Thursday , February 11 2016

From the Editor

February, 2016

  • 9 February

    dave

    Our diabetes disaster looks at the idea that patients often don’t use the information they have to regulate their blood sugars, and a lot of times this is because the right information only makes things worse. Usually this has to do with insulin dosing, and for many patients it can have ...

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February, 2016

Test Your Knowledge

Question #819

(Continued from Question #816, Question #817 and Question 818 )

Mrs. O’Doole is a 34-year-old of Irish descent. She works as a florist and is married with three children. She arrives at your clinic for her annual wellness exam. Her blood pressure is 130/84 mmHg, pulse 65, BMI 24 kg/m2 and her physical exam is notable for acne and mild hirsutism. Her only current medication is oral birth control pills. She recalls starting OCP, 15 years prior, due to irregular menses.

Based upon her medical history and physical, you believe it would be prudent to screen Mrs. O’Doole for type 2 diabetes. You discuss your recommendations with her and she agrees to be tested. The lab returns a fasting plasma glucose (FBG) of 112 mg/dL. You share these results with your patient and inform her that while only mildly elevated, she has impaired fasting glucose. She was started on lifestyle modifications plus dietary modifications, and exercise for weight loss.

At a follow-up appointment 6 months later, Mrs. O’Doole tells you despite good intentions, she has not been able to adhere to any meaningful lifestyle changes, in fact she has gained 5 pounds. At this time, her repeat fasting plasma glucose shows FPG 138 mg/dL. After discussing management options with her, you decide the best management would be metformin and lifestyle modifications.

You discuss the benefits of lifestyle changes with Mrs. O’Doole and tell her that you are referring her to an exercise program specifically for individuals with type 2 diabetes. What schedule of exercise is recommended for patients like Mrs. O’Doole?

Correct

Answer:  B. 30 minutes daily of moderate-intensity physical activity at least 5 days per week.

Patients with type 2 diabetes who are previously sedentary should aim to accumulate a minimum energy expenditure of 1000 kcal/wk. This corresponds to the American College of Sports Medicine and the American Diabetes Association guidelines for moderate-intensity physical activity for a minimum of 30 minutes at least 5 days week.

ADA recommendations advise patient with type 2 diabetes should participate in at least 150 minutes per week of moderate intensity exercise (50-70% maximum heart rate). No more than 2 days should pass without exercise and the exercise should be distributed over at least a 3-day period. In addition, at least 2 times week, individuals should engage in resistance training. Providers should use their clinical judgment in regarding the need to assess for cardiovascular risk factors before recommending a physical activity program. Individuals with type 2 diabetes have been shown to lower their A1C levels by an average of .66% when participating in structured exercise interventions of at least 8-weeks duration.

Reference(s):

American Diabetes Association. Standards of medical care in Diabetes – 2013. Diabetes Care. January 2013; 36(Suppl. 1):S11-S66. Available at http://care.diabetesjournals.org/content/36/Supplement_1/S11.full. Accessed Jan. 11, 2013.

Colberg SR, Sigal RJ, Fernhall B, et al. Exercise and type 2 diabetes. The American College of Sports Medicine and American Diabetes Association: Joint position statement. Diabetes Care. 2010; 33:2692-2696.

Incorrect

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