type 2 diabetes mellitus (T2DM) and cardiovascular disease (CVD) leading to higher all-cause mortality. However accumulating evidence suggests that not all obese subjects are at increased cardiometabolic risk and that the “metabolically healthy obese” (MHO) phenotype may exist in the absence of metabolic abnormalities. Despite the knowledge of the existence of obese metabolic phenotypes for some time now there is no standard set of criteria to define metabolic health, thus impacting on the accurate estimation of the prevalence of the MHO phenotype and making comparability between studies difficult. Furthermore prospective studies tracking the development of cardiometabolic disease and mortality in MHO have also produced conflicting results. Limited data regards the determinants of the MHO phenotype exist, particularly in relation to dietary and lifestyle behaviours. In light of the current obesity epidemic it is clear that current “one size fits all” approaches to tackle obesity are largely unsuccessful. Whether dietary, lifestyle and/or therapeutic interventions based on stratification of obese individuals according to their metabolic health phenotype are more effective remains to be seen, with limited and conflicting data available so far. This review will present the current state of the art including the epidemiology of MHO and its definitions, what factors may be important in determining metabolic health status and finally, some potential implications of the MHO phenotype in the context of obesity diagnosis, interventions and treatment.