OBJECTIVE —The goal of this study was to estimate the prevalence of diabetes and the number of people of all ages with diabetes for years 2000 and 2030. RESEARCH DESIGN AND METHODS —Data on diabetes prevalence by age and sex from a limited number of countries were extrapolated to all 191 World Health Organization member states and applied to United Nations’ population estimates for 2000 and 2030. Urban and rural populations were considered separately for developing countries. RESULTS —The prevalence of diabetes for all age-groups worldwide was estimated to be 2.8% in 2000 and 4.4% in 2030. The total number of people with diabetes is projected to rise from 171 million in 2000 to 366 million in 2030. The prevalence of diabetes is higher in men than women, but there are more women with diabetes than men. The urban population in developing countries is projected to double between 2000 and 2030. The most important demographic change to diabetes prevalence across the world appears to be the increase in the proportion of people >65 years of age. CONCLUSIONS —These findings indicate that the “diabetes epidemic” will continue even if levels of obesity remain constant. Given the increasing prevalence of obesity, it is likely that these figures provide an underestimate of future diabetes prevalence.

https://www.who.int/diabetes/facts/en/diabcare0504.pdf

Global Prevalence of Diabetes: Estimates for the year 2000 and projections for 2030

XI. STRATEGIES FOR IMPROVING DIABETES CARE D iabetes is a chronic illness that requires continuing medical care and patient self-management education to prevent acute complications and to reduce the risk of long-term complications. Diabetes care is complex and requires that many issues, beyond glycemic control, be addressed. A large body of evidence exists that supports a range of interventions to improve diabetes outcomes. These standards of care are intended to provide clinicians, patients, researchers, payors, and other interested individuals with the components of diabetes care, treatment goals, and tools to evaluate the quality of care. While individual preferences, comorbidities, and other patient factors may require modification of goals, targets that are desirable for most patients with diabetes are provided. These standards are not intended to preclude more extensive evaluation and management of the patient by other specialists as needed. For more detailed information, refer to Bode (Ed.): Medical Management of Type 1 Diabetes (1), Burant (Ed): Medical Management of Type 2 Diabetes (2), and Klingensmith (Ed): Intensive Diabetes Management (3). The recommendations included are diagnostic and therapeutic actions that are known or believed to favorably affect health outcomes of patients with diabetes. A grading system (Table 1), developed by the American Diabetes Association (ADA) and modeled after existing methods, was utilized to clarify and codify the evidence that forms the basis for the recommendations. The level of evidence that supports each recommendation is listed after each recommendation using the letters A, B, C, or E.

Standards of Medical Care in Diabetes

The purpose of this Position Stand is to provide guidance to professionals who counsel and prescribe individualized exercise to apparently healthy adults of all ages. These recommendations also may apply to adults with certain chronic diseases or disabilities, when appropriately evaluated and advised by a health professional. This document supersedes the 1998 American College of Sports Medicine (ACSM) Position Stand, "The Recommended Quantity and Quality of Exercise for Developing and Maintaining Cardiorespiratory and Muscular Fitness, and Flexibility in Healthy Adults." The scientific evidence demonstrating the beneficial effects of exercise is indisputable, and the benefits of exercise far outweigh the risks in most adults. A program of regular exercise that includes cardiorespiratory, resistance, flexibility, and neuromotor exercise training beyond activities of daily living to improve and maintain physical fitness and health is essential for most adults. The ACSM recommends that most adults engage in moderate-intensity cardiorespiratory exercise training for ≥30 min·d on ≥5 d·wk for a total of ≥150 min·wk, vigorous-intensity cardiorespiratory exercise training for ≥20 min·d on ≥3 d·wk (≥75 min·wk), or a combination of moderate- and vigorous-intensity exercise to achieve a total energy expenditure of ≥500-1000 MET·min·wk. On 2-3 d·wk, adults should also perform resistance exercises for each of the major muscle groups, and neuromotor exercise involving balance, agility, and coordination. Crucial to maintaining joint range of movement, completing a series of flexibility exercises for each the major muscle-tendon groups (a total of 60 s per exercise) on ≥2 d·wk is recommended. The exercise program should be modified according to an individual's habitual physical activity, physical function, health status, exercise responses, and stated goals. Adults who are unable or unwilling to meet the exercise targets outlined here still can benefit from engaging in amounts of exercise less than recommended. In addition to exercising regularly, there are health benefits in concurrently reducing total time engaged in sedentary pursuits and also by interspersing frequent, short bouts of standing and physical activity between periods of sedentary activity, even in physically active adults. Behaviorally based exercise interventions, the use of behavior change strategies, supervision by an experienced fitness instructor, and exercise that is pleasant and enjoyable can improve adoption and adherence to prescribed exercise programs. Educating adults about and screening for signs and symptoms of CHD and gradual progression of exercise intensity and volume may reduce the risks of exercise. Consultations with a medical professional and diagnostic exercise testing for CHD are useful when clinically indicated but are not recommended for universal screening to enhance the safety of exercise.

/pdf/quantity-and-quality-of-exercise-for-developing-and-1fohxlhqop.pdf

Quantity and Quality of Exercise for Developing and Maintaining Cardiorespiratory, Musculoskeletal, and Neuromotor Fitness in Apparently Healthy Adults: Guidance for Prescribing Exercise

Global estimates of the prevalence of diabetes for 2010 and 2030.

The primary purpose of this narrative review was to evaluate the current literature and to provide further insight into the role physical inactivity plays in the development of chronic disease and premature death. We confirm that there is irrefutable evidence of the effectiveness of regular physical activity in the primary and secondary prevention of several chronic diseases (e.g., cardiovascular disease, diabetes, cancer, hypertension, obesity, depression and osteoporosis) and premature death. We also reveal that the current Health Canada physical activity guidelines are sufficient to elicit health benefits, especially in previously sedentary people. There appears to be a linear relation between physical activity and health status, such that a further increase in physical activity and fitness will lead to additional improvements in health status.

/pdf/health-benefits-of-physical-activity-the-evidence-17tsp10zcy.pdf

Health benefits of physical activity: the evidence

Abstract Premature cardiovascular mortality is increased in long-term allogeneic stem cell transplant (allo-SCT) survivors, but little information exists regarding subclinical cardiovascular dysfunction in this population. We compared peak oxygen uptake ( $${{\dot{\mathrm V}}}$$ <mml:math xmlns:mml="http://www.w3.org/1998/Math/MathML"> <mml:mover> <mml:mi>V</mml:mi> <mml:mo>˙</mml:mo> </mml:mover> </mml:math> O 2peak ), a prognostic cardiovascular marker, and its determinants between long-term allo-SCT survivors and non-cancer controls. Fourteen allo-SCT survivors (mean ± SD, 44 ± 15 years, 50% male, median time since allo-SCT: 6.5 years [range 2–20]) and 14 age- and sex-matched controls (46 ± 13 years, 50% male) underwent cardiopulmonary exercise testing to quantify $${{\dot{\mathrm V}}}$$ <mml:math xmlns:mml="http://www.w3.org/1998/Math/MathML"> <mml:mover> <mml:mi>V</mml:mi> <mml:mo>˙</mml:mo> </mml:mover> </mml:math> O 2peak . Resting echocardiography (left-ventricular ejection fraction and strain), exercise cardiac MRI (peak cardiac and stroke volume index [CI peak , SVI peak ]), biochemistry (hemoglobin, troponin-I, B-natriuretic peptide), dual-energy x-ray absorptiometry (lean [LM] and fat [FM] mass, percent body fat [%BF]) and Fick - principal calculation (arteriovenous oxygen difference) were also performed. Survivors exhibited impaired $${{\dot{\mathrm V}}}$$ <mml:math xmlns:mml="http://www.w3.org/1998/Math/MathML"> <mml:mover> <mml:mi>V</mml:mi> <mml:mo>˙</mml:mo> </mml:mover> </mml:math> O 2peak as compared with controls (25.9 ± 5.1 vs. 33.7 ± 6.5 ml kg −1 min −1 , p = 0.002), which coincided with reduced CI peak (6.6 ± 0.8 vs. 8.6 ± 1.9 L min −1 m −2 ; p = 0.001) secondary to reduced SVI peak (48 ± 4 vs. 61 ± 8 ml m −2 ; p &lt; 0.001) rather than chronotropic impairment, and higher %BF (difference, 7.9%, p = 0.007) due to greater FM (5.8 kg; p = 0.069) and lower LM (4.3 kg, p = 0.25). All other measures were similar between groups. Despite comparable resting cardiac function and biomarker profiles, survivors exhibited reduced $${{\dot{\mathrm V}}}$$ <mml:math xmlns:mml="http://www.w3.org/1998/Math/MathML"> <mml:mover> <mml:mi>V</mml:mi> <mml:mo>˙</mml:mo> </mml:mover> </mml:math> O 2peak and exercise cardiac function and increased %BF relative to controls. These results highlight potential therapeutic avenues and the utility of exercise-based cardiovascular assessment in unmasking cardiovascular dysfunction in allo-SCT survivors. 

/pdf/reduced-cardiovascular-reserve-capacity-in-long-term-1jskuby4.pdf

Reduced cardiovascular reserve capacity in long-term allogeneic stem cell transplant survivors

Just-in-time adaptive intervention (JITAI) to Sit Less and Move More: protocol for a micro-randomised trial (MRT) in people with type 2 diabetes (Preprint)

Objectives Sedentary behaviour (SB) is associated with increased incidence of chronic diseases such as type 2 diabetes (T2D), cardiovascular disease, cancers, and premature mortality. SB interventions in workplaces are effective in reducing sitting time. Previous economic evaluations have not specifically used changes in sitting time to estimate the long-term impact of SB on chronic disease-related health and cost outcomes. This research evaluated the cost-effectiveness of three hypothetical SB interventions: behavioural (BI), environmental (EI) and multi-component intervention (MI), implemented in the Australian context, using a newly developed epidemiological model that estimates the impact of SB as a risk factor on long-term population health and associated cost outcomes. Method Pathway analysis was used to identify the resource items associated with implementing each of the three interventions using a limited societal perspective (included costs: health sector, individuals and industry; excluded costs: productivity). The effectiveness of the modelled interventions in reducing daily sitting time (informed by published meta-analyses) was modelled for the Australian working population aged 20–65 years. A multi-cohort Markov model was developed to simulate the 2019 Australian population and estimate the incidence, prevalence and mortality of five diseases causally related to excessive sitting time, over the life course. Monte-Carlo simulations were used to calculate each intervention’s mean incremental costs and benefits (quantified as health adjusted life years HALYs) compared to a do-nothing comparator. Results When implemented at the national level, the interventions were estimated to reach 1,018 organisations with 1,619,239 employees. The estimated incremental cost of SB interventions was A$159M (BI), A$688M (EI) and A$438M (MI) over a year. Incremental health-adjusted life years (HALYs) gained by BI, EI and MI were 604, 919 and 349, respectively. The mean ICER for BI was A$251,863 per HALY gained, A$737,307 for EI and A$1,250,426 for MI. Only BI had any probability (2%) of being cost-effective at a willingness-to-pay threshold of A$50,000 per HALY gained from a societal perspective. Conclusion SB interventions are not cost-effective when a reduction in sitting time is the outcome measure of interest. The cost-effectiveness results are heavily driven by the cost of the sit-stand desks and the small HALYs gained from reducing sitting time. Future research should focus on capturing non-health-benefits of these interventions, such as productivity, work satisfaction, and other health benefits: metabolic, physical, and musculoskeletal outcomes. Importantly, the health benefits of simultaneously reducing sitting time and increasing standing time for such interventions should be captured with the joint effects of these risk factors appropriately considered.

https://journals.plos.org/plosone/article/file?id=10.1371/journal.pone.0287710&type=printable

Cost-effectiveness analysis of sedentary behaviour interventions in offices to reduce sitting time in Australian desk-based workers: A modelling study

Background Interrupting prolonged sitting acutely lowers blood pressure in nonstroke populations. However, the dose-response effect in stroke survivors is unknown. The authors investigated different doses of light-intensity standing exercises that interrupt prolonged sitting and reduce blood pressure immediately and over 24 hours in stroke survivors. Methods Within-participant, laboratory-based, dose escalation trial. Conditions (8 h) were prolonged sitting and 2 experimental conditions of standing exercises with increasing frequency (3 cohorts, 2 × 5 min to 6 × 5 min). The primary outcome is the mean systolic blood pressure. Results Twenty-nine stroke survivors (aged 66 [12] y) participated. Frequent bouts of standing exercises lowered the mean systolic blood pressure following the 4 × 5-minute (-2.1 mm Hg; 95% confidence interval [CI], -3.6 to -0.6) and 6 × 5-minute conditions (-2.3 mm Hg; 95% CI, -4.2 to -0.5) compared with prolonged sitting. Diastolic blood pressure was lowered following the 6 × 5-minute condition (-1.4 mm Hg; 95% CI, -2.7 to -0.2). The 24-hour systolic blood pressure increased following the 2 × 5-minute condition (6.9 mm Hg; 95% CI, 3.1 to 10.6). Conclusions Interrupting prolonged sitting with more frequent bouts of standing exercises lowers systolic and diastolic blood pressure in stroke survivors. However, reductions may only be short term, and investigations on sustained effects are warranted.

/pdf/the-effects-of-interrupting-prolonged-sitting-with-frequent-38uyo9kk83.pdf

The Effects of Interrupting Prolonged Sitting With Frequent Bouts of Light-Intensity Standing Exercises on Blood Pressure in Stroke Survivors: A Dose Escalation Trial.

David W. Dunstan

Papers

Reduced cardiovascular reserve capacity in long-term allogeneic stem cell transplant survivors

Just-in-time adaptive intervention (JITAI) to Sit Less and Move More: protocol for a micro-randomised trial (MRT) in people with type 2 diabetes (Preprint)

Cost-effectiveness analysis of sedentary behaviour interventions in offices to reduce sitting time in Australian desk-based workers: A modelling study

The Effects of Interrupting Prolonged Sitting With Frequent Bouts of Light-Intensity Standing Exercises on Blood Pressure in Stroke Survivors: A Dose Escalation Trial.