diabetes

Diabetes and personal trainers

By Dr. Ferdinando Spatalino

The term diabetes mellitus describes a metabolic disorder of multiple etiology, characterized by chronic hyperglycemia with alteration of carbohydrate, fat and protein metabolism, caused by defects in insulin secretion or insulin action, or both.

In common parlance we distinguish two main forms of diabetes mellitus, called type 1 or insulin-dependent diabetes and adult-onset diabetes with insulin resistance or type 2 respectively.

Type 1 diabetes is autoimmune on a genetic basis; it affects young subjects up to 35 years of age and is determined by the destruction of pancreatic beta-cells resulting in absolute insulin deficiency.

Type 2 diabetes, on the other hand, affects subjects over the age of 35 and at its origin there is a phenomenon called insulin resistance, a condition in which the ability of insulin to stimulate uptake and utilization of glucose is compromised. of liver, skeletal muscle and adipose tissue, and to suppress hepatic glucose output. Type 2 diabetes may have been present for a long time before the patient or doctor notes the signs, as the hyperglycemia and the corresponding symptoms progress slowly. Among the young population is increasing - probably due to the change in eating habits and the increasingly sedentary lifestyle - another type of diabetes, the MODY (Maturity Onset Diabetes of the Young), a type 2 diabetes with early onset .

Epidemiology

Diabetes is the most widespread and important metabolic disease present in Italy and in the western world; it is estimated that the number of diabetics in Italy is around 3 million, to which must be added at least another 2 million cases not yet diagnosed. Against a prevalence of 3-5% of known cases, approximately 50% of cases of diabetes mellitus are in fact not yet diagnosed. Approximately 200, 000 new cases occur each year, of which around 15, 000 are type 1 and 185, 000 are type 2.

In Western countries, type 2 diabetes has a prevalence that fluctuates around 5% and an incidence of 23 new cases per 10, 000 per year. These numbers still tend to increase according to what is reported in the annual estimates of the International Diabetes Federation (IDF) and shown in the following table.

General economic impact and future prospects

The social impact of the diabetic disease is of this magnitude, and the number of patients is so high that in many countries of the world health spending for this disease has reached 10% of global health expenditure.

In the United States the costs have risen from 2.6 billion dollars spent in 1969 to 98.2 in 1997, with a peak of 137.7 billion dollars in 1995. As far as Europe is concerned, the most important study is the Code-2 (Costs of Diabetes in Europe - type 2) born with the aim of estimating the costs of managing patients with diabetes in eight European countries (Belgium, France, Germany, Great Britain, Italy, Holland, Spain and Sweden) type 2. The American situation and the data reported by the Code-2 study for Europe are summarized in the graph in table 2. However, it should be kept in mind that these studies do not take into account the total value of the resources used for the treatment of complications, which far exceeds that of diabetes treatment resources. The average annual costs of the diabetic patient, respectively without complications (about 1100 euros), with only one type of complications (macrovascular: 3120 euros; microvascular: 4100 euros) and with both types of complications (5650 euros), were found clearly depending on the complications themselves.

The figures show that it is extremely important to support an increasingly widespread prevention campaign, in order to limit the growth of the disease: from studies carried out it appears that minimal interventions on lifestyle habits - such as physical activity, the adoption of a balanced diet and periodic control of blood pressure and blood glucose levels - are able to delay the appearance of type 2 diabetes in at least 58% of those at risk.

Physical activity is therefore fundamental to keep the problem under control, improving the quality of life by about 50% and minimizing the risks that these imbalances cause to our physiological systems. Becoming specialized in this sector by personal trainers therefore becomes an obligation, given that the hypothetical customers to whom we all refer are identified according to the target of "Mrs. Maria", that is the ordinary person whose goal is the improvement of her state of health through fitness. The adjective "any" should not be understood in derogatory terms; rather, it refers to the possibility that our client is the bearer of various metabolic alterations, such as diabetes.

How does the personal trainer relate to the problem and how do you set up the training plan? First of all, you need to have all the information regarding the case and, more importantly, have the problem clear from a physiological point of view; we must know that training a diabetic person involves changes in the action of insulin, that the time and intensity of training are not negligible factors, that as there is a difference between type 1 diabetes and type 2 diabetes, there is also a different training approach etc.

In this regard we refer to the reading of the following informative articles:

Physical activity and diabetes

Diabetes and exercise

Diabetes and circuit training

Obesity and personal trainer ยป