Physical activity and sports participation in children and adolescents with type 1 diabetes mellitus. Nutr Metab Cardiovasc Dis. 2007;17:376-382. [PMID: 17562573 DOI: 10.1016/j.numecd.2005.10.012]

Quality of life and physical activity in type 1 diabetes

INTRODUCTION

T1 Diabetes (T1D) is one of the most common chronic diseases in children and young people [1] with almost 34 000 aged 18 years or less living with T1D [2]. Physical activity is promoted as one of a number of management tools for people living with diabetes, being associated with significant health benefits including improved glycaemic control. The benefits of physical activity on quality of life in children with T1D is unclear with confounding effects of disease duration and co-morbidities in studies.

AIM

To determine the effect of physical activity interventions on quality of life of children with type 1 diabetes.

METHODS

A systematic review was conducted and reported in line with PRISMA 2009 guidance. The CINAHL, Embase, International Pharmaceutical Abstracts, Medline, PubMed and PsychINFO databases were searched for the period January 1994 to March 2025. Papers were included in the present review if they included a study intervention in children under 19 years of age that was more than a single exercise session and had a control group (with or without T1D) as a comparator group. The primary outcome measure was Quality of Life (QoL) indicators.

RESULTS

We assessed 3020 records, of which three randomised controlled trials (RCT) published between 2007 and 2020 met study inclusion criteria. There was significant heterogeneity in study design, methods and reporting. Benefits of physical activity were not consistently seen across studies.

CONCLUSION

There remains limited data on QoL outcomes or even a standardisation for measuring QoL in this cohort as seen by the various validated tools used across studies. There continues to be a need for further work to understand the additional framework (psychological underpinning) to cause longer term impactful changes on both physical and psychological health in children with T1D.

Effect of wearable activity trackers on physical activity in children and adolescents: a systematic review and meta-analysis

BACKGROUND

Physical inactivity in children and adolescents has become a pressing public health concern. Wearable activity trackers can allow self-monitoring of physical activity behaviour and promote autonomous motivation for exercise. However, the effects of wearable trackers on physical activity in young populations remain uncertain.

METHODS

In this systematic review and meta-analysis, we searched PubMed, Embase, SPORTDiscus, and Web of Science for publications from database inception up to Aug 30, 2023, without restrictions on language. Studies were eligible if they were randomised controlled trials or clustered randomised controlled trials that examined the use of wearable activity trackers to promote physical activity, reduce sedentary behaviours, or promote overall health in participants with a mean age of 19 years or younger, with no restrictions on health condition or study settings. Studies were excluded if children or adolescents were not the primary intervention cohort, or wearable activity trackers were not worn on users' bodies to objectively track users' physical activity levels. Two independent reviewers (WWA and FR) assessed eligibility of studies and contacted authors of studies if more information was needed to assess eligibility. We also searched reference lists from relevant systematic reviews and meta-analyses. Systematic review software Covidence was used for study screening and data extraction. Study characteristics including study setting, participant characteristics, intervention characteristics, comparator, and outcome measurements were extracted from eligible studies. The two primary outcomes were objectively measured daily steps and moderate-to-vigorous physical activity. We used a random-effects model with Hartung-Knapp adjustments to calculate standardised mean differences. Between-study heterogeneity was examined using Higgins I2 and Cochran Q statistic. Publication bias was assessed using Egger's regression test. This systematic review was registered with PROSPERO, CRD42023397248.

FINDINGS

We identified 9619 studies from our database research and 174 studies from searching relevant systematic reviews and meta-analyses, of which 105 were subjected to full text screening. We included 21 eligible studies, involving 3676 children and adolescents (1618 [44%] were female and 2058 [56%] were male, mean age was 13·7 years [SD 2·7]) in our systematic review and meta-analysis. Ten studies were included in the estimation of the effect of wearable activity trackers on objectively measured daily steps and 11 were included for objectively measured moderate-to-vigorous physical activity. Compared with controls, we found a significant increase in objectively measured daily steps (standardised mean difference 0·37 [95% CI 0·09 to 0·65; p=0·013]; Q 47·60 [p<0·0001]; I2 72·7% [95% CI 53·4 to 84·0]), but not for moderate-to-vigorous physical activity (-0·08 [-0·18 to 0·02; p=0·11]; Q 10·26 [p=0·74]; I2 0·0% [0·0 to 53·6]).

INTERPRETATION

Wearable activity trackers might increase daily steps in young cohorts of various health statuses, but not moderate-to-vigorous physical activity, highlighting the potential of wearable trackers for motivating physical activity in children and adolescents. More rigorously designed trials that minimise missing data are warranted to validate our positive findings on steps and to explore possible long-term effects.

FUNDING

The Hong Kong University Grants Committee and Seed Fund for Basic Research of the University of Hong Kong.

Cardiorespiratory Fitness and Physical Activity in Pediatric Diabetes: A Systemic Review and Meta-Analysis

Importance

It is unclear whether cardiorespiratory fitness (CRF) and physical activity are lower among youths with type 1 diabetes (T1D) and type 2 diabetes (T2D) compared with youths without diabetes.

Objective

To describe the magnitude, precision, and constancy of the differences in CRF and physical activity among youths with and without diabetes.

Data Sources

MEDLINE, Embase, CINAHL, and SPORTDiscus were searched from January 1, 2000, to May 1, 2022, for eligible studies.

Study Selection

Observational studies with measures of CRF and physical activity in children and adolescents aged 18 years or younger with T1D or T2D and a control group were included.

Data Extraction and Synthesis

Data extraction was completed by 2 independent reviewers. A random-effects meta-analysis model was used to estimate differences in main outcomes. The pooled effect estimate was measured as standardized mean differences (SMDs) with 95% CIs. The Preferred Reporting Items for Systematic Review and Meta-Analyses guideline was followed.

Main Outcomes and Measures

The main outcomes were objectively measured CRF obtained from a graded maximal exercise test and subjective or objective measures of physical activity. Subgroup analyses were performed for weight status and measurement type for outcome measures.

Results

Of 7857 unique citations retrieved, 9 studies (755 participants) with measures of CRF and 9 studies (1233 participants) with measures of physical activity for youths with T2D were included; for youths with T1D, 23 studies with measures of CRF (2082 participants) and 36 studies with measures of PA (12 196 participants) were included. Random-effects models revealed that directly measured CRF was lower in youths with T2D (SMD, -1.06; 95% CI, -1.57 to -0.56; I2 = 84%; 9 studies; 755 participants) and in youths with T1D (SMD, -0.39; 95% CI, -0.70 to -0.09; I2 = 89%; 22 studies; 2082 participants) compared with controls. Random-effects models revealed that daily physical activity was marginally lower in youths with T1D (SMD, -0.29; 95% CI, -0.46 to -0.11; I2 = 89%; 31 studies; 12 196 participants) but not different among youths with T2D (SMD, -0.56; 95% CI, -1.28 to 0.16; I2 = 91%; 9 studies; 1233 participants) compared with controls. When analyses were restricted to studies with objective measures, physical activity was significantly lower in youths with T2D (SMD, -0.71; 95% CI, -1.36 to -0.05; I2 = 23%; 3 studies; 332 participants) and T1D (SMD, -0.67; 95% CI, -1.17 to -0.17; I2 = 93%; 12 studies; 1357 participants) compared with controls.

Conclusions and Relevance

These findings suggest that deficits in CRF may be larger and more consistent in youths with T2D compared with youths with T1D, suggesting an increased risk for cardiovascular disease-related morbidity in adolescents with diabetes, particularly among those with T2D. The findings reinforce calls for novel interventions to empower youths living with diabetes to engage in regular physical activity and increase their CRF.

Youth with type 1 diabetes mellitus are more inactive and sedentary than apparently healthy peers: a systematic review and meta-analysis

AIMS

To conduct a meta-analysis of differences in physical activity, sedentary behaviour, and physical fitness between children and adolescents with type 1 diabetes and their healthy peers.

METHODS

The databases EMBASE, PubMed and SportsDiscus were searched for studies. Pooled effects were calculated using random effects inverse-variance models with the Hartung-Knapp-Sidik-Jonkman adjustment.

RESULTS

Thirty-five studies were included, comprising a total of 4,751 youths (53% girls) of which 2,452 with type 1 diabetes. Youth with type 1 diabetes were less physically active (Coheńs d=-0.23, 95%CI -0.42 to -0.04), more sedentary (Coheńs d=0.33, 95%CI 0.06 to 0.61), and had lower cardiorespiratory fitness (Coheńs d=-0.52, 95%CI -0.73 to -0.31) than their healthy peers. This corresponds to -12.72 min/day of moderate-to-vigorous physical activity, 63.3 min/day of sedentary time (accelerometry) and -4.07 ml/kg/min of maximum/peak oxygen consumption. In addition, young people with type 1 diabetes were less likely to meet the international physical activity recommendations than their healthy peers (odds ratio=0.44, 95%CI 0.31 to 0.62).

CONCLUSIONS

Keeping in mind the heterogeneity between studies in the design, population and assessment, our findings show that children and adolescents with type 1 diabetes seem to be less active, more sedentary, and have lower cardiorespiratory fitness levels than their healthy peers.

Physical Activity Management for Youth With Type 1 Diabetes: Supporting Active and Inactive Children

Regular physical activity and exercise are important for youth and essential components of a healthy lifestyle. For youth with type 1 diabetes, regular physical activity can promote cardiovascular fitness, bone health, insulin sensitivity, and glucose management. However, the number of youth with type 1 diabetes who regularly meet minimum physical activity guidelines is low, and many encounter barriers to regular physical activity. Additionally, some health care professionals (HCPs) may be unsure how to approach the topic of exercise with youth and families in a busy clinic setting. This article provides an overview of current physical activity research in youth with type 1 diabetes, a basic description of exercise physiology in type 1 diabetes, and practical strategies for HCPs to conduct effective and individualized exercise consultations for youth with type 1 diabetes.

The impact of physical activity, quality of life and eating habits on cardiometabolic profile and adipokines in youth with T1D

PURPOSE

Individuals with Type-1-Diabetes (T1D) are at higher risk of having premature cardiovascular-disease (CVD). Physical activity and healthy lifestyle are major components in the prevention of diabetes' related comorbidities and complications. The aim of this study was to investigate the impact of physical activity, eating habits and quality of life in children and adolescents with T1D on diabetic control, cardiovascular and biochemical profile, infection indices, and adipokine levels.

METHODS

This cross-sectional study involved 80 participants (36 boys/44 girls) with T1D, aged (mean ± SD) 14.9 ± 3.4 years, who attended the Diabetes and Metabolism Clinic of a University Children's Hospital, using anthropometric studies, lipid profile, high-sensitivity-C-Reactive-Protein(hs-CRP), Interleukin-6(IL6), leptin and adiponectin levels. Physical activity was assessed with pedometers (total-steps/week) and questionnaire.

RESULTS

In 20(25%) children the level of exercise was >75th percentile, in 20(25%) <25th percentile and in 40(50%) children ranged between 25-75th percentile, respectively. Higher levels of physical activity were associated with weight (beta = -0.053, p < 0.001), waist circumference (beta = -0.077, p < 0.001), BMI (beta = -0.167, p = 0.009), muscle mass (beta = -0.0619, p = 0.001) and HDL-C (beta = 0.039, p = 0.033). Quality of life was positively related to weight (beta = 5.49511, p = 0.002), waist circumference (beta = 6.593345, p = 0.012), muscle mass (beta = 7.324088, p < 0.001) and T1D duration (beta = 19.22442, p = 0.005). Lipid profile was positively associated with sweets and chocolate consumption (beta = 0.348, p < 0.05), while vegetable (beta = -0.245, p < 0.05) and white milk consumption (beta = -0.2295, p < 0.05) were negatively associated with waist/height ratio.

CONCLUSIONS

In the present study, higher levels of physical activity were associated with improved lipid profile (HDL-C, triglycerides) and body composition [waist circumference, Body-Mass-Index (BMI] of children and adolescents with T1D. Higher scoring in quality-of-life questionnaires were related to older children with longer diabetes duration. Unhealthy eating habits unfavorably affected lipid profile and body composition in T1D youth.

Pre-treatment with IL-6 potentiates β-cell death induced by pro-inflammatory cytokines

BACKGROUND

Type I Diabetes mellitus (T1D) is characterized by a specific destruction of β-cells by the immune system. During this process pro-inflammatory cytokines are released in the pancreatic islets and contribute for β-cells demise. Cytokine-induced iNOS activation, via NF-κB, is implicated in induction of β-cells death, which includes ER stress activation. Physical exercise has been used as an adjunct for better glycemic control in patients with T1D, since it is able to increase glucose uptake independent of insulin. Recently, it was observed that the release of IL-6 by skeletal muscle, during physical exercise, could prevent β-cells death induced by pro-inflammatory cytokines. However, the molecular mechanisms involved in this beneficial effect on β-cells are not yet completely elucidated. Our aim was to evaluate the effect of IL-6 on β-cells exposed to pro-inflammatory cytokines.

RESULTS

Pre-treatment with IL-6 sensitized INS-1E cells to cytokine-induced cell death, increasing cytokine-induced iNOS and Caspase-3 expression. Under these conditions, however, there was a decrease in cytokines-induced p-eIF2-α but not p-IRE1expression, proteins related to ER stress. To address if this prevention of adequate UPR response is involved in the increase in β-cells death markers induced by IL-6 pre-treatment, we used a chemical chaperone (TUDCA), which improves ER folding capacity. Use of TUDCA increased cytokines-induced Caspase-3 expression and Bax/Bcl-2 ratio in the presence of IL-6 pre-treatment. However, there is no modulation of p-eIF2-α expression by TUDCA in this condition, with increase of CHOP expression.

CONCLUSION

Treatment with IL-6 alone is not beneficial for β-cells, leading to increased cell death markers and impaired UPR activation. In addition, TUDCA has not been able to restore ER homeostasis or improve β-cells viability under this condition, suggesting that other mechanisms may be involved.

Factors affecting the support for physical activity in children and adolescents with type 1 diabetes mellitus: a national survey of health care professionals' perceptions

BACKGROUND

Many children and adolescents with Type 1 Diabetes Mellitus (T1DM) don't meet the recommended levels of physical activity. Healthcare professionals (HCPs) have a key role in supporting and encouraging children and adolescents with T1DM to be physically active. This study aims to understand the perspectives of HCPs in relation to supporting physical activity and implementing guidelines relating to physical activity.

METHODS

An online mixed methods survey was circulated to HCPs in pediatric diabetes units in England and Wales. Participants were asked about how they support physical activity in their clinic and their perceptions of barriers/enablers of providing physical activity support to children and adolescents with T1DM. Quantitative data were analysed descriptively. An deductive thematic approach was applied to the free text responses using the Capability Opportunity Motivation model of Behaviour (COM-B) as a framework.

RESULTS

Responses were received from 114 individuals at 77 different pediatric diabetes units (45% of pediatric diabetes units in England and Wales). HCPs surveyed felt that the promotion of physical activity is important (90%) and advised patients to increase levels of physical activity (88%). 19% of the respondents felt they did not have sufficient knowledge to provide support. HCPs reported limited knowledge and confidence, time and resources as barriers to providing support. They also felt the current guidance was too complicated with few practical solutions.

CONCLUSION

Pediatric HCPs need training and support to be able to encourage and support children and adolescents with T1D to be a physical activity. In addition, resources that provide simple and practical advice to manage glucose around exercise are needed.

24-Hour Movement Behaviours (Physical Activity, Sedentary Behaviour and Sleep) Association with Glycaemic Control and Psychosocial Outcomes in Adolescents with Type 1 Diabetes: A Systematic Review of Quantitative and Qualitative Studies

Type 1 Diabetes (T1D) is a condition requiring 24-hour management. The way in which an individual combines their 24-hour movement behaviours (24-h MBs), which is comprised of physical activity (PA), sedentary behaviour (SB), and sleep, throughout the day can have a significant impact on physical and mental health. This mixed methods systematic review aimed to investigate 24-h MBs' relationship with glycaemic control and psychosocial outcomes in adolescents (11-18 years) with T1D. Ten databases were searched for quantitative and qualitative English language articles reporting at least one of the behaviours and their relationship with outcomes. There were no restrictions on article publication dates or study design. Articles were subjected to title and abstract screening, full text screening, data extraction and quality assessment. Data were summarised narratively, and a meta-analysis was conducted where possible. From 9922 studies, 84 were included for data extraction (quantitative (n = 76), qualitative (n = 8)). Meta-analyses revealed a significant favourable association between PA and HbA1c (-0.22 [95% CI: -0.35, -0.08; I² = 92.7%; p = 0.001). SB had an insignificant unfavourable association with HbA1c (0.12 [95% CI: -0.06, 0.28; I² = 86.1%; p = 0.07]) and sleep had an insignificant favourable association (-0.03 [95% CI: -0.21, 0.15; I² = 65.9%; p = 0.34]). Importantly, no study investigated how combinations of behaviours collectively interacted and impacted on outcomes.

Effects of a Diabetes Sports Summer Camp on the Levels of Physical Activity and Dimensions of Health-Related Quality of Life in Young Patients with Diabetes Mellitus Type 1: A Randomized Controlled Trial

Physical activity (PA) is considered an important part of the treatment of children with diabetes mellitus type 1 (T1DM). Furthermore, health-related quality of life (HRQoL) affects both the physical and mental health of patients with T1DM. The purpose of the study was to evaluate through a randomized controlled trial the impact of participation in a summer diabetes sports camp on the PA and HRQoL of children and adolescents with T1DM. Eighty-four children and adolescents with T1DM were randomly assigned into an intervention (M = 12.64, SD = 1.82, 30 female) and a control group (M = 12.67, SD = 2.50, 30 female). Intervention group participants attended a ten-day summer diabetes sports camp which included an intensive program of PA (6 h of daily PA), educational and entertaining activities as well as education on the importance of PA in the management of the disease. At baseline and at the end of the study, participants completed measures of physical activity, self-esteem, depression, health status, intention to change behavior, and life satisfaction. Results of the two-way repeated measures analysis showed no statistically significant group differences in PA levels (p < 0.05) and HRQoL parameters (p < 0.05 for all parameters). In conclusion, the results did not support the effectiveness of a 10-day diabetes sports camp on PA levels and HRQoL for children with T1DM. Longer interventions may be more effective in exerting positive influence on trait parameters of children with T1DM’s quality of life. Participation in such programs on multiple occasions should be evaluated in the future.

Lifestyle and physical fitness in adolescents with type 1 diabetes and obesity

Background

The association between Type 1 Diabetes Mellitus (T1DM) and obesity (Ob) is no longer unexpected due to unhealthy lifestyle mostly in adolescents. We compared clinical-biochemical characteristics, adherence to the Mediterranean Diet (MD), lifestyle habits and physical fitness across different weight categories of T1DM adolescents from Campania Region. As second aim, we assessed the relationship among lifestyle and physical fitness in these patients.

Methods

74 adolescents (35M; 39F; 13-18 y), with T1DM diagnosed at least 6 mo before the study, were enrolled at the Regional Center for Pediatric Diabetology of Vanvitelli University of Naples. Height, weight, Body Mass Index (BMI), BMI z-score, and Clinical Biochemical health-related parameters were determined. MD adherence, physical activity (PA) amount and sedentary habits were assessed by questionnaires. Handgrip strength, 2-Min Step test (2-MST) cardiorespiratory endurance and Timed up and go test (TUG) for agility and balance were used for physical fitness evaluation.

Results

Our sample included 22 normal weight (NW), 37 overweight (OW) and 15 with Obese (Ob) adolescents. Across the three groups, adolescents showed similar Clinical-Biochemical parameters, MD adherence, PA amount, mostly walking (9.3 h/w), daily video exposure (8.5 h/d) and similar handgrip or 2-MST performance. Better performance was observed in NW compared to OW or Ob for TUG (7 vs 8 vs 9 s; p < 0.05). A positive correlation was found between TUG test and BMI, while no correlation was found between HbA1c (glycated haemoglobin) and BMI z score or 2-MST.

Conclusions

T1DM adolescents did not meet the recommendations for active lifestyle, despite a medium/good adherence to MD, in particular in NW and OW youths. Sedentary habits correlated with a poor HbA1c. Further, reduced agility and balance were observed in adolescents with obesity compared to NW participants.Future research should be aimed to examine wider samples and to design health promotion interventions for T1DM adolescents.

Association Between Physical Activity, Sedentary Behavior and Physical Fitness and Glycated Hemoglobin in Youth with Type 1 Diabetes: A Systematic Review and Meta-analysis

BACKGROUND

Scientific literature suggests poor glycemic control in youth with type 1 diabetes (T1D) and physical inactivity, sedentary behavior and low physical fitness levels, although results are not entirely consistent.

OBJECTIVE

To meta-analyze the association between glycated hemoglobin and physical activity, sedentary behavior, and physical fitness in children and adolescents with T1D.

METHODS

Our meta-analysis was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Guidelines (PRISMA). Three databases were searched for studies. All studies meeting the following criteria were included: (1) Population: children and adolescents with a mean age between 3 and 18 years diagnosed with T1D; (2) Exposition: physical activity and/or sedentary behavior and/or cardiorespiratory fitness and/or muscular fitness; (3) Outcome: glycated hemoglobin; (4) Study design: cross-sectional, longitudinal, and case-control studies. Pooled effects were calculated using a random effects inverse-variance model with the Hartung-Knapp-Sidik-Jonkman adjustment.

RESULTS

Thirty-seven studies were included, accounting for a total of 34,863 youths with T1D (51.9% girls). Twenty-nine studies evaluated physical activity, eight sedentary behavior, 14 cardiorespiratory fitness, and two muscular fitness. A negative association between physical activity (r = - 0.09, 95% CI - 0.14 to - 0.04; I² = 63.5%), cardiorespiratory fitness (r = - 0.31, 95% CI - 0.44 to - 0.19; I² = 57.0%) and glycated hemoglobin was found. Also, the association with sedentary behavior was positive (r = 0.20, 95% CI 0.04 to 0.35; I² = 92.6%). All the associations were independent of the glycated hemoglobin levels and diabetes duration.

CONCLUSIONS

Low levels of physical activity and cardiorespiratory fitness and extensive sedentary behavior may explain part of the variance in glycated hemoglobin and part of the risk for poor glycemic control in youth with T1D.

PROSPERO

Registration number: CRD42021254362.

Sex differences in body composition in youth with type 1 diabetes and its predictive value in cardiovascular disease risk assessment

BACKGROUND

Women with type 1 diabetes (T1D) are more susceptible than men to cardiovascular disease (CVD). Signs of increased risk may already appear among adolescent girls.

OBJECTIVES

We explored the contribution of body composition to the development of CVD risk factors among youth with T1D.

METHODS

One hundred and eighty nine subjects with T1D (mean age 15.3 ± 5.1 years, 55% boys) followed between January 2018-January 2022 were included in this observational study. Sociodemographic and clinical data were extracted from medical files. Body composition was measured by bioelectrical impedance analysis, and muscle-to-fat ratio (MFR) z-scores were calculated. Logistic regression model assessed the association between body composition (MFR z-scores) and evidence of CVD risk factors.

RESULTS

Females were characterised by higher median BMI z-scores (0.47 vs. 0.04, p = 0.012), higher fat and truncal fat percentage levels (p ≤ 0.001) and lower median MFR z-scores (-0.64 vs. -0.25, p ≤ 0.001), higher median triglyceride (TG) levels (71 vs. 61 mg/dl, p = 0.05), longer disease duration to initiation of insulin pump therapy (p = 0.041), and more time spent in marked hypoglycemia (1 vs. 0.2%, p = 0.007) than males. Males' MFR z-scores were associated with several diabetes-related parameters (age at diagnosis, CGM metrics, HbA1c and insulin dose), while the females'' MFR z-scores were linked to the atherogenic dyslipidemia index (TG:HDL ratio). The odds for CVD risk factors were doubled for every 1 SD decrease in MFR z-score (OR = 0.50, CI [0.30-0.84], p = 0.009) and also increased with age (OR = 1.07, CI [1.004-1.148], p = 0.038).

CONCLUSIONS

Body composition measurement has a predictive value in CVD risk assessment in youth with T1D, with unique characteristics and influences in each sex.

The Role of Exercise on Cardiometabolic Profile and Body Composition in Youth with Type 1 Diabetes

Exercise has a direct positive effect on glycemic control by promoting insulin secretion from β-pancreatic islet-cells and by increasing skeletal muscle glucose uptake. The reduction in daily insulin needs and the optimization of glycemic control improves the patient's quality of life, self-esteem, mental wellness, as well as diabetes-related mobility and mortality. The aim of this study was to investigate the effect of physical activity in children and adolescents with type-1 diabetes (T1D) on diabetic control, cardiovascular, and biochemical profiles; hs-CRP; IL6; leptin; and adiponectin levels of the population under study. This is a prospective cross-sectional study that involved 80 participants (36 boys and 44 girls) with T1D, who were aged 6-21 years and who attended the Diabetes and Metabolism Clinic of the 2nd Pediatric Department, University of Athens, "P & A Kyriakou" Children's Hospital of Athens. Twenty (25%) children were above the 75th percentile regarding total levels of physical activity, while 40 (50%) and 20 (25%) were between the 25th and 75th percentile, as well as below the 25th percentile, respectively. In the group with an intermediate level of exercise, physical activity was negatively associated with the participant's family situation (traditional, single parent, grandparent, with others, or by himself/herself) (p = 0.013), ferritin (p = 0.031), lipoprotein(a) [Lp(a)] (p = 0.016), and squared leptin levels (p = 0.040). Whereas in the groups with extreme vs. no exercise there was a negative association with the number of daily glucose measurements (p = 0.047). However, in the group with non-vigorous exercise, physical activity was positively associated with high density lipoprotein-c (HDL-c) levels (p = 0.048). The findings of this study are indicative of the beneficial role of exercise on children and adolescents with T1D, which is achieved by primarily improving their cardiometabolic profile through the amelioration of lipid profile [HDL-c, Lp(a)] and leptin levels, as well as by reducing chronic systemic inflammatory response (ferritin) and ultimately decreasing the overall diabetes morbidity.

Impact of the COVID-19 Pandemic on the Physical Activity Profile and Glycemic Control Among Qatari Adults With Type 1 Diabetes: Effect of Vaccination Status

Objective

To investigate the impact of COVID-19, as an influent barrier on physical activity (PA) patterns and glycemic control in Qatari adults with type 1 diabetes (T1D). As the COVID-19 vaccine may have a potential impact on an individual's lifestyle, we also considered this parameter.

Methods

Physical activity level, the exercise barriers (BAPAD1), anthropometric characteristics, the method of insulin administration, and the last glycated hemoglobin in % were completed by 102 Qatari adults with T1D. Moreover, all patients were asked whether they had “been vaccinated” or had a “fear of being infected by COVID-19”.

Results

For the unvaccinated group, weight, BMI and HbA1c (%) were significantly higher than those of vaccinated group (p < 0.01) and engaged in less moderate-to-vigorous PA (MVPA) (p < 0.01) per week and had less time in vigorous PA (VPA) (p < 0.01). A significant association between VPA levels and BMI (β = −0.36, p = 0.02) and HbA1C (%) (β = −0.22; p = 0.03) was reported, and “being vaccinated” was significantly associated with MVPA (β = 0.15; p = 0.021) and VPA (β = 0.28; p = 0.032). A higher “Fear of being infected by COVID-19” score was negatively correlated with reduced PA profiles (R2 = −0.71 for MVPA; R2 = −0.69 for VPA, p < 0.01, respectively).

Conclusion

Practicing VPA during the COVID-19 pandemic confer many health benefits for Qatari individual with T1D. As the “Fear of being affected by COVID-19” appeared as a potential barrier to PA practices this latter e.g. PA, could likely not be achieved without the participants being vaccinated.

Physical Fitness and Cardiovascular Risk Factors in Novel Diabetes Subgroups

CONTEXT

Physical inactivity promotes insulin resistance and increases the risk of diabetes and cardiovascular disease. Recently introduced clustering based on simple clinical measures identified diabetes subgroups (clusters) with different risks of diabetes-related comorbidities and complications.

OBJECTIVE

This study aims to determine differences in physical fitness and cardiovascular risk between diabetes subgroups and a glucose-tolerant control group (CON). We hypothesized that the severe insulin-resistant diabetes (SIRD) subgroup would be associated with lower physical fitness and increased cardiovascular risk.

METHODS

The physical fitness and cardiovascular risk of 746 participants with recent-onset diabetes (diabetes duration of < 12 months, aged 18-69 years) and 74 CONs of the German Diabetes Study (GDS), a prospective longitudinal cohort study, were analyzed. Main outcome measures included physical fitness (VO2max from spiroerogometry), endothelial function (flow- and nitroglycerin-mediated dilation), and cardiovascular risk scores (Framingham Risk Scores for Coronary Heart Disease [FRS-CHD] and Atherosclerotic CardioVascular Disease [ASCVD] risk score).

RESULTS

VO2max was lower in SIRD than in CON, severe autoimmune diabetes (SAID) (both P < .001), and mild age-related diabetes (MARD) (P < .01) subgroups, but not different compared to severe insulin-deficient diabetes (SIDD) (P = .98) and moderate obesity-related diabetes (MOD) subgroups (P = .07) after adjustment for age, sex, and body mass index. Endothelial function was similar among all groups, whereas SAID had lower FRS-CHD and ASCVD than SIRD, MOD, and MARD (all P < .001).

CONCLUSION

Despite comparable endothelial function across all groups, SIRD showed the lowest physical fitness. Of note, SAID had the lowest cardiovascular risk within the first year after diabetes diagnosis compared to the other diabetes subgroups.

Protective effects of physical activity against health risks associated with type 1 diabetes: "Health benefits outweigh the risks"

The magnitude of diabetes mellitus (DM) has increased in recent decades, where the number of cases and the proportion of the disease have been gradually increasing over the past few decades. The chronic complications of DM affect many organ systems and account for the majority of morbidity and mortality associated with the disease. The prevalence of type 1 DM (T1DM) is increasing globally, and it has a very significant burden on countries and at an individual level. T1DM is a chronic illness that requires ongoing medical care and patient self-management to prevent complications. This study aims to discuss the health benefits of physical activity (PA) in T1DM patients. The present review article was performed following a comprehensive literature search. The search was conducted using the following electronic databases: "Cochrane Library", Web of Science, PubMed, HINARI, EMBASE, Google for grey literature, Scopus, African journals Online, and Google Scholar for articles published up to June 21, 2021. The present review focused on the effects of PA on many outcomes such as blood glucose (BG) control, physical fitness, endothelial function, insulin sensitivity, well-being, the body defense system, blood lipid profile, insulin resistance, cardiovascular diseases (CVDs), insulin requirements, blood pressure (BP), and mortality. It was found that many studies recommended the use of PA for the effective management of T1DM. PA is a component of comprehensive lifestyle modifications, which is a significant approach for the management of T1DM. It provides several health benefits, such as improving BG control, physical fitness, endothelial function, insulin sensitivity, well-being, and the body defense system. Besides this, it reduces the blood lipid profile, insulin resistance, CVDs, insulin requirements, BP, and mortality. Overall, PA has significant and essential protective effects against the health risks associated with T1DM. Even though PA has several health benefits for patients with T1DM, these patients are not well engaged in PA due to barriers such as a fear of exercise-induced hypoglycemia in particular. However, several effective strategies have been identified to control exercise-induced hypoglycemia in these patients. Finally, the present review concludes that PA should be recommended for the management of patients with T1DM due to its significant health benefits and protective effects against associated health risks. It also provides suggestions for the future direction of research in this field.

Using compositional analysis to explore the relationship between physical activity and cardiovascular health in children and adolescents with and without type 1 diabetes

OBJECTIVE

The aim of this study was to use a compositional analysis approach to account for the inherent co-dependencies between behaviors and to explore how daily movement behaviors influence cardiovascular health in children with and without T1D.

RESEARCH DESIGN AND METHODS

Augmentation index, pulse wave velocity (PWV) and heart rate variability were measured in 20 children with (11.9 ± 1.6 years) and 17 children without T1D (11.6 ± 2.2 years). Subsequently, physical activity and sleep were assessed at 20 Hz for 28 consecutive days using a wrist-worn accelerometer. Compositional analyses were utilized to explore the relative effects of each movement behavior and the overall movement complex on cardiovascular parameters, with predictive modeling used to explore the effects of reallocating 20 min between behaviors.

RESULTS

Arterial stiffness markers were most influenced by the total movement composition, whereas autonomic function was most influenced by sedentary time and sleep relative to all other behaviors. Reallocation of time from moderate-to-vigorous physical activity (MVPA) to any other behavior was predicted to negatively affect all cardiovascular measures, independent of disease status, whereas reallocating time to MVPA was consistently predicted to improve all outcome measures. Additionally, the same intensity of physical activity appeared to be more potent for cardiovascular health in T1D children compared to nondiabetic peers.

CONCLUSIONS

Intensity, rather than volume, of physical activity may be key in reducing risk of premature adverse changes in cardiovascular health, whereas increasing time in MVPA could potentially the slow progression of cardiovascular aging in children with diabetes.

Influence of Insulin Application Time and High-Intensity Intermittent Exercise on Hypoglycemic Risk in Adolescents With Type 1 Diabetes

PURPOSE

The study analyzed the influence of exercise on hypoglycemia episodes postexercise and in the subsequent 24 hours in children and adolescents with type 1 diabetes.

METHODS

Thirty young people performed the same protocol of physical exercises for 1 hour (Ex1h) and 2 hours (Ex2h) after the administration of insulin. They performed 30 minutes of exercise on a cycle ergometer with a load of 60% of maximal oxygen uptake, interspersed with maximum intensity sprints lasting 10 seconds every 5 minutes.

RESULTS

Regarding the occurrence of hypoglycemia, in the 8 hours following the exercises, there was no occurrence in Ex1h (χ2 = 0.001; P = .0001) and a greater proportion for Ex2h (n = 71 episodes, 53.8%), while Ex1h had a higher number of nocturnal hypoglycemic episodes (n = 60, 71.4%) compared with Ex2h (n = 31, 23.1%, χ2 = 49.521, P = .0001), Ex1h triggered a lower number of hypoglycemia (n = 84) than Ex2h (n = 134, χ2 = 11.504, P = .001). There was a greater reduction in the average amount of fast-acting insulin administered the day after Ex1h compared with Ex2h (P = .031).

CONCLUSIONS

Intermittent exercise performed 1 hour after insulin administration shows a lower risk of hypoglycemia within 8 hours after exercise, as well as a reduction in insulin the following day.

Physical Activity Surveillance in Adolescents with Type 1 Diabetes: A Pilot Mixed-Methods Investigation

Type 1 diabetes (T1D) affects over 2,500 children in Ireland. Insulin replacement is the mainstay of treatment for T1D, and physical activity (PA) is an important, modifiable lifestyle factor for sustaining health. Surveillance of PA for both research and clinical purposes in paediatric T1D has been limited. This study deployed both quantitative (accelerometry) and qualitative (self-report) measures to assess habitual PA patterns in children with T1D. Twenty-one participants (9 females, 12 males) between 10 and 17 years (mean 13.7 ± 1.94 years) were recruited from an Outpatients Paediatric Diabetes Clinic. Total steps, standing time (minutes (mins)) and sitting time (mins) were recorded using the activPAL 3 microactivity monitor. Clinical parameters (HbA1c, insulin regimen, and weight centiles) were measured. A self-report diary was used to measure perceived activity levels. The findings of this study show that participant children with T1D are not achieving the required steps per day to sustain physical health (recommended minimum 11,500). Females (mean = 7,306 steps ± 5,468) achieved significantly less (p = 0.001) steps per day compared to males (10,806 steps ± 5,904). No significant differences were found between genders for sitting time or standing time. Overweight or obesity was identified in 44% of female participants and 15% of male participants. Mean HbA1c for both females 8.25% (67 mmol/mol) and males 7.97% (64 mmol/mol) was above the International Society for Pediatric and Adolescent Diabetes (ISPAD) recommended <7.0% (53 mmol/mol) for children. Further research is warranted to investigate PA promotion strategies in populations of children with paediatric T1D.

Integration of Consumer-Based Activity Monitors into Clinical Practice for Children with Type 1 Diabetes: A Feasibility Study

Current technology commonly utilized in diabetes care includes continuous glucose monitors (CGMs) and insulin pumps. One often overlooked critical component to the human glucose response is daily physical activity habits. Consumer-based activity monitors may be a valid way for clinics to collect physical activity data, but whether or not children with type 1 diabetes (T1D) would wear them or use the associated mobile application is unknown. Therefore, the purpose of this study was to test the feasibility of implementing a consumer-based accelerometer directly into ongoing care for adolescents managing T1D. Methods: Adolescents with T1D were invited to participate in this study and instructed to wear a mobile physical activity monitor while also completing a diet log for a minimum of 3 days. Clinical compliance was defined as the number of participants who were compliant with all measures while also having adequate glucose recordings using either a CGM, insulin pump, or on the diet log. Feasibility was defined as >50% of the total sample reaching clinical compliance. Results: A total of 57 children and teenagers between the ages of 7 and 19 agreed to participate in this study and were included in the final analysis. Chi-square results indicated significant compliance for activity tracking (p < 0.001), diet logs (p = 0.04), and overall clinical compliance (p = 0.04). Conclusion: More than half the children in this study were compliant for both activity monitoring and diet logs. This indicates that it is feasible for children with T1D to wear a consumer-based activity monitor while also recording their diet for a minimum of three days.

Sex-Related Differences in Cardiovascular Disease Risk Profile in Children and Adolescents with Type 1 Diabetes

Cardiovascular disease (CVD) is the primary cause of higher and earlier morbidity and mortality in people with type 1 diabetes (T1D) compared to people without diabetes. In addition, women with T1D are at an even higher relative risk for CVD than men. However, the underlying pathophysiology is not well understood. Atherosclerotic changes are known to progress early in life among people with T1D, yet it is less clear when excess CVD risk begins in females with T1D. This review explores the prevalence of classical CVD risk factors (such as glycemic control, hypertension, dyslipidemia, obesity, albuminuria, smoking, diet, physical inactivity), as well as of novel biomarkers (such as chronic inflammation), in children and adolescents with T1D with particular regard to sex-related differences in risk profile. We also summarize gaps where further research and clearer clinical guidance are needed to better address this issue. Considering that girls with T1D might have a more adverse CVD risk profile than boys, the early identification of and sex-specific intervention in T1D would have the potential to reduce later CVD morbidity and excess mortality in females with T1D. To conclude, based on an extensive review of the existing literature, we found a clear difference between boys and girls with T1D in the presence of individual CVD risk factors as well as in overall CVD risk profiles; the girls were on the whole more impacted.

Association between Physical Activity and Sport Participation on Hemoglobin A1c Among Children and Adolescents with Type 1 Diabetes

Purpose: To determine associations between physical activity (PA) and sport participation on HbA1c levels in children with type 1 diabetes (T1D). Method: Pediatric patients with T1D were invited to complete a PA and sport participation survey. Data were linked to their medical records for demographic characteristics, diabetes treatment and monitoring plans, and HbA1c levels. Results: Participants consisted of 71 females and 81 males, were 13 ± 3 years old with an average HbA1c level of 8.75 ± 1.81. Children accumulating 60 min of activity 3 days or more a week had significantly lower HbA1c compared to those who accumulated less than 3 days (p < 0.01) of 60 min of activity. However, there was no significant difference in HbA1c values based on sport participation groups. A multiple linear regression model indicated that PA, race, age, duration of diagnosis, and CGM use all significantly predicted HbA1c (p < 0.05). Conclusion: This study demonstrated the significant relationship between daily PA and HbA1c. Those in this sample presented with lower HbA1c values even if accumulating less than the recommended number of days of activity. Further, it was shown that sport participation alone may not be adequate enough to impact HbA1c in a similar manner.

Maximal Fat Oxidation During Exercise Is Already Impaired in Pre-pubescent Children With Type 1 Diabetes Mellitus

Objective: We evaluated substrate utilization during submaximal exercise, together with glycemic responses and hormonal counter-regulation to exercise, in children with type 1 diabetes mellitus (T1DM).

Methods: Twelve pre-pubescent children with T1DM and 12 healthy children were matched by sex and age. Participants completed a submaximal incremental exercise test to determine their fat and carbohydrate oxidation rates by indirect calorimetry. Levels of glycemia, glucagon, cortisol, growth hormone, noradrenaline, adrenaline, and insulin were monitored until 120 min post-exercise.

Results: Absolute peak oxygen uptake (VO₂ peak) was significantly lower in the children with T1DM than in the healthy controls (1131.4 ± 102.5 vs. 1383.0 ± 316.6 ml.min⁻¹, p = 0.03). Overall carbohydrate and lipid oxidation rates were the same in the two groups, but for exercise intensities, higher than 50% of VO₂ peak, fat oxidation rate was significantly lower in the children with T1DM. The absolute maximal lipid oxidation rate was significantly lower in the T1DM children (158.1 ± 31.6 vs. 205.4 ± 42.1 mg.min⁻¹, p = 0.005), and they reached a significantly lower exercise power than the healthy controls (26.4 ± 1.2 vs. 35.4 ± 3.3 W, p = 0.03). Blood glucose responses to exercise were negatively correlated with pre-exercise blood glucose concentrations (r = −0.67; p = 0.03).

Conclusion: Metabolic and hormonal responses during sub-maximal exercise are impaired in young children with T1DM.

Association between physical activity level and cardiovascular risk factors in adolescents living with type 1 diabetes mellitus: a cross-sectional study

BACKGROUND

Type 1 diabetes mellitus (T1DM) is associated with an increased risk for cardiovascular disease (CVD) related morbidity and premature mortality. Regular physical activity plays an important role in the primary and secondary prevention of CVD, improving overall health and wellbeing. Previous observational studies have examined the associations between self-reported physical activity and CVD risk factors in largely adult Caucasian populations. However, limited work has evaluated the relationship between objectively measured physical activity and CVD risk factors in other ethnicities, particularly Chinese youth living with T1DM.

METHODS

This cross-sectional study assessed CVD risk factors, physical activity, and aerobic fitness (and their associations) in Chinese youth living with T1DM (n = 48) and peers (n = 19) without T1DM. Primary outcomes included blood pressure, lipid profiles, and physical activity (accelerometry). Statistical differences between groups were determined with chi-square, independent-samples t-tests, or analysis of covariance. The associations between aerobic fitness, daily physical activity variables, and CVD risk factors were assessed with univariate and multivariate linear regression analyses.

RESULTS

Results were summarized using means and standard deviation (SD) for normally distributed variables and medians and 25-75th quartile for non-normally distributed variables. In comparison to peers without diabetes, youth living with T1DM showed higher levels of total cholesterol (3.14 ± 0.67 vs. 4.03 ± 0.81 mmol·L-1, p = 0.001), low-density lipoprotein cholesterol (1.74 ± 0.38 vs. 2.31 ± 0.72 mmol·L-1, p = 0.005), and triglycerides (0.60 ± 0.40 vs. 0.89 ± 0.31 mmol·L-1 p = 0.012), and lower maximal oxygen power (44.43 ± 8.29 vs. 35.48 ± 8.72 mL·kg-1·min-1, p = 0.003), total physical activity counts (451.01 ± 133.52 vs. 346.87 ± 101.97 counts·min-1, p = 0.004), metabolic equivalents (METs) (2.41 ± 0.60 vs. 2.09 ± 0.41 METs, p = 0.033), moderate-to-vigorous intensity physical activity [MVPA: 89.57 (61.00-124.14) vs (53.19 (35.68-63.16) min, p = 0.001], and the percentage of time spent in MVPA [11.91 (7.74-16.22) vs 8.56 (6.18-10.12) %, p = 0.038]. The level of high-density lipoprotein cholesterol was positively associated with METs (β = 0.29, p = 0.030, model R2 = 0.168), and the level of triglycerides was negatively associated with physical activity counts (β = - 0.001, p = 0.018, model R2 = 0.205) and METs (β = - 0.359, p = 0.015, model R2 = 0.208), and positively associated with time spent in sedentary behaviour (β = 0.002, p = 0.041, model R2 = 0.156) in persons living with T1DM.

CONCLUSIONS

Chinese youth with T1DM, despite their young age and short duration of diabetes, present early signs of CVD risk, as well as low physical activity levels and cardiorespiratory fitness compared to apparently healthy peers without diabetes. Regular physical activity is associated with a beneficial cardiovascular profile in T1DM, including improvements in lipid profile. Thus, physical activity participation should be widely promoted in youth living with T1DM.

NDUFB6 Polymorphism Is Associated With Physical Activity-Mediated Metabolic Changes in Type 2 Diabetes

The rs540467 SNP in the NDUFB6 gene, encoding a mitochondrial complex I subunit, has been shown to modulate adaptations to exercise training. Interaction effects with diabetes mellitus remain unclear. We assessed associations of habitual physical activity (PA) levels with metabolic variables and examined a possible modifying effect of the rs540467 SNP. Volunteers with type 2 (n=242), type 1 diabetes (n=250) or normal glucose tolerance (control; n=139) were studied at diagnosis and subgroups with type 1 (n=96) and type 2 diabetes (n=95) after 5 years. Insulin sensitivity was measured by hyperinsulinemic-euglycemic clamps, oxygen uptake at the ventilator threshold (VO₂AT) by spiroergometry and PA by questionnaires. Translational studies investigated insulin signaling and mitochondrial function in Ndufb6 siRNA-treated C2C12 myotubes, with electronic pulse stimulation (EPS) to simulate exercising. PA levels were 10 and 6%, VO₂AT was 31% and 8% lower in type 2 and type 1 diabetes compared to control. Within 5 years, 36% of people with type 2 diabetes did not improve their insulin sensitivity despite increasing PA levels. The NDUFB6 rs540467 SNP modifies PA-mediated changes in insulin sensitivity, body composition and liver fat estimates in type 2 diabetes. Silencing Ndufb6 in myotubes reduced mitochondrial respiration and prevented rescue from palmitate-induced insulin resistance after EPS. A substantial proportion of humans with type 2 diabetes fails to respond to rising PA with increasing insulin sensitivity. This may at least partly relate to a polymorphism of the NDUFB6 gene, which may contribute to modulating mitochondrial function.

CLINICAL TRIAL REGISTRATION

ClinicalTrials.gov, identifier NCT01055093. The trial was retrospectively registered on 25^th of January 2010.

Vigorous Physical Activity Is Associated With Better Glycated Hemoglobin and Lower Fear of Hypoglycemia Scores in Youth With Type 1 Diabetes: A 2-Year Follow-Up Study

To correlate glycated hemoglobin (HbA1c) and fear of hypoglycemia scores with physical activity (PA) levels in children and adolescents with type 1 diabetes (T1D) over a period of 2 years. Twenty-eight children and 33 adolescents with T1D have been assessed for their PA profile. Personal and medical data for the patients were collected at baseline (visit 0: V0), 1 year later (V1), and 2 years later (V2). At baseline, children with T1D engaged in less moderate to vigorous PA (MVPA) (p < 0.01) per day than adolescents. These results did not differ across visits. On the contrary, adolescents spent fewer time in vigorous physical activity (VPA) (p < 0.01) than children did (p < 0.01). Fear of hypoglycemia scores correlated significantly with VPA levels (β = −0.41, p = 0.03; β = −0.44, p = 0.06; β = −0.61, p = 0.001). For HbA1c (%), significant correlations were reported with VPA levels (β = −0.54, p = 0.02; β = −0.47, p = 0.03; β = −0.62, p = 0.01) across visits. Body mass index percentile correlated with total screen time (β = 0.28, p = 0.02; β = 0.29, p = 0.01; β = 0.31, p = 0.04) and overall PA levels (β = −0.52, p = 0.02; β = −0.42, p = 0.03; β = −0.42, p = 0.01). Performing more vigorous PA a day is associated with better HbA1c with lower perceived fear of hypoglycemia among youth with T1D. Therefore, dedicating more time in VPA may be an appropriate advice for patients with T1D.

Heart Rate Variability and Cardiorespiratory Fitness in Non-Hispanic Black Versus Non-Hispanic White Adolescents With Type 1 Diabetes

BACKGROUND

Evidence indicates that fewer non-Hispanic black versus non-Hispanic white youths with type 1 diabetes are meeting treatment goals for optimal glycemic outcomes, predisposing them to risks for cardiovascular (CV) morbidity and mortality in adulthood.

PURPOSE

We sought to assess the association of sex and race with heart rate variability (HRV) and cardiorespiratory fitness in adolescents with type 1 diabetes. The association between the HRV and cardiorespiratory outcomes with glucose control was also examined.

METHODS

A secondary data analysis of 95 adolescents with type 1 diabetes (n = 66 non-Hispanic white n = 29 non-Hispanic black) was used. Using 24-hour Holter recordings, spectral and time domain measures of HRV were obtained. Cardiorespiratory fitness using a graded exercise test was completed. Descriptive statistics and Pearson correlation coefficients were used to assess associations between glucose control and study outcomes, and general linear models were applied to explore and quantify associations of sex and race with HRV and cardiorespiratory fitness.

RESULTS

Body mass index (mean [standard deviation]) was similar between non-Hispanic black (23.5 [3.9]) and non-Hispanic white (22.7 [3.8]) adolescents. Females and non-Hispanic black adolescents had significantly lower HRV and cardiorespiratory fitness levels. Moderate associations were found between lower HRV and poorer glycemic control (HbA1c). Recent HbA1c was significantly higher in non-Hispanic black (9.7 [1.8]) than non-Hispanic white (8.2 [1.2]).

CONCLUSION

Findings support the importance of early identification of CV health risks in adolescents with type 1 diabetes, particularly for non-Hispanic black adolescents. Interventions focused on overall improvement in glycemic control for adolescents with type 1 diabetes are a priority for minimizing future CV complications.

Strategies That Adolescents With Type 1 Diabetes Use in Relation to Exercise

Physical activity is an important element of type 1 diabetes management, and hypoglycemia is a known risk. There are few data on strategies adolescents use to mitigate this risk. We surveyed 66 adolescents with type 1 diabetes who were 12-18 years of age about blood glucose monitoring, carbohydrate intake, and insulin management before, during, and after exercise. The adolescents completed the International Physical Activity Questionnaire-Short Form and the Children's Hypoglycemia Fear Survey. We found that adolescents with type 1 diabetes do not generally follow guidelines about glucose monitoring or about food and insulin adjustment around exercise. More targeted education and interventions are needed to improve adolescents' uptake of recommended behaviors and improve outcomes.

A qualitative synthesis of the perceived factors that affect participation in physical activity among children and adolescents with type 1 diabetes

AIMS

To explore the qualitative literature on the perceived factors, positive and negative, affecting participation by children and adolescents with type 1 diabetes in physical activity, from the perspective of children and adolescents with type 1 diabetes, their family members, teachers or sports coaches, and healthcare professionals.

METHODS

MEDLINE, SPORTDiscus, PsycINFO, CINAHL and Scopus were systematically searched in July 2019. Eligible studies included any that reported qualitative findings on the perceived factors that affect participation in physical activity from either the perspective of children or adolescents with type 1 diabetes, their family members, teachers or coaches, and healthcare professionals.

RESULTS

The literature search yielded a total of 7859 studies, of which 14 (13 qualitative studies and one mixed-methods study) met the review inclusion criteria. In total there were 12 unique populations containing 270 individuals, 105 children or adolescents with type 1 diabetes,108 family members, 37 teachers and 20 healthcare professionals. The main factors thought to influence physical activity for this population were the individual characteristics of children and adolescents, the requirement for self-blood glucose regulation, support systems including friends, family, teachers and professionals, education and knowledge, and communication.

CONCLUSIONS

This review synthesizes views on the perceived factors from several different perspectives. The findings suggest that it is important to consider the needs of the wider support network, as well as the child's or adolescent's concerns and preferences, when developing new or existing strategies and programmes to promote physical activity in children and adolescents with type 1 diabetes.

Identifying sources of support and barriers to physical activity in pediatric type 1 diabetes

OBJECTIVES

Reports suggest that children with type 1 diabetes (T1D) perform less than the recommended daily activity and are less active than their non-diabetic peers. We aimed to: (a) Identify barriers and sources of support for exercise performance in pediatric T1D. (b) Identify strengths and limitations in the exercise-directed education provided by our diabetes team.

METHODS

Patients with T1D 5 to 20 years of age were recruited while attending a routine clinic visit. Participants completed a set of questionnaires assessing demographics, health data, barriers, and sources of support for exercise performance and diabetes related exercise education. The clinics' medical staff filled-out a questionnaire assessing the exercise-directed education provided in clinic.

RESULTS

Ninety-six subjects were included in this study, mean age 13.7 ± 3.8 years. Median weekly reported exercise time was 3.5 hours. The two most prevalent barriers were fear of hypoglycemia and low fitness, reported by 76% and 51%, respectively. Mean family and social support scores were 4.1 ± 0.7 and 3.3 ± 1.1, respectively (1-5 scale); the latter correlated with the amount of activity performed (cc = 0.360; P < .001). The majority of participants (97%) reported receiving guidance for physical activity, to their satisfaction. Yet, knowledge and implementation were suboptimal. All staff members reported conducting routine exercise-directed teaching, with variations in frequency and content.

CONCLUSIONS

Our findings suggest that in order to increase the amount of safely performed exercise in pediatric patients with T1D, fear of hypoglycemia must be addressed. Further efforts should focus on: (a) encouraging active family and social involvement (b) standardization of education.

Exercise and Type 1 Diabetes

Diabetes mellitus (DM) is the most common endocrine and metabolic disease caused by absolute or insufficient insulin secretion. Under the context of an aging population worldwide, the number of diabetic patients is increasing year by year. Most patients with diabetes have multiple complications that severely threaten their survival and living quality. DM is mainly divided into type 1 diabetes mellitus (T1DM) and type 2 diabetes mellitus (T2DM). T1DM is caused by absolute lack of insulin secretion, so the current treatment for T1DM patients is exogenous insulin replacement therapy. At present, exercise therapy has been widely recognized in the prevention and treatment of diabetes, and regular aerobic exercise has become an important part of T1DM treatment. At the same time, exercise therapy is also used in conjunction with other treatments in the prevention and treatment of diabetic complications. However, for patients with T1DM, exercise still has the risk of hypoglycemia or hyperglycemia. T1DM Patients and specialist physician need to fully understand the effects of exercise on metabolism and implement individualized exercise programs. This chapter reviews the related content of exercise and T1DM.

Muscle and bone parameters in underprivileged Indian children and adolescents with T1DM

BACKGROUND

The incidence of Type 1 diabetes mellitus (T1DM) is increasing and sarcopenia and osteoporosis have been reported to be associated with long standing diabetes. There is scarcity of data on bone health status of children with T1DM. Our aim was to assess bone health parameters [by Dual energy X-ray absorptiometry (DXA) and peripheral quantitative computed tomography (pQCT)] and muscle strength (by hand grip) in underprivileged Indian children with T1DM.

MATERIAL AND METHODS

A cross sectional, observational study was conducted in underprivileged children with diabetes attending the out patient clinic for T1DM at a tertiary care hospital. Children with T1DM with disease duration more than 1 year were included in the study. Age and gender matched controls were also enrolled. Data on age, gender, disease duration, anthropometric parameters and HbA1c were collected. Bone mineral density (BMD) was assessed by dual energy X-ray absorptiometry (Lunar iDXA) and peripheral quantitative computed tomography (pQCT, Stratec XCT 2000) and muscle strength by handgrip. Data were analysed using SPSS 25.0.

RESULTS

251 children with T1DM and 250 age gender matched controls were studied. Mean age of T1DM children was 10.8 ± 4.3yrs (controls 10.3 ± 3.6). Mean HbA1C was 9.7 ± 2.1%. The total body less head areal BMD (TBLH aBMD) and lumbar spine bone mineral apparent density (LSBMAD) Z-scores were significantly lower in children with T1DM (-1.5 ± 1.3, -1.3 ± 1.6 respectively) as compared to controls (-0.5 ± 1.3, -0.64 ± 1.5 respectively) (p < 0.05 for both). Z-scores for trabecular and total density (vBMD) were significantly lower in patients with T1DM (-0.7 ± 1.0, -0.7 ± 1.0 respectively) than controls (-0.15 ± 1.2, -0.31 ± 1.1), (p <  0.05) and trabecular density was lower at distal radius with increasing disease duration. Hand-grip strength Z-score was lower in children with T1DM (-3.0 ± 0.5) as compared to controls (-2.8 ± 0.5). Trabecular density and HbA1C concentrations were negatively correlated (R = -0.18, p < 0.05) as was muscle area and HbA1C concentrations (R = -0.17, p < 0.05,).

CONCLUSION

Bone and muscle health were affected in children with poorly controlled T1DM. With increasing disease duration, attention is required for optimising musculoskeletal health.

Young children, adolescent girls and women with type 1 diabetes are more overweight and obese than reference populations, and this is associated with increased cardiovascular risk factors

AIM

Overweight and obesity are frequently reported in young persons with type 1 diabetes, however its relative magnitude in comparison to the general population is not well understood. This study compared the prevalence of overweight and obesity in young persons with type 1 diabetes to a reference population and explored possible associated factors, including gender, age, HbA_1c , insulin regimen, age at diagnosis, diabetes duration, socio-economic status and cardiovascular disease risk factors.

METHODS

A cross-sectional review was undertaken of data collected from youth (3-17 years) in 2016 and young adults (18-30 years) in 2015 with a diagnosis of type 1 diabetes for > 3 months attending diabetes centres in Newcastle, Australia. Rates of overweight and obesity were compared with matched population survey results.

RESULTS

Data from 308 youth and 283 young adults were included. In girls, significantly higher prevalence of overweight and obesity were seen in the 5-8 (43% vs. 18%), 13-16 (41% vs. 27%), 18-24 (46% vs. 34%) and 25-30 (60% vs. 43%) years age groups; whereas in boys increased prevalence was observed in the 5-8 years age group only (41% vs. 18%). Rates of overweight and obesity increased with age across sexes. In youth, BMI standard deviation score was correlated with socio-economic status, insulin regimen, blood pressure and blood lipids (P < 0.05). In adults, BMI was positively associated with blood pressure, and longer diabetes duration (P < 0.02).

CONCLUSIONS

Overweight and obesity are over-represented in young persons with type 1 diabetes, particularly girls. As overweight is associated with other cardiovascular disease markers early intervention is paramount.

Levels of Physical Activity in Children and Adolescents with Type 1 Diabetes in Relation to the Healthy Comparators and to the Method of Insulin Therapy Used

Given the fact that physical exertion leads to blood glucose fluctuations, type one diabetes mellitus (T1D) may potentially constitute a barrier for obtaining a sufficient amount of exercise. The main purpose of the study was to compare the level of physical activity between children with T1D (n = 215) and healthy controls (n = 115) and to assess the physical activity of the study group in relation to the applied method of insulin therapy, i.e., the use of insulin pen vs. insulin pump. The level of physical activity was assessed with a hip-worn tri-axial accelerometer (ActiGraph GT3X+) used by the subjects for an uninterrupted period of seven days. Children with T1D had significantly lower median values of total time of moderate (213.3 vs. 272.1 min), vigorous (135.3 vs. 19.6 min) and moderate-to-vigorous (347.4 vs. 467.4 min) physical activity compared to healthy peers respectively, (p < 0.001) in all cases. In addition, the total median number of steps was significantly lower (53,631 vs. 67,542 steps), (p < 0.001). The method of insulin therapy was not associated with significant differences in physical activity level (p > 0.001). The level of physical activity in children and adolescents with T1D is lower than in their healthy peers and does not depend on the insulin therapy method.

Patterns of Physical Activity Adherence by Adolescents With Diabetes or Obesity Enrolled in a Personalized Community-Based Intervention

PURPOSE

The purpose of this study was to determine the feasibility of a personalized, 16-week community-based physical activity intervention for adolescents with diabetes or obesity and examine the weekly patterns of adherence to the intervention.

METHODS

Physical activity adherence was evaluated throughout the intervention using accelerometers in 46 adolescents with type 1 diabetes (N = 22), type 2 diabetes (N = 12), or obesity (N = 12) (age, 14.4 ± 1.5 years; 56.5% female; 61% Hispanic). Of these, 39 completed the intervention, and 7 did not.

RESULTS

There were no differences in baseline anthropometric characteristics or fitness between the completers versus noncompleters. Completers began above 1060 metabolic equivalent (MET) min/wk-1and stayed above 900 MET min/wk-1 for ~4 weeks and declined 39 MET min/wk-1 until end of study. Noncompleters began at 924 MET min/wk-1 yet dropped below 800 MET min/wk-1 by end of week 1 and declined an average of 151 MET min/wk-1. Interestingly, self-report of barriers to activity were higher in completers versus noncompleters.

CONCLUSIONS

Findings highlight that adolescents completing the intervention could sustain a prescribed level of personalized activity for at least 1 month but had steadfast declines in weekly activity. Even with individualized programs, factors other than barriers to activity need to be considered when designing approaches to physical activity adherence for adolescents with diabetes or obesity.

Disordered eating behaviors in adolescents with type 1 diabetes: A cross-sectional population-based study in Italy

OBJECTIVE

To evaluate the association of clinical, metabolic and socioeconomic factors with disordered eating behaviors (DEB) among adolescents with type 1 diabetes screened using the Diabetes Eating Problem Survey-Revised (DEPS-R).

METHODS

A cross-sectional, population-based study involved 163 adolescents with type 1 diabetes, aged 11-20 years, recruited from the registry for type 1 diabetes of Marche Region, Italy, who completed the DEPS-R (response rate 74.4%). Clinical characteristics, lipid profile, HbA_1c , family profile of education and occupation were evaluated. The Italian version of DEPS-R was validated, and the prevalence of DEB estimated. The association of demographic, socioeconomic, and clinical factors with DEB was evaluated by multiple correspondence analysis and multiple logistic regression.

RESULTS

The prevalence of DEPS-R-positive (score ≥20) was 27% (95% CI 17-38) in boys and 42% (95% CI 31-53) in girls. A clinical profile of DEPS-R-positive was identified: overweight, little time spent in physical activity, low socioeconomic status, poor metabolic control, skipping insulin injections. Furthermore, the probability of DEPS-R-positive increased 63% for every added unit of HbA_1c , 36% for every added number of insulin injections skipped in a week and decreased about 20% for every added hour/week spent in physical activity. Overweight youth were six times more likely to be DEPS-R-positive.

DISCUSSION

A specific clinical profile of DEPS-R-positive was identified. A multidisciplinary clinical approach aimed to normalize eating behaviors and enhance self-esteem should be used to prevent the onset of these behaviors, and continuous educational programs are needed to promote healthy behaviors and lifestyles.

Feasibility and pilot study of an intervention to support active lifestyles in youth with type 1 diabetes: The ActivPals study

BACKGROUND

Evidence suggests youth with type 1 diabetes (T1D) have lower levels of physical activity (PA) than the general population. The ActivPals intervention aimed to support youth with T1D to lead an active lifestyle.

METHODS

Twenty youth aged 7 to 16 years with T1D were recruited to a pilot randomized controlled trial. PA and quality of life (QoL) were measured using Actigraph GT3X+ monitor and Pediatric QoL scales at baseline and 1-month follow-up. A two-way, mixed ANOVA showed indicative effects of the intervention. Qualitative interviews were carried out with 16 participants to explore perceptions of the intervention.

RESULTS

An increase in moderate to vigorous PA was reported in intervention and control groups from baseline to follow-up (F(1, 14) = 5.83; P = .03), with no significance between group differences. Participants in both groups reported significantly less overall diabetes "problems" (F(1, 16) = 7.93; P = .012) and significantly less lifestyle "problems" (F(1, 16) = 7.39; P = .015) at follow-up. However, both groups also reported significant increases in "problems" with the day-to-day diabetes routine (F(1,16) = 6.48; P = .022) at follow-up. Parents reported significant increased worry about their child's diabetes at follow-up, in both groups (F(1, 14) = 5.83; P = .046). There was no significant increase in reported hypoglycemic occurrences despite increased PA. The qualitative data highlight that goal setting, self-monitoring, and social support were effective motivators for increasing PA.

CONCLUSIONS

A larger trial with longer follow-up should be conducted to explore the effect of the intervention on PA in youth with T1D.

Unhealthy lifestyle habits and diabetes-specific health-related quality of life in youths with type 1 diabetes

AIMS

Management of type 1 diabetes mellitus (T1DM) influences several aspects of life, such as adherence to healthy lifestyle habits and health-related quality of life (HRQoL). Our aim was to evaluate the association between unhealthy lifestyle habits and HRQoL in adolescents and young adults with T1DM.

METHODS

Two hundred and forty-two Caucasian patients (13-19 years) consecutively enrolled over a 12-month period in three Regional Pediatric Diabetes Centers in Italy. Demographics, clinical, and laboratory parameters, adherence to lifestyle habits (Mediterranean Diet assessed by KIDMED, Physical Activity levels and sedentary behavior by questionnaire) considered either separately or in cluster, and HRQoL by Pediatric Quality of Life Inventory Diabetes Module (PedsQL 3.0 DM) were collected. Metabolic control was determined by HbA1c_mean of previous year.

RESULTS

Only 15 (6.2%) patients fulfilled the cluster of three healthy lifestyle habits without gender differences (p = 0.353); 62 (25.6%) had 1 unhealthy lifestyle habit, and 165 (68.2%) had ≥2. Adolescents meeting physical activity recommendations had better PedsQL scores than those who did not meet. PedsQL total score and specific sub-scales decreased in patients with unhealthy lifestyle habits. High PedsQL was significantly associated with being male, living in South Italy, having lower HbA1c mean levels, and reporting lower adherence to unhealthy lifestyle habits.

CONCLUSIONS

The clustering of unhealthy lifestyle habits is associated with reduced HRQoL in adolescents and young adults with T1DM. Promoting multiple behavior changes may be a useful approach to improve the health status and the HRQoL in youths with T1DM.

Reproducibility of the plasma glucose response to moderate-intensity exercise in adolescents with Type 1 diabetes

AIMS

The aim of the study was to evaluate the reproducibility of the plasma glucose response to moderate-intensity exercise performed on different days under controlled conditions in adolescents with Type 1 diabetes.

METHODS

Eight adolescents with Type 1 diabetes on continuous subcutaneous insulin infusion completed two exercise sessions, each on two separate days, under basal insulin and fasting conditions. On each day, participants cycled twice for 30 min at 55% of their peak rate of oxygen consumption, with each exercise session separated by a 30-min rest.

RESULTS

Plasma insulin levels were similar between testing days and exercise sessions. The mean absolute drop in plasma glucose from the commencement to the end of exercise was 1.6 ± 0.5 mmol/l on day 1 and 1.9 ± 0.7 mmol/l on day 2 (P = 0.3). In response to the first exercise session, plasma glucose levels relative to baseline did not change significantly (0.2 ± 0.6 and -0.2 ± 0.5 mmol/l on days 1 and 2). By contrast, the change in plasma glucose during the second exercise session was -1.1 ± 0.7 and -1.3 ± 0.7mmol/l on days 1 and 2, respectively. The mean absolute intra-individual difference in the change in plasma glucose between testing days were 0.7 ± 0.5 [95% confidence interval (CI) 0.4-1.0] and 0.7 ± 0.4 (95% CI 0.4-1.0) mmol/l, at the end of the first and second exercise sessions respectively.

CONCLUSIONS

The plasma glucose response to moderate-intensity exercise under similar glycaemic and basal insulin conditions can be reproducible in adolescents with Type 1 diabetes.

Environmental Factors Promoting Neural Plasticity: Insights from Animal and Human Studies

We do not all grow older in the same way. Some individuals have a cognitive decline earlier and faster than others who are older in years but cerebrally younger. This is particularly easy to verify in people who have maintained regular physical activity and healthy and cognitively stimulating lifestyle and even in the clinical field. There are patients with advanced neurodegeneration, such as Alzheimer's disease (AD), that, despite this, have mild cognitive impairment. What determines this interindividual difference? Certainly, it cannot be the result of only genetic factors. We are made in a certain manner and what we do acts on our brain. In fact, our genetic basis can be modulated, modified, and changed by our experiences such as education and life events; daily, by sleep schedules and habits; or also by dietary elements. And this can be seen as true even if our experiences are indirectly driven by our genetic basis. In this paper, we will review some current scientific research on how our experiences are able to modulate the structural organization of the brain and how a healthy lifestyle (regular physical activity, correct sleep hygiene, and healthy diet) appears to positively affect cognitive reserve.

Physical activity and sedentary behavior levels in children and adolescents with type 1 diabetes using insulin pump or injection therapy - The importance of parental activity profile

In children and adolescents, treatments for type 1 diabetes (T1D) have recently evolved with the introduction of the insulin pump. However, little is known about how a pump is associated with physical activity (PA) patterns. The goal of the study was to examine the activity profile of Canadian children and adolescents with T1D according to their insulin treatment (pump vs. injections), as well as barriers to exercise and parental lifestyle habits. A self-administered questionnaire was completed by 188 subjects with T1D aged 6 to 17 and their parents at the endocrinology clinic of Sainte-Justine's University Hospital Center (Montreal, Canada). Sixty percent of patients used an insulin pump. There were no significant differences in any components of the PA profile, sedentary habits, and exercise barriers between subjects using injections and those using a pump. Fear of hypoglycemia was the main PA barrier in both treatment groups. A more diverse PA practice by parents was associated with more moderate-to-vigorous PA and less screen time in adolescents. In conclusion, type of treatment was not associated with more activity in pediatric patients with T1D and a varied parental PA profile was the main factor of interest for healthier habits in adolescents with T1D.

Development and feasibility testing of an intervention to support active lifestyles in youths with type 1 diabetes-the ActivPals programme: a study protocol

Background

The global incidence of type 1 diabetes is rising, and youths with type 1 diabetes continue to suffer poorer health than peers without diabetes. Evidence suggests youths with type 1 diabetes have physical activity (PA) levels well below the recommendations for health and have high levels of sedentary behaviour. An active lifestyle is therefore recommended to improve health. There is limited research showing effective lifestyle behaviour change in this population; therefore, an evidence gap exists between the need to promote physical activity in type 1 diabetes care and lack of understanding on how to do this. This protocol paper describes a feasibility and pilot study of the ActivPals programme—an intervention to support active lifestyles in youths with type 1 diabetes.

Methods/design

Key intervention components have been identified from preliminary work (individual and family focus, peer mentoring, technology integration and improved communication and understanding) and are being developed into a pragmatic randomised controlled trial (RCT) supported by recruitment pathways. A steering group of health care professionals and managers will refine the intervention to patient needs. A pilot trial is providing data on intervention implementation, acceptability and feasibility. Twenty youths with type 1 diabetes are being recruited and randomised into an intervention or control group. Physical activity is being measured objectively using the Actigraph GT3X+ monitor at baseline and 1-month follow-up. Contextual factors associated with intervention delivery are being explored.

Discussion

This study will contribute to the development of evidence-based, user-informed and pragmatic interventions leading to healthier lifestyles in youths with type 1 diabetes.

Assessment of habitual physical activity in adolescents with type 1 diabetes

OBJECTIVE

To evaluate habitual physical activity in a cohort of adolescents with type 1 diabetes in relation to similarly aged control subjects.

METHODS

A cross-sectional case control study of 54 healthy adolescents and 66 patients with type 1 diabetes, 14 to 18 years of age, was conducted. Subjects were surveyed using the Habitual Activity Estimation Scale, a validated self-report instrument to assess activity levels in teens. Subjects' time was classified into categories ranging from inactive (lying down, resting) to very active (increased heart rate and diaphoresis). Active time, described in relative (%) and absolute hours per day was determined for each individual. Age, sex, weight, height and body mass index were recorded for all participants, and the charts of subjects with type 1 diabetes were reviewed for most recent levels of glycated hemoglobin, low-density lipoproteins, high-density lipoproteins, total cholesterol, triglycerides and blood pressure. A regression analysis was performed to determine factors associated with hours spent being active.

RESULTS

Subjects with type 1 diabetes spent similar hours being very active (3.4 hours vs. 3.5 hours, p=0.49) but reported more time being inactive than controls (2.0 hours vs. 1.3 hours, p=0.002). In both groups, female gender was associated with more hours spent being active. Metabolic control as assessed by glycated hemoglobin worsened with activity. In the group with type 1 diabetes, more hours spent being active were associated with lower systolic blood pressure, lower serum triglyceride levels, lower total cholesterol and higher high-density lipoproteins, whereas inactivity correlated with higher low-density lipoproteins and total cholesterol.

CONCLUSIONS

Adolescents with type 1 diabetes reported significantly more time being inactive than did healthy controls. In patients with type 1 diabetes, activity was associated with improved cardiovascular risk profile.

Current perspectives on physical activity and exercise for youth with diabetes

Regular physical activity (PA) for youth with diabetes improves cardiorespiratory fitness, body composition, bone health, insulin sensitivity, and psychosocial well-being. However many youth with diabetes or pre-diabetes fail to meet minimum PA guidelines and a large percentage of youth with diabetes are overweight or obese. Active youth with type 1 diabetes tend to have lower HbA1c levels and reduced insulin needs, whereas activity in adolescents at-risk for type 2 diabetes improves various measures of metabolism and body composition. Insulin and nutrient adjustments for exercise in type 1 diabetes is complex because of varied responses to exercise type and because of the different times of day that exercise is performed. This review highlights the benefits of exercise and the established barriers to exercise participation in the pediatric diabetes population. A new exercise management algorithm for insulin and carbohydrate intake strategies for active youth with type 1 diabetes is presented.

Effect of aerobic and anaerobic exercises on glycemic control in type 1 diabetic youths

AIM: To evaluate the long-term effect of aerobic and/or anaerobic exercise on glycemic control in youths with type 1 diabetes.

METHODS: Literature review was performed in spring and summer 2014 using PubMed/MEDLINE, Google Scholar, Scopus, and ScienceDirect with the following terms: aerobic, anaerobic, high-intensity, resistance, exercise/training, combined with glycemic/metabolic control, glycated haemoglobin A1c (HbA1c) and type 1 diabetes. Only peer-reviewed articles in English were included published in the last 15 years. It was selected from 1999 to 2014. Glycemic control was measured with HbA1c. Studies with an intervention lasting at least 12 wk were included if the HbA1c was measured before and after the intervention.

RESULTS: A total of nine articles were found, and they were published between the years of 2002-2011. The sample size was 401 diabetic youths (166 males and 235 females) with an age range of 10-19 years except one study, in which the age range was 13-30 years. Study participants were from Australia, Tunisia, Lithuania, Taiwan, Turkey, Brazilia, Belgium, Egypt and France. Four studies were aerobic-based, four were combined aerobic and anaerobic programs, and one compared aerobic exercise to anaerobic one. Available studies had insufficient evidence that any type of exercise or combined training would clearly improve the glycemic control in type 1 diabetic youth. Only three (two aerobic-based and one combined) studies could provide a significant positive change in glycemic control.

CONCLUSION: The regular physical exercise has several other valuable physiological and health benefits that justify the inclusion of exercise in pediatric diabetes treatment and care.

Fitness and physical activity in youth with type 1 diabetes mellitus in good or poor glycemic control

BACKGROUND

Patients with type 1 diabetes mellitus (T1DM) may experience poor muscle health as a result of chronic hyperglycemia. Despite this, muscle function in children with T1DM with good or poor glycemic control has yet to be examined in detail.

OBJECTIVE

To assess differences in muscle-related fitness variables in children with T1DM with good glycemic control (T1DM-G), as well as those with poor glycemic control (T1DM-P), and non-diabetic, healthy controls.

SUBJECTS

Eight children with T1DM-G [glycosylated hemoglobin (HbA1c) ≤ 7.5% for 9 months], eight children with T1DM-P (HbA1c ≥ 9.0% for 9 months), and eight healthy controls completed one exercise session.

METHODS

Anaerobic and aerobic muscle functions were assessed with a maximal isometric grip strength test, a Wingate test, and an incremental continuous cycling test until exhaustion. Blood samples were collected at rest to determine HbA1c at the time of testing. Physical activity was monitored over 7 d using accelerometry.

RESULTS

Children with T1DM-P displayed lower peak oxygen consumption (VO2peak ) values (mL/kg/min) compared to healthy controls (T1DM-P: 33.2 ± 5.6, controls: 43.5 ± 6.3, p < 0.01), while T1DM-G (43.5 ± 6.3) had values similar to controls and T1DM-P. There was a negative relationship between VO2peak and HbA1c% (r = -0.54, p < 0.01). All groups were similar in all other fitness variables. There were no group differences in physical activity variables.

CONCLUSION

Children with T1DM-G did not display signs of impaired muscle function, while children with T1DM-P have signs of altered aerobic muscle capacity.

Increase in physical activity is associated with lower HbA1c levels in children and adolescents with type 1 diabetes: results from a cross-sectional study based on the Swedish pediatric diabetes quality registry (SWEDIABKIDS)

AIMS

To evaluate the associations between physical activity (PA) and metabolic control, measured by glycated hemoglobin (HbA1c), in a large group of children and adolescents with type 1 diabetes.

METHODS

Cross-sectional analysis of data from 4655 patients, comparing HbA1c values with levels of physical activity. The data for the children and adolescents were obtained from the Swedish pediatric diabetes quality registry, SWEDIABKIDS. The patients were 7-18 years of age, had type 1 diabetes and were not in remission. Patients were grouped into five groups by frequency of PA.

RESULTS

Mean HbA1c level was higher in the least physically active groups (PA0: 8.8% ± 1.5 (72 ± 16 mmol/mol)) than in the most physically active groups (PA4: 7.7% ± 1.0 (60 ± 11 mmol/mol)) (p<0.001). An inverse dose-response association was found between PA and HbA1c (β: -0.30, 95% CI: -0.34 to -0.26, p<0.001). This association was found in both sexes and all age groups, apart from girls aged 7-10 years. Multiple regression analysis revealed that the relationship remained significant (β: -0.21, 95% CI: -0.25 to -0.18, p<0.001) when adjusted for possible confounding factors.

CONCLUSIONS

Physical activity seems to influence HbA1c levels in children and adolescents with type 1 diabetes. In clinical practice these patients should be recommended daily physical activity as a part of their treatment.