Diabetes Mellitus is the term for a group of metabolic conditions which are typically characterised by an impaired insulin-stimulated glucose uptake (hyperglycemia – elevated blood sugar levels) and/or insulin deficiency by pancreatic beta cells. Peripheral neuropathy is the loss of sensory feedback to the periphery – usually the lower extremity and is among the most distressing components of diabetic complications.
There are four types of diabetes: Type 1, Type 2, gestational and other specific origins (i.e. genetic defects and drug induced). This blog will discuss Type 2 Diabetes Mellitus (T2DM) and peripheral neuropathy (PN) or more commonly termed diabetic peripheral neuropathy (DPN). DPN is a common microvascular complication of T2DM which can be associated with:
- Chronic pain
- Sleep disturbance
- Depressed mood
- Reduced productivity
- Impaired quality of life
- Increased risk of falls
DPN is the leading cause ~50-75% of non-traumatic lower limb amputations within developed countries. The risk of death is increased when patients undergo a lower limb amputation and also have a 50% chance of requiring another amputation within 3-5 years. There are several risk factors which result in DPN and are used as independent predictors, these are currently known to be:
- Central obesity
- Elevated blood pressure
- Male gender
- T2DM diagnosis of 5 years or more
- Poor glycemic control
Already there are over 250 million patients worldwide who have been diagnosed with T2DM. As this trend continues it could incur a significant burden on healthcare costs and society. In a position statement released by Exercise and Sports Science Australia (ESSA) in 2012, they stated that in 2002 every T2DM patient costs on average $10,900. If they had additional micro and macro vascular complications then the expense rose to $15,000. This totaled over $3 billion for 2002. The Australian Bureau of Statistics stated that in 2014-2015 one million Australians (4.1%) of the population have T2DM. This was a 3.8% increase from the year before.. Which with increasing trends would suggest that there are now even more T2DM patients in 2018. So how can we fix this epidemic?
Exercise? Drugs? A combination of both?
There are a number of pharmaceutical interventions which are prescribed for a person who is diagnosed with T2DM to help control blood glucose levels. The most common form of prescription medication is Metformin. The use of pharmaceutical interventions with the addition of lifestyle interventions are recommended for those with T2DM. The short-term combination of metformin therapy and lifestyle changes can aid in an increased glucose uptake by skeletal muscle to help stabilise blood glucose levels. While over a longer period of time the combinations of these therapies can enhance insulin sensitivity and decrease a diabetics HbA1c (glycosylated haemoglobin). The current recommendation is to attain a HbA1c which is <6.5%. The combined effects of metformin and exercise after a meal result in an individual’s ability to improve the glucose metabolic clearance rate without risking a hypoglycaemic event.
The Deloitte Report discusses that through intervention such as exercise, delivered by an accredited exercise physiologist, the expected annual saving in the health system expenditure is $5,107 per T2DM person. In addition to this the life time burden of disease savings is ~$2,860 for a person with T2DM.
Through supervised and individualised exercise prescriptions delivered by an accredited exercise physiologist the effects of exercise can improve blood glucose levels and help to decrease the burden of T2DM and DPN. It is important for diabetics to understand the benefits of a structured exercise program which is of a moderate to intense level. Both weight and non weight bearing activities are safe for diabetics but it is always important to check with a health professional regarding what’s right for you.
The current recommendations for an individual with T2DM regarding exercise are to:
Accredited Exercise Physiologists undergo training to provide individualised exercise prescriptions to persons with T2DM and PN. To learn more about how exercise can benefit yourself or a friend with T2DM, please contact our Accredited Exercise Physiologists on 0438014747.
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