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From PEKN 1P93 Winter 2014: Group 13: Disease Prevention, Diabetes

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[edit] Disease Prevention: Type 2 Diabetes

[edit] Background

Diabetes is one of the most onerous chronic diseases of the 21st century and is a condition that is quickly growing throughout the world (King, Aubert, & Herman, 1998).[1] With the increase in sugar consumption and lack of physical activity across North America, diabetes has turned into an epidemic and may eventually be classified as a pandemic (University of Pittsuburgh, 2013) [2] In 2011, diabetes was the sixth leading cause of death in Canada and is increasing due to an aging population, inactivity and poor nutritional diets (Statistics Canada, 2011)[3].

Furthermore, type 2 diabetes is far more prevalent than type 1 diabetes and is seen to be preventable or delayed with regular physical activity (Statistics Canada, 2011) [4]. The pancreas of individuals with type two diabetes does not provide enough insulin, or the body does not use the insulin properly. Consequently, glucose (sugar) accumulates in the blood stream causing high levels of glucose in the blood. Without the help of insulin, the sugar remains in the blood stream instead of traveling into muscles and cells to provide useable energy (Brind'Amour, 2012). [5] This may cause a person with type two diabetes to feel exhausted, hungry, thirsty, frequently urinate, have blurry vision and tingling, pain or numbness in hands and feet (Brind'Amour, 2012) [6].

It is important to be familiar with the prevention of type two diabetes because it can cause severe complications such as mortality, morbidity, organ failure and vascular disease. In addition to watching blood glucose levels, type two diabetes can be prevented through physical activity and diet, ultimately decreasing the rate of individuals becoming diagnosed with this chronic disease (Brind'Amour, 2012) [7] .

[edit] History

Apollinaire Bouchardat
Apollinaire Bouchardat

When people are at risk of type 2 diabetes, they could decrease their chances of developing the disease by 58% just by being active 30 minutes a day (Statistics Canada, 2011).[8] According to the American College of Sports Medicine (ACSM), indications of the effectiveness of exercise in reducing glycosuria have been evident since 600 B.C (Rakobowchuk, M. 2003)[9] Celsus, a medical writer in Greece had specifically prescribed exercise in the treatment of diabetes. He advocated the use of exercise, massage and other treatments to improve the wellbeing of diabetics (Rakobowchuk, M. 2003).[10] Bouchardat contributed to diabetic therapy by introducing exercise as part of the treatment of diabetes. He wrote a book known as “De la Glycosurie ou diabète sucré” which discussed the importance of exercise in diabetic therapy. The types of exercise he would recommend included hunting, military exercises, callisthenics, skating, cricket, and even billiards. Even though there was proof that exercise helped in the therapy of diabetes, one physician did not agree with this. J. Seegen thought that the increasing use of exercise in diabetic therapy was a dangerous trend. After his proposal some French scientists measured the amount of glucose uptake in a working muscle and was found to be higher than in a resting muscle. This proves Bouchardat’s theory and from here on exercise was used as part of therapy for diabetes (Rakobowchuk, M. 2003).[11] Ever since 600 B.C. physical activity has been used as a type of prevention for type 2 diabetes, and is still used in the present day.

[edit] Target Audience

The target audience for the prevention of type 2 diabetes through physical activity would predominately be children and teens. Type 2 diabetes used to be called adult-onset diabetes because it would develop in adulthood, but within the last few decades, type 2 diabetes has become prevalent in children and teens (MedlinePlus, 2011) [12]. In the past, when children and teens were diagnosed with diabetes, they were diagnosed with type 1 juvenile diabetes, but recent studies have shown that between 8% an 45% of children and teens are now being diagnosed with type 2 diabetes (Kids Health, 2014) [13]. The reason for this increase is because there is an increase in children and teens who are inactive and overweight. The reason why children and teens are the target audience is because it is extremely important for them at this age to learn and partake in an active healthy lifestyle. Also at this age, if children and teens start to become physically active, there is a good chance that they will stay physically active throughout their lives, which can help in the prevention of type 2 diabetes in the future.

[edit] Research

Type 2 diabetes research is usually focused in four areas; predication and prevention, education and programs, developing new technology and medications, and reversal techniques and strategies of the disease (Joslin Diabetes Research, 2014)[14]. This section will focus on research of preventative strategies for children and teens as the targeted audience. Most research agrees upon physical activity and a healthy diet as the main preventive strategies while decreasing obesity and smoking will also lower ones risk of the disease.

Research at the University of Manitoba revealed that the rate of childhood obesity is increasing, and obesity drastically increases the risk of developing type 2 diabetes, so preventive strategies must be employed to combat the rising obesity rate and in doing so should decrease the likelihood children and teens have at contracting the disease (Young, Dean, Flett, & Wood-Steiman, 2000)[15].

Originally type 2 diabetes was unheard of in children and teens and was even once called adult-onset diabetes due to older adults being the only ones who could contract the disease. Further research attributes the rising frequency of type 2 diabetes in children and teens to current environmental and behavioural factors such as inactivity, high-sugar diets and obesity (Zimmet, Alberti, & Shaw, 2001)[16]. Interviews with adolescents at high risk for type 2 diabetes and their parents have determined that inconsistent eating patterns and absence of a healthy-eating role model were common themes among the families interviewed. Most of the adolescents at risk failed to correlate their obesity to their increased risk of type 2 diabetes and were unaware that it put them at such a high risk. Typically the only preventive measure taken to decrease their risk was activity, which was unsuccessful and often did not involve the parent’s efforts (Seibold, Knafl, & Grey, 2003)[17].

Physical activity is especially important in the prevention of type 2 diabetes in two ways. Firstly, physical activity decreases the chance a person has at becoming obese which shows strong correlation with preventing type 2 diabetes. Also, physical activity, rather it be aerobic exercises or resistance training promote healthier blood-glucose levels and decrease insulin resistance. Consistent physical activity and moderate weight loss have been shown to prevent type 2 diabetes by up to 58% in high-risk populations (Colberg, et al., 2010)[18].

Diet also plays a crucial role in the prevention of type 2 diabetes. Research suggests diets low in saturated fats, salt and sugar are optimal as well as an overall caloric intake which will not lead to obesity is also important (American Diabetes Association, 2005)[19]. Leaner meats are also proven to be a better choice over red meats and opt for whole-grain pastas and breads over highly-processed white bread and pasta (Koning, et al., 2011)[20].


References

American Diabetes Association. (2005). Preventing Type 2 Diabetes in Children and Teens. Diabetes Spectrum, 18(4), 249-250. Retrieved from American Diabetes Spectrum.

Colberg, S., Sigal, R., Fernhall, B., Regensteiner, J., Blissmer, B., Rubin, R., . . . Braun, B. (2010). Exercise and Type 2 Diabetes. American Diabetes Association, 33(12), 147-167. Retrieved from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2992225/

Joslin Diabetes Research. (2014). What Is Type 2 Diabetes? Retrieved March 10, 2014, from Joslin Diabetes Research: http://www.joslin.org/diabetes-research/type_2_diabetes_research.html

Koning, L., Hu, F., Willett, W., Rimm, E., Chiuve, S., & Fung, T. (2011). Diet-Quality Scores and the Risk of Type 2 Diabetes in Men. Diabetes Care, 34(5), 1150–1156. Retrieved from Harvard School of Public Health: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3114491/

Seibold, E., Knafl, K., & Grey, M. (2003). The Family Context of an Intervention to Prevent Type 2 Diabetes in High-Risk Teens. The Diabetes Educator, 29(6), 997-1004 . Retrieved from http://tde.sagepub.com/content/29/6/997.short

Young, K., Dean, H., Flett, B., & Wood-Steiman, P. (2000). Childhood obesity in a population at high risk for type 2 diabetes. The Journal Of Pediatrics, 136(3), 365-369. Retrieved from http://www.sciencedirect.com/science/article/pii/S0022347600788147

Zimmet, P., Alberti, K., & Shaw, J. (2001, December). review article Global and societal implications of the diabetes epidemic. Nature, 782-787. Retrieved from http://www.nature.com/nature/journal/v414/n6865/full/414782a.html

[edit] Existing Physical Activity Programs

With health problems becoming more prevalent in today's society, many organizations are taking advantage of it and creating programs to help people prevent and manage problems like obesity, high blood pressure and diabetes . One of the more prominent problems is type 2 Diabetes which has been addressed by the University of Pittsburgh, The National Diabetes Prevention Association, Canadian Diabetes Association and many more. First off the biggest advocate of this is the National Diabetes Prevention Program, which was started by the YMCA and partners with a goal to teach participants (who are at risk of type 2 diabetes) strategies for integrating physical activity and healthy eating into their lifestyle, in efforts to prevent diabetes. The program uses coaches who educate as well as motivate and counsel participants through the activities. It recognizes the importance physical activity has in preventing and delaying type 2 diabetes, and works to help incorporate it into the participants lives (Centers for Disease Control and Prevention, 2013)[21]. Another place that plays a large role is the University of Pittsburgh, which runs the Diabetes Prevention Support Center. The program focuses on how small changes in your diet and physical activity level can reduce your risk of Type 2 Diabetes(University of Pittsburgh, 2013)[22]. They focus on two goals; to lose a minimum of 7% of their weight, specifically through healthy eating, and to achieve 150 minutes of physical activity a week (University of Pittsburgh, 2013).[23] In Canada the main program in effect that addresses type 2 Diabetes is The Canadian Diabetes Association. They have four different programs that use physical activity to address the prevention and management of type 2 diabetes. One of the programs it offers is called Planning for Regular Physical Activity. This program is beneficial in the prevention and management of type 2 diabetes, because it is a starter program intended to educate and help individuals become physically active to reduce their risks and manage type 2 diabetes. The association recommends for individuals with type 2 diabetes to complete at least one hundred and fifty minutes of moderate to vigorous aerobic exercise each week. The Canadian Diabetes Association also advocates adding in resistance training three times a week when the individual is able and ready (Canadian Diabetes Association, 2013).[24]. In America, the main existing physical activity program is the American Diabetes Association. They use physical activity to address type 2 diabetes using a mix of aerobic and resistance exercise. Aerobic exercise results in insulin being used more efficiently, whereas resistance training can decrease blood glucose levels, as well as allow your body to become sensitive to insulin. (American Diabetes Association, 2013).[25] The last program that plays a large role is one that is affiliated with Harvard. The Joslin Diabates Center focuses on the entire lifestyle change, not just solely partaking in physical activity. They stress that people not lose hope as results will not show overnight. They encourage participants to continue working each and everyday and eventually results will show. They also encourage joining different teams or groups that one will enjoy, as well as creating a positive mindset to live a healthy life. There are many opportunities for children and teens to join organized sports/ organizations that encourages physical activity to be a part of their lives and will promote the prevention of type 2 diabetes (Joslin Diabetes Center, 2014).[26]

[edit] Best Practice Activity Suggestions

Aerobic training combined with games, strength training, resistance training and simple lifestyle changes are the most effective ways to prevent type II diabetes.

[edit] Aerobic Training

For optimal results it is recommended to do 30 minutes of aerobic exercise 5 days a week (NDIC, 2012)[27]. You can easily incorporate various aerobic activities such as: brisk walking, hiking, dancing, cross-country runs and being involved in different sports (basketball, tennis, soccer etc.) Interval and circuit training are also very efficient cardio exercise you can do as shown below:

[edit] Games

Playing various games can keep one entertained and engaged in physical activity. Games such as: tag, dodgeball, capture the flag, wall ball are great games to keep a majority of people physically active. These types of games would be more of an interest to children in elementary to middle school but can also be suitable for children in high school. Sport games such as: soccer, tennis, basketball, volleyball, squash etc. is suitable for anyone and will keep anyone physically active.

[edit] Strength Training

Strength training can easily be combined with resistance training and should be done 3 times a week using different equipments such as: dumbbells, barbells and weight machines. Strength training when done properly can result in many health benefits such as overall health and wellbeing, more muscle mass less excess fat, improved joint function and faster metabolism. Strength training can specifically help to prevent type 2 diabetes because it can improve insulin sensitivity, glucose tolerance and lower your risk for heart infections (WebMD, 2012)[28]. The video below demonstrates various exercises one can do with free weights:

[edit] Simple Lifestyle Changes

There are simple steps to preventing type 2 diabetes by incorporating physical activity into your daily life. Here are some easy tips below to get active:

  • Take the stairs instead of the elevator
  • Walk the dog
  • Park farther in the parking lot
  • Walk or bike to the corner store instead of driving or taking public transit
  • Do yard work or garden
  • Do some chores and housework
  • Add brisk walking to your daily routine
  • When on the phone, walk while you talk
  • Instead of taking the shopping cart, hold your grocery bags

[edit] Resistance Training

The next step to preventing type II diabetes is doing resistance training. This should be also be done 3 times a week along with strength training using resistance bands, elastic bands or your body weight. Practices such as yoga can be considered as resistance training and help with your balance, coordination and builds muscle which will burn excess fat. However some exercises that increase your blood vessels such as heavy weight lifting can make problems worse for people diagnosed with diabetic eye problems (NDIC, 2012)[29]. Some doctors may even recommend swimming over brisk walking to the ones whose diabetes has made their feet numb (NDIC, 2012)[30]. The resistance band workout located below targets your arms and is a good start for the resistance portion of preventing type II diabetes.


Having a nutritional, healthy lifestyle is also an efficient way to prevent type 2 diabetes.

[edit] Diet

According to various studies, your diet has a huge affect on your risk of obtaining type II diabetes. Fortunately, there are simple changes you can make to your diet to add on to your prevention of diabetes.

[edit] Carbs

Replace your white bread and high carbohydrate source foods with whole grain products. Studies have shown this can lower your diabetes risk by 36 percent (Department of Nutrition, Harvard School of Public Health, 2010)[31].

[edit] Sugary Drinks

Replace your sugary drinks such as soda and juice with water, tea or even coffee. In fact there are studies showing evidence that coffee could possibly help to prevent diabetes (Department of Nutrition, Harvard School of Public Health, 2010)[32]. Sugary drinks are said to increase your insulin resistance level, contribute to chronic inflammation and high tricglyericides which results in type II diabetes (Department of Nutrition, Harvard School of Public Health, 2010)[33].

[edit] Fats

Consuming certain types of fats can either help avoid or attract type II diabetes. Polyunsaturated fats found in oils, nuts and seeds can help prevent type II diabetes whereas trans fats found in fried foods, many margarines and packaged baked goods can increase your risk of diabetes (Department of Nutrition, Harvard School of Public Health, 2010)[34].

[edit] Smoking

Diabetes is also seen as one of the many health problems connected to smoking,studies have shown that people who smoke have a 50% more chance to develop type II diabetes (Department of Nutrition, Harvard School of Public Health, 2010)[35]



To efficiently prevent type 2 diabetes one must stay active, lean and healthy by engaging themselves in physical activity daily and along side make smart, healthy choices in their diet.

[edit] Future Directions

Currently diabetes is a well-known to the public due to its high prevalence. This has allowed for multiple organizations, government funding and vast quantities of research and studies completed. Future attempts must be placed on prevention of type 2 diabetes using physical activity and proper nutrition. This will also decrease the risk of other significant diseases such as obesity and cardiovascular disease. The future direction of type 2 diabetes prevention must continue to address and emphasize the importance of physical activity and nutrition as the most important tool for prevention. The Canadian government must accept this and continue to fund activity programs and stress the importance of physical education in schools as well as the development of physical literacy to ensure youth are learning skills that will allow them to remain active for the duration of their lives.

[edit] External Links

http://www.diabetes.ca/diabetes-and-you/living-with-type-2-diabetes

http://www.diabetes.org/living-with-diabetes/parents-and-kids/children-and-type-2/preventing-type-2-in-children.html

http://www.webmd.com/diabetes/guide/type-2-diabetes

http://www.healthycanadians.gc.ca/health-sante/disease-maladie/diabete-eng.php

http://spectrum.diabetesjournals.org/content/18/4/249.full.pdf

http://www.ncbi.nlm.nih.gov/books/NBK53885

[edit] Notes and References

  1. King, H., Aubert, R., & Herman, W. (1998). Diabetes Care. Global Burden of Diabetes, Prevalence, numerical estimates, and projections, 21 (9), 1414-1431.
  2. American Diabetes Association. (2012) The History of a Wonderful Thing We Call Insulin. Retrieved from: http://diabetesstopshere.org/2012/08/21/the-history-of-a-wonderful-thing-we-call-insulin/ Sigal, Ronald. (2006) Diabetes Care. Retrieved from: http://care.diabetesjournals.org/content/29/6/1433.full.pdf+html University of Pittsburgh. (2013) Group Lifestyle Balance. Retrieved from: http://www.diabetesprevention.pitt.edu/grouplifestyle.aspx
  3. Statistics Canada. (2011). Ranking and number of deaths for the 10 leading causes, Canada. Retrieved from Statistics Canada: http://www.statcan.gc.ca/daily-quotidien/081204/t081204c1-eng.htm
  4. Statistics Canada. (2011). Leading causes of death, by sex . Retrieved from Statistics Canada: http://www.statcan.gc.ca/tables-tableaux/sum-som/l01/cst01/hlth36a-eng.htm
  5. Brind'Amour, K. (2012, November 17). What Do You Want to Know About Type 2 Diabetes?. Healthlines RSS News. Retrieved March 16, 2014, from http://www.healthline.com/health/type-2-diabetes
  6. Brind'Amour, K. (2012, November 17). What Do You Want to Know About Type 2 Diabetes?. Healthlines RSS News. Retrieved March 16, 2014, from http://www.healthline.com/health/type-2-diabetes
  7. Brind'Amour, K. (2012, November 17). What Do You Want to Know About Type 2 Diabetes?. Healthlines RSS News. Retrieved March 16, 2014, from http://www.healthline.com/health/type-2-diabetes
  8. Statistics Canada. (2011). Leading causes of death, by sex . Retrieved from Statistics Canada: http://www.statcan.gc.ca/tables-tableaux/sum-som/l01/cst01/hlth36a-eng.htm
  9. Rakobowchuk, M. (n.d.). Exercise in the Treatment of Diabetes: An Historical Development Approach. Exercise in the Treatment of Diabetes: An Historical Development Approach. Retrieved March 5, 2014, from http://www.med.uottawa.ca/historyofmedicine/hetenyi/rakobowchuk.htm#04
  10. Rakobowchuk, M. (n.d.). Exercise in the Treatment of Diabetes: An Historical Development Approach. Exercise in the Treatment of Diabetes: An Historical Development Approach. Retrieved March 5, 2014, from http://www.med.uottawa.ca/historyofmedicine/hetenyi/rakobowchuk.htm#04
  11. Rakobowchuk, M. (n.d.). Exercise in the Treatment of Diabetes: An Historical Development Approach. Exercise in the Treatment of Diabetes: An Historical Development Approach. Retrieved March 5, 2014, from http://www.med.uottawa.ca/historyofmedicine/hetenyi/rakobowchuk.htm#04
  12. "Type 2 Diabetes: MedlinePlus Medical Encyclopedia." U.S National Library of Medicine. U.S. National Library of Medicine, n.d. Web. 22 Mar. 2014.
  13. Kids Health from Nemours. Type 2 Diabetes: What is it?. Retrieved from http://kidshealth.org/parent/medical/endocrine/type2.html
  14. Joslin Diabetes Research. (2014). What Is Type 2 Diabetes? Retrieved March 10, 2014, from Joslin Diabetes Research: http://www.joslin.org/diabetes-research/type_2_diabetes_research.html
  15. Young, K., Dean, H., Flett, B., & Wood-Steiman, P. (2000). Childhood obesity in a population at high risk for type 2 diabetes. The Journal Of Pediatrics, 136(3), 365-369. Retrieved from http://www.sciencedirect.com/science/article/pii/S0022347600788147
  16. Zimmet, P., Alberti, K., & Shaw, J. (2001, December). review article Global and societal implications of the diabetes epidemic. Nature, 782-787. Retrieved from http://www.nature.com/nature/journal/v414/n6865/full/414782a.html
  17. Seibold, E., Knafl, K., & Grey, M. (2003). The Family Context of an Intervention to Prevent Type 2 Diabetes in High-Risk Teens. The Diabetes Educator, 29(6), 997-1004 . Retrieved from http://tde.sagepub.com/content/29/6/997.short
  18. Colberg, S., Sigal, R., Fernhall, B., Regensteiner, J., Blissmer, B., Rubin, R., . . . Braun, B. (2010). Exercise and Type 2 Diabetes. American Diabetes Association, 33(12), 147-167. Retrieved from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2992225/
  19. American Diabetes Association. (2005). Preventing Type 2 Diabetes in Children and Teens. Diabetes Spectrum, 18(4), 249-250. Retrieved from American Diabetes Spectrum.
  20. Koning, L., Hu, F., Willett, W., Rimm, E., Chiuve, S., & Fung, T. (2011). Diet-Quality Scores and the Risk of Type 2 Diabetes in Men. Diabetes Care, 34(5), 1150–1156. Retrieved from Harvard School of Public Health: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3114491/
  21. Centers for Disease Control and Prevention. (2013, December). National Diabetes Prevention Program . Retrieved from Centers for Disease Control and Prevention: http://www.cdc.gov/diabetes/prevention/about.htm
  22. University of Pittsburgh. (2013). Group Lifestyle Balance. Retrieved from: http://www.diabetesprevention.pitt.edu/grouplifestyle.aspx
  23. University of Pittsburgh. (2013). Group Lifestyle Balance. Retrieved from: http://www.diabetesprevention.pitt.edu/grouplifestyle.aspx
  24. Canadian Diabetes Association. (2013). Exercise. Retrieved from: http://www.diabetes.ca/diabetes-and-you/healthy-living-resources/exercise
  25. American Diabetes Association. (2013). What we Recommend. Retrieved from: http://www.diabetes.org/food-and-fitness/fitness/types-of-activity/what-we-recommend.html
  26. Joslin Diabetes Center. (2014). Tips for Increasing Physical Activity. Retrieved from: http://www.joslin.org/care/tips_for_increasing_physical_activity.html
  27. National Diabetes Information ClearingHouse. What I need to know about Physical Activity and Diabetes? . Retrieved from http://diabetes.niddk.nih.gov/dm/pubs/physical_ez/
  28. WebMD. (2012). Diabetes Health Center. Retrieved fromhttp://www.webmd.com/diabetes/strength-training-diabetes
  29. National Diabetes Information ClearingHouse. What I need to know about Physical Activity and Diabetes? . Retrieved from http://diabetes.niddk.nih.gov/dm/pubs/physical_ez/
  30. National Diabetes Information ClearingHouse. What I need to know about Physical Activity and Diabetes? . Retrieved from http://diabetes.niddk.nih.gov/dm/pubs/physical_ez/
  31. Sun Q, Spiegelman D, van Dam RM,et al. (2010). White rice, brown rice, and risk of type 2 diabetes in US men and women. Arch Intern Med. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/20548009
  32. van Dam RM, Willett WC, Manson JE, Hu FB. (2006). Coffee, caffeine, and risk of type 2 diabetes: a prospective cohort study in younger and middle-aged U.S. women. Diabetes Care. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/16443894
  33. van Dam RM, Willett WC, Manson JE, Hu FB. (2006). Coffee, caffeine, and risk of type 2 diabetes: a prospective cohort study in younger and middle-aged U.S. women. Diabetes Care. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/16443894
  34. Hu FB, Manson JE, Stampfer MJ, et al. (2001). Diet, lifestyle, and the risk of type 2 diabetes mellitus in women. N Engl J Med. Retried from http://www.ncbi.nlm.nih.gov/pubmed/11556298?dopt=Citation
  35. Willi C, Bodenmann P, Ghali WA, Faris PD, Cornuz J. (2007). Active Smoking and the Risk of Type 2 Diabetes: A Systematic Review and Meta-analyis. JAMA. Retrieved from http://jama.jamanetwork.com/article.aspx?articleid=209729
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