Analysis of Type 2 Diabetes and Obesity: Key Measures in Diet and Exercise Therapy for Diabetes

Diabetes Mellitus:

Diabetes mellitus (DM) is a group of clinical syndromes caused by the interaction of genetic and environmental factors. Its characteristic symptom is hyperglycemia. Most diabetes mellitus can be classified into two main categories based on their etiology and pathogenesis: Type 1 and Type 2 diabetes. Type 1 diabetes is mainly caused by the destruction of pancreatic β-cells, leading to an absolute deficiency of insulin secretion, and is not significantly related to obesity. Type 2 diabetes accounts for more than 90% of all diabetes cases and refers to diabetes that can resist ketoacidosis in the absence of exogenous insulin. Type 2 diabetes (non-insulin-dependent diabetes mellitus, NIDDM) is mainly caused by abnormal insulin secretion and decreased sensitivity of target tissues to insulin, leading to a series of metabolic disorders involving glucose, protein, fat, water, and electrolytes. Early stages are often asymptomatic, while typical cases in the middle and late stages may present with the "three highs and one low" symptoms: polydipsia, polyuria, polyphagia, and weight loss. Approximately 80% of patients with type 2 diabetes are obese to varying degrees.

Type 2 diabetes can also be divided into obese and non-obese types based on weight. Compared to non-obese diabetes, obese patients have significant acquired insulin resistance (IR) and hyperinsulinemia. Treatment for type 2 diabetes generally includes diet therapy, exercise therapy, and drug therapy. Treatment methods for type 2 diabetes include:

I. Non-drug therapy

(I) Diet therapy

Diet therapy is of great importance for obese patients with type 2 diabetes. Diet therapy is a fundamental treatment measure for type 2 diabetes; appropriate dietary restriction can reduce the burden on β-cells and is beneficial for the control of type 2 diabetes. The main principle of diet therapy is to limit total calorie intake, with the distribution ratio of various nutrients being "two highs" (high carbohydrates, high dietary fiber), "four lows" (low sugar, low salt, low fat, low cholesterol), and "one balanced" (protein). Very low-calorie diets have been increasingly used in the treatment of obese patients with type 2 diabetes in recent years, and are particularly effective in controlling blood sugar, blood pressure, and blood lipids. The general course of treatment is 3 months, during which full medical monitoring is necessary. After 3 months, a low-calorie diet can be switched to.

Type 2 diabetes is generally accompanied by hypertension. Excessive sodium intake is detrimental to the prevention and treatment of hypertension. It is generally recommended to consume 5-6g of sodium per day or less.

Diabetic patients should limit alcohol consumption, especially obese individuals. Patients with hypertension and hypertriglyceridemia should be aware that 1g of alcohol contains 29kJ of energy, and its metabolism is similar to that of fat. Since alcohol inhibits gluconeogenesis, food should be consumed after drinking to prevent hypoglycemia, especially for patients taking sulfonylureas (SU) or injecting insulin.

(II) Exercise Therapy

Exercise therapy is an important treatment for type 2 diabetes. Moderate physical activity can increase energy expenditure, reduce weight, especially reducing fat accumulation in the abdomen and trunk, increasing the utilization of glucose by muscles and fat, reducing glycogenolysis and thus lowering blood sugar, and increasing insulin sensitivity. Most patients with type 2 diabetes die or become disabled due to coronary heart disease, stroke, and peripheral vascular disease caused by arteriosclerosis. Appropriate exercise can protect against risk factors for coronary heart disease and can improve factors such as plasma lipoprotein levels, hyperinsulinemia, hyperglycemia, certain coagulation factor parameters, and blood pressure. However, it is important to note that exercise can lead to some potential complications in patients with type 2 diabetes. When insulin secretion is severely insufficient, exercise can worsen hyperglycemia and easily cause ketosis, while it can easily cause hypoglycemia in patients using insulin or sulfonylureas. In patients with microvascular complications, exercise can reduce vasodilation and increase capillary permeability, easily leading to egg-yolk urine. Exercise can also raise blood pressure, increasing the risk of retinal hemorrhage. Therefore, exercise therapy must be tailored to the specific condition. It is most effective for overweight patients with type 2 diabetes, but contraindicated in those with excessively high blood sugar, excessive insulin dosage, ketosis, severe cardiac or renal complications, hypertension, fever, severe infection, or active tuberculosis. Caution should be exercised in patients with microvascular complications. If there are no contraindications, the form of exercise can be determined according to the patient's wishes, such as walking, swimming, aerobics, Tai Chi, etc. Each exercise session should last for 20 to 30 minutes, and it is best to exercise at least 3 days a week.