Abstract
Abstract. Summary: The prevalence of obesity is increasing world-wide. Obesity is associated with a plethora of metabolic and clinical constraints, which result in a higher risk for the development of cardiovascular complications and metabolic disease, particularly insulin resistance and type 2 diabetes. Obesity is an acknowledged determinant of glycemic control in patients with type 1 diabetes and accounts for the majority of premature death due to cardiovascular events. Physical exercise is generally recommended in patients with diabetes in order to prevent the development of or reduce existing obesity, as adopted by every international treatment guideline so far. Regular physical exercise has a beneficial impact on body composition, cardiovascular integrity, insulin sensitivity and quality of life. However, only a minority of patients participates in regular physical exercise, due to individual or disease-related barriers. In type 2 diabetes, there is robust evidence for beneficial effects of physical exercise on glycemic control, cardiovascular health and the development of diabetes-related long-term complications. In type 1 diabetes and patients treated with insulin, a higher risk for exercise-related hypoglycemia has to be considered, which requires certain prerequisites and adequate adaptions of insulin dosing. Current treatment guidelines do only incompletely address the development of exercise-related hypoglycemia. However, every patient with diabetes should participate in regular physical exercise in order to support and enable sufficient treatment and optimal glycemic control.
Zusammenfassung. Die Prävalenz der Adipositas nimmt weltweit zu und erhöht das Risiko, an Diabetes zu erkranken. Sport gilt als bewährte Methode in der Behandlung von Adipositas und wird insbesondere für eine erfolgreiche Diabetes-Therapie empfohlen. Sport wirkt sich positiv auf die Körperkomposition, das kardiovaskuläre System und die Lebensqualität aus. Allerdings schaffen es nur wenige Menschen mit Diabetes, Sport regelmässig und dauerhaft durchzuführen. Der Nutzen für die glykämische Kontrolle und kardiovaskuläre Risikofaktoren ist klar belegt für Menschen mit Typ-2-Diabetes. Bei Behandlung mit Insulin muss besonderes Augenmerk auf eine adäquate Dosisanpassung der Insulintherapie gelegt werden, um mitunter schwere Hypoglykämien zu vermeiden. Sport sollte von jedem Menschen mit Diabetes regelmässig ausgeübt werden, um die bestehende Therapie zu unterstützen und zu ergänzen.
Résumé. La prévalence de l’obésité augmente dans le monde entier et, avec elle, le nombre de facteurs de risque cardiovasculaire. L’obésité est associée à une variété de troubles métaboliques et cliniques qui se traduisent par un risque plus élevé de souffrir de maladies cardiovasculaires ou métaboliques. En particulier, le développement de la résistance à l’insuline et du diabète sucré de type 2 est étroitement lié à l’obésité. Mais les personnes atteintes de diabète de type 1 développent également des facteurs de risque cardiovasculaire beaucoup plus fréquemment et bénéficient d’une réduction de poids dans leur contrôle glycémique. Pour prévenir le surpoids ou pour réduire le surpoids existant, le sport est considéré comme la méthode la plus largement acceptée et éprouvée. Le sport est considéré dans toutes les directives de traitement comme une condition de base pour une thérapie du diabète réussie. L’exercice régulier a un effet positif sur la composition corporelle, le système cardiovasculaire, la sensibilité à l’insuline et la qualité de vie. Cependant, peu de personnes atteintes de diabète parviennent à intégrer le sport dans leur vie de façon régulière et permanente. Les avantages de l’exercice pour la qualité du contrôle glycémique, la réduction des facteurs de risque cardiovasculaire et la prévention des complications associées au diabète sont clairement documentés pour les personnes atteintes de diabète de type 2. Chez les personnes atteintes de diabète de type 1 (et les personnes atteintes de diabète de type 2 traitées à l’insuline), une attention particulière doit être accordée à l’adaptation adéquate de l’insulinothérapie. Le sport en combinaison avec une insulinothérapie existante peut augmenter de manière significative le risque d’hypoglycémie parfois sévère, et les directives thérapeutiques actuelles ne peuvent que partiellement réduire ce risque. Néanmoins, un programme sportif régulier et individualisé devrait être suivi par chaque personne atteinte de diabète afin de soutenir et de compléter de manière optimale la thérapie antidiabétique existante.
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