Abstract des Autors

As glucose is the main fuel for the exercising skeletal muscle, it is not surprising that physical activity and diabetes have important and reciprocal effects. A regular, moderate and preferentially aerobic exertion may prevent or delay diabetes occurrence in genetically predisposed individuals. Moreover, exertion has favourable effects on both type I (IDDM) and type II (NIDDM) diabetes. It ameliorates the biological effectiveness of insulin, increases the non insulin-dependent peripheral uptake of glucose, and improves the cardiovascular risk factors and reduces the fatty mass of overweight patients. Importantly, sport also promotes socialization and has favourable psychological effects, by increasing the self-confidence and well being. On the other hand, diabetes impairs the metabolic paths that accomplish the increased energy demand during exercise, thus predisposing to the development of the "exertion-induced metabolic complications", such as exertional hypoglycemia, late onset hypoglycemia, exertional hyperglycemia and ketosis. The occurrence of these adverse effects depends upon the metabolic condition and circulating level of insulin at the onset of exertion, as well as the ability to check and promptly correct glycemic derangement by the patient himself/herself (self-management). Exertion can also reveal or worsen diabetes-associated organ dysfunctions (heart, retinal and kidney disease, diabetic foot, etc) caused by the micro-macro-angiopathy and neuropathy (autonomic and sensitive) occurring in patients with a long lasting diabetes. Lastly, diabetes makes the patient prone to traumatic injuries during exertion and impairs wound healing. Despite this, patients with diabetes should be encouraged and helped to practice a physical activity tailored to their clinical condition. In the present paper, the strategies (life style, diet and treatment) devoted to increase the favourable effects and reduce the risks of sport practice are discussed, taking into account the characteristics of both IDDM and NIDDM. Verf.-Referat