OBJECTIVE—To examine the effect of high-intensity progressive resistance training combined with moderate weight loss on glycemic control and body composition in older patients with type 2 diabetes. RESEARCH DESIGN AND METHODS—Sedentary, overweight men and women with type 2 diabetes, aged 60–80 years (n = 36), were randomized to high-intensity progressive resistance training plus moderate weight loss (RT & WL group) or moderate weight loss plus a control program (WL group). Clinical and laboratory measurements were assessed at 0, 3, and 6 months. RESULTS—HbA1c fell significantly more in RT & WL than WL at 3 months (0.6 ± 0.7 vs. 0.07 ± 0.8%, P < 0.05) and 6 months (1.2 ± 1.0 vs. 0.4 ± 0.8%, P < 0.05). Similar reductions in body weight (RT & WL 2.5 ± 2.9 vs. WL 3.1 ± 2.1 kg) and fat mass (RT & WL 2.4 ± 2.7 vs. WL 2.7 ± 2.5 kg) were observed after 6 months. In contrast, lean body mass (LBM) increased in the RT & WL group (0.5 ± 1.1 kg) and decreased in the WL group (0.4 ± 1.0) after 6 months (P < 0.05). There were no between-group differences for fasting glucose, insulin, serum lipids and lipoproteins, or resting blood pressure. CONCLUSIONS—High-intensity progressive resistance training, in combination with moderate weight loss, was effective in improving glycemic control in older patients with type 2 diabetes. Additional benefits of improved muscular strength and LBM identify high-intensity resistance training as a feasible and effective component in the management program for older patients with type 2 diabetes.

The Australian Diabetes, Obesity and Lifestyle Study (AusDiab) addresses the urgent need for data on diabetes prevalence, risk factors and associated conditions in Australia. Here we describe the methods used and the response rates obtained. AusDiab was a population-based cross-sectional survey of national diabetes mellitus prevalence and associated risk factors in people aged > or =25 years, conducted between May 1999 and December 2000 in the six states and the Northern Territory of Australia. The study involved an initial household interview, followed by a biomedical examination that included an oral glucose tolerance test (OGTT), standard anthropometric tests, blood pressure measurements and the administration of questionnaires. Of the 20347 eligible people (aged > or =25 years and resident at the address for > or =6 months) who completed a household interview, 11247 (55.3%) attended for the biomedical examination. Of those who completed the biomedical examination 55.1% were female. Comparisons with the 1998 Australian population estimates showed that younger age responders were under-represented at the biomedical examination, while the middle-aged and older age groups were over-represented. Weighting of the AusDiab data for age and gender have corrected for this bias. AusDiab, which is the largest national diabetes prevalence study undertaken in a developed nation to have used an OGTT, provides a valuable national resource for the study of the prevalence and possible causes of diabetes, as well as identifying possible risk factors that may lead to diabetes. Furthermore, it generates the baseline data for a prospective 5-year cohort study. The data will be important for national and regional public health and lifestyle education and health promotion programs.

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OBJECTIVE -To determine the prevalence and factors associated with diabetic retinopathy in the Australian population and to estimate the time difference between disease onset and clinical diagnosis of type 2 diabetes.RESEARCH DESIGN AND METHODS -The Australian Diabetes, Obesity and Lifestyle study (AusDiab) included 11,247 adults aged Ն25 years in 42 randomly selected areas of Australia. Retinopathy was assessed in participants identified as having diabetes (based on self-report and oral glucose tolerance test), impaired fasting glucose, and impaired glucose tolerance and in a random sample with normal glucose tolerance. Data were available for 2,177 participants.RESULTS -Overall, 15.3% of those with diabetes had retinopathy. The prevalence of retinopathy was 21.9% in those with known type 2 diabetes (KDM) and 6.2% in those newly diagnosed (NDM). The prevalence of proliferative diabetic retinopathy (PDR) was 2.1% in those with KDM. No cases of PDR were found in those with NDM. Untreated vision threatening retinopathy (presence of PDR or macular edema) was present in 1.2% (n ϭ 4). Factors associated with retinopathy were duration of diabetes, HbA 1c , and systolic blood pressure. Using linear extrapolation of the prevalence of retinopathy with diabetes duration, the onset of diabetes in this population was approximately the time of diagnosis.CONCLUSIONS -This is one of the first national studies of diabetic retinopathy in a developed country. The prevalence of retinopathy was similar to that in other population-based studies. Vision threatening retinopathy was relatively rare; however, four untreated cases were identified. Regular screening for diabetic retinopathy and more aggressive management of modifiable risk factors could reduce the numbers of people who develop vision-threatening retinopathy. Diabetes Care 26:1731-1737, 2003D iabetic retinopathy is a common complication of diabetes and despite the availability of effective treatment, it remains one of the leading causes of visual loss (1-5). Internationally there have been many studies assessing the prevalence of retinopathy, though few have looked at both those with previously and newly diagnosed diabetes (6 -8), and only one from a developed country has used a nationally representative population (9). Several factors have consistently been identified by both cross-sectional and prospective studies as risk factors in the development of diabetic retinopathy: duration of diabetes, systolic blood pressure (SBP), glycemic control, and urinary albumin (7,10). Other factors, including BMI, smoking, serum lipids, and Cpeptide, have shown varying results (7, 10 -13).By the time of clinical diagnosis of type 2 diabetes, some individuals already show evidence of diabetic retinopathy (7,14 -16), indicating that diabetes may have been present for several years. Extrapolating the relationship between duration of diabetes and prevalence of retinopathy back to a prevalence of zero, previous studies have estimated that the actual onset of diabetes is up to 12 years befor...

The number of years lived with obesity is directly associated with the risk of mortality. This needs to be taken into account when estimating its burden on mortality.