How a structured exercise programme involving cardio and resistance exercise affects type 2 diabetes mellitus volunteers Ashley Hill BA(Hons) July 2019 First supervisor: Professor M Joan Taylor Second supervisor: Dr Tarsem Sahota This thesis is submitted for the fulfilment of the requirements of the degree of Master of Philosophy Leicester School of Pharmacy Department of Health and Life Science Abstract Background T2DM is a metabolic disorder that is rapidly increasing in prevalence, it has become a 21st century epidemic and addressing this is one of the greatest global health challenges of our time. In the UK £10.3 billion or 10% of the NHS budget was spent on diabetes mellitus. It is essential that a prevention approach to T2DM is utilised within the NHS. Aims The aims of this study are to compare physiological, metabolic parameters and inflammatory markers from type 2 diabetes mellitus (T2DM) and non-diabetic (ND) volunteers over a 6-week exercise period. Methods This was a very interesting study where T2DM and ND volunteers completed one of three structured exercise programmes involving either a combination of cardio and resistance exercise, cardio exercise or resistance exercise twice a week for 6- weeks. Various parameters were recorded at baseline to compare with results after 1 exercise session and again after 12 exercise sessions. Key findings Oral glucose tolerance test area under the curve results showed noticeable reductions from 1612.40 to 1354.10 mmol/L*min. Weight reduced by 2.58 kg in the T2 combination group after intervention which showed a statistically significant reduction from before to after intervention with a p-value of 0.049. Time to peak reduced in the T2 resistance group from 80 to 47 minutes. Total cholesterol reduced in the T2 resistance group after intervention from 5.34 to 4.68 mmol/L. Inflammatory marker results are also presented at the end of the results chapter. I Table of Contents Abstract ...................................................................................................................................................................... I Table of Contents .................................................................................................................................................. II List of Figures ........................................................................................................................................................ VI List of Tables ........................................................................................................................................................XII Chapter 1 Introduction .............................................................................................................................. 1 1.1 Aims of the study ..................................................................................................................................................1 1.2 Background and history ....................................................................................................................................1 1.3 Metabolic syndrome ...........................................................................................................................................4 1.4 Diet ..............................................................................................................................................................................5 1.4.1 The ketogenic diet ................................................................................................................................................7 1.4.2 Atkins diet ................................................................................................................................................................9 1.4.3 Paleo diet ..................................................................................................................................................................9 1.4.4 Pioppi diet................................................................................................................................................................9 1.5 Carbohydrates .................................................................................................................................................... 10 1.6 Proteins .................................................................................................................................................................. 13 1.7 Lipids ......................................................................................................................................................................14 1.8 Type 2 diabetes mellitus ................................................................................................................................ 14 1.9 Insulin resistance .............................................................................................................................................. 15 1.10 Type 1 diabetes mellitus ................................................................................................................................ 16 1.11 LADA (Latent autoimmune diabetes of adulthood) ........................................................................... 17 1.12 Gestational diabetes mellitus ....................................................................................................................... 17 1.13 MODY (Maturity onset diabetes of young) ............................................................................................ 18 1.14 Prevalence of diabetes .................................................................................................................................... 18 1.15 Causes of T2DM .................................................................................................................................................. 19 1.16 Diagnosis tests for diabetes mellitus ........................................................................................................ 26 1.16.1 HbA1c ................................................................................................................................................................ 27 1.16.2 Oral glucose tolerance test (OGTT) ...................................................................................................... 27 1.16.3 Fasting blood glucose test ........................................................................................................................ 27 1.16.4 Post-prandial blood glucose level (PPBG) ........................................................................................ 28 1.16.5 Random blood glucose monitoring test ............................................................................................. 28 1.17 Insulin sensitivity test ..................................................................................................................................... 28 1.18 Treatment ............................................................................................................................................................. 28 1.18.1 Lifestyle changes .......................................................................................................................................... 28 II 1.18.2 Oral medication ............................................................................................................................................ 30 1.18.2a Metformin ......................................................................................................................................................... 30 1.18.2b Sulphonylurea ................................................................................................................................................ 31 1.18.2c Dipeptidyl peptidase-4 (DPP-4) inhibitors ....................................................................................... 31 1.18.2d Alpha-glucosidase inhibitors (AGI) ....................................................................................................... 32 1.18.2e Glucagon like peptide-1 (GLP-1) agonists ......................................................................................... 32 1.18.2f Sodium glucose co-transporter 2 (SGLT2) inhibitors .................................................................. 32 1.18.2g Meglitinide ....................................................................................................................................................... 33 1.18.2h Thiazolidinedione (Glitazones) .............................................................................................................. 33 1.18.3 Insulin ............................................................................................................................................................... 33 1.18.4 Adjunct Treatment ...................................................................................................................................... 33 1.18.4a Angiotensin converting enzyme ACE inhibitors ............................................................................. 34 1.18.4b Beta-blockers .................................................................................................................................................. 34 1.18.4c Statins ................................................................................................................................................................