I hope this newsletter finds you and your family well. Spring is here (theoretically) and I am sure hoping we can get a few more nice days soon. It will be good to get back outside on the bike and my patients will be more likely to get out and exercise.  

This month I am focusing the newsletter on diabetes. This disease affects more than 29 million Americans and 1 in 4 doesn't know that they have it. Another 86 million adults (1 in 3) have prediabetes. Many of these people will go on to develop diabetes in the future. People with diabetes are at increased risk of serious health complications including vision loss, heart disease, stroke, kidney failure, amputation of toes, feet or legs, and premature death. In 2012, diabetes and its related complications accounted for $245 billion in total medical costs and lost work and wages. This figure is up from $174 billion in 2007. The good thing is that most cases of type 2 (adult-onset) diabetes can be prevented through lifestyle. Previous newsletters have discussed dietary changes that can be beneficial. The articles this month will focus on other lifestyle ways to prevent this disease. 

Almost everyone will have trouble sleeping at times. But are there long-term effects to sleep deprivation? The second article shows that even losing 30 minutes of sleep per night during the week can increase your risk of developing diabetes.  

Finally, we have belly fat. No one wants it. Those who have it are at higher risk of diabetes (as well as heart disease, liver disease and hypertension). What type of exercise helps us to lose belly fat. The answer may surprise you.   

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Antibiotics increase risk of diabetes 

 

Over the past several years, physicians have been trying to get people to take fewer unnecessary antibiotics. Research has shown that most bronchitis, sinusitis and sore throats are due to viruses and that giving antibiotics for these conditions doesn't help. This article, from the University of Pennsylvania and published in the European Journal of Endocrinology, show the results of giving antibiotics for these conditions is not only higher risk of drug resistance bacteria such as MRSA, but may be putting people at a higher risk of diabetes in the future.    

Summary of findings:

• Objective:

  • Gut microbiota influence metabolic pathways relevant to the pathogenesis of obesity, insulin-resistance and diabetes. 

  • Antibiotic therapy can alter the microbiota and is commonly used in western countries. 

  • We sought to evaluate whether past antibiotic exposure increases diabetes risk.

• Research design and methods:
• We conducted a nested case-control study using a large population-based database from the United Kingdom (UK). 
• Cases were defined as those with incident diagnosis of diabetes. 
• For every case, 4 eligible controls matched on age, sex, practice-site, and duration of follow-up before index-date were selected using incidence-density sampling.
• Exposure of interest was antibiotic therapy >1 year before index-date. Odds ratios (ORs) and 95% confidence intervals (CIs) were estimated using conditional logistic regression. 
• The risk was adjusted for body mass index (BMI), smoking, last glucose level and number of infections before index-date, as well as past medical history of coronary artery disease and hyperlipidemia.
• Results: 
• The study included 208,002 diabetic cases and 815,576 matched controls. 
• Exposure to a single antibiotic prescription was not associated with higher adjusted diabetes risk. 
• Treatment with 2-5 antibiotic courses was associated with increase in diabetic risk for penicillin, cephalosporins, macrolides and quinolones with adjusted OR ranging from 1.08 (95%CI 1.05-1.11) for penicillin to 1.15 (95%CI 1.08-1.23) for quinolones. 
• The risk increased with the number of antibiotic courses and reached 1.37 (95%CI 1.19-1.58) for >5 courses of quinolones. 
• There was no association between exposure to anti-virals and anti-fungals and diabetes risk.

Conclusions: Exposure to certain antibiotic groups increases diabetes risk.            

Any exercise = belly fat loss

Summary of findings:  

• Background: Exercise reduces obesity and related glucose tolerance, but whether increasing exercise intensity offers additional benefit at fixed exercise amounts is unknown.

• Objective: To determine the separate effects of exercise amount and intensity on abdominal obesity and glucose tolerance.

• Design: 24-week, single-center, parallel-group trial from 2009 to 2013. (ClinicalTrials.gov: NCT00955071)

• Setting: Kingston, Ontario, Canada.

• Participants: 300 abdominally obese adults.

• Intervention:

• Control (no exercise) (n = 75) or 5 weekly sessions of low-amount, low-intensity exercise (LALI) (180 and 300 kcal/session for women and men, respectively, at 50% of maximum oxygen consumption [V̇o2peak]) (n = 73);

• high-amount, low-intensity exercise (HALI) (360 and 600 kcal/session, respectively, at 50% of V̇o2peak) (n = 76); or

• high-amount, high-intensity exercise (HAHI) (360 and 600 kcal/session, respectively, at 75% of V̇o2peak) (n = 76).

• Daily unsupervised physical activity and sedentary time were measured by accelerometer.

• Measurements: Waist circumference and 2-hour glucose level (primary outcomes) and cardiorespiratory fitness and measures of insulin action (secondary measurements).

• Results: 217 participants (72.3%) completed the intervention.

• Mean exercise time in minutes per session was 31 (SD, 4.4) for LALI, 58 (SD, 7.6) for HALI, and 40 (SD, 6.2) for HAHI.

• Daily unsupervised physical activity and sedentary time did not change in any exercise group versus control (P > 0.33).

• After adjustment for age and sex in a linear mixed model, reductions in waist circumference were greater in the LALI (−3.9 cm [95% CI, −5.6 to −2.3 cm]; P < 0.001), HALI (−4.6 cm [CI, −6.2 to −3.0 cm]; P < 0.001), and HAHI (−4.6 cm [CI, −6.3 to −2.9 cm]; P < 0.001) groups than the control group but did not differ among the exercise groups (P > 0.43).

• After adjustment for covariates, reductions in 2-hour glucose level were greater in the HAHI group (−0.7 mmol/L [−12.5 mg/dL] [CI, −1.3 to −0.1 mmol/L {−23.5 to −1.5 mg/dL}]; P = 0.027) than the control group but did not differ for the LALI or HALI group versus the control group (P > 0.159).

• Weight loss was greater in all exercise groups than the control group (P < 0.001); however, reduction in body weight did not differ among the exercise groups (P > 0.182).

• Limitation: The clinical importance of reducing 2-hour glucose level in nondiabetic adults remains undetermined.

• Conclusion: Fixed amounts of exercise independent of exercise intensity resulted in similar reductions in abdominal obesity. Reduction in 2-hour glucose level was restricted to high-intensity exercise.