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Davis EA, Shetty VB, Teo SY, Lim RJ, Patton SR, Taplin CE. Physical Activity Management for Youth With Type 1 Diabetes: Supporting Active and Inactive Children. Diabetes Spectr 2023; 36:137-145. [PMID: 37193201 PMCID: PMC10182969 DOI: 10.2337/dsi22-0020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/18/2023]
Abstract
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.
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Affiliation(s)
- Elizabeth A. Davis
- Department of Endocrinology and Diabetes, Perth Children’s Hospital, Perth, Western Australia, Australia
- Telethon Kids Institute, University of Western Australia, Perth, Western Australia, Australia
- Centre for Child Health Research, University of Western Australia, Perth, Western Australia, Australia
| | - Vinutha B. Shetty
- Department of Endocrinology and Diabetes, Perth Children’s Hospital, Perth, Western Australia, Australia
- Telethon Kids Institute, University of Western Australia, Perth, Western Australia, Australia
- Centre for Child Health Research, University of Western Australia, Perth, Western Australia, Australia
| | - Shaun Y.M. Teo
- Telethon Kids Institute, University of Western Australia, Perth, Western Australia, Australia
| | - Rachel J. Lim
- Telethon Kids Institute, University of Western Australia, Perth, Western Australia, Australia
| | | | - Craig E. Taplin
- Department of Endocrinology and Diabetes, Perth Children’s Hospital, Perth, Western Australia, Australia
- Telethon Kids Institute, University of Western Australia, Perth, Western Australia, Australia
- Centre for Child Health Research, University of Western Australia, Perth, Western Australia, Australia
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Huerta-Uribe N, Chueca-Guindulain MJ, Berrade-Zubiri S, Burillo-Sánchez E, Izquierdo M, García-Hermoso A. Is fear of hypoglycemia a major barrier to an active lifestyle in children and adolescents with type 1 diabetes? The Diactive-1 Study. Scand J Med Sci Sports 2023. [PMID: 37051775 DOI: 10.1111/sms.14369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Revised: 03/07/2023] [Accepted: 03/30/2023] [Indexed: 04/14/2023]
Abstract
Studies on fear of hypoglycemia as a barrier to physical activity among youth with type 1 diabetes (T1D) have been limited and controversial, most of which used self-reported assessment. The aim of the study was to evaluate the relationship between fear of hypoglycemia and physical activity and glycemic metrics in children and adolescents with T1D. Seventy-four participants (6-18 years of age; 44.6% females) with T1D were included in the study. Physical activity was assessed through accelerometry on nine consecutive days, and blood glucose metrics were simultaneously tracked using continuous glucose monitoring (time-in-range and hypoglycemic events). A closed question was used to evaluate the avoidance of physical activity due to fear of hypoglycemia. Fifteen participants (20%) reported avoiding physical activity due to fear of hypoglycemia. The group reporting no fear of hypoglycemia showed lower total physical activity (-35.33 min/day, 95% confidence interval [CI] (-77.57 to -1.47)) and light physical activity (-29.81 min/day, 95% CI -64.01 to -2.75) and higher sedentary time (77.95 min/day, 95% CI 26.46-136.87) per day compared with those with fear of hypoglycemia. No difference was found between those patients with fear of hypoglycemia in terms of meeting the recommendations of glycated hemoglobin, glucose coefficient of variation, and time-in-range when compared to those with no fear of hypoglycemia. In conclusion, children and adolescents with fear of hypoglycemia were more active, less sedentary, and had similar glycemic metrics to those without fear. Our results therefore suggest that fear of hypoglycemia may be less of a barrier to an active lifestyle than previously believed.
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Affiliation(s)
- Nidia Huerta-Uribe
- Navarrabiomed, Hospital Universitario de Navarra, IdiSNA, Universidad Pública de Navarra (UPNA), Pamplona, Spain
| | | | - Sara Berrade-Zubiri
- Pediatric Endocrinology Unit, Hospital Universitario de Navarra (CHN), IdiSNA, Pamplona, Spain
| | | | - Mikel Izquierdo
- Navarrabiomed, Hospital Universitario de Navarra, IdiSNA, Universidad Pública de Navarra (UPNA), Pamplona, Spain
| | - Antonio García-Hermoso
- Navarrabiomed, Hospital Universitario de Navarra, IdiSNA, Universidad Pública de Navarra (UPNA), Pamplona, Spain
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Parent C, Lespagnol E, Berthoin S, Tagougui S, Heyman J, Stuckens C, Gueorguieva I, Balestra C, Tonoli C, Kozon B, Fontaine P, Weill J, Rabasa-Lhoret R, Heyman E. Barriers to Physical Activity in Children and Adults Living With Type 1 Diabetes: A Complex Link With Real-life Glycemic Excursions. Can J Diabetes 2023; 47:124-132. [PMID: 36411182 DOI: 10.1016/j.jcjd.2022.10.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Revised: 10/14/2022] [Accepted: 10/17/2022] [Indexed: 11/05/2022]
Abstract
OBJECTIVES Ever since the first research on barriers to physical activity (PA) highlighting fear of hypoglycemia as a major barrier, many studies have attempted to understand their demographic and behavioural determinants. However, no research has been conducted on whether these perceived barriers toward PA are based on real-life-experienced adverse glycemic effects of exercise. METHODS Sixty-two adults and 53 children/adolescents living with type 1 diabetes, along with their parents, completed the Barriers to Physical Activity in Type 1 Diabetes-1 (BAPAD-1) questionnaire on barriers to PA. Continuous glucose-monitoring data were collected during 1 week of everyday life for 26 adults and 33 children/adolescents. Multiple linear regressions were used to explore links between BAPAD-1 scores and glycemic excursions experienced during and after everyday-life self-reported PA sessions, controlling for behavioural (accelerometry) and demographic confounders. RESULTS In children/adolescents, the more time spent in hypoglycemia on nights after PA sessions, the more they reported hypoglycemic risk as a barrier (ß=+0.365, p=0.034). Conversely, in adults, the higher the proportion of PA sessions accompanied by a drop in blood glucose, the less hypoglycemia was a barrier (ß=-0.046, p=0.004). In parents, BAPAD-1 scores were unrelated to children/adolescents' everyday-life exercise-induced hypo/hyperglycemia. CONCLUSIONS In children/adolescents, fear of hypoglycemia was predominant in those exposed to nocturnal hypoglycemia associated with PA sessions. In adults, fewer barriers may mean they accept a bigger drop in their glycemia during PA. This shows the importance of finding and promoting age-specific solutions to prevent exercise-induced hypoglycemia.
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Affiliation(s)
- Cassandra Parent
- Univ. Lille, Univ. Artois, Univ. Littoral Côte d'Opale, ULR 7369 - URePSSS - Unité de Recherche Pluridisciplinaire Sport Santé Société, F-59000 Lille, France
| | - Elodie Lespagnol
- Univ. Lille, Univ. Artois, Univ. Littoral Côte d'Opale, ULR 7369 - URePSSS - Unité de Recherche Pluridisciplinaire Sport Santé Société, F-59000 Lille, France
| | - Serge Berthoin
- Univ. Lille, Univ. Artois, Univ. Littoral Côte d'Opale, ULR 7369 - URePSSS - Unité de Recherche Pluridisciplinaire Sport Santé Société, F-59000 Lille, France
| | - Sémah Tagougui
- Univ. Lille, Univ. Artois, Univ. Littoral Côte d'Opale, ULR 7369 - URePSSS - Unité de Recherche Pluridisciplinaire Sport Santé Société, F-59000 Lille, France
| | - Joris Heyman
- CNRS, UMR 6118, Transferts d'eau et de matière dans les milieux hétérogènes complexes-Géosciences, Université Rennes, Rennes, France
| | - Chantal Stuckens
- Department of Pediatrics, Lille University Hospital, Lille, France
| | - Iva Gueorguieva
- Department of Pediatrics, Lille University Hospital, Lille, France
| | - Costantino Balestra
- Laboratory of Environmental and Occupational (Integrative) Physiology, Haute Ecole Bruxelles-Brabant, Auderghem, Brussels, Belgium
| | - Cajsa Tonoli
- Human Physiology Research Group, Faculty of Physical Education and Physical Therapy, Vrije Universiteit Brussel, Brussels, Belgium
| | - Bérengère Kozon
- Department of Diabetology, Lille University Hospital, Lille, France
| | - Pierre Fontaine
- Department of Diabetology, Lille University Hospital, Lille, France
| | - Jacques Weill
- Department of Pediatrics, Lille University Hospital, Lille, France
| | - Rémi Rabasa-Lhoret
- Institut de Recherches Cliniques de Montréal, Montréal, Québec, Canada; Department of Nutrition, Université de Montréal, Montréal, Québec, Canada
| | - Elsa Heyman
- Univ. Lille, Univ. Artois, Univ. Littoral Côte d'Opale, ULR 7369 - URePSSS - Unité de Recherche Pluridisciplinaire Sport Santé Société, F-59000 Lille, France; Institut Universitaire de France, Paris, France.
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