Ten-Year Experience with an Exercise-Based Outpatient Life-Style Modification Program in the Treatment of Diabetes Mellitus

Schneider, Stephen H.; Khachadurian, Avedis K.; Amorosa, Louis F.; Clemow, Lynn; Ruderman, Neil B.

doi:10.2337/diacare.15.11.1800

Cited by 154 publications

(70 citation statements)

References 22 publications

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“…Our results are comparable with those observed by others in adults with IDDM (McCargar et al, 1991;Wallberg-Henriksson et al, 1986;Yki-Ja Èrvinen et al, 1984;Wallberg-Henriksson et al, 1982;Schneider et al, 1992;Zinman et al, 1984;WallbergHenriksson et al, 1984). Failure to show any changes in resting heart rate may be explained by the fact that the measurement was not made after a suf®cient period of rest and because participants did not achieve the required exercise intensity (Ekelund et al, 1988).…”

Section: Discussionsupporting

confidence: 93%

Lifestyle intervention in people with insulin-dependent diabetes mellitus (IDDM)

Mann

Lewis‐Barned

et al. 1997

Eur J Clin Nutr

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Objective: To investigate the impact of intensive lifestyle education on dietary practices, exercise and metabolic measurements in people with insulin-dependent diabetes mellitus (IDDM). Design: Sixty-one volunteer subjects with IDDM were randomised to intensive (Group 1) or standard (Group 2) education programmes for six months. During a second six month period of observation Group 1 subjects received routine surveillance for their condition and those in Group 2 were given intensive advice (phase 2). Current insulin regimens were modi®ed to optimise glycaemic control before the start of the intervention phase. Nutrient intakes, weight, blood pressure, glycated haemoglobin (HbA 1 ), plasma lipids, lipoproteins and maximal oxygen consumption (VO 2 max) were measured at the time of recruitment and at three monthly intervals during the trial and phase 2. Setting: Department of Human Nutrition at the University of Otago. Results: Glycated haemoglobin decreased signi®cantly in both groups between recruitment and randomisation, the improvement being sustained during the six months of the randomised trial and for group 1 during the six months of post trial observation. A further decrease was seen in Group 2 during the second six month period when they were given intensive advice. Comparable changes were seen with total and low density lipoprotein (LDL) cholesterol in Group 1 during the trial, but signi®cant decreases were only seen in Group 2 in association with intensive intervention (phase 2). These changes occurred in parallel with increases in intakes of carbohydrate and monounsaturated fatty acids, a reduction in intakes of total and saturated fat, and an improvement in maximum oxygen consumption. Conclusions: A lifestyle programme for people with IDDM results in modest changes in diet and exercise habits suf®cient to improve measures of glycaemic control and lipoprotein mediated risk of coronary heart disease independent of changes in insulin regime. More innovative approaches to achieve lifestyle changes are required to meet current recommendations which in turn are likely to produce even greater bene®cial changes than those observed here.

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Section: Discussionsupporting

confidence: 93%

Lifestyle intervention in people with insulin-dependent diabetes mellitus (IDDM)

Mann

Lewis‐Barned

et al. 1997

Eur J Clin Nutr

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“…Most metabolic studies find a significant effect of exercise on glucose control [22][23][24] and on triglycerides. 25,26 A meta-analysis of clinical trials on the effect of exercise on glucose control found that interventions longer than 8 weeks reduced HbA1c from 8.31% to 7.65% (weighted mean difference 0.66%, PϽ0.001) independently of body mass.…”

Section: Discussionmentioning

confidence: 99%

Physical Activity in Relation to Cardiovascular Disease and Total Mortality Among Men With Type 2 Diabetes

et al. 2003

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Background-The present study was conducted to examine the relationship of physical activity with risk of cardiovascular disease (CVD) and mortality among men with type 2 diabetes. CVD risk and mortality are increased in type 2 diabetes. Few epidemiological studies have investigated the effect of physical activity on these outcomes among type 2 diabetics. Methods and Results-Of the 3058 men who reported a diagnosis of diabetes at age 30 years or older in the Health Professionals' Follow-up Study (HPFS), we excluded 255 who reported a physical impairment. In the remaining 2803 men, physical activity was assessed every 2 years; 266 new cases of CVD and 355 deaths of all causes were identified during 14 years of follow-up. Relative risks of CVD and death were estimated from Cox proportional hazards analysis with adjustment for potential confounders. The multivariate relative risks of CVD incidence corresponding to quintiles of total physical activity were 1.0, 0.87, 0.64, 0.72, and 0.67 (P trend ϭ0.07). The corresponding multivariate relative risks for total mortality were 1.0, 0.80, 0.57, 0.58, and 0.58 (P trend ϭ0.005). Walking was associated with reduced risk of total mortality. Relative risks across quintiles of walking were 1.0, 0.97, 0.87, 0.97, and 0.57 (P trend ϭ0.002). Walking pace was inversely associated with CVD, fatal CVD, and total mortality independently of walking hours. Conclusions-Physical activity was associated with reduced risk of CVD, cardiovascular death, and total mortality in men with type 2 diabetes. Walking and walking pace were associated with reduced total mortality. (Circulation. 2003;107: 2435-2439.)

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“…However, compliance to lifestyle changes has been proven to be poor in the long term [10]. In the last decades, bariatric surgery has emerged as a potential therapy for diabetes [11].…”

Section: Introductionmentioning

confidence: 99%

Genes involved in mitochondrial biogenesis/function are induced in response to bilio-pancreatic diversion in morbidly obese individuals with normal glucose tolerance but not in type 2 diabetic patients

et al. 2009

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Aims/hypothesis The mechanisms allowing normalisation of insulin sensitivity and reversal of type 2 diabetes after bilio-pancreatic diversion (BPD) have not been elucidated. We studied whether the expression of genes relevant to mitochondrial biogenesis/function is induced in response to BPD and whether the response differs between morbidly obese patients with normal glucose tolerance (NGT) and patients with type 2 diabetes. Methods The effect of stable weight reduction after BPD on metabolic variables and expression of nuclear genes encoding for mitochondrial proteins or regulators of mitochondrial function was investigated in skeletal muscle. Insulin sensitivity was assessed by euglycaemic-hyperinsulinaemic clamp and substrate oxidation by indirect calorimetry.Results Both NGT and type 2 diabetic patients showed a net improvement of insulin sensitivity, with the latter also showing blood glucose normalisation. NGT patients had a large increase in glucose oxidation and substantial reduction in lipid oxidation. In contrast, type 2 diabetic patients had a blunted response to BPD in terms of glucose oxidation. NGT patients showed increased expression of genes encoding mitofusin 2, porin or citrate synthase; no significant changes were detected in diabetic patients. The expression of genes regulating mitochondrial activity (PGC-1β [also known as PPARGC1B], PGC-1α [also known as PPARGC1A], PPARδ [also known as PPARD], SIRT1) was induced only in NGT patients. Conclusions/interpretation These findings indicate that weight loss after BPD exerts a beneficial effect on insulin sensitivity via mechanisms that are independent of the Diabetologia

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Ten-Year Experience with an Exercise-Based Outpatient Life-Style Modification Program in the Treatment of Diabetes Mellitus

Cited by 154 publications

References 22 publications

Lifestyle intervention in people with insulin-dependent diabetes mellitus (IDDM)

Lifestyle intervention in people with insulin-dependent diabetes mellitus (IDDM)

Physical Activity in Relation to Cardiovascular Disease and Total Mortality Among Men With Type 2 Diabetes

Genes involved in mitochondrial biogenesis/function are induced in response to bilio-pancreatic diversion in morbidly obese individuals with normal glucose tolerance but not in type 2 diabetic patients

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