1. DIABETES AND THE HEART/MUSCLE MASS DR STEFAN VAN NIEKERK MBCHB (STELL) CCFP (CANANDA) DIP SPORT MED (CASEM)

3. HISTORY OF DIABETES ▪ Since Antiquity diseases causing weakness, thirst and excessive urination were known ▪ Aristaeus of Cappadocia was the first to use the term DIABETES (Greek for Siphon) ▪ Avicenna observed (by tasting) the sweet urine and added the term Mellitus (meaning honey sweet) ▪ Since then our understanding has markedly increased with modern terms such as Type 1 and Type 2, gestational Diabetes etc. adding to our body of evidence

4. DIABETES HISTORY Urine taste wheel

5. DIABETES AND THE HEART ▪ Cardiovascular disease is the major cause for illness and death in Diabetics

6. EXPECTED PROGRESSION OF DIABETES IN DEVELOPING COUNTRIES ▪ Age standardised increase in IHD due to DM expected to increase by 27 % in African men by 2015 and 70 % by 2030 ▪ Increases of 24% by 2015 and 74% by 2030 in African females Deaths occur at a much younger Age in developing countries

7. DIABETES EFFECT ON CARDIOVASCULAR SYSTEM ▪ Diabetics have much higher rates of high blood pressure, elevated cholesterol, obesity and physical inactivity than age related peers ▪ Diabetics have much higher rates of Chronic Kidney disease and kidney failure requiring dialysis than peers ▪ Chronic kidney disease is a major contributor to disease profile of diabetics and increases the risk for other heart events twofold ▪ Damage to blood vessels occur at a younger age and to a greater extent in diabetics compared with their peers ▪ Effect of diabetes on the blood vessel can be explained through the effect on the cells lining of the blood vessel (endothelium)

8. DM

9. CVS COMPLICATIONS OF DM

10. DM AND NERVES

11. DIABETES AND BLOOD VESSELS

12. DIABETES AND ENDOTHELIUM

13. DIABETES AND ENDOTHELIAL DYSFUNCTION ▪ Endothelial dysfunction nearly uniformly present in diabetics ▪ Manifests itself in numerous blood vessel diseases ▪ Risk factor for atherosclerosis, peripheral artery disease, congestive heart failure,stroke and erectile dysfunction ▪ Limits the opening of blood vessels to supply exercising muscle ▪ Diabetics have poor exercise capacity, even when accounting for all other risk factors

14. DIABETES AND ISCHEMIC HEART DISEASE

15. ISCHEMIC HEAT DISEASE Diabetics develop coronary artery disease ▪ At a younger age ▪ More extensively ▪ With more complications Than age related peers Diabetics often present differently than non diabetics with acute events May not have pain with acute heart attack, may only feel tired, short of breath, nauseous or dizzy

16. IHD Newer investigations to earlier diagnose IHD in diabetics are being investigated

17. HEART FAILURE ▪ Diabetes is a major risk factor for the development of Heart Failure ▪ Diabetics with heart failure have a worse prognosis than non diabetics with a 5 year survival of 37 % ▪ Endothelial dysfunction nearly uniformly present in diabetics…

18. DIABETES AND CHRONIC KIDNEY DISEASE

19. THE GOOD NEWS ▪ Obesity is often cited as a risk factor for IHD – BUT ▪ Obese adults who exercise have better health outcomes than thin age related peers who are sedentary ▪ Diabetics have endothelial dysfunction BUT ▪ Exercise blunts the effects of endothelial dysfunction on the diabetic

20. GOOD NEWS ▪ Heart failure has a poor prognosis, especially in diabetics BUT ▪ Exercise improves mortality by 11% and hospitalization by 15% per year Exercise in diabetics improve all parameters of cardiovascular risk profile Exercise improves mental health and leads to an improvement in quality of life

21. GOOD NEWS ▪ Diabetics on dialysis who pedal and exercise bike while n dialysis have improved blood sugar, blood pressure control and fewer cardiovascular events than sedentary dialysis patients ▪ Even small improvements in functional capacity incurs major improvements in quality of life “Those who have no time for bodily exercise will sooner or later find time for illness” Earl of Derby 1873

22. MUSCLE LOSS Loss of muscle can have many causes: IHD Diabetes COPD Advanced age Cancer Endocrine disease Many other causes

23. DIABETIC MUSCLE

24. MUSCLE LOSS ▪ Many older Diabetics suffer from muscle loss ▪ For many this loss of muscle provides the basis for frailty ▪ So called “cardiac cachexia” is becoming a well known term ▪ Muscle loss is identified as a major risk factor for falls, decreased ability to perform Activities of Daily living and cognitive deterioration ▪ Muscle loss can be treated

25. MUSCLE LOSS ▪ Aerobic exercise training especially helpful in Diabetics with muscle loss and heart failure as well as peripheral vascular disease ▪ Resistance training improves physical fitness, improves function and decreases DEPENDENCE ▪ Results in improved Quality of the years lived End of presentation

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30. TWO CONTENT LAYOUT WITH TABLE ▪ First bullet point here ▪ Second bullet point here ▪ Third bullet point here Group 1Group 2 Class 18295 Class 27688 Class 38490

31. TWO CONTENT LAYOUT WITH SMARTART ▪ First bullet point here ▪ Second bullet point here ▪ Third bullet point here Step 3 Title Step 2 Title Step 1 Title