Self Management of Diabetes - Essay Example

Self Management of Diabetes Diabetes Self Management Type 2 diabetes is a chronic illness which has a decreased insulin sensitivity as well as poor glucose control. It is considered by many to be at epidemic stages and the number one public health crisis in our time. It affects more than 9% of the population and Hispanics over the age of 50 may have an incidence rate of over 30% of their population (Vincent, 2009). It was the 6th leading cause of death in the United States in 2002 and morbidity from complications is high. It not only affects mortality rates but severe side effects such as end stage renal disease, cardiac disease, and blindness often occurs (Clark, 2003). Obesity is a major risk factor for the development of diabetes and the numbers of people that are becoming obese is increasing rapidly. It is the major cause of premature mortality and morbidity due to cardiovascular, renal, ophthalmic and neurological disease. It is widely accepted that control of the lifestyle situation including diet and exercise decrease the risk of complications and control the Hg1c (Porth & Matfin, 2007). This paper will discuss recent studies affecting the overall Hg1c with combined strength and aerobic exercise programs. Self management of diabetes includes diet, exercise, medication, and blood sugar control. Exercise, however has been shown to be highly important. Lean muscle mass improves Hg1c (Sigal, Kenny, Boule et.al. 2007). There has been some controversy in determining whether that exercise should be aerobic or strength or both. In researching this, studies relating to diet and other controls were eliminated and a search was conducted for supporting evidence that both types of exercise included in routines for these patients improved overall blood glucose control and limited complications from the disease. Five peer reviewed studies were retained from many found as they included both exercise routines against controls. Historically, aerobic exercise has been used to attempt to improve glucose levels in diabetic patients. However, there is a great deal of literature available now that shows a great deal of merit for adding resistance exercise to this routine for control. It appears that glucose control is only one of the benefits of this kind of routine for diabetic patients. Strength, endurance, and power are benefits received (Marcus, Smith, Morrell, 2008). There is also an increase in lean tissue mass which creates an increase in metabolic rate. The importance of physical activity in these patients cannot be denied. It is considered not only preventative but also therapeutic (Tokmakidis, Zois, Votaklis, et.al. 2004). The change that occurs in muscle mass coupled with effects on glucose uptake are the reasons for better control. This occurs even in people with insulin resistance. In operationalizing this data, education is the key. Over the past years, diabetics have been taught that walking is the perfect exercise to control their HgA1c and to some point that is true, it is the perfect exercise. However, there is a gap in the education as far as adding the needed strength training. It may be clearly important, due to the large numbers of diabetics now, to design and implement diabetic exercise programs that are couple with regular education programs. Certainly controlling blood sugar and preventing complications of this disease proves to be financially needed for both the patients and the healthcare system. Sigal, Kenny, & Boule et.al. (2007) published a study in the Annuls of Internal Medicine on this very issue. Previous studies evaluated by them determined that the effects of aerobic exercise alone provided for better glucose control. They felt that there was likelihood that a combination of aerobic and strength exercises would lead to better control. They performed a randomized control trial set in 8 community based facilities. Included in this study were 251 adults age 39 to 70 with type 2 diabete (Sigal, et.al., 2007). Patients were screened and accepted only with a negative stress test and clearance by a cardiologist. Two groups were used and who was on which group was randomized. One group got aerobic training coupled with resistance training and the control group had just aerobic training. Exercise training occurred 3 times per week for 22 weeks. At the end of 6 months hg A1c was -0.51 in those that had both kinds of training and -0.38 in the control group (Sigal, et.al., 2007). The conclusion was that aerobic exercise alone does decrease A1c but there is a much better result with aerobic and strength training together. This study was well tailored and well reported covering the subject matter appropriately. In 2008, a study done by Marcus, Smith, and Morrell et.al. supported that study. They also studied the use of both types of exercise in the control of diabetes A1c levels. Their participants were 15 Type 2 diabetics which participated in the study for 16 weeks. There were two separate groups, one with aerobic exercise and one with aerobic and strength training. They included the following outcome measures: thigh lean tissue, intramuscular fat, glycosylated hemoglobin, body mass index, and 6 minute walk distance. There were significant improvements in both groups with more improvement in thigh lean tissue and BMI in those doing both kinds of exercise. It is recognized that in this population of patients there is an increasing resting metabolic rate, protein reserve, exercise tolerance and functional mobility with patient who increase lean tissue mass. This study may have tried to prove too much with to many parameters which caused their finding to be less than significant. Short and long term effects of strength plus aerobic training for adult diabetics was the concern of Tokmakidis, Zois, and Volaklis et.al. (2004). They were concerned with the affect of this kind of program on the glycemic control, insulin action, and exercise capacity of postmenopausal women with type 2 diabetes. 9 women participated in this study for four months. There were 3 sets of 12 repetitions at 60% and one repetition at maximum strength coupled with 2 aerobic training sessions (Tokmakidis et.al., 2004). Patients were screened prior to the study using stress test, maximum strength measures and glucose tolerance test. At conclusion of the test, it was determined that the addition of strength training gave these women better blood sugar control. The study admits that it was a limited study and that there are cardiovascular components that could be better studied as well as defining the program better for type 2 diabetic (Tokmakidis, 2004). This was a small study that was not statistically significant and though they did show some improvement in results, it did not appear to be sound results as there was no control group studied. On the other hand, another specialty study was done by Vincent (2009) in which she studied the effects of a culturally tailored program for Mexican Americans with type 2 diabetes. This study was based on physical activity for a focus group as Latinos are the fastest growing group of diabetics in the United States today. Mexican Americans out of that group are the hardest hit with 25-30% of Mexican American greater than the age of 50 having type 2 diabetes (Vincent, 2009). In this study, 17 Mexican American were studied. There was a pretest, posttest, control group design with 10 subjects in each group. Outcome measures that were included were the total number of steps walked weekly, weight, and BMI. Results suggested a positive effect from the physical activity level on weight and sense of control over their diabetes. There was a great increase in the number of steps walked by the study group. There was an average 5 lb weight loss. The control group was only instructed in the program and not managed through the exercises and though they felt they had better control, it did not show in testing. The author felt that there was enough information to recommend the need for culturally tailored diabetic programs for Mexican Americans with type 2 diabetes (Vincent, 2009). However, the study was very limited and types of exercise were not well controlled. The control group had no exercise routine at all, just instructions and yet the author did not prove significant different. It appears that further study is definitely warranted her. Finally, Clark, Hampson, and Avery et.al. (2004) completed a study on tailored lifestyle management. The study was somewhat limited and does not go far enough to support the exercise theories previously discussed. However, the aim of this study was to develop, implement, and evaluate a brief intervention to prove adherence to a tailored lifestyle management technique would improve outcomes. They chose to reduce fat intake and increase physical activity levels. They used a randomized control trial. One hundred people participated in the study between the ages of 40 and 70 and assessments were done three times throughout the study(Clark, et.al., 2004). Participants were in one of two groups. The first group was the intervention group while the second group received a brief tailored intervention including follow up telephone calls. The intervention group received instruction in dietary habits, exercise and behavior modification. Results included a reduction in waist size and better compliance with diet with most patients while increased exercise over the long term did not seem to occur in either group. There is evidence from the study that tailored lifestyle interventions do show effectiveness in improvement in type 2 diabetes. It is noted that further study is needed. Overall, when comparing these studies, it is noted that they were not consistent in the sense of what was studied and how the studies were conducted. Each of the studies had some parameters that were the same while some were completely different. Each of the studies was preformed in essentially the same study manner except that in some cases the numbers of participants were not statistically appropriate. There are gaps in the results where some measured several outcomes while some measured only one. Those that had more than two outcomes measured were not able to give enough pertinent information to make the data convincing. In conclusion, it is clear that diabetes is at epidemic proportions throughout the world at this time. Type 2 diabetes is difficult to control and each individual must learn to manage their own disease through specific efforts which usually include, diet, medication and exercise. For quite some time an aerobic or walking program has been recommended for control of A1cs in type 2 diabetes but it appears from these studies that there may be a better program. That program would include not only aerobic or walking exercise but strength training. The advantages of that are reduced waist size, reduced BMI, better controlled A1c, and more lean muscle mass. These outcomes may very well decrease the numbers of critical morbidities in the future of these patients. Resources Clark, M. Hampson, S., Avery, L. et.al. (2004). Effects of a tailored self-management Intervention in patients with Type 2 diabetes. 9. 365. Marcus, R., Smith, S., Morrell, G. et.al. (2008). Comparison of combined aerobic and Force eccentric resistance exercise with aerobic exercise only for people with type 2 diabetes mellitus. Physical Therapy. 88(11). Porth, M & Matfin, G. (2007). Pathophysiology. Lippincott: Philedelphia. Sigal R., Kenny, G., Boule, N. (2007). Effects of aerobic training, resistance training, or Both on glycemic control in type 2 diabetes. Annuls of Internal Medicine. 147(6). Tokmakidis, S., Volaklis, K. Touvra, A. (2004). The effects of a combined strength and Aerobic exercise program on glucose control and insulin action in women with Type 2 diabetes. Journal of Applied Physiology. 92. 437-442. Vincent, D. (2009). Culturally tailored education to promote lifestyle change in Mexican Americans with type 2 diabetes. Read More