Physical Activity in Reducing Risk of Type 2 Diabetes in High-Risk Individuals - Essay Example

Content Epidemiological Studies: EPIDEMIOLOGICAL Studies on the Role of Physical Activity in Reducing Risk of Type 2 Diabetes in High Risk Individuals By Name Presented to Instructor Course Institution, State Due Date Introduction This paper explores the most up to date epidemiological studies examining how effective physical activity is in managing and lowering the risk of developing major complications in Type 2 Diabetes in the elderly population. The paper presents relevant evidence to individuals at risk or suffering from Type 2 Diabetes and illustrates how these patients suffering from this niche of chronic diseases can take control and play a significant role in their health and prevent progression to a chronic illness or development of serious complications. Many individuals are not aware of the risk factors for developing diabetes, leave alone Type 2 Diabetes until they are diagnosed (NHMRC, 2013). This state of affairs calls for effective education to shade more light on their health risks about Type 2 Diabetes as well as other types of chronic diseases. The writer settled on this particular subject as a foundational study into the discipline of Diabetes Education with a central focus on providing people at risks and those already suffering from diabetes the motivation necessary their outcome. Furthermore, a lot of scholars have conducted studies to postulate diabetes prevention and management programs that have been confirmed useful; however, a few have not been effectively applied in the context of the elderly population. Therefore, this essay sought for appropriate application for their implementation and success by exploring epidemiological studies. Moreover, despite a substantial record of literature on the benefits of Diabetes management and prevention, there has been an accelerated prevalence of the problem of diabetes. Thus, the application to practice has borne limited fruits. This type of secondary management and prevention still calls for increased state support to facilitate its implementation. Overview of Physical Activity and Type 2 Diabetes Type 2 Diabetes is a significant cause of disease and untimely deaths in most countries (Yates et al., 2015, p. 289). Type 2 Diabetes is an increasing challenge not only for the Australian, but also global healthcare system since its overall prevalence has accelerated from 1.5 to 5.5 percent in 1990 to 2008 respectively (NHMRC, 2013), and contributes to the increase. It causes higher GP visits and hospitalization due to complications, besides its considerably higher cost estimated at $6 billion dollars and still rising (NHMRC, 2013). Additionally, over 30 and 14 percent of Australian diabetic population experience impaired fasting glucose levels and impaired glucose tolerance (IGT) respectively. Besides being a significant cause of cardiovascular morbidity and death, Type 2 Diabetes enhances the risk of suffering coronary heart disease (CHD) by three to Sevenfold and two-to-threefold in women and men respectively (Imamura et al., 2013, p. 1428). Economic costs for Type 2 Diabetes are high. Attempts to lower the effect of diabetes complications have predominantly focused on regulating hyperglycemia and dyslipidemia (Booth et al., 2012, p. 280), alongside hypertension control (LAHEAD, 2013, p. 829) by employing medication interventions, despite the limited evidence of prolonged benefits. Nonetheless, diabetes management and prevention out to stretch to a comprehensive intervention strategy that encompasses physical activity to lower the risk of complications related to diabetes (Imamura et al., 2013, p. 1419). Lifestyle interventions, including physical exercise, are vital factors for self-management in individuals with Type 2 Diabetes primarily to avert macrovascular complications coupled with premature mortality (Orchard et al., 2013, p. 47). Increased physical activity has historically been considered a central pillar of diabetes management and preventions. Type 2 Diabetes patients are always urged to reserve at least 150 minutes of their time (per week) to engage in moderate to intense aerobic physical exercise (Yates, et al., 2015, p. 289). Walking has been highly recommended since it necessitates no particular facilities, can easily be adapted to the daily routine, and is much safer. Additionally, weight loss, particularly through physical activity, is recommended for overweight and obese persons with Type 2 Diabetes. This recommendation is anchored on a series of short-term studies revealing myriad benefits of weight loss, such as enhanced glycemic regulation, cardiovascular illness risk factors, comorbidities associated with obesity and improved quality of life (Imamura et al., 2013, p. 1428). Summary of Current Epidemiological Studies Examining the Role of Physical Activity in Reducing the Risk of Type 2 Diabetes A prospective study of weight training and risk of type 2 diabetes mellitus in men (Grøntved et al., 2012) This prospective cohort study set to determine the relationship between weight training and risk of Type 2 Diabetes Mellitus in American men and to evaluate the effect of using both weight training and aerobic exercise. The investigation followed up 32,003 US diabetic male Health professionals aged between 40 and 75 from 1990 to 2008 respectively. The study followed up eight training and aerobic activities the research participant undertook on a weekly basis, including brisk walking, sprinting/running, jogging, cycling, playing, swimming and rowing, and tennis and squash, which were reported through questionnaires biennially. The outcome of the 18-years follow-up documented 2278 new incidences of Type 2 Diabetes Mellitus. The research employed self-report to assess family history of Type 2 Diabetes mellitus at baseline. Also, the time-dependent Cox proportional regression was utilized in estimating relative risks (RR) of Type 2 Diabetes by groups of weight instruction and aerobic exercise. The multivariable-adjustable models indicated a dose-response correlation between an accelerating amount of duration spent on weight instruction and aerobic practice and lower risk of developing Type 2 Diabetes Mellitus (p 6 h/night) and the number of counts of overall daily activity in the whole research sample. Also, secondary scales involved the period spent sedentary and in light, average, and vigorous physical engagement. Participants who sleep for short periods experienced no sleep abnormalities and exhibited symptoms of enhanced sleep pressure that were consistent with a behavioral trend of habitual sleep curtailment. By comparison, research participants who slept for a threshold of at least 6 hours per night (>six h/night), short sleepers showed 27 percent lower daily activity counts (p = 0.042). Also, they spent limited duration engaged in moderate-plus-vigorous physical engagement and maintained more sedentary -43 min/day; p = 0.010) and +69 min/day; p = 0.026 respectively. The findings of this study show that young adults from urban areas with the parental history of Type 2 Diabetes that have a habit of curtailing their sleep exhibit less daily physical engagement coupled with enhanced sedentary life, which has the potential of scaling up their metabolic risk of Type 2 Diabetes. Cardiovascular effects of intensive lifestyle intervention in type 2 Diabetes (Look AHEAD Research Group, 2013) The aim of this randomized controlled trial was to investigate whether intensive intervention strategy for weight loss reduced cardiovascular morbidity and death in adults living with Type 2 Diabetes, who are either overweight or obese. It assigned 5145 adults with Type 2 Diabetes who were either overweight or obese at a total of 16 US health research centers. The study followed up two groups; intensive lifestyle intervention and diabetes support and instruction with (N=2570 and N=2575, respectively). The latter contained three category schedules per year concentrating on diet, physical activity, and social support from the first to the fourth year. The 13-years-and-half follow-up indicated that weight loss was higher in the intervention unit compared to the control unit across the study period; 8.6 percent vs. 0.7 percent and 6.0 percent vs. 3.5 percent at one year and research end, respectively. Additionally, the intensive lifestyle intervention further yielded greater reductions in hemoglobin A1C as well as higher initial improvement in health fitness and all risk factors associated with the cardiovascular problem, except LDL cholesterol. Chi-square, Poisson regression, and Fisher’s exact were complemented with Wilcoxon rank-sum and two-sample-t-tests to make a comparison of baseline characteristics and core safety outcomes between the two study groups. On top of that, generalized linear regression and estimating equations were used to model physical and laboratory scales and medication intervention from baseline across ten years. The final sample that was followed up comprised 403 and 418 Type 2 Diabetes patients in the intervention group and control group, respectively. The intervention group scored 1.83/100 individual-years while the control group scored 1.92/100 resulting in a risk ratio of 0.95; 95 percent CI 0.83 to 1.09, p = 0.505). Minimal intensity physical activity (standing and walking) of longer duration improves insulin action and plasma lipids more than shorter periods of moderate to vigorous exercise (cycling) in sedentary subjects when energy expenditure is comparable (Duvivier et al., 2013). Minimal intensity physical activity (standing and walking) of longer duration improves insulin action and plasma lipids more than shorter periods of moderate to vigorous exercise (cycling) in sedentary subjects when energy expenditure is comparable (Duvivier et al., 2013) This randomized trial had an objective to determine whether minimal intensity physical activities (such as standing and walking) done for prolonged time enhances insulin function and plasma lipids more compared to shorter durations of moderate to vigorous physical activity (like cycling) in sedentary participants by comparing their energy expenditure. The study featured a total of 18 participants, aged between 19 to 23, BMI 20.0 – 25.2 kgm-2., and adhered to three physical engagement regimes. The subjects were asked to sit 14 hr/day for the sitting regime; to sit 13 hr/day and to replace 1 hour of sitting with intensive activity 1 hour for exercise regime; to replace six hours with four hour walking and two hour standing (minimal intensity physical activity regime). The four-day follow-up showed that both the sitting and exercise sessions featured comparable numbers of sitting hours. Also, the exercise and minimal intensity session exhibited equal daily energy consumption. The study used an activator monitor (ActivPAL), complimented with a diary, to evaluate physical activity on a daily basis. The oral glucose test ad plasma lipids were measured during the fasting state, the morning preceding four days of the three regimes. The area falling under the insulin curve in the course of OGTT (6727.3±4329.4 mU•min/ml) was considerably lower after the vigorous physical activity regime than both sitting (7752.0±3014.4) and exercise regimes (8320.4±5383.7). Furthermore, the levels of non-HDL cholesterol, triglycerides and apolipoprotein B plasma indicated non-significant patterns for improvement compared to exercise. The outcome of this research suggests that one hour engaged in physical activity daily cannot compensate the adverse consequences of inactivity on the level of insulin and plasma lipids when the remaining part of the day is spent sitting. On the contrary, reducing the level of inactivity by scaling up the duration spent walking or standing (minimal intensity physical activity) yields more desirable outcomes compared to one hour of physical exercise, when energy consumption is maintained at a constant level. Strengths and Limitations of these Studies The major strength of these four epidemiological studies is the use of common study parameters in examining the role of physical activity, as a risk factor, on the management and prevention of diabetes. All the studies targeted the elderly who were either living with Type 2 Diabetes or those are risk of developing the health condition. Furthermore, the studies employed relevant research designs in investigating the subject matter; counterbalanced, randomized crossover design (Duvivier et al., 2013); Cohort design (Grøntved et al., 2012); randomized trial (Look AHEAD Research Group, 20130; and self-reported design (Booth el al., 2012). Additionally, all the four studies build on outcomes of previous appropriately formatted randomized control trial studies as well as other relevant study design such as cohort studies. Building from previous relevant studies helps enhance the internal validity of these four studies as their results reinforce previous findings (LAHEAD, 2013, p. 829). However, a significant weakness of cohort studies is the point that other variables may bear a significant contribution to the observed relationship (Yates et al., 2015, p. 289) thus compromising the validity of the research findings. In the Grøntved et al. (2012) study the researchers managed to select the final sample from a relatively large cohort as it involved a total sample of 32,003 actual research participants that was thoroughly screened from the 508,332 multitudes of US men, enabling effective random sampling that could result in minimal error when selecting such a high-risk cohort from a relatively large universe. Since engaging in weight instruction or aerobic activity for a minimum threshold of 250 minutes per week was independently related to a reduced risk of Type 2 Diabetes Mellitus of 34 percent (95 percent CI, 7-54 percent) and 52 percent (95 percent CL, 45-58 percent), respectively, men who took part in aerobic activities and weight instruction for a minimum of 150 minutes a week exhibited the greatest decrease in Type 2 Diabetes Mellitus risk (59 percent; 95 percent CL, 39-73 percent). However, the is a chance of confounding happening in the event the study fails to focus on participants who exhibit a particular characteristic. Just as Grøntved et al. (2012), the Look AHEAD Research Group (2013) study involved a relatively large size of participants from a large cohort as it featured a sample of 5,145 overweight and obese persons living with Type 2 Diabetes that were recruited at 16 US centers. The randomized trial was designed and undertaken by the investigators, and all investigations were accomplished by the coordinating center, besides the research being confirmed by the institutional review task force at the center. Also, the trial was not blinded; rather medical evaluators and end point adjudicators were masked to treatment task. Also, the size of the control group was almost equal to that of the intervention group, which implied that in almost all the incidences there exist sufficient anthropometric data. This resulted in a fairly equal ratio (403 vs. 418), hence enhancing the consistency of the two groups and potentially revealed all the significant effects. If the ration would otherwise be unequal and less balanced, some critical effects would have probably been masked. The major limitation of the Duvivier et al. (2013) and Booth et al. (2012) studies is that four days and 23 days, respectively, are considerably shorter compared to the other two trials. Hence, they might not estimate the risk of Type Diabetes effectively. Furthermore, the sizes of their sample groups, Duvivier et al. (18) and Booth et al. (48) very incomparable with the other two trials, thus, compound the difficulty in comparing them. The Implications of the Discussed Risk to Patients and Policy Makers in Healthcare Lifestyle patterns, age, gender, and family health history constitutes the major risk factors for Type 2 Diabetes. Limited engagement in physical activity, which is closely connected to excessive weight gain, increases the risk for Type 2 Diabetes in adults with a parental record of Type 2 Diabetes. Also, reduced physical activity in those high at risk increases the risk for developing this chronic disease. Obesity in immediate family members of diabetic victims correlates with the high risk of Type 2 Diabetes by close to 40 percent and physical activity is a cornerstone, which influences the overall and visceral adiposity than other environmental factors. Therefore, the knowledge of how lifestyle patterns, age, gender, and family health history constitute a risk for Type 2 Diabetes could yield better strategies for metabolic risk reduction. Furthermore, attaining a moderate-to-vigorous weekly 150 minutes of weekly physical activity is related to a reduction in the risk of Type 2 Diabetes (Williams and Thompson, 2013, p. 1085). More recent evidence of randomized control trials intensive activity can boost glycemic regulation in Type 2 Diabetic patients (LAHEAD, 2013, p.145). Therefore, it is imperative for those deemed susceptible to and living with the chronic disease to undertake a more physical activity for the recommended time. As many health practitioners and institutions have recommended physical activity for Type 2 Diabetes, its rate of uptake has been consistently higher (Seshasai et al., 2011, p. 829). According to Williams and Thompson (2013, p. 1086), more has to be done to promote physical activity in diabetes management and prevention programs. For instance, physical training facilities should not only be accessible, but also affordable to all social classes so that no patient fall a victim of his socioeconomic status. Moreover, it is prudent to promote the programs incorporating physical activities at the population level to enhance people’s awareness about the risks of suffering Type 2 Diabetes (Williams and Thompson, 2013, p. 1090) and the knowledge that they can play a vital role in its prevention and management (Booth et al., 2012, p. 283). The cost of diabetes prevention and management is increasingly becoming unbearable to the government, thus leaving prevention as the only viable and cost-effective option. Implications for Individual Practice In light of Diabetes Management and Prevention Programs, it has been illustrated vividly that engaging in regular and appropriate physical exercise can help prevent the development or Type 2 Diabetes, lower a plethora of complications associated with it, and improve the management or coping with the illness in both high-risk individuals. The anticipation of the author is to serve in a GP’s practice and pursue a special interest in promoting physical activity in diabetic populations and informing individuals diagnosed with the condition that they have an active chance to redeem their health outcomes with physical activity. Additionally, with better knowledge about this intervention, I am in a better position to suggest and develop intervention proposals to local authorities, unearthing the findings, in an attempt to champion for a formal management and prevention initiative through, for example through councils. Type 2 Diabetes has widely been acknowledged as a national and global health priority (Williams and Thompson, 2013, p. 1085) for a considerable period, yet is impacts and prevalence are constantly rising, with no prospective signs of a surge. Although, there has been an enhanced support for diabetes management and prevention, there still exists a gap in Diabetes Educators teaming with other major players to revamp their expertise regarding diabetes prevention and increase its access to those who are susceptible and the community at large. Primary Preventions entails empowering people to make informed decisions, but knowledge of the particular risks is an added advantage to the realization of the program. If you can inform people that despite being susceptible to Type 2 Diabetes, taking place in weight instruction or aerobic activity for a minimum threshold of 250 minutes per week was independently related to a reduced chance of Type 2 Diabetes Mellitus of 34 percent (95 percent CI, 7-54 percent) and 52 percent (95 percent CL, 45-58 percent), respectively (Grøntved et al., 2012, p. 1310), then it can be a firm foundation for initiating change. Many people often overlook the benefits of physical activity given the current poor lifestyle patterns enhanced with the Internet, but only open their minds when they encounter chronic diseases such as Type 2 Diabetes. Additionally, since there is proof that is engaging in physical activity improves insulin action (Duvivier et al., 2013, p. 8); this establishes another reliable pillar for promoting Primary Prevention. Lay Persons’ Perspective on the Role of Physical Activity to Diabetes Management The challenge of diabetes may not be a vocabulary to many lay people given its recent prevalence. However, a few may not comprehend its risks factors. The results of a short study conducted by (Booth et al., 2012, p. 278) showed that a considerable percentage of the participants were not aware of the risks of Type 2 Diabetes. Also, just a few confirmed to understand its relationship with physical activity (Aune et al., 2015, p. 529). This situation means that many lay people may not understand that lifestyle patterns, age, gender, and family health history constitute significant risk factors for Type 2 Diabetes. Also, the situation justifies the need for better education at the community level to help lay people understand the significance of physical activity in preventing the disease. Additionally, patients understanding of the health benefits of physical activity can depend on their individual perception of this intervention. Some of the participants held that few benefits accrue from engaging in exercise (Grøntved et al., 2012, p. 1307), as a consequent, they did not perceive it as a priority. Hence, GPs have to understand their patients’ perception of the benefits of exercise in managing diabetes and assist them to make informed health and lifestyle decisions. They should help them understand its fruits and the various strategies for undertaking exercise (Booth et al., 2012, p. 278). Some individuals, when diagnosed with the condition, may lose focus in life and become uncertain about how to go about it (Williams, P. T., & Thompson, 2013, p. 1086), while some might lack guidance as to what helpful lifestyle choices they might take to cope better with the condition (Booth et al., 2012, p. 280), thus justifying the need for more support and specific Diabetes Management and Prevention approach. Conclusion Physical activity promises people susceptible and living with Type 2 Diabetes a chance to play a significant role in shaping their life regarding the illness. Myriad epidemiological studies have documented evidence that physical activity reduces the risk for Type 2 Diabetes, besides improving its management. For instance, Grøntved et al. (2012, p. 1312) affirmed that men who took part in aerobic activities and weight instruction for a minimum of 150 minutes a week exhibited the greatest decrease in Type 2 Diabetes Mellitus risk. Better outcomes are realized when people engage in regular and appropriate exercises. This process can be facilitated by instruction the community about the benefits of physical activity. Therefore, healthcare givers, including GPs and Diabetes instructors, have a function in informing people how physical activity enhances Type 2 Diabetes outcomes. Focusing on community education and with government support, GP can tackle the issue effectively. Reference List Aune, D., Norat, T., Leitzmann, M., Tonstad, S., & Vatten, L. J, 2015, “Physical activity and the risk of type 2 diabetes: a systematic review and dose–response meta-analysis.” European journal of epidemiology, 30(7), 529-542. Booth, J. N., Bromley, L. E., Darukhanavala, A. P., Whitmore, H. R., Imperial, J. G., & Penev, P. D, 2012, “Reduced physical activity in adults at risk for type 2 diabetes who curtail their sleep.” Obesity, 20(2), 278-284. Accessed from: http://onlinelibrary.wiley.com/doi/10.1038/oby.2011.306/full Duvivier, B. M., Schaper, N. C., Bremers, M. A., van Crombrugge, G., Menheere, P. 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