Continued exercise for 10 years linked to reduced risk type 2 diabetes

15th February 2023

Continued moderate or vigorous exercise over a 10-year period is associated with a significantly reduced risk of incident type 2 diabetes

Participants who continued to exercise for up to 10 years following completion of a 12 month randomised trial, had a significantly lower risk of developing incident type 2 diabetes according to the findings of a study by Chinese researchers.

Globally, type 2 diabetes affects around 462 million people or just over 6% of the entire population. Lifestyle modifications such as diet or increased exercise are known to reduce the risk of developing the disease. However, most of the available evidence for effects of lifestyle modification has been derived from high-risk individuals, for instance, those with elevated fasting glucose levels, or those who are both overweight and having impaired glucose tolerance. A further problem is that many of these intervention studies were of a relatively short duration. It is therefore less unclear whether maintenance of lifestyle modifications such as increased physical activity, over the longer term, still reduces the risk of developing T2D.

In the current study, Chinese researchers reported the longer term outcomes of a 12 month randomised trial they had undertaken. In the original trial, participants with non-alcoholic fatty liver disease, were randomised to vigorous to moderate physical activity, moderate exercise (brisk walking) or no exercise for 12 months. The results of the trial showed that both forms of exercise were effective at reducing intrahepatic triglyceride levels compared to those who did not exercise.

Following the trial, the majority of the study participants were followed-up after 2 and 10 years to assess the incidence of T2D, defined as a fasting plasma glucose of 6.9 mmol/L and a HBA1c of > 6.5% and or the use of anti-diabetic treatment.

Continued exercise and incident type 2 diabetes

From an original cohort of 208 participants who completed the year long trial, 195 and 179 remained for subsequent assessment after 2 and 10 years respectively.

The cumulative incidence of T2D was 2.1 per 100 person-years, 1.9 and 4.1 in those who continued with vigorous, moderate or no exercise respectively. In fact, the risk of T2D was reduced by 49% among those performing vigorous exercise (relative risk, RR = 0.51, 95% CI 0.27 – 0.94, p = 0.01) and by 53% among moderate level intensity exercise (RR = 0.47, 95% CI 0.25 – 0.89, p = 0.01) compared to the non-exercising group.

While both exercise groups had significant reductions in HBA1c levels compared to non-exercisers during the follow-up period, fasting plasma glucose levels while numerically lower in the two exercising groups than the non-exercise control group, these differences were non-significant.

The authors suggested that vigorous to moderate aerobic physical activity could be used to prevent T2D, particularly in those with obesity.

Citation
Chen Y et al. Effect of Moderate and Vigorous Aerobic Exercise on Incident Diabetes in Adults With Obesity: A 10-Year Follow-up of a Randomized Clinical Trial. JAMA Intern Med 2023

Standardised radiology alert system effective for incidental findings follow-up

30th June 2022

A standardised radiology alert system has enabled the follow-up of the majority of ED patients for whom incidental findings were detected

A standardised radiology notification system which identified and subsequently ensured the follow-up of emergency department patients for whom incidental findings were detected in scans, has proved to be highly successful. This was the conclusion of a study by a team from the Department of Emergency Medicine and the Vanderbilt Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, US.

The presence of incidental findings and which are unrelated to the initial indication for a radiological scan are not uncommon. For example, in a study of 1155 patients who had an emergency abdominal computed tomography scan, 700 had incidental findings detected, of which, 143 were deemed indeterminate requiring urgent investigations. The presence of incidental findings are commonly detected in scans for trauma patients, with some that require urgent evaluation (type 1 findings) or at least should be communicated to patients (type 2 findings). Using this classification, in one study that retrospectively reviewed 3092 patients, type 1 findings were present in 32% of all scans and type 2 findings in 41.2% of scans. Communication of findings to patients and appropriate follow-up is needed particularly where the findings indicate a potential malignancy. For the present study, the US team developed a standardised radiology reporting system that created an electronic trigger to ensure that patients with incidental radiology findings were connected with an appropriate outpatient surveillance follow-up.

The team retrospectively examined the value of their standardised radiology reporting system by including all adult emergency department visits with a critical radiology alert for incidental findings. Operationally, if a radiologist identified important clinical or incidental findings, these were added to a critical alert messaging system which activated a ‘stop sign’ icon on the emergency department, indicating to clinicians that the alert needed to be reviewed and acknowledged. The emergency department clinicians were then required to complete an appropriate follow-up request form which was sent to members of the department whose role was to liaise with patients and primary care physicians to arrange the recommended follow-up. For the present study, the authors set the primary outcome measure as the proportion of emergency department (ED) patient visits with identified incidental findings that had documented communication with the patients and surveillance plans. For the secondary outcome, the team looked at the frequencies of post-ED surveillance clinic visits.

Standardised radiology alert system outcomes

During the period of analysis, there were 64,731 ED visits of which 932 (1.44%) patient visits had critical radiology alerts. This total included 53 visits with multiple findings so that the actual total was 982 incidental findings.

The primary outcome was met in 95.3% (95% CI 93.9% – 96.6%) of ED patient visits. For the secondary outcome, 99.1% of in-network referral to a primary care provider or specialist occurred.

The authors concluded that the successful implementation of a standardised radiology notification and referral system is an important patient safety intervention that provides the opportunity to detect undiagnosed malignancies.

Citation
Barrett TW et al. Catching Those Who Fall Through the Cracks: Integrating a Follow-Up Process for Emergency Department Patients with Incidental Radiologic Findings Ann Emerg Med 2022