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Physical activity has a beneficial effect on the cardiovascular risk and the well-being in patients with type 2 diabetes. Thereby, both aerobic physical activities and resistance activities are recommended. DIAfit is a programm for patients with type 2 diabetes that is being implemented in Switzerland. Its objective is to allow the initiation of a structured physical activity in the setting of a pluridisciplinary team to promote a healthy lifestyle.

Functional insulin therapy is a teaching approach of intensified insulin therapy. Its aim is to transfer to the patient the decisional process and the management of its insulin treatment, this according to the various acts of everyday life, and particularly meals. The principles of functional insulin therapy, the pedagogic approach, the benefits observed in type 1 diabetic patients (better diabetes control, and particularly decrease in the number of severe hypoglycaemic events) are briefly described - Nevertheless, to apply this functional insulin therapy in practice, requires a specific teaching program preferably ambulatory in real everyday life conditions, and carried out by a staff highly qualified in diabetology.

Evaluation of autonomic defects in polyneuropathies or diseases of the central nervous system is assuming increasing importance. Five simple non-invasive cardiovascular tests are described: an orthostatic test taking account of changes in arterial blood pressure, the orthostatic test of Ewing, the Valsalva maneuver, sustained handgrip, and heart beat to beat variation. The physiological mechanisms involved in each test, the need to bear in mind failure of the effector organs (cardiovascular system) and also the effect of medication are discussed. Finally, the beat to beat variation expressed as the coefficient of variation and as the meansquare successive difference, measured in 32 healthy subjects, are suggested as reference values.

An outpatient educational system for diabetics has been employed in Delémont since 1984 in the form of a 4-day course consisting of a total of 15 teaching hours. This teaching method has been evaluated in the first 51 patients. The level of information (tested by a series of multiple choice questions which are submitted to the patients at the beginning, at the end of the course and three months later) was found to improve. The score (0-17) rose from 6.6 to 11.9 and then 12.5; n = 35; p less than 0.001. The HbA1c fell significantly in a three month period from 8.8 to 7.8%, n = 12, p less than 0.02. The slight lowering of average fasting serum glucose levels (from 10.4 to 9.7 mmol/l) and of the patients' weights (from 75.4 to 74.6 kgs) was not significant. - The advantage of the educational system that has been studied is its low cost and the fact that it is accepted well by patients.

Failure of autonomic functions in diabetes has been investigated. Cardiovascular reflexes, and thermoregulation during heat exposure, were studied in 11 diabetic patients. Five had clinical signs of sensorimotor neuropathy and 6 served as age- and sex-matched controls. The subjects were studied by the following tests: orthostatic test, Valsalva, beat-to-beat variation during normal and forced respiration, and analysis of urinary catecholamines. Thermoregulation was measured for 80 minutes, at an ambient temperature of 37 degrees C, in a gradient layer direct calorimeter measuring evaporative heat losses with a precision of +/- 1 watt. The cardiovascular tests showed a relationship between the sensorimotor defects and the autonomic dysfunctions. The beat-to-beat variation was found to be the most sensitive test, the Valsalva and orthostatic test being respectively less so. However, the diabetic patients' autonomic disorders were not associated with a significant decrease in evaporative heat losses. The internal temperature (esophageal) at which sweating began (set point) was higher in some of the neuropathic diabetics than in the controls. Once the set point had been reached, however, the increase in evaporative heat losses was greater in diabetics than in controls. These findings can be accounted for by zones of compensatory hypersweating in patients with polyneuropathy. The changes in evaporative heat loss pattern may represent an early alteration in autonomic diabetic neuropathy.