Impact of Exercise on Patients with Diabetes Mellitus

Bret Goodpaster, Ph.D. Exercise Physiologist Assistant Professor of Medicine University of Pittsburgh Division of Endocrinology and Metabolism

Learning Objectives After completing this section, you should be able to: 1. Discuss the relative role of physical activity in body– weight regulation, i.e., energy balance. 2. Define insulin resistance and describe its role in the development of type 2 diabetes. 3. Compare and contrast the effects of exercise and dieting on body weight, body composition and metabolism. 4. Debate the impact of exercise on glucose control.

Two Main Types of Diabetes Mellitus O

Type 1 • Insulin required to live • Ketoacidosis (⇑ Fat metabolism) • Weight Loss • Average onset = 11 years old

O

Type II

• Not initially dependent on insulin • Insulin resistance/ insensitivity • > 80% are overweight • Average onset > 40 years

1

Type 2 Diabetes

Type 1 Diabetes

Results from insulin resistance (a condition in which the body fails to properly use insulin), combined with relative insulin deficiency.

Results from the body's failure to produce insulin.

It is estimated that 5%– 10% of Americans who are diagnosed with diabetes have type 1 diabetes.

Most Americans who are diagnosed with diabetes have type 2 diabetes.

Source: ADA website 2005

Type 2 Diabetes O O O O O

>30 million worldwide ( 18.5 million in the United States) Many individuals do not know they have Type 2 diabetes 90%–95% of all Diabetes mellitus is Type 2 Increasing in incidence in last four decades Population specific (Native Americans, Hispanic, African–American)

Risk Factors for Type 2 Diabetes O O O

O O

Obesity

O

Age

Body fat distribution O Previous gestational diabetes (GDM) Family history of diabetes O Elevated fasting glucose levels Physical inactivity O Impaired glucose tolerance Race/ethnicity

2

Obesity and Risk of Type 2 Diabetes 93.2

Age-adjusted relative risk

100

Women Men

70

42.1

40 10

5

0

1.0

1.0