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This Week’s Question #446 - Diabetes In Control.com Newsletter

A 48-year-old woman who has had type 2 diabetes for 6 years is seen for her

semiannual examination. She has long-term rheumatoid arthritis treated

successfully

with low-dosage prednisone (2.5 mg daily). Her blood glucose is well controlled

with rosiglitazone and metformin. She asks about effective weight-loss

strategies; her body mass index is 32. She consulted a dietitian and lost 1.8 kg

(4 lb) in the past 2 months; however, her hemoglobin A1C value slowly

increased and is now 7.2%, which she finds “frustrating.†She would

like to lose more weight quickly.

Which of the following changes, if any, should be made to this patient's

diabetes management plan to stabilize and then reduce the hemoglobin A1C value

and to facilitate weight loss?

A. Make no additional changes to the management plan

B. Initiate a resistance-training exercise plan

C. Increase the rosiglitazone dosage

D. Add a secretagogue

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Key Point

Painful neuropathy in patients with diabetes is treated with a stepwise approach

that includes use of antidepressants. Resistance or strength training can

improve glycemic control and reduce the requirement for diabetes medications;

this approach has little risk and increased benefit for patients with type

2 diabetes who have injury or are at risk for injury because of age, arthritis,

obesity, or other physical conditions.

Resistance training or strength training can improve glycemic control and reduce

the requirement for diabetes medications. This exercise method is safe

and effective and can be performed at home with a phone book, soup cans, or

liter bottles of water. Conditioning muscles in the legs, arms, and abdomen

benefit from lifting and repetitive motion performed in a graduated fashion.

Muscle-strengthening exercise benefits young and elderly patients and can

be implemented in patients at risk for injuries, including rheumatoid arthritis.

Many resources provide information about resistance training, including

books, local gyms, and community fitness programs.

This patient's initial weight loss while working with a dietitian was

significant, which indicates that she understood the concepts taught. She is now

asking

for a new strategy, which indicates a readiness to change. Making no change to

her management plan will not help her lose weight more quickly. Increasing

the dosage of rosiglitazone will likely result in weight gain caused by fluid

retention, which has been noted to be approximately 2 kg (4.4 lb) in most

people taking this drug. Adding a secretagogue may put this patient at risk for

hypoglycemia.

Bibliography

list of 5 items

1. American Diabetes Association. Position statement: standards of medical care

in diabetesâ€â€2006 [erratum in Diabetes Care 2006;29:1192]. Diabetes Care.

2006;29:S4-42. [PMID: 16373931] [

PubMed]

2. Boulé NG, Haddad E, Kenny GP, Wells GA, Sigal RJ. Effects of exercise on

glycemic control and body mass in type 2 diabetes mellitus: a meta-analysis

of controlled clinical trials. JAMA. 2001;286:1218-27. [PMID: 11559268] [

PubMed]

3. Castaneda C, Layne JE, Munoz-Orians L, Gordon PL, Walsmith J, Foldvari M, et

al. A randomized controlled trial of resistance exercise training to improve

glycemic control in older adults with type 2 diabetes. Diabetes Care.

2002;25:2335-41. [PMID: 12453982] [

PubMed]

4. Joslin Diabetes Center & Joslin Clinic. Clinical guidelines for

pharmacological management of type 2 diabetes: 9/7/06. Available at:

www.joslin.org/Files/Pharm_ClinGuide9706final.pdf

.. Accessed 3 October 2006.

5. Neporent L, Schlosberg S, Archer SJ. Weight Training for Dummies. 3rd edition

Hoboken, NJ: Wiley & Sons, Inc., 1996.

list end

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