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Physical activity, type II diabetes, and metabolic syndrome:prevention and intervention
2糖尿病定義我國衛生署 , WHO, ADA
糖尿病 空腹至少 8 小時靜脈血漿糖值≧ 126 mg/dl 75 公克口服葡萄糖耐量試驗 (oral glucose
tolerance test, OGTT) , 2 小時的靜脈血漿糖值≧ 200 mg/dl
前期糖尿病 (prediabetes) 空腹血糖異常 (impaired fasting glucose, IFG): 空腹血漿糖值 110-126 mg/dl
葡萄糖耐量異常 (impaired glucose tolerance, IGT): OGTT2小時靜脈血漿糖值 140-200 mg/dl
3Key defects in onset of hyperglycemia in Type II DM
↑Hepatic glucose production ↓insulin secretion ↓insulin action Insulin resistance: suppressed or delayed
response to insulin Usually due to defect in cells that respond to
insulin, rather than insulin production Pivotal pathophysiological defects: Insulin
resistance in muscle and liver, beta-cell failure
Teixeira-Lemos, 2011
4Exercise/insulin activate GLUT-4 (glucose transporter-4) translocation
5
葉曉文 , 2011
6
葉曉文 , 2011
7
葉曉文 , 2011
8
葉曉文 , 2011
9
Definition of metabolic Syndrome
National Cholesterol Education Program’s Adult Treatment Panel III report (ATP III)
if 3 out of the following 5 criteria Central obesity 腰圍
Europe/US: ≥ 94 cm (male) or ≥ 80 cm (female) Taiwan: ≥ 90 cm (male) or ≥ 80 cm (female)
HDL < 40 mg/dl (male) or < 50 mg/dl (female) Triglycerides > 150 mg/dl fasting glucose > 100 mg/dl blood pressure > 130/85 mmHg
10Worldwide prevalence of metabolic syndrome
Desroches, 2007
11
Definition of metabolic syndrome in children: International Diabetes Federation
12
Lakka, 2007
13
Physical activity in etiology of MetS
Lakka, 2007
14Obesity and diabetes37,878 women, 6.9 years follow-up
Weinstein, 2004
15
PA and diabetes
Weinstein, 2004
16
Energy expenditure and diabetes
Weinstein, 2004
17
Walking and diabetes
Weinstein, 2004
18
PA, obesity and diabetes
Weinstein, 2004
19
PA, obesity and diabetes
Weinstein, 2004
20PA, obesity and diabetesneed to combine PA and weight loss
Weinstein, 2004
21
PA, obesity, and risk for DM
Hu, 2007
22
PA, fasting glucose, and risk for DM
Hu, 2007
23PA, fasting glucose, obesity, and risk for DM
Hu, 2007
24
Bassuk, 2005
25
Bassuk, 2005
26ProActive TrialPhysical activity measured by accelerometry30-50 yr, low PA, follow-up 1 year
Simmons, 2008
27
Moderate PA reduce fasting insulinPhysical activity measured by accelerometry
Ekelund, 2009
28
Vigorous PA and MetS
Lakka, 2007
29PA intensity and type II diabetesInsulin Resistance Atherosclerosis Study, n=1625, 1992-94
Mayer-Davis EJ, 1998
Vigorous: 6 METs
30
PA intensity and type II diabetesInsulin Resistance Atherosclerosis Study, n=1625, 1992-94
Mayer-Davis EJ, 1998
Vigorous: 6 METs
31
2-wk interval training in obese men
4-6 30s Wingate/session, 6 sessions
Whyte, 2010
32
Whyte, 2010
2-wk interval training in obese men
33
Change in PA and Type II DM
Lakka, 2007
34
Increase PA, decrease DM risk
Hu, 2007
35
Finnish Diabetes Prevention Program:3234 at-risk, 2.8 years follow-up
Church, 2011
36
Lifestyle (exercise) prevent MS
Orchard, 2005
37
Lifestyle (exercise) prevent MS
Orchard, 2005
38Exercise training and insulin resistance
Church, 2011
39MONET study137 overweight/obese postmenopausal women
MONET: Montreal–Ottawa New Emerging TeamKarelis, 2008
40MONET study137 overweight/obese postmenopausal women
Karelis, 2008
41
MONET study6 mo. caloric restriction/resistance exercise
42
MONET study6 mo. caloric restriction/resistance exercise
Drapeau, 2011
43
The HERITAGE Family Study
investigate the contribution of regular exercise to changes in risk factors for cardiovascular disease and Type 2 diabetes
genetics of cardiovascular, metabolic, and hormonal responses to exercise training ages of 17 and 65 yr healthy but sedentary
20-wk aerobic exercise training program
44PA decrease risk factors in those already having MetS
Katzmarzyk, 2003
45PA decrease number of risk factor in those already having MetS
Katzmarzyk, 2003
46PA decrease number of risk factor in high-risk subjects
Katzmarzyk, 2003
47Type II DM and reactive oxygen species (ROS)
oxidative stress secondary to hyperglycaemia and hyperlipidaemia occurs before the appearance of clinical manifestations of late diabetes complications suggesting a key role in the pathogenesis of the disease.
Insulin resistance and pancreatic b-cell dysfunctionare modulated by ROS
ROS disrupt insulin-induced cellular redistribution of insulin receptor substrate-1 (IRS-1) and phosphatidylinositol 3-kinase (PI3K), impairing insulin-induced glucose transporter type 4 (GLUT4) translocation in 3T3-L1 adipocytes
Teixeira-Lemos, 2011
48
Type II DM and inflammation dyslipidaemic phenotype of diabetes: ↑TG, ↑
oxidized LDL, ↓HDL lipotoxicity profile of diabetes Lack of exercise leads to accumulation of visceral or
deep subcutaneous adipose stores, leads to large adipocytes that are resistant to insulin-evoked lipolysis suppression, resulting in ↑release of FFA and glycerol
fat cells produce adipocytokines (adipokines) go to muscle, liver and arterial tissue, where exert
deleterious effects on metabolism and vascular function Adipose tissue of obese and type 2 diabetic
individuals is infiltrated by mononuclear cells and is in a state of chronic inflammation Teixeira-Lemos, 2011
49
Type II DM and inflammation The adipocytes and infiltrated macrophages
secrete pro-inflammatory/pro-thrombotic cytokines TNF-a, IL-6, resistin, adipsin, acylation-
stimulating protein (ASP), plasminogen activator inhibitor 1 (PAI-1) and angiotensinogen
promote atherogenesis and cause insulin resistance
Low adiponectin in type II DM a potent insulin-sensitizing and anti-atherogenic
adipokineTeixeira-Lemos, 2011
50Exercise prevent Type II DMantioxidant and anti-inflammation
Teixeira-Lemos, 2011
51Exercise prevent Type II DMantioxidant and anti-inflammation
Teixeira-Lemos, 2011
52Exercise prevent Type II DMantioxidant and anti-inflammation
Teixeira-Lemos, 2011
53Exercise prevent Type II DMantioxidant and anti-inflammation
Teixeira-Lemos, 2011
54Exercise prevent Type II DMantioxidant and anti-inflammation
Teixeira-Lemos, 2011
55
PA and prevention of MetS Intervention studies show that exercise training has
a mild or moderate favorable effect on many metabolic and cardiovascular risk factors that constitute or are related to the MetS
favorable lifestyle changes, including regular physical activity, are effective in the prevention of type 2 diabetes in individuals with overweight and impaired glucose tolerance
↑total volume of moderate-intensity PA, maintain good cardiorespiratory and muscular fitness appears to markedly decrease the risk for MetS, especially in high-risk groups
Brisk walking > 30 min/dayLakka, 2007
56
American Diabetes Association/ACSM Position Statement
Exercise plays a major role in the prevention and control of insulin resistance and type 2 diabetes
Both aerobic and resistance training improve insulin action and can assist with glucose levels, lipids, BP CV risk, mortality, and QOL
Exercise MUST be undertaken regularly to have continued benefits
Most persons with type 2 diabetes can perform exercise safely with certain precautions
Colberg, 2010
57Consensus in Insulin Resistance in Children
lack of a clear cutoff to define insulin resistance in children childhood weight gain increase the risk of insulin resistance
in children Insulin resistance is a risk factor for prediabetes and T2D in
childhood Exercise and fitness improve insulin sensitivity through
weight loss and also mechanisms independent of weight loss in adolescents
PA increases insulin sensitivity, an important component of any intervention
weight gain velocity during childhood is associated with lower insulin sensitivity in adulthood
prevention strategies should be started early in life lifestyle interventions should be included, whereas metformin
should be limited to selected casesLevy-Marchal,2010
58
Telford 2007