Diabetes and MorbidityMortality

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Diabetes and Morbidity/Mortality

• Dr. Gene May

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Chapter 1Introduction

• ObjectiveThe Objective of this study was to
  investigate the morbidity/mortality risks
  associated with diabetes.

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Introduction, cont.

• Definitions
• Aerobic Exercise (aerobics) - a program of
  physical conditioning based on sustained
  strenuous exercise and intended to improve
  cardiorespiratory fitness.
•  
• Anaerobic Exercise - activity that improves the
  efficiency of the anaerobic energy- producing
  systems.

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Definitions, cont.

• Body Composition- body fat. 
• Cholesterol - the most abundant steroid in animal
  tissues, widely believed to play an important
  role in the pathogenesis of atheroma formation in
  arteries.
• Diabetes - a metabolic disease in which
  carbohydrate utilization is reduced due to an
   insufficient level of insulin production and/or
  by cellular insulin resistance. 
• Exercise - bodily exertion for the sake of
  restoring the organs and functions to a healthy
  state or keeping them healthy.

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Definitions, cont.

• Health - optimal function without evidence of
  disease or abnormality. 
• Hypertension - abnormally high blood pressure.
• Morbidity - a diseased state.
• Mortality - a fatal outcome. 
• Obesity - an excessive amount of body fat,
  generally defined as gt 25 in men and gt 35 in
  women.

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Definitions, cont.

• Overweight - body weight that exceeds the normal
  or standard weight for a particular individual
  based on gender, height, and frame size. 
• Physical Activity - any intensity of movement
  higher than that required in sedentary living and
  occupations. 
• Physical Fitness - a set of attributes relating
  to one's ability to perform physical activity. 

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Definitions, cont.

• Health related physical fitness - an acceptable
  level of the fitness components that relate to
  overall health. The components are
  cardiorespiratory fitness, muscular
  strength/endurance, body composition, and
  flexibility.

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Introduction, cont.

• The Popular OpinionDiabetes increases ones
  risk for CAD, stroke, hypertension, and PVD.
  People with this disease have a relatively high
  mortality rate (Wilmore and Costill, 1999, p.
  684).

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Chapter 2Review of the Literature

• Introduction Frequently, the popular or
  prevailing opinions in health matters are not
  actually supported by scientific studies.
  Several studies were consulted to ascertain
  confirmation or refutation of the popular and
  prevailing opinion.

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Review of the Literature

• Related Literature Tierney et al. (2001)
  analyzed 28,795death certificates in North
  Dakota from 1992-1996 of those age 18 and older.
  Mortality was double in the diabetic versus
  non-diabetic population. Risk of HD and IHD
  mortality was 2-4 times higher in the diabetic
  population. Relative risk decreased with age.

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Related Literature, cont.

• The San Antonio Heart Study (Wei et al., 1998)
  followed 4,875 subjects for 7-8 years to
  investigate the effects of diabetes and
  hyperglycemia on all-cause and cardiovascular
  mortality. Diabetics were 2.1-3.2 men, women)
  times more likely to die than non-diabetics.
  Higher levels of blood sugar increased risk.

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Related Literature, cont.

• Gu, Cowie, and Harris (1998) reported from the
  NHANES I study of 14,374 subjects, ages 25 to 74,
  that diabetics were from 3.6 to 1.5 times as
  likely to die as non-diabetics, decreasing with
  age.

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Related Literature, cont.

• Isomaa et al. (2001) studied 4,483 subjects in
  Finland and Sweden ages 35-70. There was an
  increased risk of 3 to 1 metabolic syndrome to
  non-metabolic syndrome in CHD. The CVD mortality
  increase was 1.8.

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Related Literature, cont.

• Bertoni, Saydah, and Brancati (2001) reported
  from NHANES II that in 9208 adults ages 30-74
  were at approximately double the risk of dying
  from infectious disease if they had diabetes.

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Related Literature, cont.

• Wei et al. (2000) followed 1263 men with
  confirmed type 2 Diabetes for 23 years. Low fit
  diabetics had 2.1 times the mortality of highly
  fit diabetics

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Review of the Literature

• Summary Diabetics have approximately twice the
  mortality rate of non-diabetics. This
  discrepancy decreases with age and is apparently
  eliminated with high levels of fitness among type
  2 diabetics.

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Chapter 3Conclusions

• Related Literature and popular opinionThe
  related literature consulted confirms the
  popular and prevailing medical opinion that
  diabetes increases morbidity and mortality.
  However, the evidence weakens when physical
  fitness levels are considered.

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Conclusions, cont.

• Summary and RecommendationsAlthough the
  literature is rather unanimous with regard to the
  morbidity/mortality risks of diabetes, more study
  of the effects of fitness levels in diabetics
  should be undertaken.

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Summary and Recommendations, cont.

• Increase physical fitness through physical
  activity!

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References

• Bertoni, A., Brancat, F., Saydah, S. (2001).
  Diabetes and the risk of infection-related
  mortality in the U.S. Diabetes Care, 24,
  1049-1055.
• Gu, K., Cowie, C., Harris, M. (1998).
  Mortality in adults with and without diabetes in
  a national cohort of the U.S. population, 1971-
  1993. Diabetes Care. 21, 1138-1144.

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References, cont.

• Isomaa, B., Almgren, P. Tuomi, T., Forsen, B.
  (2001). Cardiovascular morbidity and mortality
  associated with the metabolic syndrome. Diabetes
  Care. 24, 683-691.
• Tierney, E., Geiss, L., Engelau, M., Thompson,
  T. (2001). Population-based estimates of
  mortality associated with diabetes Use of a
  death certificate check box in North Dakota.
  American Journal of Public Health. 91, 84-92.

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References, cont.

• Wei, M., Gaskill, S., Haffner, S., Stern, M.
  (1998). Effects of diabetes and level of
  glycemia on all-cause and cardiovascular
  mortality The San Antonio Heart Study. Diabetes
  Care. 21,1167-1172.
• Wei, M., Gibbons, L., Kampert, J., Nichaman, M.,
  Blair, S. (2000). Low cardiorespiratory
  fitness and physical inactivity as predictors of
  mortality in men with type 2 diabetes. Annals of
  Internal Medicine. 132, 605-611.

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References, cont.

• Wilmore, J., Costill, D., (1999)
• Physiology of Sport and Exercise.
• Champaign, IL Human Kinetics