223 research outputs found
Physical activity/exercise training in type 2 diabetes. The role of the Italian Diabetes and Exercise Study
No full textCardiorespiratory fitness is inversely related to the development of type 2 diabetes and cardiovascular morbidity and mortality. Trials in individuals with impaired glucose tolerance have highlighted the role of physical activity/exercise in the prevention of type 2 diabetes. Moreover, physical activity and exercise training have been recognized as treatment options for patients with type 2 diabetes. Both aerobic and resistance training were shown to produce beneficial effects by reducing HbA1c, inducing weight loss and improving fat distribution, lipid profile and blood pressure in patients with type 2 diabetes. Mixed aerobic and resistance training was recently shown to be more effective than either one alone in ameliorating HbA1c. However, further research is needed to establish the volume, intensity and type of exercise that are required to reduce cardiovascular burden and particularly to define the best strategy for promoting long-term compliance and durable lifestyle changes in individuals with type 2 diabetes. The Italian Diabetes Exercise Study (IDES) is a prospective Italian multicentre randomized controlled trial, of larger size and longer duration than previously published trials. It has been designed to assess the combined effect of structured counselling and supervisedmixed (aerobic plus resistance) exercise training, as compared with counselling alone, on HbA1c and other cardiovascular risk factors as well as fitness parameters in individuals with type 2 diabetes and the metabolic syndrome. This study was also aimed at testing a sustainable strategy for promoting and maintaining a sufficient level of physical activity among individuals with type 2 diabetes to be implemented at the population level. Copyright © 2009 John Wiley & Sons, Ltd
The Italian Diabetes and Exercise Study (IDES) : design and methods for a prospective Italian multicentre trial of intensive lifestyle intervention in people with type 2 diabetes and the metabolic syndrome
No full textThe IDES is a prospective Italian multicentre randomized controlled trial to evaluate the efficacy of an intensive lifestyle intervention on modifiable cardiovascular disease (CVD) risk factors in a large cohort of people with type 2 diabetes and the metabolic syndrome. METHODS AND RESULTS: We recruited 606 subjects with type 2 diabetes and waist circumference >94 cm (M) and >80 cm (F), plus >1 other metabolic syndrome trait (IDF criteria) for both sexes, aged 40-75 years, BMI 27-40 kg/m(2), diabetes duration >1 year with a sedentary lifestyle of >6 months. Patients were randomized into two groups: a control group, receiving conventional care including exercise counselling and an intervention group, treated with a mixed (aerobic and resistance) exercise programme (150 min/week) prescribed and supervised for 12 months. Primary outcome is HbA1c reduction. Secondary outcomes include other traditional and non-traditional risk factors and their relationship to exercise volume/intensity and fitness; dosage of glucose, lipid and blood pressure-lowering drugs; global CVD 10-year risk; patient well-being; and costs. CONCLUSION: This trial verifies whether a prescribed and supervised exercise programme, including both aerobic and resistance training, is more effective than conventional exercise counselling in reducing modifiable CVD risk factors in type 2 diabetic subjects with the metabolic syndrom
The Italian Diabetes and Exercise Study (IDES): Design and methods for a prospective Italian multicentre trial of intensive lifestyle intervention in people with type 2 diabetes and the metabolic syndrome
No full textBackground and aims: The IDES is a prospective Italian multicentre randomized controlled trial to evaluate the efficacy of an intensive lifestyle intervention on modifiable cardiovascular disease (CVD) risk factors in a large cohort of people with type 2 diabetes and the metabolic syndrome. Methods and results: We recruited 606 subjects with type 2 diabetes and waist circumference >94 cm (M) and >80 cm (F), plus >1 other metabolic syndrome trait (IDF criteria) for both sexes, aged 40e75 years, BMI 27e40 kg/m2, diabetes duration >1 year with a sedentary lifestyle of >6 months. Patients were randomized into two groups: a control group, receiving conventional care including exercise counselling and an intervention group, treated with a mixed (aerobic and resistance) exercise programme (150 min/week) prescribed and supervised for 12 months. Primary outcome is HbA1c reduction. Secondary outcomes include other traditional and non-traditional risk factors and their relationship to exercise volume/intensity and fitness; dosage of glucose, lipid and blood pressure-lowering drugs; global CVD 10-year risk; patient well-being; and costs. Conclusion: This trial verifies whether a prescribed and supervised exercise programme, including both aerobic and resistance training, is more effective than conventional exercise counselling in reducing modifiable CVD risk factors in type 2 diabetic subjects with the metabolic syndrome
Relationship of exercise volume to improvements of quality of life with supervised exercise training in patients with type 2 diabetes in a randomised controlled trial: the Italian Diabetes and Exercise Study (IDES)
No full textA positive impact of exercise intervention programmes on quality of life (QoL) may be important for long-term patient compliance to exercise recommendations. We have previously shown that QoL improves significantly with supervised exercise, whereas it worsens with counselling alone, in patients with type 2 diabetes from the Italian Diabetes and Exercise Study (IDES). Here, we report data on the relationship between changes in QoL and volume of physical activity/exercise in these individuals. Methods This multicentre parallel randomised controlled, open-label, trial enrolled sedentary patients with type 2 diabetes (n0606 of 691 eligible) in 22 outpatient diabetes clinics.
Patients were randomised by centre, age and diabetes reatment using a permuted-block design to twice-a-week supervised aerobic and resistance training plus exercise counselling (exercise group) versus counselling alone (control group) for 12 months. Health-related QoL was ssessed by the 36-Item Short Form (SF-36) Health Survey. Results In the exercise group (n0268 of 303 randomised), there was a trend for increasing QoL with increasing exercise volume, with significant improvement of the hysical component summary (PCS) measure only above 17.5 metabolic equivalents h−1 week −1 and a clear volume-relationship for the mental component summary (MCS) measure. A relationship with volume of physical activity also was observed in the control group (n0260 of 303 randomised), despite overall deterioration of all scores. Independent correlates of improvements in both PCS and MCS were exercise volume, study arm and, inversely, baseline score. Conclusions/interpretation This large trial shows a relationship between changes in physical and mental health-related QoL measures and volume of physical activity/exercise, with supervised exercise training also providing volume independent benefits
Effect of an intensive exercise intervention strategy on modifiable cardiovascular risk factors in subjects with type 2 diabetes mellitus: A randomized controlled trial: The Italian Diabetes and Exercise Study (IDES)
No full textBackground: This study aimed to assess the efficacy of an intensive exercise intervention strategy in promoting physical activity (PA) and improving hemoglobin A1c (HbA1c) level and other modifiable cardiovascular risk factors in patients with type 2 diabetes mellitus (T2DM). Methods: Of 691 eligible sedentary patients with T2DM and the metabolic syndrome, 606 were enrolled in 22 outpatient diabetes clinics across Italy and randomized by center, age, and diabetes treatment to twice-a-week supervised aerobic and resistance training plus structured exercise counseling (exercise group) vs counseling alone (control group) for 12 months. End points included HbA1c level (primary) and other cardiovascular risk factors and coronary heart disease risk scores (secondary). Results: The mean (SD) volume of PA (metabolic equivalent hours per week) was significantly higher (P < .001) in the exercise (total PA [nonsupervised conditioning PA + supervised PA], 20.0 [0.9], and nonsupervised, 12.4 [7.4]) vs control (10.0 [8.7]) group. Compared with the control group, supervised exercise produced significant improvements (mean difference [95% confidence interval]) in physical fitness; HbA 1c level (-0.30% [-0.49% to -0.10%]; P < .001); systolic (-4.2 mm Hg [-6.9 to -1.6 mmHg]; P=.002) and diastolic (-1.7mmHg [-3.3 to -1.1 mm Hg]; P=.03) blood pressure; high-density lipoprotein (3.7 mg/dL [2.2 to 5.3 mg/dL]; P < .001) and low-density lipoprotein (-9.6 mg/dL [-15.9 to -3.3 mg/dL]; P=.003) cholesterol level; waist circumference (-3.6 cm [-4.4 to -2.9 cm]; P < .001); body mass index; insulin resistance; inflammation; and risk scores. These parameters improved only marginally in controls. Conclusions: This exercise intervention strategy was effective in promoting PA and improving HbA1c and cardiovascular risk profile. Conversely, counseling alone, though successful in achieving the currently recommended amount of activity, was of limited efficacy on cardiovascular risk factors, suggesting the need for a larger volume of PA in these high-risk subjects. Trial Registration: isrctn.org Identifier: ISRCTN-04252749 ©2010 American Medical Association. All rights reserved
Effect of an intensive exercise intervention strategy on modifiable cardiovascular risk factors in subjects with type 2 diabetes mellitus: a randomized controlled trial: the Italian Diabetes and Exercise Study (IDES)
No full textBackground: This study aimed to assess the efficacy of an intensive exercise intervention strategy in promoting physical activity (PA) and improving hemoglobin A1c (HbA1c) level and other modifiable cardiovascular risk factors in patients with type 2 diabetes mellitus (T2DM). Methods: Of 691 eligible sedentary patients with T2DM and the metabolic syndrome, 606 were enrolled in 22 outpatient diabetes clinics across Italy and randomized by center, age, and diabetes treatment to twice-a-week supervised aerobic and resistance training plus structured exercise counseling (exercise group) vs counseling alone (control group) for 12 months. End points included HbA1c level (primary) and other cardiovascular risk factors and coronary heart disease risk scores (secondary). Results: The mean (SD) volume of PA (metabolic equivalent hours per week) was significantly higher (P < .001) in the exercise (total PA [nonsupervised conditioning PA + supervised PA], 20.0 [0.9], and nonsupervised, 12.4 [7.4]) vs control (10.0 [8.7]) group. Compared with the control group, supervised exercise produced significant improvements (mean difference [95% confidence interval]) in physical fitness; HbA 1c level (-0.30% [-0.49% to -0.10%]; P < .001); systolic (-4.2 mm Hg [-6.9 to -1.6 mmHg]; P=.002) and diastolic (-1.7mmHg [-3.3 to -1.1 mm Hg]; P=.03) blood pressure; high-density lipoprotein (3.7 mg/dL [2.2 to 5.3 mg/dL]; P < .001) and low-density lipoprotein (-9.6 mg/dL [-15.9 to -3.3 mg/dL]; P=.003) cholesterol level; waist circumference (-3.6 cm [-4.4 to -2.9 cm]; P < .001); body mass index; insulin resistance; inflammation; and risk scores. These parameters improved only marginally in controls. Conclusions: This exercise intervention strategy was effective in promoting PA and improving HbA1c and cardiovascular risk profile. Conversely, counseling alone, though successful in achieving the currently recommended amount of activity, was of limited efficacy on cardiovascular risk factors, suggesting the need for a larger volume of PA in these high-risk subjects. Trial Registration: isrctn.org Identifier: ISRCTN-0425274
Prevention of type 2 diabetes in British Bangladeshis: qualitative study of community, religious, and professional perspectives
No full textObjective:To understand lay beliefs and attitudes, religious teachings, and professional perceptions in relation to diabetes prevention in the Bangladeshi community.
Design: Qualitative study (focus groups and semistructured interviews).
Setting: Tower Hamlets, a socioeconomically deprived London borough, United Kingdom.
Participants: Bangladeshi people without diabetes (phase 1), religious leaders and Islamic scholars (phase 2), and health professionals (phase 3).
Methods: 17 focus groups were run using purposive sampling in three sequential phases. Thematic analysis was used iteratively to achieve progressive focusing and to develop theory. To explore tensions in preliminary data fictional vignettes were created, which were discussed by participants in subsequent phases. The PEN-3 multilevel theoretical framework was used to inform data analysis and synthesis.
Results: Most lay participants accepted the concept of diabetes prevention and were more knowledgeable than expected. Practical and structural barriers to a healthy lifestyle were commonly reported. There was a strong desire to comply with cultural norms, particularly those relating to modesty. Religious leaders provided considerable support from Islamic teachings for messages about diabetes prevention. Some clinicians incorrectly perceived Bangladeshis to be poorly informed and fatalistic, although they also expressed concerns about their own limited cultural understanding.
Conclusion: Contrary to the views of health professionals and earlier research, poor knowledge was not the main barrier to healthy lifestyle choices. The norms and expectations of Islam offer many opportunities for supporting diabetes prevention. Interventions designed for the white population, however, need adaptation before they will be meaningful to many Bangladeshis. Religion may have an important part to play in supporting health promotion in this community. The potential for collaborative working between health educators and religious leaders should be explored further and the low cultural understanding of health professionals addressed
Insulin pump therapy in children and adolescents with type 1 diabetes: The Italian viewpoint
No full textBackground and Aim: A panel of experts of the Italian Society of Paediatric Endocrinology and Diabetology translated into Italian the international insulin pump therapy recommendations in children and adolescents with type 1 diabetes. Methods: After an extensive review of the literature using evidence-based recommendations, several issues were taken into account, such as patient selection, advantages and disadvantages, instrument choice, insulin type, therapy planning and follow-up, emergencies, nutrition, particular occasions (like parties, holidays, sick days, travels), exercise, continuous glucose monitoring and integrated system, neonatal diabetes. The panel evaluated the cost-effectiveness of insulin pump therapy compared to multiple daily injection therapy, analysing the cost-benefit ratio. Results: Some tweak was needed due to the Italian dietetic singularity, meal schedule, climate and lifestyle. Insulin pump therapy in neonatal diabetes is a new issue and no guidelines have been published yet for this age-group. Moreover, legal issues according to the Italian law have been added and are peculiarity of our recommendations. An "informed therapeutic agreement" between the patient and his/her family and the diabetic team has to be signed before starting insulin pump therapy. Conclusions: We think that nowadays the need for clinical guidelines is important and worth the effort that all countries develop faithful adaptation into their local languages taking into account specific contexts and local peculiarities, without making substantial modifications to the original text. © Mattioli 1885
A biopsychosocial model of diabetes self-management: mediators and moderators
No full textDiabetes mellitus (diabetes), an endocrine disorder, is in epidemic proportions globally, threatening the well being of people affected and challenging health care systems. In the main, diabetes warrants adjustments to lifestyle and therapeutic interventions simply to self-manage the condition. Research in self-management of diabetes has targeted socio-cognitive theory and espoused self-efficacy as the main driver of self-management. More recently, self-regulatory theory has focused on illness representations and argued they are the force underpinning goal directed behaviours. Research to-date has tended to adopt one or other of the prevailing theoretical models to the exclusion of key concepts in other explanatory health behaviour models. Studies are lacking in demonstrating a comprehensive exploration of the interrelationships between self-regulatory skills inherent in self-management, illness representations and self-efficacy with other potential health behaviour determinants. In this thesis, it was postulated that an integrated biopsychosocial model of self-management was warranted to account for the complexities of human understanding and interactions within a naturalistic setting.
The purpose of this dissertation was to develop and substantiate a conceptual model of diabetes self-management integrating key concepts from health behaviour theories within a structure of four broad determinants of health behaviour, which were: personal traits, diabetes traits, socio-environmental factors and health contextual factors. Specifically, determinants associated with diabetes self-management behaviours and the predictors for its success for those with type 1 and type 2 diabetes was sought. In order to substantiate the proposed integrated model a cross-sectional design, using quantitative survey methodology, was undertaken. Structural equation modelling allowed interrelationships in the integrated model to be explored simultaneously and advanced model testing thus far in the field. The study involved males (n = 504) and females (n = 519), aged over 18 years (M = 63.90, SD = 13.89) who had a diagnosis of either type 1 or type 2 diabetes and who resided in Western Australia.
Model testing substantiated the integrated biopsychosocial model proposed and was relatively parsimonious, making the application of the findings to a clinical setting possible. Key predictors for both types of diabetes were: self-efficacy, diabetes distress, diabetes traits, self-determination support by health care professionals and to some extent age of the person with diabetes. In addition, locus of control by doctors was important for type 2 diabetes and marital status and socio-economic status for type 1 diabetes. The presence of emotional distress had a negative effect on interrelated factors, emphasising the criticality of its assessment and management by health professionals if self-management is to be achieved. Illness representations had low or minimal predictive power, refuting claims that it is responsible for the initiation of goal directed behaviours.
The integrated model, a first of its kind in the Australian context, contributes to existing knowledge in diabetes self-management through its attention to contextualising the self-regulatory individual within their personal, social and health environment. In particular it makes explicit the distinguishing integrated predictors for type 1 and type 2 diabetes previously unknown in the adult population. Through the understanding of predictors, the health sector is better placed to target predictors in supporting self-management
The clinical effectiveness of diabetes education models for Type 2 diabetes: a systematic review
No full textObjective: To examine the clinical effectiveness of patient education models for adults with Type 2 diabetes.Data sources: Electronic databases were searched from 2002 to January 2007.Review methods: A systematic review of the literature on educational interventions in diabetes was undertaken. This was an update of a previous systematic review.Results: Including studies identified in the previous systematic review, there were 13 published studies. Eight studies of education on multiple aspects of diabetes self-management were identified that provided education that was focused on a particular aspect of self-management. The quality of reporting and methodology of the studies was variable. Studies of multi-component educational interventions yielded mixed results. Some trials reported significant improvements on measures of diabetic control but others did not. Positive effects may be attributable to longer-term interventions with a shorter duration between the end of the intervention and the follow-up evaluation point. There may also be an effect of having a multi-professional team delivering the educational programme. Studies of focused educational interventions did not yield consistent results. Some effects were shown on measures of diabetic control in studies that focused on diet or exercise alone. Although the effects shown were generally small, those that were present did appear to be relatively long-lasting. This update review does not substantially alter the conclusions of the previous systematic review; for each outcome, the proportion of studies that demonstrated significant effects of education was similar.Conclusions: Based on the evidence, it would seem that education delivered by a team of educators, with some degree of reinforcement of that education made at additional points of contact, may provide the best opportunity for improvements in patient outcomes. Educators need to have time and resources to fulfil the needs of any structured educational programme. There is also a need for education to have a clear programme at the outset. From the evidence reported it is unclear what resources would need to be directed at the educators themselves to ensure that they can deliver programmes successfully. Any future research should consider patient education within the context of overall diabetes care and as such follow guidelines for the development and evaluation of complex interventions. Good-quality, longer-term studies would be desirable, but these would require careful consideration around the nature of any control group. Information is needed to clarify the sensitivity of diabetes education programmes to the performance of the diabetes educators, in order to ensure success and cost-effectiveness of education programmes.<br/
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