Abstract des Autors

As reported in the first part of this paper, regular physical exertion can improve the metabolic, clinical and mental state of patients with diabetes. However, since exertion may be associated with a number of adverse effects and risks, the diabetologist and the sports practictioner should carefully evaluate the basal state of the patients together, according to their own specific expertise. In this respect, a diagnostic algorithm is proposed, based on the glycemic profile over several days, the level of glycosylated haemoglobin and an in-depth investigation in order to detect cardiac, retinal, renal and nervous disturbances and the diabetic foot. The analysis of the results will indicate the most appropriate sports and the most suitable training program (length and frequency of the training sessions and exertion intensity) for each individual. Practising a number of sports should be prohibited to diabetic patients, due to the high death risk (which can involve other participants) if hypoglycemia occurs. Some sports are generally inadvisable because of the high risk of injury or because of their practice is associated with a marked elevation of arterial pressure. Finally, preclusion to specific sports may be dictated by the presence of one or more diabetes-induced organ diseases. As the effects of training on glucose metabolism are unpredictable in the single individual, each patient must be taught to be able to self-manage his/her disease and complications, and the diabetologist must assess and certify such a capability, by law. The medical cooperation should continue during the follow-up of the exercising patient, with a specific metabolic surveillance provided by the diabetologist, and serial evaluations of patient fitness and tolerance to training by the sports practitioner. Such interdisciplinary cooperation could overcome the still deficient regulations on this issue and ensure that exercising patients with diabetes are under appropriate medical surveillance. Verf.-Referat