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Exercise and feet

Many people around the world live with diabetes, and the number is on the rise. One complication related to diabetes, diabetic peripheral neuropathy, can cause individuals to develop foot ulcers and, in extreme cases, amputation might be necessary. Previously, doctors and scientists have recommended that individuals with this complication stay off their feet. Now, a University of Missouri researcher has concluded that individuals with diabetic peripheral neuropathy be able to engage in a graduated walking program under close supervision of a medical professional and thus prevent other life threatening illnesses.

Diabetic peripheral neuropathy is a nerve disorder that mostly affects the legs and feet by causing ulcerations, pain, tingling or even total loss of feeling. Ulcers might occur due to loss of muscle, which would expose the bones to greater pressure under the foot, or to loss of feeling in the foot.

"Physical activity is recommended for people with diabetes because it is proven to reduce the risk of mortality and development of cardiovascular disease," said Joseph LeMaster, an associate professor of family and community medicine at the University of Missouri. "Individuals with type 2 diabetes can increase their risk of cardiovascular disease by 34 percent and their risk of mortality by 39 percent if they do not participate regularly in some type of moderately intense exercise. People who have diabetes are already less active than most of the population and those with diabetic peripheral neuropathy tend to be even less active."

In the MU study, LeMaster examined the effects of lower-extremity exercise and walking intervention programs on foot ulcer occurrence in people with diabetic peripheral neuropathy. Participants with diabetic neuropathy were assigned to one of two groups: an intervention group, which was frequently monitored and assisted through leg strengthening exercises, a graduated walking program and motivational telephone calls every two weeks, and a control group. Both groups received diabetic and regular foot care education and eight sessions with a physical therapist.

During the first six months, LeMaster noted an increase in the total number of minor foot lesions and ulcers. However, at the end of the year, the number of lesions and ulcers in the intervention group had started to decrease compared to the control group, indicating a reduced risk.

"Because weight-bearing activity did not lead to a significant increase in foot ulcers, our study suggests that weight-bearing exercise might be appropriate for people with neuropathy if the patient currently has no foot ulcers, wears proper footwear, and is in a walking program that is well-supervised and safely monitored by a medical professional," LeMaster said.
 

 

Bariatric surgery improves co-morbidities

Patients who undergo bariatric surgery (weight loss surgery) lose more than just weight. Recent research finds they also see their diabetes, hyperlipidemia, hypertension, and obstructive sleep apnea either go away, or improve significantly. It appears that the surgery alters the body's chemistry, resulting in improvements in these metabolic conditions, and other obesity-related consequences. In the case of diabetes, for example, the rearrangement of the intestinal tract has an immediate positive impact on the disease even before the patient begins to shed large amounts of weight. This may be due to alterations in intestinal hormones after the operation.

The findings come from an elaborate systematic review and meta-analysis of the bariatric surgery literature. A total of 2738 English-language citations published between 1900 and 2003 were screened. All told, these represented 22,094 patients undergoing some sort of bariatric surgery. At least two-thirds were women.

Overall, the mean percentage of excess weight loss was 61.2% for all procedures. Mortality was lowest for restrictive procedures (0.1%) such as gastric banding. Gastric bypass produced a 61.6% of excess weight loss, and a mortality rate of only 0.5%. (JAMA, 2004:292:1724-37)

 

MEDICINE IN THE NEWS
New gene mutation shown to be linked to appearance of type 1 diabetes and thyroid disorders
Alterations to a key gene that helps regulate the immune system can increase a person's risk of getting early-onset diabetes or having thyroid problems, British researchers say.
Insulin resistance may influence heart disease in type 1 diabetes
Blood sugar control might have little influence over the development of heart disease in type 1 diabetics, a new study says.
Instead, researchers say insulin resistance -- the hallmark of type 2 diabetes -- is a better indicator of who's going to get heart disease among type 1 diabetics

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Stem cell research is gathering pace and fueling hopes. But the search for a cure for diabetes may still take several years. The area is fraught with controversy, and hotly debated.

Thyroid autoimmunity is a risk factor for miscarriage

An association between serum anti-TPO and antithyroglobulin antibody concentrations and an increased risk of spontaneous miscarriage was recognized 15 years ago. This association was independent of thyroid hormone status. The results of subsequent studies of women in the US, Europe and Asia were similar; on average, the risk was increased 2- to 3-fold, but was sometimes higher. High serum antithyroid antibodies have also been associated with recurrent miscarriage, defined as three or more spontaneous pregnancy losses.

Are low-carb diets for real?   If you are interested in losing weight, chances are you’ve heard about low-carb diets. Low-carb (or low carbohydrate) diets are all the rage these days. Housewives and young professionals have heard about it, tried it, and passed on the message. The food industry has jumped onto the bandwagon by putting out new lines of low-carb foods. Advertising is working overtime to sell the idea. Well, low-carb diets are in the hot seat, reported the US press recently.

The insulin pump - is it for me? Switching to the insulin pump brings flexibility and freedom, but you must be prepared to work at it.

 

 

 

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