Effects of Tai Chi in diabetes patients: Insights from recent research.

Tai Chi, a practice that combines elements of both exercise and mindfulness, offers a wide range of health benefits. The body of evidence concerning the impact of Tai Chi on diabetes has recently been growing. This editorial aims to provide a concise summary of the current state of evidence for Tai Chi's effects on individuals with type 2 diabetes (T2D). The review includes 3 randomized controlled trials (RCTs) and 5 systematic reviews and meta-analyses, all of which investigate the effectiveness of Tai Chi on various health outcomes in individuals with T2D. Tai Chi demonstrates a significant effect to enhance glycemic control, lower blood pressure, improve serum lipid profiles, reduce insulin resistance, positively influence obesity-related indices, and improve overall quality of life in individuals with T2D. However, it is noteworthy that recent RCTs have reported inconsistent findings regarding the effects of Tai Chi on glycemic control and insulin resistance. The author also delves into potential mechanisms by which Tai Chi may exert its influence on the human body. Finally, the editorial highlights the critical issues that warrant further exploration in the future.

The Effect of Exercise on Cardiovascular Autonomic Nervous Function in Patients with Diabetes: A Systematic Review.

BACKGROUND: Diabetic neuropathy, including autonomic neuropathy, is a severe complication in patients with poorly controlled diabetes. Specifically, cardiovascular autonomic neuropathy (CAN) plays a significant prognostic role in cardiovascular morbidity and mortality. Exercise, an essential component of diabetes treatment, may have a therapeutic effect on patients with diabetes complicated by CAN. However, it remains unclear whether exercise has a therapeutic or protective effect in diabetes patients with CAN. METHODS: The author conducted a systematic search of PubMed/MEDLINE, Embase, and The Cochrane Library, resulting in the identification of eight eligible randomized controlled trials for this review. RESULTS: Exercise, including aerobic exercise combined with resistance training (RT), high-intensity interval training, and progressive RT, has shown a beneficial effect on cardiac autonomic function (CAF) in patients with type 2 diabetes, as measured by heart rate variability, heart rate recovery, and baroreflex sensitivity. However, most studies had low quality. Moreover, there were no relevant studies examining the effect of exercise on CAF in older patients, patients with poorly controlled diabetes, and patients with type 1 diabetes. CONCLUSIONS: Exercise has the potential to manage patients with CAN by balancing sympathetic and parasympathetic nervous system functions; however, further studies are warranted in the future.

The Effects of Mindfulness on Glycemic Control in People with Diabetes: An Overview of Systematic Reviews and Meta-Analyses.

Background: Previous research has demonstrated the effectiveness of mindfulness interventions in improving glycemic control. By enhancing attention control, emotion regulation, and self-awareness, mindfulness shows promise in managing the lifestyle factors associated with cardiovascular disease risk. However, the impact of mindfulness on glycemic control in people with diabetes remains unclear. This overview aims to summarize the current evidence of the impact of mindfulness interventions on glycemic control in people with diabetes and propose suggestions for future research. Methods: The author searched electronic databases (PubMed/MEDLINE, Embase, and Cochrane Library) to identify relevant systematic reviews and meta-analyses. The current evidence regarding the effects of mindfulness on glycemic control in people with diabetes was summarized. Results: This review evaluated a total of five systematic reviews and meta-analyses of randomized controlled trials (RCTs). Mindfulness interventions show potential for improving glycemic control as measured by hemoglobin A1c (HbA1c) levels, as well as reducing stress, depression, and anxiety in people with diabetes. Four out of five systematic reviews and meta-analyses reported a significant reduction in HbA1c levels by approximately 0.3%. However, the available studies lacked adequate description of key characteristics of study subjects, such as body mass index, medication, and disease conditions, which are essential for assessing the impact of mindfulness on glycemic control. Moreover, there was significant heterogeneity in the intervention methods employed across the included RCTs. Conclusions: Mindfulness interventions are effective in improving glycemic control in people with type 2 diabetes. However, the overall quality of the reviewed studies raises uncertainty regarding the effectiveness of mindfulness as a treatment for people with diabetes. Further research is necessary to elucidate the biological effects of mindfulness on physiological, neurological, and endocrinological functions in humans.

Association of the use of psychotropic drugs with hospitalization, cardiovascular events, and mortality in patients with type 2 diabetes: a propensity score-matched cohort study.

Background: Use of psychotropic drugs (PD) may be associated with impairment of physical function. However, few studies have assessed the impact of PD on health outcomes in patients with type 2 diabetes. This study aimed to examine the associations between psychotropic drug use and handgrip strength (HGS) and between the use of PD and hospitalization in patients with type 2 diabetes. Methods: From April 2013 to December 2015, we conducted a retrospective cohort study in patients with type 2 diabetes at the National Center for Global Health and Medicine Kohnodai Hospital. Patients aged 20 years and over who can measure HGS were included. All participants received nutritional guidance regarding diet therapy for type 2 diabetes at baseline. Nonpsychotropic drug users were matched one-to-one with the PD users using propensity score matching method with respect to their baseline covariates. The differences in HGS and the number of patients who had hospitalizations during the study period were examined. By Cox proportional hazard regression analysis, the association between the use of PD and repeated hospitalizations was estimated. Results: A total of 1,282 patients were enrolled and followed up for 2.36 ± 0.73 years. In the propensity score matching cohort, HGS was significantly lower (p = 0.006) in PD users than non-PD users. PD users had more hospitalizations than non-PD users. Cox proportional hazard regression analysis confirmed the association of repeated hospitalizations with the use of PD (hazard ratio = 2.138; 95% confidence interval, 1.144-3.995, p = 0.017)). In addition, HGS was significantly and inversely correlated with the number of hospitalizations (r = -0.143, p = 0.013). Conclusions: The use of PD could increase the risk of repeated hospitalizations. Skeletal muscle may play a role in reducing the risk of hospitalization in patients who are treated with PD.

Periodic health checkups reduce the risk of hospitalization in patients with type 2 diabetes.

Introduction: Periodic health checkups (PHCs) represent a unique system in Japan that is useful for the early detection of lifestyle-related diseases and cardiovascular diseases (CVDs). This study aims to investigate the association of PHCs with the hospitalization risk of patients with type 2 diabetes mellitus (T2DM). Methods: A retrospective cohort study was conducted from April 2013 to December 2015 and included participant information such as CVD history, lifestyle, and whether PHC was conducted in addition to regular medical examinations. Difference in clinical data between patients with and without PHC was examined. Furthermore, Cox regression analysis was performed to investigate the independent association of PHCs with hospitalization. Results: Herein, 1,256 patients were selected and followed up for 2.35 ± 0.73 years. In the PHC group, body mass index, waist circumference, proportion of patients with a history of CVD, and number of hospitalizations were lower than those in the non-PHC group. Furthermore, the PHC group exhibited a significant association with lower hospitalization risk (hazard ratio = 0.825; 95% confidence interval, 0.684 to 0.997; p = 0.046) in the Cox model. Conclusion: This study revealed that PHCs minimized the risk of hospitalization in patients with T2DM. Furthermore, we discussed the effectiveness of PHCs in enhancing health outcomes and reducing health care costs in such patients.

Handgrip strength is inversely associated with augmentation index in patients with type 2 diabetes.

Handgrip strength (HGS) is a measure of overall skeletal muscle strength and is used to identify risks for cardiovascular disease and mortality. Furthermore, HGS is an indicator of arterial stiffness that leads to atherosclerotic cardiovascular disease. This study aimed to examine the relationship between HGS and augmentation index (AIx) in patients with type 2 diabetes. A cross-sectional study was conducted to examine patients with type 2 diabetes whose HGS and AIx were measured in our hospital. AIx was measured noninvasively using an applanation tonometer, and multiple regression analyses were conducted to assess the independent relationship between HGS and AIx. This study included 404 patients. After adjusting for age, gender, body mass index, duration of diabetes, smoking and exercise habit, biochemical parameters, and physiological parameters related to arterial stiffness, HGS was found to be independently and inversely associated with AIx (ß = - 0.270, p = 0.006). HGS was independently and inversely associated with AIx in patients with type 2 diabetes. Patients with diminished HGS should be subjected to intensive exercise therapy for reducing the risk of arterial stiffness and cardiovascular disease.Trial registration: UMIN000023010.

Effects of Exercise on Circulating Muscle-related Cytokines in Adults with Type 2 Diabetes and/or Obesity.

BACKGROUND: Skeletal muscle is an endocrine organ that plays an important role in metabolic health by secreting a variety of myokines. Recent studies have shown that exercise significantly decreases interleukin-6 (IL-6) and tumor necrosis factor-α (TNF-α) in patients with type 2 diabetes (T2D). This paper explores the effect of chronic exercise on myokines in patients with T2D and/or obesity. METHODS: The author searched for relevant English-language articles in PubMed. A total of 14 randomized controlled studies were found to be eligible for this short review. RESULTS: It has been observed that chronic exercise does not change brain-derived neurotrophic factor (BDNF), irisin, and secreted protein acidic and rich in cysteine levels, whereas it decreases TNF-α levels in patients with T2D. Combined aerobic exercise (AE) and resistance training (RT) or sprint interval training increase insulin-like growth factor 1 (IGF-1) levels and decrease IL-6 and IL-15 levels in patients with T2D. Combined AE and RT may also increase IL-15 levels in obese individuals. In addition, RT alone may increase BDNF, IGF-1, and IL-7 levels in overweight individuals. However, AE alone does not change circulating myokine levels in patients with T2D, while it may increase myonectin levels in obese individuals. CONCLUSION: This short review demonstrated that exercise appears to have favorable effects on some myokines in patients with T2D and/or obesity. However, it remains inconclusive due to the heterogeneity in subject characteristics and exercise modalities.

Comparison of severe hyponatremia in patients with and without psychiatric diseases: A single-center retrospective study.

Aims: Hyponatremia is a common electrolyte disorder. The severe hyponatremia has a mortality rate of 4%-40%. Psychiatric patients are likely to develop the condition because of polydipsia or the adverse effects of antipsychotics. We investigated the characteristics of patients with and without psychiatric diseases who developed severe hyponatremia. Materials and Methods: We retrospectively investigated cases admitted to our hospital (all departments) between October 2012 and November 2015 with a serum sodium concentration of ≤125 mmol/l on admission. We compared patient characteristics, etiology, and clinical course between psychiatric and nonpsychiatric patients. Results: In total, 123 cases (62 female) were analyzed. Psychiatric disorders were present in 69 cases (56%), including schizophrenia (n = 19), anorexia (n = 16), mood disorders (n = 14), and organic mental disorders (n = 9). The mean patient age was 63 years. The mean serum sodium concentration on admission was 119 mmol/l, and the main causes of hyponatremia were polydipsia (20%), insufficient sodium intake (18%), and syndrome of inappropriate antidiuretic hormone secretion (16%). Compared with the nonpsychiatric group, the psychiatric group was significantly younger (55 vs. 74 years), was more likely to have polydipsia (30% vs. 6%), and had a lower in-hospital mortality (0% vs. 17%). Conclusions: Our study found differences in the clinical picture between psychiatric and nonpsychiatric patients with severe hyponatremia. Clinicians need to monitor serum sodium because the symptoms of hyponatremia can mimic those of psychiatric diseases.

Patient Satisfaction with Telemedicine in Adults with Diabetes: A Systematic Review.

Patient satisfaction assessment is essential for improving the quality of healthcare. Diabetes management using telemedicine technology is promising in the 21st century. However, the number of randomised controlled trials (RCTs) examining the effect of telemedicine on satisfaction in patients with diabetes is limited. This systematic review aimed to summarise the current evidence on patient satisfaction with telemedicine in adults with diabetes and discuss related issues and future directions of telemedicine in patients with diabetes. The author systematically searched PubMed/MEDLINE, Embase and The Cochrane Library, and a total of six RCTs were eligible for this review. Patient satisfaction with telemedicine was as high as conventional face-to-face care; however, telemedicine appeared not to significantly increase patient satisfaction compared with conventional face-to-face care in the included studies. Significant heterogeneity was noted between the studies, including participants' age, study duration, the method of assessing patient satisfaction and types of telemedicine. Further studies are required to provide firm evidence to healthcare providers who are willing to use telemedicine in diabetes management. Telemedicine technology has been advancing and is a key tool in providing high-quality healthcare to patients with diabetes in the 21st century.

What can hand grip strength tell us about type 2 diabetes?: mortality, morbidities and risk of diabetes.

INTRODUCTION: Hand grip strength (HGS) has been determined as a simple and cost effective method for evaluating overall skeletal muscle strength and quality. It has been used in numerous clinical studies to examine the association between skeletal muscle and type 2 diabetes (T2D). Previous studies have shown that HGS is significantly associated with mortality and cardiovascular disease (CVD) in patients with T2D. As the prevalence of T2D has seen a steady increase globally, HGS measurement can be useful and essential in managing T2D. AREAS COVERED: This narrative review summarizes the current evidence regarding the association between HGS and T2D. HGS has been considered a useful tool for identifying risks for T2D, CVD, and mortality and evaluating skeletal muscle strength and quality. OPINION: HGS should be measured in all patients with T2D together with height, weight, and waist circumference. However, there is yet no standard method used in measuring for HGS. T2D patients with a low HGS can engage in resistance training more effectively with appropriate advice based on HGS. Future studies clarifying the genetic association between skeletal muscle and T2D are needed to provide individualized exercise therapy.

Association of Glucagon With Obesity, Glycemic Control and Renal Function in Adults With Type 2 Diabetes Mellitus.

OBJECTIVES: In this study, we used a double-antibody sandwich enzyme-linked immunosorbent assay to assess the association between blood glucagon levels and indices of obesity, glycemic control and renal function in patients with type 2 diabetes mellitus (T2DM). METHODS: This investigation was a cross-sectional study on inpatients with T2DM who had plasma glucagon levels measured during hospitalization. Associations of fasting glucagon levels (G0), 120-minute postbreakfast plasma glucagon (G120), fasting glucagon/C-peptide ratio (G0/CPR0) and postbreakfast glucagon/C-peptide ratio (G120/CPR120) with clinical data were evaluated using multiple regression analysis. RESULTS: A total of 345 patients were enrolled in the study. G0, and G120 were significantly and positively associated with serum C-peptide levels. Moreover, G0 and G120 were positively associated with waist circumference, and G0 was negatively associated with duration of diabetes mellitus. Interestingly, both G0 and G120 were negatively associated with the estimated glomerular filtration rate. In addition, G120/CPR120 was positively associated with duration of diabetes mellitus and glycoalbumin levels. CONCLUSIONS: The balance between glucagon and insulin secretion is significantly associated with abdominal obesity and important for maintaining glucose homeostasis. Postprandial hyperglucagonemia could also be related to deterioration of renal function.

Effects of Diaphragmatic Breathing on Health: A Narrative Review.

Background: Breathing is an essential part of life. Diaphragmatic breathing (DB) is slow and deep breathing that affects the brain and the cardiovascular, respiratory, and gastrointestinal systems through the modulation of autonomic nervous functions. However, the effects of DB on human health need to be further investigated. Methods: The author conducted a PubMed search regarding the current evidence of the effect of DB on health. Results: This review consists of a total of 10 systematic reviews and 15 randomized controlled trials (RCTs). DB appears to be effective for improving the exercise capacity and respiratory function in patients with chronic obstructive pulmonary disease (COPD). Although the effect of DB on the quality of life (QoL) of patients with asthma needs to be investigated, it may also help in reducing stress; treating eating disorders, chronic functional constipation, hypertension, migraine, and anxiety; and improving the QoL of patients with cancer and gastroesophageal reflux disease (GERD) and the cardiorespiratory fitness of patients with heart failure. Conclusions: Based on this narrative review, the exact usefulness of DB in clinical practice is unclear due to the poor quality of studies. However, it may be a feasible and practical treatment method for various disorders.

Validity of Visceral Fat Area Measurement by Bioelectrical Impedance Analysis in Japanese Obese Individuals.

INTRODUCTION: Obesity management is a critical global issue. It is essential to evaluate visceral adiposity which is associated with metabolic syndrome and cardiovascular disease. AIM: This study aims at precisely evaluating the necessity of visceral adipose tissue in obesity management. METHODS: We assessed the validity of visceral fat area (VFA) measurement using bioelectrical impedance analysis (BIA) with computed tomography (CT) as a reference in obese subjects. Although VFABIA exhibited significant correlation with VFACT, the difference between VFACT and VFABIA increased with an advancing degree of obesity. RESULT AND CONCLUSION: The BIA device seemingly underestimated VFA in obese subjects compared with the normal-weight subjects.

Perspectives on Interval Exercise Interventions for Non-Alcoholic Fatty Liver Disease.

Non-alcoholic fatty liver disease (NAFLD) is the most common chronic liver disease and is associated with an increased risk of type 2 diabetes, cardiovascular disease, cirrhosis, and liver cancer. Exercise therapy is the most effective treatment for patients with NAFLD. High-intensity interval training (HIIT) is attracting attention as a time-efficient and an effective exercise modality for treating patients with NAFLD. Previous studies have shown that HIIT can reduce fat mass, visceral adipose tissue, and intrahepatic lipid levels and improve hepatic stiffness. HIIT may be an optimal exercise therapy to improve NAFLD in patients with a lack of time.

Risk factors for patients with diabetes who have abnormal toe-brachial index and normal ankle-brachial index.

AIM: To investigate the association of ankle-brachial index (ABI) and toe-brachial index (TBI) with metabolic parameters and the risk factors causing a divergence between ABI and TBI in patients with diabetes. METHODS: Outpatients who were simultaneously examined for both ABI and TBI were included. Multiple regression analysis was performed to assess the association of ABI and TBI with metabolic parameters. Furthermore, logistic regression analysis was performed to detect the risk factors causing a divergence between ABI and TBI. RESULTS: Of the 307 patients that were enrolled, 77 had normal ABI but decreased TBI. ABI was inversely associated with plasma glucose and triglycerides and positively associated with high-density lipoprotein cholesterol. In contrast, TBI was inversely associated with the duration of diabetes, plasma glucose and haemoglobin A1c. Logistic regression analysis showed that smoking history and a history of cardiovascular disease were associated with an increased risk of the divergence between ABI and TBI. CONCLUSION: Our findings suggest that smoking history and a history of cardiovascular disease are important risk factors in patients with diabetes who had normal ABI but decreased TBI. Patients with multiple vascular complications are at a high risk of coexisting peripheral artery disease, even if their ABI is normal.

Effects of glucose-lowering agents on cardiorespiratory fitness.

Exercise therapy is essential for the management of type 2 diabetes (T2D). However, patients with T2D show lower physical activity and reduced cardiorespiratory fitness than healthy individuals. It would be ideal for clinicians to co-prescribe glucose-lowering agents that improve cardiorespiratory fitness or exercise capacity in conjunction with exercise therapy. Metformin does not improve cardiorespiratory fitness and may attenuate any beneficial effect of exercise in patients with T2D. In contrast, thiazolidinediones appear to improve cardiorespiratory fitness in patients with T2D. Although evidence is limited, sodium-glucose cotransporter 2 (SGLT2) inhibitors may improve cardiorespiratory fitness in patients with heart failure, and the effect of glucagon-like peptide-1 (GLP-1) receptor agonists on cardiorespiratory fitness is controversial. Recent clinical trials have shown that both SGLT2 inhibitors and GLP-1 receptor agonists exert a favorable effect on cardiovascular disease. It becomes more important to choose drugs that have beneficial effects on the cardiovascular system beyond glucose-lowering effects. Further studies are warranted to determine an ideal glucose-lowering agent combined with exercise therapy for the treatment of T2D.