Treatment Goals in Type 2 Diabetes

In most cases of type 2 diabetes, cells in muscle, fat, and the liver become resistant to insulin. Insulin doesn't interact normally with these cells, so they don't take in enough sugar. Insufficient insulin is produced by the pancreas to control blood sugar levels. Diabetes mellitus patients need to have their symptoms eliminated and have complications prevented or at least slowed down. In type 2 diabetes mellitus, there is hyperglycemia as a consequence of insulin resistance, insufficient insulin secretion, and excessive or inappropriate glucagon release.

Type 2 Diabetes Mellitus
Introduction:
Type 2 diabetes is primarily the result of two interrelated problems: Cells in muscle, fat and the
liver become resistant to insulin. Because these cells don't interact in a normal way with insulin,
they don't take in enough sugar. The pancreas is unable to produce enough insulin to manage
blood sugar levels.
The goals in caring for patients with diabetes mellitus are to eliminate symptoms and to prevent,
or at least slow, the development of complications. Microvascular (i.e., eye and kidney disease)
risk reduction is accomplished through control of glycemia and blood pressure; macro vascular
(i.e., coronary, cerebrovascular, peripheral vascular) risk reduction, through control of lipids and
hypertension, smoking cessation, and aspirin therapy; and metabolic and neurologic risk
reduction, through control of glycemia.
Type 2 diabetes mellitus consists of an array of dysfunctions characterized by hyperglycemia and
resulting from the combination of resistance to insulin action, inadequate insulin secretion, and
excessive or inappropriate glucagon secretion.
Treatment goals in type 2 diabetes
The goal of treatment in type 2 diabetes is to achieve and maintain optimal BG, lipid, and blood
pressure (BP) levels to prevent or delay chronic complications of diabetes. Many people with type 2
diabetes can achieve BG control by following a nutritious meal plan and exercise program, losing
excess weight, implementing necessary self-care behaviors, and taking oral medications, although
others may need supplemental insulin. Diet and PA are central to the management and prevention of
type 2 diabetes because they help treat the associated glucose, lipid, BP control abnormalities, as
well as aid in weight loss and maintenance. When medications are used to control type 2 diabetes,
they should augment lifestyle improvements, not replace them.
Programme: Week 5:
Aerobic Exercises
Aim to get at least 30 minutes of cardio (aerobic) exercise most days of the week. If the thought of
finding 30 minutes too difficult, you can break up the exercise into shorter periods, say 10 minutes
here and there, aiming for a minimum of 30 minutes at the end of the day.
Aerobic exercises include:
 Tennis
 Dancing and Zumba
 Jogging/Running
 Walking
 Basketball
 Swimming
 Biking
Try to build up to 30 minutes gradually by adding a few minutes to each walk or exercise every
other week until you can manage 20-30 minutes at a time. But don't stop there—try to keep adding
a few minutes over time to reach 60, even 90 minutes, a day to keep building your duration and
fitness.

Also, stretch your creativity when it comes to fitting in exercise. Take a walk at lunch, or get the
whole family out after dinner for a game of basketball. Remember that walking your dog is a form
of exercise. Taking the stairs is exercise. Walking from your car and into the store is exercise—so
park farther away.
You need to find a way to exercise that you actually enjoy—because if it’s not fun, you won’t do
it. It’ll be harder to stay motivated, even if you know all the benefits of exercise. Consider taking
group classes at the gym, or find a friend to walk or run with. Having someone else exercising with
you does make it more fun and motivating.
Week 6:Strength Training
Once you have been able to include aerobic activity into your days, then you can start to add in
some resistance training.
Strength training helps you to achieve lean, efficient muscles. These resistance-type exercises,
adding to walking or jogging, also support strong, healthy bones. Building more muscle in place of
fat, is particularly beneficial when you have type 2 diabetes because muscles use the most glucose,
so the more you use your muscles, the more effective you can be at controlling your blood glucose
level.
Weight training is one of the most used strength building techniques, although you can also use
your own body weight to build up strength—think of pull-ups and planks.
When you’re starting a weight training program, make sure you know how to use all the
equipment. Ask the staff at your gym how you should properly use the weights, or consider getting
a personal trainer to learn the best exercises for you.
Lifting weights for 20-30 minutes two or three times a week is sufficient to get the full benefits of
strength training.
Week 7:
Flexibility Training
With flexibility training, you’ll improve how well your muscles and joints work. Stretching before
and after exercise (especially after exercise) reduces muscle soreness and actually relaxes your
muscles.
Week 8:
Create a Routine and Stick with It
Make a commitment to exercise; make it a priority. Your long-term health depends on it, so as
tough as it may be to find time or to motivate yourself to exercise, keep at it. It will help you lose
weight (if you need to do that), and it will make your body more efficient at using its insulin and
glucose.
Another 8-week training plan:
Rationale:
When you have type 2 diabetes, physical activity is an important component of your treatment plan.
It’s also important to have a healthy meal plan and maintain your blood glucose level through
medications or insulin, if necessary.
If you stay fit and active throughout your life, you’ll be able to better control your diabetes and keep
your blood glucose level in the correct range. Controlling your blood glucose level is essential to
preventing long-term complications, such as nerve pain and kidney disease.
Explanation of Reasoning:

Exercise has so many benefits, but the most critical one is that it makes it easier to control your
blood glucose (blood sugar) level. People with type 2 diabetes have too much glucose in their
blood, either because their body doesn’t produce enough insulin to process it, or because their body
doesn’t use insulin properly (insulin resistant).
In either case, exercise can reduce the glucose in your blood. Muscles can use glucose without
insulin when you’re exercising. In other words, it doesn’t matter if you’re insulin resistant or if you
don’t have enough insulin: when you exercise, your muscles get the glucose they need, and in turn,
your blood glucose level goes down.
If you’re insulin resistant, exercise actually makes your insulin more effective. That is—your
insulin resistance goes down when you exercise, and your cells can use the glucose more
effectively.
Exercise can also help people with type 2 diabetes avoid long-term complications, especially heart
problems. People with diabetes are likely to develop blocked arteries (heart disease), which can lead
to a heart attack or stroke. Exercise helps keep your heart healthy and strong. Plus, exercise helps
you maintain good cholesterol—and that helps you avoid high cholesterol and the buildup of plaque
that may block the blood from passing easily through your arteries.
Additionally, there are all the traditional benefits of exercise:
 Lower blood pressure
 Better control of weight
 Increased level of good cholesterol (HDL)
 Leaner, stronger muscles
 Stronger bones
 More energy
 Improved mood
 Better sleep
 Stress management
But Before You Begin Exercising…
When most people are diagnosed with type 2 diabetes, they are overweight, so the idea of
exercising is particularly daunting. For your health, you have to get started on a good, reasonable
exercise plan, but first...You should talk to your doctor.
Your doctor will be able to assess your heart health, which is particularly important if you already
have blocked arteries or high blood pressure. You also need to take into consideration any other
diabetes-related complications-retinopathy or neuropathy, for example. As you begin an exercise
program, your doctor can refer you to an exercise physiologist or diabetes educator to help you
figure out the best exercise program that allows you to get in shape for your fitness level.
Also before you begin exercising, you need to set realistic goals. If you haven’t exercised much
recently, you will want to start slow and gradually increase the amount and intensity of the activity.
Remember to stay hydrated by drinking water and always have a treatment for low blood glucose
handy (a 15 g carb snack is a good idea). It is smart to check your blood sugar with your glucose
meter before and after exercise to make sure you are in a safe range.

Being diagnosed with type 2 diabetes does change your life, but making small changes to your
routine can help you incorporate more physical activity into your day. You need to do what works
for your body and your lifestyle. See the suggestions below for what types of exercise to do.
Allow yourself some time to build up to a steady, challenging exercise routine. And be okay with
going slow—it’s better for your body in the long run.
Client Page:
Information sources
The following electronical databases will be searched: PubMed, EMBASE, PsycINFO, PSYNDEX,
Social Science Citation Index, and CINAHL. Grey literature will be searched in greylit and through
the homepages of the WHO and international, health care, or public health departments (e.g.,
Department of Health & Social Care, UK; Agency for Healthcare Research and Quality (AHRQ);
US Preventive Services Task Force). We will search manually for additional studies by cross-
checking the reference lists of all included studies.
Data management
The search results will be uploaded and managed using Microsoft Excel. A PRISMA flow diagram
will be used to summarize and visualize study selection.
Data extraction
A standardized extraction form will be developed for this review. The data extraction form will be
piloted on a sample of five articles by the reviewers involved in the scoping review and will be
assessed for completeness and applicability. Based on the pilot testing, any modifications to the
standardized data extraction form needed will be undertaken to ensure the data necessary to address
the research questions are obtained. The extraction form will contain general study characteristics
and communication strategies. We will also extract the diabetes type, which will allow us to
perform subgroup analyses in case the communication strategies differ between T2DM and GDM in
any way. If possible, we will try to categorize the identified communication strategies. Data will be
extracted by one reviewer and checked by another. Disagreements will be resolved through
discussion and consensus.
Data items
The preliminary data-extraction categories will be derived from our overarching research question.
The following data will be collected:
 Study characteristics (e.g., country, setting, publication date, number of participants, target
disease, study design/method)
 Patient’s characteristics (e.g., age, gender, affiliation to vulnerable group)
 Inclusion/exclusion criteria
 Communication strategies
 Implementation factors
Data synthesis
We will use Arksey and O’Malley’s methods [9] of reporting and provide a descriptive analysis of
the extent, nature, and distribution of the studies included in the review as well as a narrative,
thematic summary of the data collected. This will be achieved by summarizing the literature
according to the types of vulnerable groups, communication strategies, comparators,

implementation factors and outcomes identified. We aim to map the research landscape in this area.
This will be facilitated by some form of visual representation of the data to map the extent, range,
and nature of research in this area. Data will be charted, categorized, and summarized. We will
report quantitative (e.g., frequency) and qualitative results. Furthermore, we will seek to explore
similarities and differences, both within and between studies, to identify patterns and themes and to
postulate explanations for findings. By doing so, we will also consider the robustness of the
included studies themselves by reporting on the overall strength of and confidence in the findings. If
possible, we will stratify our results by vulnerable groups.
Discussion:
The main aim of this review is to identify and describe communication strategies for the prevention
of T2DM/GDM in vulnerable groups. The results will be used to inform the “National education
and communication strategy on diabetes mellitus in UK”. In particular, the results will be discussed
in focus groups of experts to develop recommendations for communication strategies targeting
vulnerable groups.