scholarly journals Exercise intolerance in Type 2 diabetes: is there a cardiovascular contribution?

2018 ◽  
Vol 124 (5) ◽  
pp. 1117-1139 ◽  
Author(s):  
Veronica J. Poitras ◽  
Robert W. Hudson ◽  
Michael E. Tschakovsky
Keyword(s):  
Type 2 Diabetes ◽  
Oxygen Delivery ◽  
Diabetes Management ◽  
Vascular Dysfunction ◽  
Muscle Blood Flow ◽  
Submaximal Exercise ◽  
Exercise Intolerance ◽  
Future Research ◽  
Muscle Oxygen

Physical activity is critically important for Type 2 diabetes management, yet adherence levels are poor. This might be partly due to disproportionate exercise intolerance. Submaximal exercise tolerance is highly sensitive to muscle oxygenation; impairments in exercising muscle oxygen delivery may contribute to exercise intolerance in Type 2 diabetes since there is considerable evidence for the existence of both cardiac and peripheral vascular dysfunction. While uncompromised cardiac output during submaximal exercise is consistently observed in Type 2 diabetes, it remains to be determined whether an elevated cardiac sympathetic afferent reflex could sympathetically restrain exercising muscle blood flow. Furthermore, while deficits in endothelial function are common in Type 2 diabetes and are often cited as impairing exercising muscle oxygen delivery, no direct evidence in exercise exists, and there are several other vasoregulatory mechanisms whose dysfunction could contribute. Finally, while there are findings of impaired oxygen delivery, conflicting evidence also exists. A definitive conclusion that Type 2 diabetes compromises exercising muscle oxygen delivery remains premature. We review these potentially dysfunctional mechanisms in terms of how they could impair oxygen delivery in exercise, evaluate the current literature on whether an oxygen delivery deficit is actually manifest, and correspondingly identify key directions for future research.

scholarly journals SUN-691 Type 2 Diabetes Management in the Context of Smith-Magenis Syndrome: Case Report

2020 ◽  
Vol 4 (Supplement_1) ◽  
Author(s):  
Kylie Tamm Mulvaney ◽  
Airani Sathananthan
Keyword(s):  
Type 2 Diabetes ◽  
Peripheral Neuropathy ◽  
Diabetes Management ◽  
Psychosocial Health ◽  
Exercise Intolerance ◽  
Hormone Deficiency ◽  
Lifestyle Modifications ◽  
Truncal Obesity ◽  
Wake Patterns

Abstract Background: Smith-Magenis syndrome (SMS) is a rare condition caused by microdeletion chromosome 17p11.2 via RAI1 gene mutations, causing disrupted circadian sleep-wake patterns. Characteristic behaviors include: sleep disturbance, anxiety, maladaptive habits with self-injury (biting, picking, self-hugging, page-flipping) and outbursts. Characteristic features include: craniofacial abnormalities, short stature, 2/3 toe syndactyly, scoliosis, cardiac and genitourinary defects, hypotonia, peripheral neuropathy, epilepsy, childhood-onset truncal obesity, toileting difficulties. Management of adults with SMS span multiple disciplines: otolaryngology, audiology, ophthalmology, assessments of scoliosis, seizures, familial psychosocial health, sleep and behavioral changes with each medication. Annual assessments include: fasting lipids, thyroid panel, screening urinalysis. Patients should receive standard treatment for comorbid endocrine conditions, classically: hypercholesterolemia, hypothyroidism, growth hormone deficiency. Clinical Case: 49-year-old Hispanic female with history of SMS who presented to endocrinology for type 2 diabetes mellitus (T2DM) management. Past medical history includes T2DM with peripheral neuropathy, hypertension, hypercholesterolemia, intellectual disability, anxiety, recurrent genitourinary infections, sleep apnea. Physical exam is remarkable for macroglossia, truncal obesity, scoliosis, extremity excoriations evident of skin picking and xerosis, syndactyly of 2nd-3rd toes. Patient exhibited maladaptive behaviors like page-flipping, self-hugging, tantrums. Over the past 3 years, BMI remained in the obese range (>30 kg/m2) and A1c fluctuated from 7.0 to 10.6% averaging 8.8% (<5.7%). Patient is currently managed on insulin glargine, pioglitazone and liraglutide. She did not tolerate metformin due to dose-dependent diarrhea. Patient’s mother chose against SGLT2 inhibitors due to diminished genitourinary hygiene. T2DM management was complicated by patient behaviors, including nocturnal consumption of fructose-containing food and beverages, exercise intolerance, and associated caregiver fatigue. Conclusion: This case describes a patient managed for metabolic dysfunction in conjunction with a rare microdeletion disorder causing neurobehavioral disturbance with disrupted circadian sleep-wake patterns. The most difficult aspects of diabetes management included difficulty implementing lifestyle modifications to control the patient’s hyperglycemia.

Patient Centered Studies Focusing on Diabetes Self-Management: A Scoping Review

2020 ◽  
Vol 16 (6) ◽  
pp. 557-569
Author(s):  
Monika Salkar ◽  
Meagen Rosenthal ◽  
Tanvee Thakur ◽  
Austin Arnold
Keyword(s):  
Type 2 Diabetes ◽  
Scoping Review ◽  
Diabetes Management ◽  
Current Knowledge ◽  
Future Research ◽  
Patient Centered ◽  
Pubmed Database ◽  
Research Questions ◽  
The Impact

Background: Type 2 diabetes continues to be a significant burden to patients and health systems globally. Addressing this condition from an alternative perspective, patients and various other stakeholders from three northern Mississippi communities co-created patient-centered research questions focused on type 2 diabetes management. Objective: The objective of this scoping review was to explore current literature focusing on nine patient- centered research questions to establish current knowledge and identify future research needs in the area of type 2 diabetes. Methods: A scoping review was conducted to obtain an overview of research related to the study purpose. The PubMed database was searched from March 2013 to March 2018 to identify patient-centered studies focused on type 2 diabetes and relevant to one of the nine research questions. Results: A total of 33 studies were identified and included. For five of the research questions, there was either no previous research literature or only “related” studies could be identified. These largely unexplored topics included how the understanding of guidelines by healthcare providers, specialty, and communication of medication side-effects impact patients’ understanding and outcomes, the impact of improving patients’ preparedness to communicate with providers, and whether younger patients require weight management programs that account for this populations’ needs. Conclusion: This lack of previous literature presents a unique opportunity to partner with patients to conduct this study and help improve the management of type 2 diabetes.

scholarly journals Association of Exercise Intolerance in Type 2 Diabetes With Skeletal Muscle Blood Flow Reserve

2015 ◽  
Vol 8 (8) ◽  
pp. 913-921 ◽  
Author(s):  
Julian W. Sacre ◽  
Christine L. Jellis ◽  
Brian A. Haluska ◽  
Carly Jenkins ◽  
Jeff S. Coombes ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Skeletal Muscle ◽  
Blood Flow ◽  
Muscle Blood Flow ◽  
Exercise Intolerance ◽  
Skeletal Muscle Blood Flow ◽  
Flow Reserve

scholarly journals Type 2 Diabetes Management Among Older Black American Men During the COVID-19 Pandemic: A Qualitative Investigation

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. 737-737
Author(s):  
Ledric Sherman ◽  
DeLawnia Comer-HaGans ◽  
Sara Vera
Keyword(s):  
Type 2 Diabetes ◽  
Black Men ◽  
Diabetes Management ◽  
Video Conferencing ◽  
Future Research ◽  
Racial Groups ◽  
Qualitative Investigation ◽  
Global Pandemic ◽  
Hospital Stays

Abstract As COVID-19 swept across the globe in 2020, it appeared to have infected and killed Black Americans at a disproportionately higher rate. However, few studies have focused specifically on the complications of managing diabetes, expressly type 2 diabetes (T2D), among Black men during the global pandemic. Therefore, the purpose of this qualitative study was to seek understanding of the experiences in managing T2D among Black men during the COVID-19 pandemic. One on one interviews were conducted via Zoom video conferencing with twenty-two (n=22) Black men regarding their experience of managing type 2 diabetes (T2D) in a pandemic environment. Four main themes emerged from the study, which are: (1) stress levels during the pandemic, (2) barriers to managing my diabetes, (3) who/what is helping the most, and (4) communication with health-care provider. As more information becomes available, it is apparent that having diabetes increases the risk for detrimental COVID-19 outcomes (i.e. increased lengths of hospital stays, the need for mechanical ventilation, and mortality. Future research efforts are crucially needed to provide an improved understanding of how individuals across all racial groups are managing diabetes during the COVID-19 pandemic.

Frequency of Diabetes-Related Complications in Type 1 and Type 2 Diabetes—Results from the International Diabetes Management Practices Study (IDMPS)

Diabetes ◽  
2018 ◽  
Vol 67 (Supplement 1) ◽  
pp. 1584-P
Author(s):  
JUAN J. GAGLIARDINO ◽  
PABLO ASCHNER ◽  
HASAN M. ILKOVA ◽  
FERNANDO J. LAVALLE-GONZALEZ ◽  
AMBADY RAMACHANDRAN ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Management Practices ◽  
Diabetes Management

1311-P: Machine Learning (ML) Application to Predict Patient Risk of Nonadherence in Type 2 Diabetes Management Using U.S. Claims Databases

Diabetes ◽  
2019 ◽  
Vol 68 (Supplement 1) ◽  
pp. 1311-P
Author(s):  
XIN CHEN ◽  
GAIL FERNANDES ◽  
JIE CHEN ◽  
ZHIWEN LIU ◽  
RICHARD BAUMGARTNER
Keyword(s):  
Machine Learning ◽  
Type 2 Diabetes ◽  
Diabetes Management ◽  
Patient Risk

The Role of Disordered Eating in Type 2 Diabetes: A Pilot Study

2021 ◽  
pp. 155982762110024
Author(s):  
Alyssa M. Vela ◽  
Brooke Palmer ◽  
Virginia Gil-Rivas ◽  
Fary Cachelin
Keyword(s):  
Physical Activity ◽  
Type 2 Diabetes ◽  
Disordered Eating ◽  
Lifestyle Intervention ◽  
Eating Behaviors ◽  
Diabetes Management ◽  
Behavioral Therapy ◽  
Exercise Stress ◽  
Increased Risk

Rates of type 2 diabetes mellitus continue to rise around the world, largely due to lifestyle factors such as poor diet, overeating, and lack of physical activity. Diet and eating is often the most challenging aspect of management and, when disordered, has been associated with increased risk for diabetes-related complications. Thus, there is a clear need for accessible and evidence-based interventions that address the complex lifestyle behaviors that influence diabetes management. The current study sought to assess the efficacy and acceptability of a pilot lifestyle intervention for women with type 2 diabetes and disordered eating. The intervention followed a cognitive behavioral therapy guided-self-help (CBTgsh) model and included several pillars of lifestyle medicine, including: diet, exercise, stress, and relationships. Ten women completed the 12-week intervention that provided social support, encouraged physical activity, and addressed eating behaviors and cognitions. Results indicate the lifestyle intervention was a feasible treatment for disordered eating behaviors among women with type 2 diabetes and was also associated with improved diabetes-related quality of life. The intervention was also acceptable to participants who reported satisfaction with the program. The current CBTgsh lifestyle intervention is a promising treatment option to reduce disordered eating and improve diabetes management.

scholarly journals Hyperinsulinemia and Its Pivotal Role in Aging, Obesity, Type 2 Diabetes, Cardiovascular Disease and Cancer

2021 ◽  
Vol 22 (15) ◽  
pp. 7797
Author(s):  
Joseph A. M. J. L. Janssen
Keyword(s):  
Insulin Resistance ◽  
Type 2 Diabetes ◽  
Cardiovascular Disease ◽  
Insulin Secretion ◽  
Early Stage ◽  
Insulin Clearance ◽  
Future Research ◽  
Age Related ◽  
Hepatic Insulin Clearance

For many years, the dogma has been that insulin resistance precedes the development of hyperinsulinemia. However, recent data suggest a reverse order and place hyperinsulinemia mechanistically upstream of insulin resistance. Genetic background, consumption of the “modern” Western diet and over-nutrition may increase insulin secretion, decrease insulin pulses and/or reduce hepatic insulin clearance, thereby causing hyperinsulinemia. Hyperinsulinemia disturbs the balance of the insulin–GH–IGF axis and shifts the insulin : GH ratio towards insulin and away from GH. This insulin–GH shift promotes energy storage and lipid synthesis and hinders lipid breakdown, resulting in obesity due to higher fat accumulation and lower energy expenditure. Hyperinsulinemia is an important etiological factor in the development of metabolic syndrome, type 2 diabetes, cardiovascular disease, cancer and premature mortality. It has been further hypothesized that nutritionally driven insulin exposure controls the rate of mammalian aging. Interventions that normalize/reduce plasma insulin concentrations might play a key role in the prevention and treatment of age-related decline, obesity, type 2 diabetes, cardiovascular disease and cancer. Caloric restriction, increasing hepatic insulin clearance and maximizing insulin sensitivity are at present the three main strategies available for managing hyperinsulinemia. This may slow down age-related physiological decline and prevent age-related diseases. Drugs that reduce insulin (hyper) secretion, normalize pulsatile insulin secretion and/or increase hepatic insulin clearance may also have the potential to prevent or delay the progression of hyperinsulinemia-mediated diseases. Future research should focus on new strategies to minimize hyperinsulinemia at an early stage, aiming at successfully preventing and treating hyperinsulinemia-mediated diseases.

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