Читать книгу Pathy's Principles and Practice of Geriatric Medicine - Группа авторов - Страница 198

Ageing patients with type 2 diabetes exhibit greater declines in muscle strength and functional capacity and more rapid loss of muscle mass than normoglycaemic controls.^165,166 Indeed, diabetes complications such as peripheral vascular disease and peripheral neuropathy are associated with poor gait ability, impaired balance, and increased risk of falls.^165,166 In frail patients with diabetes, enhancement in functional capacity is crucial and may be more beneficial than attention to metabolic control alone.¹⁶⁷ Accordingly, an important conceptual idea is that the focus in older people with diabetes should be on functionality.¹⁶⁸ Therefore, in addition to metabolic control, effective strategies are needed to prevent the exacerbated loss of strength and functional capacity in ageing adults with diabetes because these individuals exhibit an increased risk of the development of frailty syndrome, institutionalisation, and disability.^{11,59,126‐127}

Thus, exercise interventions, including resistance training, together with pharmacological and dietary interventions, represent the cornerstones of type 2 diabetes mellitus management.^151,169 Along with the beneficial effects of exercise interventions for older adults with diabetes on glycaemic control,^151,169 increased insulin sensitivity, decreased amount of intra‐abdominal adipose tissue and muscle fat infiltration,⁷⁸ and the cardiovascular risk factors associated with diabetes,²² physical exercise improves muscle mass, strength, power output, cardiovascular function, and functional capacity,⁷⁸ as it does in healthy elders. It may also help prevent dementia in older adults with diabetes,⁴ although systematic review indicates more study is needed.¹⁷⁰ In frail older people with diabetes with functional decline, multicomponent exercise programmes composed of resistance, endurance, balance, and gait retraining should be employed to increase functional capacity and quality of life and avoid falls, institutionalisation, and disability.¹⁴⁷ Furthermore, because muscle power is an important predictor of functional capacity, strategies to develop skeletal muscle power in this population must be included to prevent or postpone functional limitations and subsequent disability.^4,17,52,171