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The Diabetes Epidemic

Diabetes has grown to “epidemic” proportions, and the latest statistics revealed by the U.S. Centers for Disease Control and Prevention state that 30.3 million Americans have diabetes, including the 7.2 million people who weren’t even aware of it. Diabetes is affecting people of all ages, including 132,000 children and adolescents younger than 18 years old. ()

The prevalence of Sarto by Franco Sarto Seville Ankle Boot Womens pjLweV
is also on the rise, as it’s estimated that almost 34 million U.S. adults were prediabetic in 2015. People with prediabetes have blood glucose levels that are above normal but below the defined threshold of diabetes. Without proper intervention, people with prediabetes are very likely to become type 2 diabetics within a decade.

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The cost of diabetes to our nation is a staggering $245 billion a year as of 2012. The American Diabetes Association reports that the average medical expenditure for people with diabetes was about $13,700 per year. People with diabetes typically have medical costs that are approximately 2.3 times higher than those without diabetes. ()

Aside from the financial costs of diabetes, the more frightening findings are the complications and co-existing conditions. In 2014, 7.2 million hospital discharges were reported with diabetes as a listed diagnosis. Patients with diabetes were treated for major cardiovascular diseases, ischemic heart disease , stroke, lower-extremity amputation and diabetic ketoacidosis.

heart disease The Cause of Diabetes

Diabetes is an illness related to elevated blood sugar levels. When you stop releasing and responding to normal amounts of insulin after eating foods with carbohydrates, sugar and fats, you have diabetes. Insulin, a hormone that’s broken down and transported to cells to be used as energy, is released by the pancreas to help with the storage of sugar and fats. But people with diabetes don’t respond to insulin properly, which causes high blood sugar levels and diabetes symptoms.

It’s important to note that there’s a difference between type 1 and type 2 diabetes. Here’s an explanation of the two types of diabetes and what causes these conditions:

The primary objective of the present study was to determine whether long-term moderate exercise training can improve functional capacity in patients with stable chronic heart failure and whether this improvement can translate into a favorable outcome. Other objectives of the study were as follows: (1) to assess the effect of exercise training on quality of life, (2) to identify patients who can benefit the most from exercise training, and (3) to select the independent predictors of outcome.

Initially, 110 consecutive patients with chronic heart failure in stable condition were recruited. However, after the screening visit at baseline, 11 patients decided not to participate. Thus, 99 patients (mean age, 59±14 years) were studied. All patients were clinically stable in the 3 months before the study. Criteria for eligibility were heart failure, left ventricular ejection fraction ≤40%, and sinus rhythm. The diagnosis of chronic heart failure was based on clinical symptoms and signs and/or radiological evidence of pulmonary congestion. Clinical characteristics of the patients are summarized in Table 1 . The cause of heart failure was ischemic cardiomyopathy (85%) or idiopathic dilated cardiomyopathy (15%). Mitral insufficiency was present in 42 patients and was mild in all. Exclusion criteria were unstable angina, recent acute myocardial infarction, decompensated congestive heart failure, hemodynamically significant valvular heart disease, significant chronic pulmonary illness, uncontrolled hypertension, renal insufficiency (serum creatinine ≥2.5 mg/dL), and orthopedic or neurological limitations. Medications were not altered throughout the duration of the study and were administered at standard doses.

View this table:
Table 1.

Baseline Characteristics of the Patients in the 2 Treatment Groups


The protocol, approved by the Ethical Committee of the Lancisi Institute, was a prospective, randomized, controlled study. All patients gave written informed consent.

Patients were randomized into 2 homogeneous groups. The exercise group (group T, n=50) underwent exercise training for 14 months. The control group (group NT, n=49) did not exercise. On study entry and at the 2nd and 14th months, all patients performed an exercise test with gas exchange analysis and an echocardiographic study. At the same times, the subgroup of patients with ischemic heart disease (37 in group T and 37 in group NT) underwent thallium myocardial scintigraphy to evaluate the effects of exercise training on myocardial perfusion at different times. All studies were performed by skilled operators and evaluated by 2 experienced observers blinded to each other’s interpretation. A third observer was asked to resolve differences when agreement was not achieved. A consensus decision was obtained in all cases.

Exercise Training

Exercise training was performed in 2 phases. Initially, patients exercised 3 times a week for 8 weeks at 60% of peak V̇ o . This protocol was followed by a 12-month maintenance program of the same intensity but with only 2 sessions a week. Each session lasted ≈1 hour, beginning with a warm-up phase of stretching exercises (15 to 20 minutes) followed by 40 minutes of cycling on an electronically braked cycle ergometer (Sensorimedics 800S). Blood pressure and heart rate were measured at rest before exercising, at the middle of work on the cycle ergometer, and after 5 minutes of loadless recovery. All sessions were held at the hospital gymnasium under the supervision of a cardiologist.


M-mode and 2-dimensional echocardiographic studies were performed at baseline and at months 2 and 14 in all patients according to the recommendations of the American Society of Echocardiography. We used an ultrasound system with a 2-dimensional mechanical sector scanner (2.5 MHz, ESAOTE). Left ventricular end-diastolic volume (EDV) and end-systolic volume (ESV) were obtained from the apical 4- and 2-chamber views by a modified Simpson’s rule, from which ejection fraction was automatically calculated as the difference between EDV and ESV normalized to EDV. We used a biplane algorithm to calculate left ventricular volumes. Normal values from our laboratory and reproducibility data have been published recently.

Cardiopulmonary Exercise Test

In the fasting state, an incremental exercise test was performed until volitional fatigue or symptoms or signs of myocardial ischemia appeared. Adrienne Vittadini Kala Kitten Heel Sandal Womens YuaHoa
Patients pedaled in the upright position on an electronically braked cycle ergometer (Ergometrics 800 S) at a constant rate of 60 rpm. The work rate was increased 1 W every 5 seconds (ramp). Expired gases were analyzed by use of a metabolic chart (Sensormedics 2900 Z). Calibration of volumes and gases (O and CO) was carefully performed before each test. The ventilatory threshold was measured by the V-slope method. Peak oxygen uptake was the mean oxygen uptake over the last 30 seconds of exercise.

At the end of the exercise test, 3 mCi of thallium was injected into an antecubital vein. Planar 201 Tl imaging was begun within 5 minutes in the anterior, 45° left anterior oblique, and 70° left anterior oblique views (Apex Elscint). Redistribution studies were performed 3 hours after stress imaging. Twenty-four hours later, 1 mCi of thallium was reinjected in patients with scintigraphic evidence of a fixed defect noted in the redistribution images. After reinjection, a third set of images was reacquired within 15 minutes.

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