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Cholekho S, Fan Z, Tan H. Case report: catamenial hyperglycemia: the trigger of recurrent DKA in a female patient with three-year follow-up. Front Endocrinol (Lausanne) 2024; 15:1305332. [PMID: 38444588 PMCID: PMC10912938 DOI: 10.3389/fendo.2024.1305332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2023] [Accepted: 01/09/2024] [Indexed: 03/07/2024] Open
Abstract
Background Catamenial hyperglycemia is a rare type of spontaneous, recurring Diabetic Ketoacidosis(DKA) in females during the luteal phase, most commonly observed in type 1 diabetes mellitus. Even with controlled serum glucose levels, adherence to a diabetic diet, medications, and in the absence of other common influencing factors such as infection, glucose levels tend to increase during the premenstrual period. This uncommon issue related to the menstrual cycle phase has not been extensively researched. Therefore, this study aims to diagnose catamenial hyperglycemia promptly and initiate early treatment to prevent complications. Case report We presented a case of a 19-year-old girl who experienced recurrent DKA during the premenstrual period, without an apparent cause. She was admitted multiple times to various hospitals and sought consultations, undergoing numerous laboratory and imaging examinations, yet the etiology remained elusive. Ultimately, she received a diagnosis of catamenial diabetic hyperglycemia. To prevent recurrence of complications associated with catamenial hyperglycemia, we initiated a comprehensive approach which included continuous glucose monitoring, adherence to a strict diabetic diet, diabetic health education, regular exercise, timely medication administration, and increase in insulin dosage during the premenstrual period based on glucose levels. Conclusions Although catamenial hyperglycemia is rare, it should be considered a cause of recurrent hyperglycemia in any postpubertal female to prevent complications. The specific underlying mechanisms responsible for catamenial hyperglycemia or DKA remain unidentified.
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Affiliation(s)
| | | | - Huiwen Tan
- Department of Endocrinology and Metabolism, West China Hospital, Sichuan University, Chengdu, China
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2
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Zhang J, Tam WWS, Hounsri K, Kusuyama J, Wu VX. Effectiveness of Combined Aerobic and Resistance Exercise on Cognition, Metabolic Health, Physical Function, and Health-related Quality of Life in Middle-aged and Older Adults With Type 2 Diabetes Mellitus: A Systematic Review and Meta-analysis. Arch Phys Med Rehabil 2023:S0003-9993(23)00591-9. [PMID: 37875170 DOI: 10.1016/j.apmr.2023.10.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Revised: 09/02/2023] [Accepted: 10/09/2023] [Indexed: 10/26/2023]
Abstract
OBJECTIVES To evaluate the effectiveness of combined aerobic and resistance exercise on cognition, metabolic health, physical function, and health-related quality of life (HRQoL) in middle-aged and older adults with type 2 diabetes mellitus (T2DM). DATA SOURCE AND STUDY SELECTION Systematic search of CINAHL, Cochrane, EMBASE, Scopus, PubMed, ProQuest Dissertation and Thesis, PsycINFO, Web of Science databases, and gray literature from Google Scholar. Pertinent randomized controlled trials (RCTs) were selected. The Protocol was registered in the International Prospective Register of Systematic Reviews (PROSPERO CRD42023387336). DATA EXTRACTION The risk of bias was evaluated using the Cochrane Risk of Bias tool by 2 reviewers independently. Outcome data were extracted in a fixed-effect model if heterogeneity test were not significant and I2≤50%; otherwise, the random-effects model was used. DATA SYNTHESIS Sixteen studies with 2426 participants were included in this review. Combined aerobic and resistance exercise had significant positive effects on cognition (SMD=0.34, 95% CI: 0.13 to 0.55), metabolic health on HbA1c (SMD=-0.35, 95% CI: -0.48 to -0.22) and lipid profile (total cholesterol SMD=-0.20, 95% CI: -0.34 to -0.07; low-density lipoprotein SMD=-0.19, 95% CI: -0.33 to -0.05; high-density lipoprotein SMD=0.25, 95% CI: 0.12 to 0.39; and triglycerides SMD=-0.18, 95% CI: -0.31 to -0.04), physical function on aerobic oxygen uptake (SMD=0.58, 95% CI: 0.21 to 0.95) and body mass index (MD=-1.33, 95% CI: -1.84 to -0.82), and physical HRQoL (MD=4.17, 95% CI: 0.86 to 7.48). Our results showed that clinically important effects on cognition may occur in combining the low-moderate intensity of aerobic exercise and progressive intensity of resistance training, the total duration of the exercise needs to be at least 135 minutes per week, among which, resistance training should be at least 60 minutes. CONCLUSION Combined aerobic and resistance exercise effectively improves cognition, ameliorates metabolic health, enhances physical function, and increases physical HRQoL in middle-aged and older adults with T2DM. More RCTs and longitudinal follow-ups are required to provide future evidence of structured combined aerobic and resistance exercise on other domains of cognition.
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Affiliation(s)
- Jinghua Zhang
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Clinical Research Centre, Singapore
| | - Wilson Wai San Tam
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Clinical Research Centre, Singapore
| | - Kanokwan Hounsri
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Clinical Research Centre, Singapore
| | - Joji Kusuyama
- Graduate School of Medicine and Dentistry, Tokyo Medical and Dental University, Tokyo, Japan
| | - Vivien Xi Wu
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Clinical Research Centre, Singapore; NUSMED Healthy Longevity Translational Research Programme, National University of Singapore, Singapore.
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3
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Bishop FK, Addala A, Corbin KD, Muntis FR, Pratley RE, Riddell MC, Mayer-Davis EJ, Maahs DM, Zaharieva DP. An Overview of Diet and Physical Activity for Healthy Weight in Adolescents and Young Adults with Type 1 Diabetes: Lessons Learned from the ACT1ON Consortium. Nutrients 2023; 15:nu15112500. [PMID: 37299463 DOI: 10.3390/nu15112500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Revised: 05/18/2023] [Accepted: 05/24/2023] [Indexed: 06/12/2023] Open
Abstract
The prevalence of overweight and obesity in young people with type 1 diabetes (T1D) now parallels that of the general population. Excess adiposity increases the risk of cardiovascular disease, which is already elevated up to 10-fold in T1D, underscoring a compelling need to address weight management as part of routine T1D care. Sustainable weight management requires both diet and physical activity (PA). Diet and PA approaches must be optimized towards the underlying metabolic and behavioral challenges unique to T1D to support glycemic control throughout the day. Diet strategies for people with T1D need to take into consideration glycemic management, metabolic status, clinical goals, personal preferences, and sociocultural considerations. A major barrier to weight management in this high-risk population is the challenge of integrating regular PA with day-to-day management of T1D. Specifically, exercise poses a substantial challenge due to the increased risk of hypoglycemia and/or hyperglycemia. Indeed, about two-thirds of individuals with T1D do not engage in the recommended amount of PA. Hypoglycemia presents a serious health risk, yet prevention and treatment often necessitates the consumption of additional calories, which may prohibit weight loss over time. Exercising safely is a concern and challenge with weight management and maintaining cardiometabolic health for individuals living with T1D and many healthcare professionals. Thus, a tremendous opportunity exists to improve exercise participation and cardiometabolic outcomes in this population. This article will review dietary strategies, the role of combined PA and diet for weight management, current resources for PA and glucose management, barriers to PA adherence in adults with T1D, as well as findings and lessons learned from the Advancing Care for Type 1 Diabetes and Obesity Network (ACT1ON).
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Affiliation(s)
- Franziska K Bishop
- Division of Endocrinology, Department of Pediatrics, School of Medicine, Stanford University, Stanford, CA 94304, USA
| | - Ananta Addala
- Division of Endocrinology, Department of Pediatrics, School of Medicine, Stanford University, Stanford, CA 94304, USA
| | - Karen D Corbin
- AdventHealth, Translational Research Institute, Orlando, FL 32804, USA
| | - Franklin R Muntis
- Department of Nutrition, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - Richard E Pratley
- AdventHealth, Translational Research Institute, Orlando, FL 32804, USA
| | - Michael C Riddell
- School of Kinesiology and Health Science, Muscle Health Research Centre, York University, Toronto, ON M3J 1P3, Canada
| | - Elizabeth J Mayer-Davis
- Department of Nutrition, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - David M Maahs
- Division of Endocrinology, Department of Pediatrics, School of Medicine, Stanford University, Stanford, CA 94304, USA
- Stanford Diabetes Research Center, Stanford, CA 94305, USA
| | - Dessi P Zaharieva
- Division of Endocrinology, Department of Pediatrics, School of Medicine, Stanford University, Stanford, CA 94304, USA
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4
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Martin-Rivera F, Maroto-Izquierdo S, García-López D, Alarcón-Gómez J. Exercise interventions for patients with type 1 diabetes mellitus: A narrative review with practical recommendations. World J Diabetes 2023; 14:539-548. [PMID: 37273254 PMCID: PMC10236987 DOI: 10.4239/wjd.v14.i5.539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 01/08/2023] [Accepted: 04/11/2023] [Indexed: 05/15/2023] Open
Abstract
Type 1 diabetes mellitus (T1DM) is a chronic endocrine disease that results from autoimmune destruction of pancreatic insulin-producing β cells, which can lead to microvascular (e.g., retinopathy, neuropathy, and nephropathy) and macro-vascular complications (e.g., coronary arterial disease, peripheral artery disease, stroke, and heart failure) as a consequence of chronic hyperglycemia. Despite the widely available and compelling evidence that regular exercise is an efficient strategy to prevent cardiovascular disease and to improve functional capacity and psychological well-being in people with T1DM, over 60% of individuals with T1DM do not exercise regularly. It is, therefore, crucial to devise approaches to motivate patients with T1DM to exercise, to adhere to a training program, and to inform them of its specific characteristics (e.g., exercise mode, intensity, volume, and frequency). Moreover, given the metabolic alterations that occur during acute bouts of exercise in T1DM patients, exercise prescription in this population should be carefully analyzed to maximize its benefits and to reduce its potential risks.
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Affiliation(s)
- Fernando Martin-Rivera
- Department of Physical Education and Sports, University of Valencia, Valencia 46010, Spain
| | - Sergio Maroto-Izquierdo
- Department of Health Sciences, Miguel de Cervantes European University, Valladolid 47012, Spain
| | - David García-López
- Department of Health Sciences, Miguel de Cervantes European University, Valladolid 47012, Spain
| | - Jesús Alarcón-Gómez
- Department of Physical Education and Sports, University of Valencia, Valencia 46010, Spain
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5
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Quesnel DA, Cooper M, Fernandez-Del-Valle M, Reilly A, Calogero RM. Medical and physiological complications of exercise for individuals with an eating disorder: A narrative review. J Eat Disord 2023; 11:3. [PMID: 36627654 PMCID: PMC9832767 DOI: 10.1186/s40337-022-00685-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Accepted: 11/01/2022] [Indexed: 01/12/2023] Open
Abstract
Individuals with eating disorders (ED) experience prolonged malnutrition, binge episodes, and compensatory behaviours that affect every organ system. Psychological and physiological symptoms are worsened with comorbid dysfunctional exercise, seen in up to 80% of those with an ED. Although return to exercise is an important component of treatment and recovery, little is known about the contraindications and risks of exercise engagement specific to those with an ED. This paper provides a comprehensive narrative review of the medical and physiological complications of engaging in exercise during ED treatment and outlines when exercise may be contraindicated or used in modified or cautionary ways. We conducted a literature search on MEDLINE, PubMed, and PsychArticles to identify relevant articles, which yielded six categories of medical and physiological complications of ED that may be exacerbated by exercise: energy availability, cardiovascular health, electrolyte abnormalities, biomedical function markers, sex hormones, and body composition. We summarize the evidence for these complications for readers and offer an initial set of recommendations for incorporating exercise during ED treatment based on our findings. This review may serve as a resource for members of ED treatment teams to help evaluate more readily and confidently whether exercise is safe for individual patients and when modifications and caution may be warranted.
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Affiliation(s)
- Danika A Quesnel
- Department of Psychological Clinical Science, University of Toronto, 320 Huron Street, Toronto, ON, M5S 3J7, Canada.
| | - Marita Cooper
- Department of Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Maria Fernandez-Del-Valle
- Department of Functional Biology, University of Oviedo, Oviedo, Spain.,Health Research Institute of the Principality of Asturias (ISPA), Oviedo, Spain
| | - Alanah Reilly
- Alanah Reilly Exercise Physiologist, Brisbane, Australia
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6
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Weitgasser R, Ocenasek H, Fallwickl S. Race Across America: First Athlete With Type 1 Diabetes to Finish Solo With Diabetes Technology Support. Diabetes Spectr 2022; 35:227-231. [PMID: 35668881 PMCID: PMC9160562 DOI: 10.2337/ds21-0033] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Raimund Weitgasser
- Department of Internal Medicine/Diabetology and Metabolism, Wehrle-Diakonissen Hospital, Salzburg, Austria
- Paracelsus Medical University Salzburg, Salzburg, Austria
| | - Helmuth Ocenasek
- Institute for Sport and Health Medicine, Linz, Austria
- CARDIOMED Centre for Outpatient Cardiac Rehabilitation, Linz, Austria
| | - Susanne Fallwickl
- Cardio-Pulmonary Rehabilitation, Rehabilitation Center Hochegg, Grimmenstein, Austria
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7
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Reid H, Ridout AJ, Tomaz SA, Kelly P, Jones N. Benefits outweigh the risks: a consensus statement on the risks of physical activity for people living with long-term conditions. Br J Sports Med 2021; 56:427-438. [PMID: 34649919 PMCID: PMC8995821 DOI: 10.1136/bjsports-2021-104281] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/16/2021] [Indexed: 12/29/2022]
Abstract
Introduction The benefits of physical activity for people living with long-term conditions (LTCs) are well established. However, the risks of physical activity are less well documented. The fear of exacerbating symptoms and causing adverse events is a persuasive barrier to physical activity in this population. This work aimed to agree clear statements for use by healthcare professionals about medical risks of physical activity for people living with LTCs through expert consensus. These statements addressed the following questions: (1) Is increasing physical activity safe for people living with one or more LTC? (2) Are the symptoms and clinical syndromes associated with common LTCs aggravated in the short or long term by increasing physical activity levels? (3) What specific risks should healthcare professionals consider when advising symptomatic people with one or more LTCs to increase their physical activity levels? Methods Statements were developed in a multistage process, guided by the Appraisal of Guidelines for Research and Evaluation tool. A patient and clinician involvement process, a rapid literature review and a steering group workshop informed the development of draft symptom and syndrome-based statements. We then tested and refined the draft statements and supporting evidence using a three-stage modified online Delphi study, incorporating a multidisciplinary expert panel with a broad range of clinical specialties. Results Twenty-eight experts completed the Delphi process. All statements achieved consensus with a final agreement between 88.5%–96.5%. Five ‘impact statements’ conclude that (1) for people living with LTCs, the benefits of physical activity far outweigh the risks, (2) despite the risks being very low, perceived risk is high, (3) person-centred conversations are essential for addressing perceived risk, (4) everybody has their own starting point and (5) people should stop and seek medical attention if they experience a dramatic increase in symptoms. In addition, eight symptom/syndrome-based statements discuss specific risks for musculoskeletal pain, fatigue, shortness of breath, cardiac chest pain, palpitations, dysglycaemia, cognitive impairment and falls and frailty. Conclusion Clear, consistent messaging on risk across healthcare will improve people living with LTCs confidence to be physically active. Addressing the fear of adverse events on an individual level will help healthcare professionals affect meaningful behavioural change in day-to-day practice. Evidence does not support routine preparticipation medical clearance for people with stable LTCs if they build up gradually from their current level. The need for medical guidance, as opposed to clearance, should be determined by individuals with specific concerns about active symptoms. As part of a system-wide approach, consistent messaging from healthcare professionals around risk will also help reduce cross-sector barriers to engagement for this population.
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Affiliation(s)
- Hamish Reid
- Moving Medicine, Faculty of Sport And Exercise Medicine, Edinburgh, UK.,Advanced Wellbeing Research Centre, Sheffield Hallam University, Sheffield, South Yorkshire, UK
| | - Ashley Jane Ridout
- Sport and Exercise Medicine, Oxford University Hospitals NHS Foundation Trust Nuffield Orthopaedic Centre, Oxford, Oxfordshire, UK
| | - Simone Annabella Tomaz
- Stirling Physical Activity Research Knowledge and Learning Exchange (SPARKLE), University of Stirling, Stirling, UK
| | - Paul Kelly
- Physical Activity for Health Research Centre, University of Edinburgh Institute for Sport Physical Education and Health Sciences, Edinburgh, UK
| | - Natasha Jones
- Moving Medicine, Faculty of Sport And Exercise Medicine, Edinburgh, UK .,Sport and Exercise Medicine, Oxford University Hospitals NHS Foundation Trust Nuffield Orthopaedic Centre, Oxford, Oxfordshire, UK
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8
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Wang W, Huang M, Wang J. THE EFFECT OF PHYSICAL EXERCISE ON BLOOD SUGAR CONTROL IN DIABETIC PATIENTS. REV BRAS MED ESPORTE 2021. [DOI: 10.1590/1517-8692202127032021_0103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
ABSTRACT Introduction Diabetes is a metabolic disease characterized by hyperglycemia. It is a metabolic syndrome in which blood sugar levels increase due to defects in insulin secretion or impaired function, or even both defects. Object To understand the effect of diabetic patients in controlling blood sugar through physical exercise, the paper analyzes the correlation between the exercise status and physiological indicators of diabetic patients in our hospital. Methods We randomly selected 41 diabetic patients and monitored their exercise. At the same time, we check the physiological indicators of the patients after the exercise is completed and analyze the control of blood sugar by sports. Results After healthy physical exercise, the blood sugar level of diabetic patients tended to stabilize, and the glycosylated hemoglobin level decreased. The blood sugar levels of patients who did not participate in healthy physical exercises were not stable, and their glycosylated hemoglobin levels did not improve. Conclusion Healthy sports is a simple, easy, safe and effective adjuvant therapy for the prevention and treatment of diabetes, and it is worthy of clinical promotion. Level of evidence II; Therapeutic studies - investigation of treatment results.
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9
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Jabbour G, Bragazzi NL. Continuous Blood Glucose Monitoring Increases Vigorous Physical Activity Levels and Is Associated With Reduced Hypoglycemia Avoidance Behavior In Youth With Type 1 Diabetes. Front Endocrinol (Lausanne) 2021; 12:722123. [PMID: 34557162 PMCID: PMC8454404 DOI: 10.3389/fendo.2021.722123] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Accepted: 08/20/2021] [Indexed: 12/30/2022] Open
Abstract
The primary goal of this study was to explore physical activity (PA) levels, hypoglycemia fear scores and hypoglycemia episodes according to insulin administration and blood glucose monitoring methods in youth with type 1 diabetes (T1D). A self-administered questionnaire was completed by 28 children and 33 adolescents with T1D, and their PA was assessed. Hypoglycemia episodes, fear of hypoglycemia scores, insulin therapy (pump vs. injection) and blood glucose monitoring (continuous blood glucose monitors [CGMs] vs. blood glucose meters) methods are reported in the present work. There were no significant differences in the number of hypoglycemic episodes, child hypoglycemia fear survey behavior or total scores, or any components of the PA profile between youth using injections and those using a pump. However, these variables differed significantly when compared according to blood glucose monitoring method (CGMs vs. blood glucose meters): 41.2 vs. 81.8, p<0.01; 1.03 ± 0.05 vs. 2.6 ± 0.63, p<0.01; 1.09 ± 0.43 vs. 2.94 ± 0.22, p<0.01; and 222 ± 18 vs. 49 ± 11, p<0.01 (for total time in vigorous PA in minutes per week), respectively. CGM use correlated significantly with VPA levels (β=0.6; p=0.04). Higher VPA levels were associated with higher child hypoglycemia fear survey behavior scores (β=0.52; p=0.04). The latter correlates negatively with the number of episodes of hypoglycemia in the past 12 months in all category groups. The type of insulin injection was not associated with more activity in youth with T1D. In contrast, CGM use may be associated with increased vigorous PA among T1D youth. Those with higher hypoglycemia fear survey behavior scores engaged in more VPA and had fewer hypoglycemia episodes. Although CGM use ensures continuous monitoring of glycemia during exercise, increasing hypoglycemia avoidance behavior is still a necessary part of exercise management strategies in active youth with T1D.
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Affiliation(s)
- Georges Jabbour
- Department of Physical Education, College of Education, Qatar University, Doha, Qatar
- *Correspondence: Georges Jabbour, ,
| | - Nicola Luigi Bragazzi
- Laboratory for Industrial and Applied Mathematics (LIAM), Department of Mathematics and Statistics, York University, Toronto, ON, Canada
- Department of Health Sciences (DISSAL), Postgraduate School of Public Health, University of Genoa, Genoa, Italy
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10
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Buckley JP, Riddell M, Mellor D, Bracken RM, Ross MK, LaGerche A, Poirier P. Acute glycaemic management before, during and after exercise for cardiac rehabilitation participants with diabetes mellitus: a joint statement of the British and Canadian Associations of Cardiovascular Prevention and Rehabilitation, the International Council for Cardiovascular Prevention and Rehabilitation and the British Association of Sport and Exercise Sciences. Br J Sports Med 2020; 55:bjsports-2020-102446. [PMID: 33361136 DOI: 10.1136/bjsports-2020-102446] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/19/2020] [Indexed: 12/12/2022]
Abstract
Type 1 (T1) and type 2 (T2) diabetes mellitus (DM) are significant precursors and comorbidities to cardiovascular disease and prevalence of both types is still rising globally. Currently,~25% of participants (and rising) attending cardiac rehabilitation in Europe, North America and Australia have been reported to have DM (>90% have T2DM). While there is some debate over whether improving glycaemic control in those with heart disease can independently improve future cardiovascular health-related outcomes, for the individual patient whose blood glucose is well controlled, it can aid the exercise programme in being more efficacious. Good glycaemic management not only helps to mitigate the risk of acute glycaemic events during exercising, it also aids in achieving the requisite physiological and psycho-social aims of the exercise component of cardiac rehabilitation (CR). These benefits are strongly associated with effective behaviour change, including increased enjoyment, adherence and self-efficacy. It is known that CR participants with DM have lower uptake and adherence rates compared with those without DM. This expert statement provides CR practitioners with nine recommendations aimed to aid in the participant's improved blood glucose control before, during and after exercise so as to prevent the risk of glycaemic events that could mitigate their beneficial participation.
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Affiliation(s)
- John P Buckley
- Shrewsbury Centre for Active Living, University of Chester Faculty of Medicine and Life Sciences, Chester, Cheshire West and Chester, UK
- Institute of Sport Exercise and Health, University College London, London, UK
| | - Michael Riddell
- School of Kinesiology and Health Science, York University, Toronto, Ontario, Canada
- LMC Healthcare, Diabetes and Endocrinology, Toronto, Ontario, Canada
| | - Duane Mellor
- Aston Medical School, Aston University, Birmingham, West Midlands, UK
- Sport and Exercise Science, Swansea University College of Engineering, Swansea, Wales, UK
| | - Richard M Bracken
- Sport and Exercise Science, Swansea University College of Engineering, Swansea, Wales, UK
| | - Marie-Kristelle Ross
- Hotel-Dieu de Levis, Laval University Faculty of Medicine, Quebec city, Quebec, Canada
| | - Andre LaGerche
- Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia
- St Vincent's Hospital Melbourne Pty Ltd, Fitzroy, Victoria, Australia
| | - Paul Poirier
- Cardiology, Institut universitaire de cardiologie et de pneumologie de Québec, Quebec City, Quebec, Canada
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11
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Abstract
PURPOSE OF REVIEW This review sought to evaluate the role of exercise in patients with obesity and comorbid hypertension, with a focus on contemporary literature (since January 2015). RECENT FINDINGS No reviews have included patients classified with both obesity and hypertension and there is a paucity of randomised controlled trials examining the benefits of exercise in this population. Moreover, just one of 19 reviews examining the role of exercise on blood pressure included studies that met pre-defined inclusion criterion for hypertension, although seven conducted subgroup analyses stratified by mean baseline blood pressure. These demonstrated significantly larger reductions in blood pressure in hypertensive than pre-hypertensive and normotensive samples. There is a significant research-practice gap for understanding and influencing the role of exercise for patients with obesity and hypertension. This review provides recommendations for future research and consensus-based recommendations that promote exercise as a principle therapy for patients with obesity and hypertension.
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Affiliation(s)
- Shelley E Keating
- Centre for Research on Exercise, Physical Activity and Health, School of Human Movement and Nutrition Sciences, The University of Queensland, St Lucia, QLD, Australia. .,Physiology and Ultrasound Lab in Science and Exercise (PULSE), School of Human Movement and Nutrition Sciences, The University of Queensland, St Lucia, QLD, Australia.
| | - Jeff S Coombes
- Centre for Research on Exercise, Physical Activity and Health, School of Human Movement and Nutrition Sciences, The University of Queensland, St Lucia, QLD, Australia
| | - Michael Stowasser
- Endocrine Hypertension Research Center, University of Queensland Diamantina Institute, Princess Alexandra Hospital, Brisbane, QLD, Australia
| | - Tom G Bailey
- Centre for Research on Exercise, Physical Activity and Health, School of Human Movement and Nutrition Sciences, The University of Queensland, St Lucia, QLD, Australia.,Physiology and Ultrasound Lab in Science and Exercise (PULSE), School of Human Movement and Nutrition Sciences, The University of Queensland, St Lucia, QLD, Australia
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12
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Cockcroft EJ, Narendran P, Andrews RC. Exercise‐induced hypoglycaemia in type 1 diabetes. Exp Physiol 2020; 105:590-599. [DOI: 10.1113/ep088219] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Accepted: 11/26/2019] [Indexed: 12/30/2022]
Affiliation(s)
| | - P. Narendran
- Department of DiabetesUniversity Hospitals Birmingham NHS Foundation Trust Birmingham UK
- Institute of Immunology and ImmunotherapyUniversity of Birmingham Birmingham UK
| | - R. C. Andrews
- University of Exeter Medical School Exeter UK
- Department of DiabetesTaunton and Somerset NHS Foundation Trust Taunton UK
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