End-Stage Renal Disease in People With Type 2 Diabetes: Systemic Manifestations and Exercise Implications

Abstract

2] The United States has demonstrated a 12% increase in prevalence of people with diabetes in the last decade. The prevalence has doubled among African Americans, tripled among Hispanic Americans, and also increased among Native Americans. 7 In addition, approximately 1,800 new cases of diabetes are diagnosed each day, or approximately 655,000 new cases each year. According to Clark and Clark, "we are in the midst of an epidemic of diabetes affecting an estimated 110 million people worldwide." 2( p330) Furthermore, the number of people with diabetes is expected to double during the next 2 decades as a result of many countries embracing a Western lifestyle that usually includes decreased physical activity and increased obesity. pe 2 diabetes, formerly known as adult-onset or non-insulin-dependent diabetes mellitus, comprises 90% of all cases of diabetes and has a slow and insidious onset. 9 -11 According to Ludwig and Ebbeling, 12 however, age may no longer be a factor when distinguishing between type 1 and type 2 diabetes. There is an increase in the number of children currently being diagnosed with type 2 diabetes, which is most likely a result of an increase in obesity among children. In type 2 diabetes, insulin secretion is normal or increased. The target cells in the body, however, are less sensitive to insulin, and, therefore, the cells cannot effectively utilize glucose for energy. Long-term obesity is a risk factor for developing type 2 diabetes, as 80% of individuals with type 2 diabetes are considered to be obese, having a body mass index (BMI) greater than or equal to 30 kg/m 2 , whereas the other 20% are above their ideal weight or have a BMI of 25 to 29.9 kg/m 2 . Type 2 diabetes has a higher incidence rate among African Americans, Native Americans, Japanese, Puerto Ricans, and Hispanics. Type 2 diabetes can be controlled by diet alone or by a combination of medications (oral hypoglycemics or insulin), exercise, and diet.