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Miranda-Tueros M, Ramirez-Peña J, Cabanillas-Lazo M, Paz-Ibarra JL, Pinedo-Torres I. Effects of aerobic exercise on components of the metabolic syndrome in older adults with type 2 diabetes mellitus: systematic review and meta-analysis. Rev Peru Med Exp Salud Publica 2024; 41:146-155. [PMID: 39166637 PMCID: PMC11300696 DOI: 10.17843/rpmesp.2024.412.12751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Accepted: 03/27/2024] [Indexed: 08/23/2024] Open
Abstract
OBJECTIVE. To determine the effects of aerobic exercise on the components of the metabolic syndrome in older adult diabetic patients by means of a systematic review with meta-analysis. MATERIALS AND METHODS. We used the PubMed/Medline, Scopus, Cochrane library, Web of Science databases and the Google Scholar search engine. Randomized controlled trials (RCTs) were selected according to the inclusion criteria. Two reviewers independently determined whether studies met the inclusion criteria, extracted data, and used the Cochrane risk of bias tool (RoB 2). Quantitative analyses were performed in R v 4.0.5, using random effects. RESULTS. We identified 8697 studies, of which 7 RCTs were included in the qualitative synthesis. Most studies were assessed as having a high or low RoB in at least three domains. Meta-analysis showed that aerobic exercise was effective in improving glucose levels (standardized mean difference [SMD]: -1.04; 95% confidence interval [95% CI] -1.27, -0.81), systolic blood pressure (SMD: -0.79; 95% CI: -1.02, -0.56), diastolic blood pressure (SMD: -0.75; 95% CI: -0.98, -0.52), glycosylated hemoglobin (SMD: -0.57, 95% CI: -0.77, -0.37), HDL (SMD: 0.35, 95% CI: 0.15, 0.55), triglycerides (SMD: -0.26, 95% CI: -0.47, -0.06). No significant adverse effects were reported. The level of certainty of the results was low for fasting glucose, moderate for systolic and diastolic blood pressure, and very low for the other outcomes, in addition to few adverse effects. However, these results should be interpreted with caution due to the use of surrogate markers. CONCLUSIONS. Aerobic exercise was shown to have a significant improvement in the components of the metabolic syndrome in older diabetic adults, and no major adverse effects were reported. However, we recommend more RCTs with longer intervention time to establish the impact on symptoms and complications. Motivation for the study. The motivation for this research arises from the high prevalence of metabolic syndrome and diabetes mellitus around the world. Despite their impact, there is a gap in knowledge regarding non-pharmacological interventions in older adults aimed at improving the metabolic profile of these patients. Main findings. Our results show a significant improvement in glucose, blood pressure, glycosylated hemoglobin, HDL, and triglyceride levels after the aerobic exercise intervention. In addition, no significant adverse effects were observed. Public health implications. Physical exercise is an affordable and globally available strategy. It improves the metabolic profile of older adult patients with metabolic syndrome.
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Affiliation(s)
- Mercedes Miranda-Tueros
- Universidad Científica del Sur, Faculty of Health Sciences, Lima, Peru.Universidad Científica del SurUniversidad Científica del SurFaculty of Health SciencesLimaPeru
| | - Joshua Ramirez-Peña
- Universidad Científica del Sur, Faculty of Health Sciences, Lima, Peru.Universidad Científica del SurUniversidad Científica del SurFaculty of Health SciencesLimaPeru
| | - Miguel Cabanillas-Lazo
- Clinical and Health Effectiveness Network, REDECS, Lima, Peru.Clinical and Health Effectiveness NetworkREDECSLimaPeru
- University of Huanuco, Huanuco, Peru.University of HuanucoUUniversity of HuanucoHuánucoPeru
| | - José Luis Paz-Ibarra
- School of Medicine, Universidad Nacional Mayor de San Marcos, Lima, Peru.Universidad Nacional Mayor de San MarcosSchool of MedicineUniversidad Nacional Mayor de San MarcosLimaPeru
- Edgardo Rebagliati Martins National Hospital, Lima, Peru.Edgardo Rebagliati Martins National HospitalLimaPerú
| | - Isabel Pinedo-Torres
- NEURONECS Research Group: Neuroscience, clinical effectiveness and public health, Universidad Científica del Sur, Lima, Peru.Universidad Científica del SurNEURONECS Research Group: Neuroscience, clinical effectiveness and public healthUniversidad Científica del SurLimaPeru
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Lazić A, Stanković D, Trajković N, Cadenas-Sanchez C. Effects of HIIT Interventions on Cardiorespiratory Fitness and Glycemic Parameters in Adults with Type 1 Diabetes: A Systematic Review and Meta-Analysis. Sports Med 2024:10.1007/s40279-024-02059-4. [PMID: 38904921 DOI: 10.1007/s40279-024-02059-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/25/2024] [Indexed: 06/22/2024]
Abstract
BACKGROUND Individuals with type 1 diabetes mellitus (T1DM) face impaired cardiorespiratory fitness and glycemic control, increasing the risk of cardiovascular complications. High-intensity interval training (HIIT) has emerged as a promising exercise modality with potential benefits for both aspects in this population. OBJECTIVES The primary aim was to investigate the effects of HIIT on cardiorespiratory fitness and glycemic parameters in patients with T1DM. The secondary aim was to examine the most effective HIIT protocol for cardiorespiratory fitness and glycemic parameters in patients with T1DM. DESIGN Systematic review and meta-analysis. DATA SOURCES Two major electronic databases (Web of Science and PubMed) were searched up to February 2024. ELIGIBILITY CRITERIA FOR SELECTING STUDIES Randomized and non-randomized trials involving adult patients with T1DM, free of complications and other diseases examining the effects of HIIT (HIIT pre vs. post; HIIT vs. control group or HIIT vs. moderate-intensity continuous training (MICT)) on cardiorespiratory fitness and glycemic parameters were included. RESULTS A total of ten studies met the inclusion criteria. The meta-analysis revealed a significant improvement in cardiorespiratory fitness following HIIT interventions (pre vs. post) in patients with T1DM (standardized mean difference (SMD) = 0.59, 95% confidence interval (CI) = 0.16 to 1, p = 0.01). Furthermore, HIIT (pre vs. post) was associated with significant improvements in 24-h mean glucose control (SMD = - 0.44, 95% CI = - 0.81 to - 0.06, p = 0.02), but the results (pre vs. post) failed to identify significant improvements in fasting glucose (SMD = - 0.26, 95% CI = - 0.78 to 0.24, p = 0.3) and glycated hemoglobin (HbA1C) values (SMD = - 0.28, 95% CI = - 0.61 to 0.05, p = 0.1). However, in comparison with a control group, HIIT showed significantly favorable effects on HbA1C (SMD = - 0.74, 95% CI = - 1.35 to - 0.14, p = 0.02). Finally, the meta-regression analysis did not find any moderating effect of any HIIT characteristics (i.e., intervention duration, session duration, work time, rest time, number of bouts, and intensity) on cardiorespiratory fitness and glycemic parameters. CONCLUSION Our systematic review and meta-analysis show that T1DM patients who performed a HIIT intervention significantly improved cardiorespiratory fitness and reduced their 24-h mean glucose levels, but not their HbA1C and fasting glucose. These findings support the application of HIIT interventions in T1DM patients. However, the guidelines for the most effective protocol remain unclear; hence, future studies are needed.
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Affiliation(s)
- Anja Lazić
- Faculty of Sport and Physical Education, University of Niš, Niš, Serbia
| | - Dušan Stanković
- Faculty of Sport and Physical Education, University of Niš, Niš, Serbia
| | - Nebojša Trajković
- Faculty of Sport and Physical Education, University of Niš, Niš, Serbia
| | - Cristina Cadenas-Sanchez
- Department of Physical Education and Sports, Faculty of Sports Science, Sport and Health University Research Institute (iMUDS), University of Granada; CIBEROBN, ISCIII, Granada, Spain.
- Stanford University, Department of Cardiology, Stanford; Veterans Affair Palo Alto Health Care System, Palo Alto, California, USA.
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Alshahrani SA, Salem F, harbi SA, Alshahrani A, AlAhmari Y. Assessment of self-management care and glycated hemoglobin level among diabetes mellitus patients attend diabetic center in armed forces hospital in southern region, Kingdom Saudi Arabia. J Family Med Prim Care 2024; 13:2425-2431. [PMID: 39027872 PMCID: PMC11254090 DOI: 10.4103/jfmpc.jfmpc_1786_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Revised: 12/05/2023] [Accepted: 01/08/2024] [Indexed: 07/20/2024] Open
Abstract
Background Diabetes mellitus (DM) requires patients to take on a high level of responsibility for their daily care. Thus, care for people with diabetes is moving toward patients taking an active role in their own health care. Objective To evaluate the impact of self-management care on glycemic control in individuals with DM and determine the correlation between glycated hemoglobin (A1C) levels and self-management practices. Material and Methods A cross-sectional descriptive study was conducted among diabetes patients at a diabetic center in Armed Forces Military hospitals, Southern region. A questionnaire of demographic and clinical information and self-management measured with the Diabetes Self-Management Questionnaire was used. Glycemic control was assessed using HbA1c levels. Results The study involved 255 patients with diabetes, of which 61.2% were females and 81.6% aged ≥41 years. The average diabetic self-management score was 6.49 on a scale of 10. The mean glucose self-management subscale score was 7.83 points, while the mean dietary control (DC) subscale score was 4.89. The patients had a mean physical activity (PA) subscale score of 6.31 and 8.75 for healthcare usage. Patients with higher education were significantly less likely to have poor glycemic control. Diabetes duration was significantly and positively correlated with poorer glycemic control. Mean perceived PA and DC scores were significantly associated with glycemic control. Conclusion Type 2 diabetes patients had satisfactory self-care practices. Many did not achieve the target glycemic control for diabetes.
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Affiliation(s)
- Salehah A. Alshahrani
- Family Medicine Department, Armed Forces Hospital in Southern Region, Kingdom Saudi Arabia
| | - Fatima Salem
- Endocrinology Department, Armed Forces Hospital in Southern Region, Kingdom Saudi Arabia
| | - Sana Al harbi
- Family Medicine Department, Armed Forces Hospital in Southern Region, Kingdom Saudi Arabia
| | - Ali Alshahrani
- College of Medicine, King Khalid University, Kingdom Saudi Arabia
| | - Yasser AlAhmari
- College of Medicine, King Khalid University, Kingdom Saudi Arabia
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Turner LV, Marak MC, Gal RL, Calhoun P, Li Z, Jacobs PG, Clements MA, Martin CK, Doyle FJ, Patton SR, Castle JR, Gillingham MB, Beck RW, Rickels MR, Riddell MC. Associations between daily step count classifications and continuous glucose monitoring metrics in adults with type 1 diabetes: analysis of the Type 1 Diabetes Exercise Initiative (T1DEXI) cohort. Diabetologia 2024; 67:1009-1022. [PMID: 38502241 DOI: 10.1007/s00125-024-06127-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Accepted: 02/16/2024] [Indexed: 03/21/2024]
Abstract
AIMS/HYPOTHESIS Adults with type 1 diabetes should perform daily physical activity to help maintain health and fitness, but the influence of daily step counts on continuous glucose monitoring (CGM) metrics are unclear. This analysis used the Type 1 Diabetes Exercise Initiative (T1DEXI) dataset to investigate the effect of daily step count on CGM-based metrics. METHODS In a 4 week free-living observational study of adults with type 1 diabetes, with available CGM and step count data, we categorised participants into three groups-below (<7000), meeting (7000-10,000) or exceeding (>10,000) the daily step count goal-to determine if step count category influenced CGM metrics, including per cent time in range (TIR: 3.9-10.0 mmol/l), time below range (TBR: <3.9 mmol/l) and time above range (TAR: >10.0 mmol/l). RESULTS A total of 464 adults with type 1 diabetes (mean±SD age 37±14 years; HbA1c 48.8±8.1 mmol/mol [6.6±0.7%]; 73% female; 45% hybrid closed-loop system, 38% standard insulin pump, 17% multiple daily insulin injections) were included in the study. Between-participant analyses showed that individuals who exceeded the mean daily step count goal over the 4 week period had a similar TIR (75±14%) to those meeting (74±14%) or below (75±16%) the step count goal (p>0.05). In the within-participant comparisons, TIR was higher on days when the step count goal was exceeded or met (both 75±15%) than on days below the step count goal (73±16%; both p<0.001). The TBR was also higher when individuals exceeded the step count goals (3.1%±3.2%) than on days when they met or were below step count goals (difference in means -0.3% [p=0.006] and -0.4% [p=0.001], respectively). The total daily insulin dose was lower on days when step count goals were exceeded (0.52±0.18 U/kg; p<0.001) or were met (0.53±0.18 U/kg; p<0.001) than on days when step counts were below the current recommendation (0.55±0.18 U/kg). Step count had a larger effect on CGM-based metrics in participants with a baseline HbA1c ≥53 mmol/mol (≥7.0%). CONCLUSIONS/INTERPRETATION Our results suggest that, compared with days with low step counts, days with higher step counts are associated with slight increases in both TIR and TBR, along with small reductions in total daily insulin requirements, in adults living with type 1 diabetes. DATA AVAILABILITY The data that support the findings reported here are available on the Vivli Platform (ID: T1-DEXI; https://doi.org/10.25934/PR00008428 ).
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Affiliation(s)
- Lauren V Turner
- School of Kinesiology and Health Science, York University, Toronto, ON, Canada
| | | | - Robin L Gal
- Jaeb Center for Health Research, Tampa, FL, USA
| | | | - Zoey Li
- Jaeb Center for Health Research, Tampa, FL, USA
| | - Peter G Jacobs
- Department of Biomedical Engineering, Oregon Health & Science University, Portland, OR, USA
| | | | - Corby K Martin
- Pennington Biomedical Research Center, Louisiana State University, Baton Rouge, LA, USA
| | - Francis J Doyle
- Harvard John A. Paulson School of Engineering and Applied Sciences, Harvard University, Cambridge, MA, USA
| | | | - Jessica R Castle
- Harold Schnitzer Diabetes Health Center, Oregon Health & Science University, Portland, OR, USA
| | - Melanie B Gillingham
- Department of Molecular and Medical Genetics, Oregon Health & Science University, Portland, OR, USA
| | - Roy W Beck
- Jaeb Center for Health Research, Tampa, FL, USA
| | - Michael R Rickels
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Michael C Riddell
- School of Kinesiology and Health Science, York University, Toronto, ON, Canada.
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Li Z, Calhoun P, Rickels MR, Gal RL, Beck RW, Jacobs PG, Clements MA, Patton SR, Castle JR, Martin CK, Gillingham MB, Doyle FJ, Riddell MC. Factors Affecting Reproducibility of Change in Glucose During Exercise: Results From the Type 1 Diabetes and EXercise Initiative. J Diabetes Sci Technol 2024:19322968241234687. [PMID: 38456512 DOI: 10.1177/19322968241234687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/09/2024]
Abstract
AIMS To evaluate factors affecting within-participant reproducibility in glycemic response to different forms of exercise. METHODS Structured exercise sessions ~30 minutes in length from the Type 1 Diabetes Exercise Initiative (T1DEXI) study were used to assess within-participant glycemic variability during and after exercise. The effect of several pre-exercise factors on the within-participant glycemic variability was evaluated. RESULTS Data from 476 adults with type 1 diabetes were analyzed. A participant's change in glucose during exercise was reproducible within 15 mg/dL of the participant's other exercise sessions only 32% of the time. Participants who exercised with lower and more consistent glucose level, insulin on board (IOB), and carbohydrate intake at exercise start had less variability in glycemic change during exercise. Participants with lower mean glucose (P < .001), lower glucose coefficient of variation (CV) (P < .001), and lower % time <70 mg/dL (P = .005) on sedentary days had less variable 24-hour post-exercise mean glucose. CONCLUSIONS Reproducibility of change in glucose during exercise was low in this cohort of adults with T1D, but more consistency in pre-exercise glucose levels, IOB, and carbohydrates may increase this reproducibility. Mean glucose variability in the 24 hours after exercise is influenced more by the participant's overall glycemic control than other modifiable factors.
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Affiliation(s)
- Zoey Li
- JAEB Center for Health Research, Tampa, FL, USA
| | | | - Michael R Rickels
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Robin L Gal
- JAEB Center for Health Research, Tampa, FL, USA
| | - Roy W Beck
- JAEB Center for Health Research, Tampa, FL, USA
| | - Peter G Jacobs
- Department of Biomedical Engineering, Oregon Health and Science University, Portland, OR, USA
| | | | | | - Jessica R Castle
- Harold Schnitzer Diabetes Health Center, Oregon Health & Science University, Portland, OR, USA
| | - Corby K Martin
- Pennington Biomedical Research Center, Louisiana State University, Baton Rouge, LA, USA
| | - Melanie B Gillingham
- Department of Molecular and Medical Genetics, Oregon Health & Science University, Portland, OR, USA
| | - Francis J Doyle
- Harvard John A. Paulson School of Engineering and Applied Sciences, Harvard University, Cambridge, MA, USA
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Rilstone S, Oliver N, Godsland I, Tanushi B, Thomas M, Hill N. A Randomized Controlled Trial Assessing the Impact of Continuous Glucose Monitoring with a Predictive Hypoglycemia Alert Function on Hypoglycemia in Physical Activity for People with Type 1 Diabetes (PACE). Diabetes Technol Ther 2024; 26:95-102. [PMID: 37943579 DOI: 10.1089/dia.2023.0376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2023]
Abstract
Background: Uptake of exercise in people with type 1 diabetes (T1D) is low despite significant health benefits. Fear of hypoglycemia is the main barrier to exercise. Continuous glucose monitoring (CGM) with predictive alarms warning of impending hypoglycemia may improve self-management of diabetes around exercise. Aim: To assess the impact of Dexcom G6 real-time CGM system with a predictive hypoglycemia alert function on the frequency, duration, and severity of hypoglycemia occurring during and after regular (≥150 min/week) physical activity in people with T1D. Methods: After 10 days of blinded run-in (Baseline), CGM was unblinded and participants randomized 1:1 to have the "urgent low soon" (ULS) alert switched "on" or "off" for 40 days. Participants then switched alerts "off" or "on," respectively, for a further 40 days. Physical activity, and carbohydrate and insulin doses were recorded. Results: Twenty-four participants (8 men, 16 women) were randomized. There was no difference in change from baseline of hypoglycemia <3.0 and <3.9 mmol/L with the ULS on or off during the 24 h after exercise. With ULS alert "on" time spent below 2.8 mmol/L compared with baseline was significantly (P = 0.04) lower than with ULS "off" in the 24 h after exercise. In mixed effects regression, timing of the exercise and baseline HbA1c independently affected risk of hypoglycemia during exercise; exercise timing also affected hypoglycemia risk after exercise. Conclusion: A CGM device with an ULS alert reduces exposure to hypoglycemia below 2.8 mmol/L overall and in the 24 h after exercise compared with a threshold alert.
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Affiliation(s)
- Siân Rilstone
- Department of Nutrition & Dietetics, Imperial College Healthcare NHS Trust, London, United Kingdom
- Department of Metabolism, Digestion and Reproduction, Imperial College London, London, United Kingdom
| | - Nick Oliver
- Department of Metabolism, Digestion and Reproduction, Imperial College London, London, United Kingdom
| | - Ian Godsland
- Department of Metabolism, Digestion and Reproduction, Imperial College London, London, United Kingdom
| | - Bruno Tanushi
- Department of Metabolism, Digestion and Reproduction, Imperial College London, London, United Kingdom
| | - Maria Thomas
- Department of Metabolism, Digestion and Reproduction, Imperial College London, London, United Kingdom
| | - Neil Hill
- Diabetes and Endocrinology, Imperial College Healthcare NHS Trust, London, United Kingdom
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Zimmer RT, Birnbaumer P, Sternad C, Zunner BEM, Schierbauer J, Fritsch M, Fröhlich-Reiterer E, Hofmann P, Sourij H, Aberer F, Moser O. Impact of a 4-week intensive track and field training intervention on glycaemia in adolescents with type 1 diabetes: The ChilDFiT1 study. Diabetes Obes Metab 2024; 26:631-641. [PMID: 37985360 DOI: 10.1111/dom.15352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Revised: 10/10/2023] [Accepted: 10/17/2023] [Indexed: 11/22/2023]
Abstract
AIM To investigate the safety and efficacy of track and field training compared with intensification of insulin treatment only in adolescents with type 1 diabetes (T1D). MATERIALS AND METHODS Eighteen adolescents (seven females) with T1D were included (age 15.1 ± 1.1 years, HbA1c 7.3% ± 1.0% [56.3 ± 10.9 mmol/mol]). After a 4-week observational control phase, participants were randomized to either stand-alone intensive glycaemic management (IT; telemedicine or on-site visits, three times/week) or additionally performed track and field exercise (EX; three 60-minute sessions/week) for 4 weeks. Glycaemia was assessed via continuous glucose monitoring during observational control and intervention phases. RESULTS Time in range (70-180 mg/dL; 3.9-10.0 mmol/L) significantly improved from the observational control phase to the exercise intervention phase in EX (69% ± 13% vs. 72% ± 11%, P = .049), but not in IT (59% ± 22% vs. 62% ± 16%, P = .399). Time below range 1 (54-69 mg/dL; < 3.9 mmol/L) improved in IT (3.1% ± 1.9% vs. 2.0% ± 0.8%, P = .017) and remained stable in EX (2.0% ± 1.7 vs. 1.9% ± 1.1%, P = .999). The EX group's HbA1c ameliorated preintervention to postintervention (mean difference: ΔHbA1c -0.19% ± 0.17%, P = .042), which was not seen within the IT group (ΔHbA1c -0.16% ± 0.37%, P = .40). Glucose standard deviation was reduced significantly in EX (55 ± 11 vs. 51 ± 10 mg/dL [3.1 ± 0.6 vs. 2.8 ± 0.6 mmol/L], P = .011), but not in IT (70 ± 24 vs. 63 ± 18 mg/dL [3.9 ± 1.3 vs. 3.5 ± 1.0 mmol/L], P = .186). CONCLUSION Track and field training combined with intensive glycaemic management improved glycaemia in adolescents with T1D, which was not observed in the non-exercise group.
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Affiliation(s)
- Rebecca T Zimmer
- Division of Exercise Physiology and Metabolism, BaySpo-Bayreuth Center of Sport Science, University Bayreuth, Bayreuth, Germany
| | - Philipp Birnbaumer
- Exercise Physiology, Training & Training Therapy Research Group, Institute of Human Movement Science, Sport and Health, University of Graz, Graz, Austria
| | - Christoph Sternad
- Interdisciplinary Metabolic Medicine Trials Unit, Division of Endocrinology and Diabetology, Medical University of Graz, Graz, Austria
| | - Beate E M Zunner
- Division of Exercise Physiology and Metabolism, BaySpo-Bayreuth Center of Sport Science, University Bayreuth, Bayreuth, Germany
| | - Janis Schierbauer
- Division of Exercise Physiology and Metabolism, BaySpo-Bayreuth Center of Sport Science, University Bayreuth, Bayreuth, Germany
| | - Maria Fritsch
- Department of Pediatrics and Adolescent Medicine, Division of General Pediatrics, Medical University Graz, Graz, Austria
| | - Elke Fröhlich-Reiterer
- Department of Pediatrics and Adolescent Medicine, Division of General Pediatrics, Medical University Graz, Graz, Austria
| | - Peter Hofmann
- Exercise Physiology, Training & Training Therapy Research Group, Institute of Human Movement Science, Sport and Health, University of Graz, Graz, Austria
| | - Harald Sourij
- Interdisciplinary Metabolic Medicine Trials Unit, Division of Endocrinology and Diabetology, Medical University of Graz, Graz, Austria
| | - Felix Aberer
- Division of Exercise Physiology and Metabolism, BaySpo-Bayreuth Center of Sport Science, University Bayreuth, Bayreuth, Germany
- Interdisciplinary Metabolic Medicine Trials Unit, Division of Endocrinology and Diabetology, Medical University of Graz, Graz, Austria
| | - Othmar Moser
- Division of Exercise Physiology and Metabolism, BaySpo-Bayreuth Center of Sport Science, University Bayreuth, Bayreuth, Germany
- Interdisciplinary Metabolic Medicine Trials Unit, Division of Endocrinology and Diabetology, Medical University of Graz, Graz, Austria
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Zimmer RT, Auth A, Schierbauer J, Haupt S, Wachsmuth N, Zimmermann P, Voit T, Battelino T, Sourij H, Moser O. (Hybrid) Closed-Loop Systems: From Announced to Unannounced Exercise. Diabetes Technol Ther 2023. [PMID: 38133645 DOI: 10.1089/dia.2023.0293] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2023]
Abstract
Physical activity and exercise have many beneficial effects on general and type 1 diabetes (T1D) specific health and are recommended for individuals with T1D. Despite these health benefits, many people with T1D still avoid exercise since glycemic management during physical activity poses substantial glycemic and psychological challenges - which hold particularly true for unannounced exercise when using an AID system. Automated insulin delivery (AID) systems have demonstrated their efficacy in improving overall glycemia and in managing announced exercise in numerous studies. They are proven to increase time in range (70-180 mg/dL) and can especially counteract nocturnal hypoglycemia, even when evening exercise was performed. AID-systems consist of a pump administering insulin as well as a CGM sensor (plus transmitter), both communicating with a control algorithm integrated into a device (insulin pump, mobile phone/smart watch). Nevertheless, without manual pre-exercise adaptions, these systems still face a significant challenge around physical activity. Automatically adapting to the rapidly changing insulin requirements during unannounced exercise and physical activity is still the Achilles' heel of current AID systems. There is an urgent need for improving current AID-systems to safely and automatically maintain glucose management without causing derailments - so that going forward, exercise announcements will not be necessary in the future. Therefore, this narrative literature review aimed to discuss technological strategies to how current AID-systems can be improved in the future and become more proficient in overcoming the hurdle of unannounced exercise. For this purpose, the current state-of-the-art therapy recommendations for AID and exercise as well as novel research approaches are presented along with potential future solutions - in order to rectify their deficiencies in the endeavor to achieve fully automated AID-systems even around unannounced exercise.
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Affiliation(s)
- Rebecca Tanja Zimmer
- University of Bayreuth, 26523, Division Exercise Physiology and Metabolism Institute of Sport Science, Bayreuth, Bavaria, Germany;
| | - Alexander Auth
- University of Bayreuth, 26523, Division Exercise Physiology and Metabolism Institute of Sport Science, Bayreuth, Bavaria, Germany;
| | - Janis Schierbauer
- University of Bayreuth, 26523, Division Exercise Physiology and Metabolism Institute of Sport Science, Bayreuth, Bavaria, Germany;
| | - Sandra Haupt
- University of Bayreuth, 26523, Division Exercise Physiology and Metabolism Institute of Sport Science, Bayreuth, Bavaria, Germany;
| | - Nadine Wachsmuth
- University of Bayreuth, 26523, Division Exercise Physiology and Metabolism Institute of Sport Science, Bayreuth, Bavaria, Germany;
| | - Paul Zimmermann
- University of Bayreuth, 26523, Division Exercise Physiology and Metabolism Institute of Sport Science, Bayreuth, Bavaria, Germany;
| | - Thomas Voit
- University of Bayreuth, 26523, Division Exercise Physiology and Metabolism Institute of Sport Science, Bayreuth, Bavaria, Germany;
| | - Tadej Battelino
- University Children's Hospital, Ljubljana, Slovenia, Department of Endocrinology, Diabetes and Metabolism, Bohoriceva 20, Ljubljana, Slovenia, 1000
- Slovenia;
| | - Harald Sourij
- Medical University of Graz, 31475, Auenbruggerplatz 15, 8036 Graz, Graz, Austria, 8036;
| | - Othmar Moser
- University of Bayreuth, 26523, Division Exercise Physiology and Metabolism Institute of Sport Science, Universitätsstraße 30, Bayreuth, Bayern, Germany, 95440;
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Amirkhosravi L, Kordestani Z, Nikooei R, Safi Z, Yeganeh-Hajahmadi M, Mirtajaddini-Goki M. Exercise-related alterations in MCT1 and GLUT4 expressions in the liver and pancreas of rats with STZ-induced diabetes. J Diabetes Metab Disord 2023; 22:1355-1363. [PMID: 37975118 PMCID: PMC10638214 DOI: 10.1007/s40200-023-01255-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Accepted: 06/19/2023] [Indexed: 11/19/2023]
Abstract
Background The liver and pancreas tissues play a central role in controlling glucose homeostasis. In patients with type I diabetes mellitus (T1DM), the function of these tissues is impaired. The positive effects of exercise have been shown in diabetic patients. To demonstrate the positive effects of exercise in T1DM, we examined the effects of moderate-intensity endurance training (MIET) on the liver enzymes and expression of MCT1 and GLUT4 genes. Methods Male Wistar rats were allocated into 4 groups of control (C), training (T), diabetic control (DC), and diabetes + training (DT). The serum levels of liver enzymes such as alanine aminotransferase (ALT), aspartate transaminase (AST), and alkaline phosphatase (ALP) were determined by ELIZA. MCT1 and GLUT4 mRNA expressions in the liver and pancreas tissues were evaluated through real-time qPCR after 10 weeks of training. Results The mRNA levels of MCT1 and GLUT4 decreased in DC group and increased in DT group. T1DM led to weight loss, but the weight loss was less in the DT group. T1DM caused an increase in liver enzymes such as ALT, AST and ALP, whereas endurance training preserved enzymatic levels. Conclusion These results suggested that MIET increases levels of MCT1 and GLUT4 liver and pancreas in the diabetic rats and improves liver function tests. Upregulation of MCT1 and GLUT4 can probably improve the function of liver and pancreas tissues and promote glucose homeostasis in T1DM.
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Affiliation(s)
- Ladan Amirkhosravi
- Endocrinology and Metabolism Research Center, Institute of Basic and Clinical Physiology Sciences, Kerman University of Medical Sciences, Kerman, Iran
| | - Zeinab Kordestani
- Physiology Research Center, Institute of Neuropharmacology, Kerman University of Medical Sciences, Kerman, Iran
| | - Rohollah Nikooei
- Department of Exercise Physiology, Faculty of Physical Education and Sport Science, Shahid Bahonar University of Kerman, Kerman, Iran
| | - Zohreh Safi
- Physiology Research Center, Institute of Neuropharmacology, Kerman University of Medical Sciences, Kerman, Iran
| | - Mahboobeh Yeganeh-Hajahmadi
- Physiology Research Center, Institute of Neuropharmacology, Kerman University of Medical Sciences, Kerman, Iran
| | - Maryamossadat Mirtajaddini-Goki
- Department of Exercise Physiology, Faculty of Physical Education and Sport Science, Shahid Bahonar University of Kerman, Kerman, Iran
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10
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Aljawarneh YM, Wood GL, Wardell DW, Al-Jarrah MD. The associations between physical activity, health-related quality of life, regimen adherence, and glycemic control in adolescents with type 1 diabetes: A cross-sectional study. Prim Care Diabetes 2023:S1751-9918(23)00068-2. [PMID: 37080862 DOI: 10.1016/j.pcd.2023.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Revised: 03/25/2023] [Accepted: 04/03/2023] [Indexed: 04/22/2023]
Abstract
BACKGROUND Adolescents with Type 1 Diabetes (T1D) display a greater than two-fold higher risk of developing diabetes-related complications compared with their healthy peers and the risk increases markedly as glycated hemoglobin (HbA1c) increases. The majority of the known factors associated with improved glycemic control in adolescents with T1D are geared toward Western populations. Therefore, this study examined the associations between Physical Activity (PA), Health-Related Quality of Life (HRQoL), and regimen adherence on glycemic control in a Middle Eastern population of adolescents with T1D METHODS: The study utilized a cross-sectional design of Jordanian adolescents (aged 12-18) with T1D (n = 74). Self-reported measures used were the Pediatric Quality of Life-Diabetes Module, the International Physical Activity Questionnaire, and the Summary of Diabetes Self-Care Activities. HbA1c values were obtained from the medical records. Correlation analyses were conducted using Pearson's and Spearman's correlation tests. Multiple regression analyses were conducted to determine if HRQoL, PA, and regimen adherence predict glycemic control. RESULTS Only 14.8 % of the participants demonstrated good glycemic control (HbA1c ≤ 7.5 %). Participants with poor control had a statistically significant lower mean PA of MET-minutes/week (3531.9 ± 1356.75 vs. 1619.81 ± 1481.95, p < .001) compared to those with good control. The total sample was found to demonstrate low HRQoL (47.70 ± 10.32). Participants were within the acceptable range of PA (1885.38 ± 1601.13) MET-minutes/week. HbA1c significantly inversely correlated with PA (r = -0.328, p = .010) and regimen adherence (r = -0.299, p = .018). The regression analysis revealed that PA significantly predicted glycemic control (β = -0.367, p < .01) as adherence (β = -0.409, p < .01) and disease duration did (β = 0.444, p < .01). CONCLUSION Better glycemic control was significantly associated with higher PA and regimen adherence levels. The correlation between PA and glycemic control depends highly on the level of regimen adherence or arguably, adherence acts as a buffer in the correlation between PA and glycemic control. There was no significant association between glycemic control and HRQoL.
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Affiliation(s)
- Yousef M Aljawarneh
- School of Nursing at Higher Colleges of Technology, Fujairah 1626, United Arab Emirates.
| | - Geri LoBiondo Wood
- Nursing Program at The University of Texas Health Science Center-Houston, Cizik School of Nursing, 6901 Bertner Avenue, Ste. 580, Houston, TX 77030, USA
| | - Diane W Wardell
- School of Nursing at The University of Texas Health Science Center-Houston, 6901 Bertner Avenue, Ste. 615, Houston, TX 77030, USA
| | - Muhammed D Al-Jarrah
- Department of Rehabilitation Sciences at The Jordan University of Science and Technology, 3030 Ar-Ramtha, Jordan
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11
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Coomans de Brachène A, Scoubeau C, Musuaya AE, Costa-Junior JM, Castela A, Carpentier J, Faoro V, Klass M, Cnop M, Eizirik DL. Exercise as a non-pharmacological intervention to protect pancreatic beta cells in individuals with type 1 and type 2 diabetes. Diabetologia 2023; 66:450-460. [PMID: 36401627 PMCID: PMC9676790 DOI: 10.1007/s00125-022-05837-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Accepted: 10/06/2022] [Indexed: 11/21/2022]
Abstract
AIMS/HYPOTHESIS Diabetes is characterised by progressive loss of functional pancreatic beta cells. None of the therapeutic agents used to treat diabetes arrest this process; preventing beta cell loss remains a major unmet need. We have previously shown that serum from eight young healthy male participants who exercised for 8 weeks protected human islets and insulin-producing EndoC-βH1 cells from apoptosis induced by proinflammatory cytokines or the endoplasmic reticulum (ER) stressor thapsigargin. Whether this protective effect is influenced by sex, age, training modality, ancestry or diabetes is unknown. METHODS We enrolled 82 individuals, male or female, non-diabetic or diabetic, from different origins, in different supervised training protocols for 8-12 weeks (including training at home during the COVID-19 pandemic). EndoC-βH1 cells were treated with 'exercised' serum or with the exerkine clusterin to ascertain cytoprotection from ER stress. RESULTS The exercise interventions were effective and improved [Formula: see text] values in both younger and older, non-obese and obese, non-diabetic and diabetic participants. Serum obtained after training conferred significant beta cell protection (28% to 35% protection after 4 and 8 weeks of training, respectively) from severe ER stress-induced apoptosis. Cytoprotection was not affected by the type of exercise training or participant age, sex, BMI or ancestry, and persisted for up to 2 months after the end of the training programme. Serum from exercised participants with type 1 or type 2 diabetes was similarly protective. Clusterin reproduced the beneficial effects of exercised sera. CONCLUSIONS/INTERPRETATION These data uncover the unexpected potential to preserve beta cell health by exercise training, opening a new avenue to prevent or slow diabetes progression through humoral muscle-beta cell crosstalk.
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Affiliation(s)
| | - Corentin Scoubeau
- Laboratory for Biometry and Exercise Nutrition, Université Libre de Bruxelles, Brussels, Belgium
| | - Anyïshai E Musuaya
- ULB Center for Diabetes Research, Medical Faculty, Université Libre de Bruxelles, Brussels, Belgium
| | - Jose Maria Costa-Junior
- ULB Center for Diabetes Research, Medical Faculty, Université Libre de Bruxelles, Brussels, Belgium
| | - Angela Castela
- ULB Center for Diabetes Research, Medical Faculty, Université Libre de Bruxelles, Brussels, Belgium
| | - Julie Carpentier
- Laboratory for Biometry and Exercise Nutrition, Université Libre de Bruxelles, Brussels, Belgium
| | - Vitalie Faoro
- Cardiopulmonary Exercise Laboratory, Université Libre de Bruxelles, Brussels, Belgium
| | - Malgorzata Klass
- Laboratory for Biometry and Exercise Nutrition, Université Libre de Bruxelles, Brussels, Belgium
- Laboratory of Applied Biology and Research Unit in Applied Neurophysiology, Université Libre de Bruxelles, Brussels, Belgium
| | - Miriam Cnop
- ULB Center for Diabetes Research, Medical Faculty, Université Libre de Bruxelles, Brussels, Belgium
- Division of Endocrinology, Erasmus Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Decio L Eizirik
- ULB Center for Diabetes Research, Medical Faculty, Université Libre de Bruxelles, Brussels, Belgium
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12
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Esefeld K, Kress S, Behrens M, Zimmer P, Stumvoll M, Thurm U, Gehr B, Halle M, Brinkmann C. Diabetes, Sports and Exercise. Exp Clin Endocrinol Diabetes 2023; 131:51-60. [PMID: 36638806 DOI: 10.1055/a-1946-3768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Affiliation(s)
- Katrin Esefeld
- Department of Preventive Sports Medicine, Klinikum rechts der Isar, Technical University Munich, Munich, Germany.,German Center for Cardiovascular Research (Deutsches Zentrum für Herzkreislaufforschung - DZHK), partner site Munich Heart Alliance (MHA), Munich, Germany
| | - Stephan Kress
- Diabetes, Sport and Physical Activity Working Group of the DDG.,Department of Internal Medicine I, Vinzentius Hospital Landau, Landau, Germany
| | - Meinolf Behrens
- Diabetes, Sport and Physical Activity Working Group of the DDG.,Diabetes Center Minden, Minden, Germany
| | - Peter Zimmer
- Diabetes, Sport and Physical Activity Working Group of the DDG
| | - Michael Stumvoll
- Department of Internal Medicine III, University Hospital Leipzig, Leipzig, Germany
| | - Ulrike Thurm
- Diabetes, Sport and Physical Activity Working Group of the DDG
| | - Bernhard Gehr
- Diabetes, Sport and Physical Activity Working Group of the DDG.,m&i specialized clinic Bad Heilbrunn, Bad Heilbrunn, Germany
| | - Martin Halle
- Department of Preventive Sports Medicine, Klinikum rechts der Isar, Technical University Munich, Munich, Germany.,German Center for Cardiovascular Research (Deutsches Zentrum für Herzkreislaufforschung - DZHK), partner site Munich Heart Alliance (MHA), Munich, Germany.,Diabetes, Sport and Physical Activity Working Group of the DDG
| | - Christian Brinkmann
- Diabetes, Sport and Physical Activity Working Group of the DDG.,Institute of Cardiovascular Research and Sport Medicine, German Sport University Cologne, Cologne, Germany.,IST University of Applied Sciences Düsseldorf, Düsseldorf, Germany
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13
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Sigal RJ, Yardley JE, Perkins BA, Riddell MC, Goldfield GS, Donovan L, Malcolm J, Hadjiyannakis S, Edwards AL, Gougeon R, Wells GA, Pacaud D, Woo V, Ford GT, Coyle D, Phillips P, Doucette S, Khandwala F, Kenny GP. The Resistance Exercise in Already Active Diabetic Individuals (READI) Randomised Clinical Trial. J Clin Endocrinol Metab 2022; 108:e63-e75. [PMID: 36459469 DOI: 10.1210/clinem/dgac682] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 11/23/2022] [Accepted: 11/28/2022] [Indexed: 12/05/2022]
Abstract
OBJECTIVE To evaluate the incremental impact of resistance training on HbA1c, fitness, body composition and cardiometabolic risk factors in aerobically-active people with type 1 diabetes. RESEARCH DESIGN AND METHODS The Resistance Exercise in Already-active Diabetic Individuals (READI) trial (NCT00410436) was a four-centre randomized parallel-group trial. After a 5-week run-in period with diabetes management optimization, 131 aerobically-active individuals with type 1 diabetes were randomized to resistance exercise (n = 71, intervention - INT) or control (n = 60, CON) for 22 additional weeks. Both groups maintained their aerobic activities and were provided dietary counselling throughout. Exercise training was three times per week at community-based facilities. The primary outcome was HbA1c, and secondary outcomes included fitness (peak oxygen consumption, muscle strength), body composition (anthropometrics, dual-energy X-ray absorptiometry, computed tomography) and cardiometabolic risk markers (lipids, apolipoproteins). Assessors were blinded to group allocation. RESULTS There were no significant differences in HbA1c change between INT and CON. Declines in HbA1c [INT: 7.75 ± 0.10% (61.2 ± 1.1 mmol/mol) to 7.55 ± 0.10% (59 ± 1.1 mmol/mol); CON: 7.70 ± 0.11% (60.7 ± 1.2 mmol/mol) to 7.57 ± 0.11% (59.6 ± 1.3 mmol/mol); intergroup difference in change -0.07 [95% CI -0.31, 0.18]. Waist circumference decreased more in INT than CON after six months (p = 0.02). Muscular strength increased more in INT than in CON (p < 0.001). There were no intergroup differences in hypoglycemia or any other variables. CONCLUSIONS Adding resistance training did not impact glycemia, but it increased strength and reduced waist circumference, in aerobically active individuals with type 1 diabetes.
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Affiliation(s)
- Ronald J Sigal
- Departments of Medicine, Cardiac Sciences and Community Health Sciences, Cumming School of Medicine, Faculties of Medicine and Kinesiology, University of Calgary, Canada
- School of Human Kinetics, University of Ottawa, Ottawa, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
| | - Jane E Yardley
- School of Human Kinetics, University of Ottawa, Ottawa, Canada
- University of Alberta, Augustana Faculty, Camrose, Canada
- Alberta Diabetes Institute, Edmonton, Canada
| | - Bruce A Perkins
- Mount Sinai Hospital and Lunenfeld Tanenbaum Research Institute, University of Toronto, Toronto, Canada
| | - Michael C Riddell
- School of Kinesiology and Health Science, York University, Toronto, Canada
| | - Gary S Goldfield
- Healthy Active Living & Obesity Research Group, Children's Hospital of Eastern Ontario Research Institute, Ottawa, Canada
| | - Lois Donovan
- Departments of Medicine, Obstetrics and Gynecology, Alberta Children's Hospital Research Institute, University of Calgary Cumming School of Medicine, Calgary, Canada
| | - Janine Malcolm
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
- Department of Medicine, University of Ottawa, Ottawa, Canada
| | - Stasia Hadjiyannakis
- Healthy Active Living & Obesity Research Group, Children's Hospital of Eastern Ontario Research Institute, Ottawa, Canada
| | - Alun L Edwards
- Departments of Medicine, Cardiac Sciences and Community Health Sciences, Cumming School of Medicine, Faculties of Medicine and Kinesiology, University of Calgary, Canada
| | - Réjeanne Gougeon
- Crabtree Nutrition Laboratories, Research Institute and Department of Medicine, McGill University Health Centre, Montreal, Canada
| | - George A Wells
- Cardiovascular Research Methods Centre, University of Ottawa Heart Institute, Ottawa, Canada
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, Canada
| | - Danièle Pacaud
- Alberta Children's Hospital, Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Vincent Woo
- Section of Endocrinology and Metabolism, Health Sciences Centre, University of Manitoba, Winnipeg, Canada
| | - Gordon T Ford
- Department of Medicine, Cumming School of Medicine, University of Calgary, Canada
| | - Doug Coyle
- Cardiovascular Research Methods Centre, University of Ottawa Heart Institute, Ottawa, Canada
| | - Penny Phillips
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
| | - Steve Doucette
- Department of Community Health and Epidemiology, Dalhousie University, Halifax, Canada
| | - Farah Khandwala
- Cancer Epidemiology and Prevention Research, Alberta Health Services, Calgary, Canada
| | - Glen P Kenny
- School of Human Kinetics, University of Ottawa, Ottawa, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
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14
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Montt-Blanchard D, Dubois-Camacho K, Costa-Cordella S, Sánchez R. Domesticating the condition: Design lessons gained from a marathon on how to cope with barriers imposed by type 1 diabetes. Front Psychol 2022; 13:1013877. [PMID: 36420398 PMCID: PMC9677098 DOI: 10.3389/fpsyg.2022.1013877] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2022] [Accepted: 10/04/2022] [Indexed: 11/03/2023] Open
Abstract
Through analytical autoethnographic analysis of marathon preparation, this study examines challenges faced by people with Type 1 Diabetes (T1D) who engage in high-performance sports. Autoethnographer and second-person perspectives (T1D runners, family members, and health providers) were collected through introspective activities (autoethnographic diary and in-depth interviews) to understand the T1D runner's coping experience. Six insights involved in T1D self-management were identified and analyzed with reference to related design tools (prototyping, archetyping and journey mapping). Finally, we conclude with a discussion of how endurance physical activity (PA) such as running helps to "domesticate" T1D, a term coined to reflect the difficulties that T1D presents for PA accomplishment and how T1D runners' experiences give them an opportunity to overcome PA barriers promoting physical culture and enriching further health psychology studies.
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Affiliation(s)
| | - Karen Dubois-Camacho
- Faculty of Medicine, Institute of Biomedical Sciences, Universidad de Chile, Santiago, Chile
| | - Stefanella Costa-Cordella
- Faculty of Psychology, Universidad Diego Portales, Santiago, Chile
- Millennium Institute for Depression and Personality Research (MIDAP), Santiago, Chile
| | - Raimundo Sánchez
- Faculty of Engineering and Sciences, Universidad Adolfo Ibañez, Santiago, Chile
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15
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Zhang Z, Zhu Y, Wang Q, Chang T, Liu C, Zhu Y, Wang X, Cao X. Global Trends and Research Hotspots of Exercise for Intervening Diabetes: A Bibliometric Analysis. Front Public Health 2022; 10:902825. [PMID: 35875005 PMCID: PMC9300903 DOI: 10.3389/fpubh.2022.902825] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Accepted: 05/31/2022] [Indexed: 12/25/2022] Open
Abstract
BackgroundDiabetes is a chronic metabolic disease characterized by hyperglycemia that often occurs in adults. Many studies have indicated that exercise is beneficial to the medical management of diabetes. Bibliometric analysis can help investigators to identify the current research concerns to guide future research directions. Nevertheless, the overview bibliometric analysis of this global research topic related to exercise and diabetes is lacking. The present bibliometric study aimed to investigate development trends and research hotspots of exercise and diabetes research and provide researchers with new perspectives in further studies.Materials and MethodsThe articles and reviews regarding exercise and diabetes between 2000 and 2020 were retrieved from the Web of Science Core Collection. The scientometrics analytical tool CiteSpace software was used to analyze the cooperation among countries/institutions/journals/authors, analysis of co-occurrence keywords, keywords bursts, and references.ResultsIn all, 3,029 peer-reviewed papers were found with a persistently increased tendency over time. The most prolific country and institution were the USA (965) and Univ Alberta (76), respectively. Diabetes Care published most papers (178) and was the most co-cited journal (2,630). Riddell MC had the most publications (53), and Sigal RJ was the most influential author (503 cited times). Colberg et al.'s paper (co-citation counts: 183) showed the strongest citation bursts by the end of 2020, which was the most representative reference. The four research focuses were mellitus, exercise, physical activity, and glycemic control. The two frontiers trends were sedentary behavior and stress. The combination of aerobic and resistance training can effectively improve glycemic control, decrease HbA1c levels, enhance cardiorespiratory fitness, improve lipid levels, and decrease the demand for non-insulin antihyperglycemic agents.ConclusionsThis study offers a scientific perspective on exercise and diabetes research and provides investigators with valuable information to detect the current research condition, hotspots, and emerging trends for further study.
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Affiliation(s)
- Zhijie Zhang
- Rehabilitation Therapy Center, Luoyang Orthopedic Hospital of Henan Province, Luoyang, China
| | - Yuanchun Zhu
- Department of Sport Rehabilitation, Shanghai University of Sport, Shanghai, China
| | - Qingfeng Wang
- Rehabilitation Therapy Center, Luoyang Orthopedic Hospital of Henan Province, Luoyang, China
| | - Tiantian Chang
- Department of Sport Rehabilitation, Shanghai University of Sport, Shanghai, China
| | - Chunlong Liu
- Clinical Medical College of Acupuncture, Moxibustion and Rehabilitation, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Yi Zhu
- Department of Musculoskeletal Pain Rehabilitation, The Fifth Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Xueqiang Wang
- Department of Sport Rehabilitation, Shanghai University of Sport, Shanghai, China
| | - Xiangyang Cao
- Rehabilitation Therapy Center, Luoyang Orthopedic Hospital of Henan Province, Luoyang, China
- *Correspondence: Xiangyang Cao
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16
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García-Hermoso A, Ezzatvar Y, Huerta-Uribe N, Alonso-Martínez AM, Chueca-Guindulain MJ, Berrade-Zubiri S, Izquierdo M, Ramírez-Vélez R. Effects of exercise training on glycaemic control in youths with type 1 diabetes: a systematic review and meta-analysis of randomised controlled trials. Eur J Sport Sci 2022; 23:1056-1067. [PMID: 35659492 DOI: 10.1080/17461391.2022.2086489] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
AbstractThe aim of the study is to evaluate whether exercise interventions are associated with improved glycaemic control in children and adolescents with type 1 diabetes mellitus (T1DM), and to examine its relationship with the characteristics of the intervention (i.e., type, intensity, length, and duration of the sessions). Eligible criteria were randomised controlled trials of youth aged 6-18 years with T1DM, participating in an exercise-based intervention where glycaemic control is measured (i.e., glycated haemoglobin [HbA1c]). Pooled effect sizes (Hedges'g) were calculated using random-effects inverse-variance analyses. Fourteen studies enrolling 509 patients were analysed. Effect size was expressed as Hedges' g to correct for possible small sample bias. Overall, HbA1c levels in the exercise group (g=-0.38 95% confidence interval [CI], -0.66 to -0.11; mean difference [MD]=-0.62%) were reduced compared with the control group. Concurrent training (g=-0.63 95%CI, -1.05 to -0.21), high-intensity exercise (g=-0.43 95%CI, -0.83 to -0.03), interventions ≥24 weeks (g=-0.92 95%CI, -1.44 to -0.40), and sessions ≥60 minutes (g=-0.71 95%CI, -1.05 to -0.08) showed larger changes (MD=-0.66% to 1.30%). In conclusion, our study suggests that programs longer than 24 weeks with at least 60 min/session of high-intensity concurrent exercise may serve as a supportive therapy to metabolic control in youth with T1DM.
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Affiliation(s)
- Antonio García-Hermoso
- Navarrabiomed, Complejo Hospitalario de Navarra (CHN), Universidad Pública de Navarra (UPNA), IdiSNA, Pamplona, Spain
| | - Yasmin Ezzatvar
- Department of Nursing, Universitat de València, Valencia, Spain
| | - Nidia Huerta-Uribe
- Navarrabiomed, Complejo Hospitalario de Navarra (CHN), Universidad Pública de Navarra (UPNA), IdiSNA, Pamplona, Spain
| | - Alicia M Alonso-Martínez
- Navarrabiomed, Complejo Hospitalario de Navarra (CHN), Universidad Pública de Navarra (UPNA), IdiSNA, Pamplona, Spain
| | | | - Sara Berrade-Zubiri
- Pediatric Endocrinology Unit, Complejo Hospitalario de Navarra, IdiSNA, Pamplona, Spain
| | - Mikel Izquierdo
- Navarrabiomed, Complejo Hospitalario de Navarra (CHN), Universidad Pública de Navarra (UPNA), IdiSNA, Pamplona, Spain
| | - Robinson Ramírez-Vélez
- Navarrabiomed, Complejo Hospitalario de Navarra (CHN), Universidad Pública de Navarra (UPNA), IdiSNA, Pamplona, Spain
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17
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Duran AT, Romero E, Diaz KM. Is Sedentary Behavior a Novel Risk Factor for Cardiovascular Disease? Curr Cardiol Rep 2022; 24:393-403. [PMID: 35182312 DOI: 10.1007/s11886-022-01657-w] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/07/2021] [Indexed: 01/16/2023]
Abstract
PURPOSE OF REVIEW Review the most recent evidence on the role of sedentary behavior in the prevention of cardiovascular disease (CVD). RECENT FINDINGS Prospective cohort studies continue to suggest a relationship between sedentary behavior and CVD, but the dose-response association, and the implications of sedentary pattern (vs. total volume) and context on CVD risk require further investigation. Most recent evidence suggests that physical activity influences the association between sedentary time and CVD risk, and that replacing sedentary time with other movement behaviors yields cardiometabolic benefits. Short-term intervention studies have further demonstrated that interrupting prolonged sitting with bouts of physical activity can elicit acute improvements on cardiometabolic biomarkers and vascular function relative to prolonged, uninterrupted sitting, albeit limited evidence exists on the long-term effects. More conclusive evidence regarding the implications of sedentary time on CVD risk is warranted before the optimal sedentary behavior reduction prescription for the prevention of CVD can be elucidated.
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Affiliation(s)
- Andrea T Duran
- Columbia University Irving Medical Center, 622 West 168 Street, New York, NY, 10032, USA.
| | - Emily Romero
- Teachers College, Columbia University, 525 West 120th Street, New York, NY, USA
| | - Keith M Diaz
- Columbia University Irving Medical Center, 622 West 168 Street, New York, NY, 10032, USA
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18
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Cristello Sarteau A, Mayer-Davis E. Too Much Dietary Flexibility May Hinder, Not Help: Could More Specific Targets for Daily Food Intake Distribution Promote Glycemic Management among Youth with Type 1 Diabetes? Nutrients 2022; 14:nu14040824. [PMID: 35215477 PMCID: PMC8877269 DOI: 10.3390/nu14040824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 01/28/2022] [Accepted: 02/09/2022] [Indexed: 01/09/2023] Open
Abstract
Average glycemic levels among youth with type 1 diabetes (T1D) have worsened in some parts of the world over the past decade despite simultaneous increased uptake of diabetes technology, thereby highlighting the persistent need to identify effective behavioral strategies to manage glycemia during this life stage. Nutrition is fundamental to T1D management. We reviewed the evidence base of eating strategies tested to date to improve glycemic levels among youth with T1D in order to identify promising directions for future research. No eating strategy tested among youth with T1D since the advent of flexible insulin regimens—including widely promoted carbohydrate counting and low glycemic index strategies—is robustly supported by the existing evidence base, which is characterized by few prospective studies, small study sample sizes, and lack of replication of results due to marked differences in study design or eating strategy tested. Further, focus on macronutrients or food groups without consideration of food intake distribution throughout the day or day-to-day consistency may partially underlie the lack of glycemic benefits observed in studies to date. Increased attention paid to these factors by future observational and experimental studies may facilitate identification of behavioral targets that increase glycemic predictability and management among youth with T1D.
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Affiliation(s)
- Angelica Cristello Sarteau
- Department of Nutrition, University of North Carolina at Chapel Hill, 245 Rosenau Drive, Chapel Hill, NC 27599, USA;
- Correspondence:
| | - Elizabeth Mayer-Davis
- Department of Nutrition, University of North Carolina at Chapel Hill, 245 Rosenau Drive, Chapel Hill, NC 27599, USA;
- School of Medicine, University of North Carolina at Chapel Hill, 245 Rosenau Drive, Chapel Hill, NC 27599, USA
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Trojian T, Colberg S, Harris G, Oh R, Dixit S, Gibson M, Corcoran M, Ramey L, Berg PV. American Medical Society for Sports Medicine Position Statement on the Care of the Athlete and Athletic Person With Diabetes. Clin J Sport Med 2022; 32:8-20. [PMID: 34930869 DOI: 10.1097/jsm.0000000000000906] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Accepted: 10/06/2020] [Indexed: 02/02/2023]
Abstract
ABSTRACT The American Medical Society for Sports Medicine (AMSSM) developed this position statement to assist physicians and other health professionals in managing athletes and active people with diabetes. The AMSSM selected the author panel through an application process to identify members with clinical and academic expertise in the care of active patients with diabetes. This article reviews the current knowledge and gaps regarding the benefits and risks of various types of exercise and management issues for athletes and physically active people with diabetes, including nutrition and rehabilitation issues. Resistance exercises seem to be beneficial for patients with type 1 diabetes, and the new medications for patients with type 2 diabetes generally do not need adjustment with exercise. In preparing this statement, the authors conducted an evidence review and received open comment from the AMSSM Board of Directors before finalizing the recommendations.
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20
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Hacke C, Schreiber J, Weisser B. Application of the Templates TIDieR and CERT Reveal Incomplete Reporting and Poor Replicability of Exercise Interventions for Type 2 Diabetes Mellitus. Curr Diabetes Rev 2022; 18:e250821195838. [PMID: 34433402 DOI: 10.2174/1871525719666210825150957] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 06/16/2021] [Accepted: 07/16/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND Exercise is strongly recommended for the management of type 2 diabetes mellitus (T2DM). However, incomplete intervention reporting in clinical trials limits the replication of exercise protocols. As previously demonstrated by us for exercise and hypertension, the reporting quality might also be insufficient in studies with respect to T2DM and exercise. OBJECTIVE The aim of the study was to assess the completeness of exercise intervention reporting in randomized controlled trials (RCTs) for T2DM. METHODS Two independent reviewers applied the Consensus on Exercise Reporting Template (CERT) and the template for intervention description and replication (TIDieR) to 23 exercise trials obtained from the most recent and frequently cited meta-analysis in current guidelines. The completeness of reporting was evaluated, focusing on the F.I.T.T. components (frequency, intensity, time, type). Interrater agreement and associations with publication year and journal impact factor were examined. RESULTS Mean CERT score was 11/19 (range 5-17), and 8/12 (range 4-12) for TIDieR. F.I.T.T. components were almost completely described, whereas overall completeness of exercise reporting was 60% and 68% (CERT and TIDieR). Replication of each exercise of the respective program was not possible in 52% of interventions. The majority of items had shown excellent agreement. No associations with publication year or impact factor were found. CONCLUSION Exercise interventions were not found to be sufficiently reported in RCTs that currently guide clinical practice in T2DM. Replication in further studies or clinical practice is limited due to poor exercise description. We suggest the use of more specific CERT for reporting results of exercise interventions. Further refinement for internal diseases is needed to better describe exercise interventions.
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Affiliation(s)
- Claudia Hacke
- Department of Sports Medicine, Institute of Sports Science, Christian-Albrechts-University Kiel, Kiel, Germany
| | - Janika Schreiber
- Department of Sports Medicine, Institute of Sports Science, Christian-Albrechts-University Kiel, Kiel, Germany
| | - Burkhard Weisser
- Department of Sports Medicine, Institute of Sports Science, Christian-Albrechts-University Kiel, Kiel, Germany
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21
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Bassi-Dibai D, Santos-de-Araújo AD, Dibai-Filho AV, de Azevedo LFS, Goulart CDL, Luz GCP, Burke PR, Garcia-Araújo AS, Borghi-Silva A. Rehabilitation of Individuals With Diabetes Mellitus: Focus on Diabetic Myopathy. Front Endocrinol (Lausanne) 2022; 13:869921. [PMID: 35498435 PMCID: PMC9047902 DOI: 10.3389/fendo.2022.869921] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2022] [Accepted: 03/21/2022] [Indexed: 12/20/2022] Open
Abstract
Diabetes mellitus (DM) is a chronic metabolic disease characterized by high blood glucose levels, causing serious damage to the cardiovascular, respiratory, renal and other systems. The prevalence of type 2 diabetes mellitus (T2DM) was 6.28% in 2017, considering all age groups worldwide (prevalence rate of 6,059 cases per 100,000), and its global prevalence is projected to increase to 7,079 cases per 100,000 by 2030. Furthermore, these individuals are often affected by diabetic myopathy, which is the failure to preserve muscle mass and function in the course of DM. This happens in type 1 diabetes mellitus (T1DM) and T2DM. As skeletal muscle plays a key role in locomotion and glucose homeostasis, diabetic myopathy may contribute to additional complications of the disease. In addition, chronic hyperglycemia is associated with lung functional changes seen in patients with DM, such as reduced lung volumes and compliance, inspiratory muscle strength, and lung elastic recoil. Thus, the weakness of the inspiratory muscles, a consequence of diabetic myopathy, can influence exercise tolerance. Thus, moderate strength training in T2DM can contribute to the gain of peripheral muscle strength. Although the literature is robust on the loss of mass and consequent muscle weakness in diabetic myopathy, triggering pathophysiological factors, the impact on functional capacity, as well as the prescription of physical exercise for this condition deserves to be further explored. This review aims to explore the consequences of diabetic myopathy and its implication in rehabilitation from prescription to safety in the practice of physical exercises for these individuals.
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Affiliation(s)
| | | | | | | | - Cássia da Luz Goulart
- Postgraduate Program in Physical Therapy, Universidade Federal de São Carlos, São Carlos, Brazil
| | | | | | | | - Audrey Borghi-Silva
- Postgraduate Program in Physical Therapy, Universidade Federal de São Carlos, São Carlos, Brazil
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22
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Golka M, Spiller M, Schmidt N, Turnowsky A, Grauduszus M, Matthes J, Joisten C. The effect of structured aerobic exercise on adherence, body mass index, hemoglobin A1c, and quality of life in type 1 and type 2 diabetes mellitus. TRANSLATIONAL SPORTS MEDICINE 2021. [DOI: 10.1002/tsm2.286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Max Golka
- Institute of Movement and Neurosciences German Sport University Cologne Cologne Germany
- Department of Pharmacology University of Cologne Cologne Germany
| | - Mark Spiller
- Institute of Movement and Neurosciences German Sport University Cologne Cologne Germany
| | - Nikola Schmidt
- Institute of Movement and Neurosciences German Sport University Cologne Cologne Germany
| | - Anna Turnowsky
- Department of Child and Adolescent Psychiatry University Medical Center Hamburg‐Eppendorf Hamburg Germany
| | - Martin Grauduszus
- Institute of Movement and Neurosciences German Sport University Cologne Cologne Germany
| | - Jan Matthes
- Department of Pharmacology University of Cologne Cologne Germany
| | - Christine Joisten
- Institute of Movement and Neurosciences German Sport University Cologne Cologne Germany
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23
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Esefeld K, Kress S, Behrens M, Zimmer P, Stumvoll M, Thurm U, Gehr B, Brinkmann C, Halle M. Diabetes, Sport und Bewegung. DIABETOL STOFFWECHS 2021. [DOI: 10.1055/a-1515-8792] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Affiliation(s)
- Katrin Esefeld
- Präventive und Rehabilitative Sportmedizin, Klinikum rechts der Isar, Technische Universität München, München
- Deutsches Zentrum für Herzkreislaufforschung (DZHK), partner site Munich Heart Alliance (MHA), München
| | - Stephan Kress
- AG Diabetes, Sport und Bewegung der DDG
- Medizinische Klinik Vinzentius-Krankenhaus Landau
| | - Meinolf Behrens
- AG Diabetes, Sport und Bewegung der DDG
- Diabeteszentrum Minden, Minden
| | | | - Michael Stumvoll
- Medizinische Klinik und Poliklinik III, Universitätsklinik Leipzig, Leipzig
| | | | - Bernhard Gehr
- AG Diabetes, Sport und Bewegung der DDG
- m&i Fachklinik Bad Heilbrunn
| | - Christian Brinkmann
- AG Diabetes, Sport und Bewegung der DDG
- Institut für Kreislaufforschung und Sportmedizin, Deutsche Sporthochschule Köln, Köln
- IST Hochschule Düsseldorf, Düsseldorf
| | - Martin Halle
- Präventive und Rehabilitative Sportmedizin, Klinikum rechts der Isar, Technische Universität München, München
- AG Diabetes, Sport und Bewegung der DDG
- Deutsches Zentrum für Herzkreislaufforschung (DZHK), partner site Munich Heart Alliance (MHA), München
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24
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Shetty VB, Soon WHK, Roberts AG, Fried L, Roby HC, Smith GJ, Fournier PA, Jones TW, Davis EA. A Novel Mobile Health App to Educate and Empower Young People With Type 1 Diabetes to Exercise Safely: Prospective Single-Arm Mixed Methods Pilot Study. JMIR Diabetes 2021; 6:e29739. [PMID: 34647896 PMCID: PMC8554675 DOI: 10.2196/29739] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Revised: 08/19/2021] [Accepted: 09/09/2021] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Empowering young people with type 1 diabetes (T1D) to manage their blood glucose levels during exercise is a complex challenge faced by health care professionals due to the unpredictable nature of exercise and its effect on blood glucose levels. Mobile health (mHealth) apps would be useful as a decision-support aid to effectively contextualize a blood glucose result and take appropriate action to optimize glucose levels during and after exercise. A novel mHealth app acT1ve was recently developed, based on expert consensus exercise guidelines, to provide real-time support for young people with T1D during exercise. OBJECTIVE Our aim was to pilot acT1ve in a free-living setting to assess its acceptability and functionality, and gather feedback on the user experience before testing it in a larger clinical trial. METHODS A prospective single-arm mixed method design was used. Ten participants with T1D (mean age 17.7 years, SD 4.2 years; mean HbA1c, 54 mmol/mol, SD 5.5 mmol/mol [7.1%, SD 0.5%]) had acT1ve installed on their phones, and were asked to use the app to guide their exercise management for 6 weeks. At the end of 6 weeks, participants completed both a semistructured interview and the user Mobile Application Rating Scale (uMARS). All semistructured interviews were transcribed. Thematic analysis was conducted whereby interview transcripts were independently analyzed by 2 researchers to uncover important and relevant themes. The uMARS was scored for 4 quality subscales (engagement, functionality, esthetics, and information), and a total quality score was obtained from the weighted average of the 4 subscales. Scores for the 4 objective subscales were determined by the mean score of each of its individual questions. The perceived impact and subjective quality of acT1ve for each participant were calculated by averaging the scores of their related questions, but were not considered in the total quality score. All scores have a maximal possible value of 5, and they are presented as medians, IQRs, and ranges. RESULTS The main themes arising from the interview analysis were "increased knowledge," "increased confidence to exercise," and "suitability" for people who were less engaged in exercise. The uMARS scores for acT1ve were high (out of 5) for its total quality (median 4.3, IQR 4.2-4.6), engagement (median 3.9, IQR 3.6-4.2), functionality (median 4.8, IQR 4.5-4.8), information (median 4.6, IQR 4.5-4.8), esthetics (median 4.3, IQR 4.0-4.7), subjective quality (median 4.0, IQR 3.8-4.2), and perceived impact (median 4.3, IQR 3.6-4.5). CONCLUSIONS The acT1ve app is functional and acceptable, with a high user satisfaction. The efficacy and safety of this app will be tested in a randomized controlled trial in the next phase of this study. TRIAL REGISTRATION Australian New Zealand Clinical Trials Registry (ANZCTR) ACTRN12619001414101; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=378373.
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Affiliation(s)
- Vinutha B Shetty
- Department of Endocrinology and Diabetes, Perth Children's Hospital, Perth, Australia.,Telethon Kids Institute, Children's Diabetes Centre, The University of Western Australia, Perth, Australia.,Division of Pediatrics, The University of Western Australia, Perth, Australia
| | - Wayne H K Soon
- Telethon Kids Institute, Children's Diabetes Centre, The University of Western Australia, Perth, Australia
| | - Alison G Roberts
- Telethon Kids Institute, Children's Diabetes Centre, The University of Western Australia, Perth, Australia
| | - Leanne Fried
- Telethon Kids Institute, Children's Diabetes Centre, The University of Western Australia, Perth, Australia
| | - Heather C Roby
- Telethon Kids Institute, Children's Diabetes Centre, The University of Western Australia, Perth, Australia
| | - Grant J Smith
- Telethon Kids Institute, Children's Diabetes Centre, The University of Western Australia, Perth, Australia
| | - Paul A Fournier
- Telethon Kids Institute, Children's Diabetes Centre, The University of Western Australia, Perth, Australia.,Exercise and Health, School of Human Sciences, The University of Western Australia, Perth, Australia
| | - Timothy W Jones
- Department of Endocrinology and Diabetes, Perth Children's Hospital, Perth, Australia.,Telethon Kids Institute, Children's Diabetes Centre, The University of Western Australia, Perth, Australia.,Division of Pediatrics, The University of Western Australia, Perth, Australia
| | - Elizabeth A Davis
- Department of Endocrinology and Diabetes, Perth Children's Hospital, Perth, Australia.,Telethon Kids Institute, Children's Diabetes Centre, The University of Western Australia, Perth, Australia.,Division of Pediatrics, The University of Western Australia, Perth, Australia
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25
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Ohko H, Umemoto Y, Sakurai Y, Araki S, Kojima D, Kamijo Y, Murai K, Yasuoka Y, Tajima F. The effects of endurance exercise combined with high-temperature head-out water immersion on serum concentration of brain-derived neurotrophic factor in healthy young men. Int J Hyperthermia 2021; 38:1077-1085. [PMID: 34278925 DOI: 10.1080/02656736.2021.1922761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
OBJECTIVES To evaluate acute changes in serum brain-derived neurotrophic factor (BDNF) concentration following combined endurance exercise and heat stress through head-out water immersion (HOI). SETTING Observational study with crossover design. METHODS Ten healthy young male participants performed HOI at 40 °C (40 °C HOI) or continuous cycling at 60% of maximal oxygen uptake while immersed in 40 °C (40 °C HOI-ex) or 23 °C water (23 °C HOI-ex) for 15 min. Serum BDNF, cortisol and lactate concentrations, and core temperature (Tcore) were measured pre, immediately post, and 15 and 30 min post-immersion. RESULTS BDNF concentration increased immediately and 15 min after 40 °C HOI-ex, but not after 40 °C or 23 °C HOI-ex. No changes in Tcore concentration were observed during 23 °C HOI-ex (Pre; 37.3 °C ± 0.3 °C, Post; 37.8 °C ± 0.2 °C, Post 15; 37.4 °C ± 0.3 °C, Post 30; 37.2 °C ± 0.2 °C). Tcore increased significantly post, post 15, and post 30 min of 40 °C HOI (Pre; 37.1 °C ± 0.4 °C, Post; 38.8 °C ± 0.5 °C, Post 15; 37.9 °C ± 0.4 °C, Post 30; 37.9 °C ± 0.2 °C) and 40 °C HOI-ex (Pre; 37.2 °C ± 0.2 °C, Post; 40.2 °C ± 0.7 °C, Post 15; 38.9 °C ± 0.5 °C, Post 30; 38.3 °C ± 0.5 °C). Tcore was higher in 40 °C HOI-ex compared with 40 °C HOI and 23 °C HOI-ex immediately post and post 15 min. Plasma lactate and cortisol were significantly higher in 40 °C HOI-ex compared with 40 °C HOI and 23 °C HOI-ex after immersion (p = 0.001). CONCLUSION While 15 min HOI alone or thermoneutral exercise do not increase BDNF concentration, both combined may form a time-efficient strategy to acutely elevate BDNF.
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Affiliation(s)
- Hiroshi Ohko
- Department of Rehabilitation and Care, Seijoh University, Aichi, Japan
| | - Yasunori Umemoto
- Department of Rehabilitation Medicine, Wakayama Medical University, School of Medicine, Wakayama, Japan
| | - Yuta Sakurai
- Research Center of Sports Medicine and Balneology, Nachikatsuura Balneologic Town Hospital, Tenma-Nachikatuurachou, Japan
| | - Shouhei Araki
- Research Center of Sports Medicine and Balneology, Nachikatsuura Balneologic Town Hospital, Tenma-Nachikatuurachou, Japan
| | - Daisuke Kojima
- Department of Rehabilitation Medicine, Wakayama Medical University, School of Medicine, Wakayama, Japan
| | - Yoshiichiro Kamijo
- Department of Rehabilitation Medicine, Wakayama Medical University, School of Medicine, Wakayama, Japan
| | - Kota Murai
- Department of Rehabilitation Medicine, Wakayama Medical University, School of Medicine, Wakayama, Japan
| | - Yoshinori Yasuoka
- Department of Rehabilitation Medicine, Wakayama Medical University, School of Medicine, Wakayama, Japan
| | - Fumihiro Tajima
- Department of Rehabilitation Medicine, Wakayama Medical University, School of Medicine, Wakayama, Japan.,Research Center of Sports Medicine and Balneology, Nachikatsuura Balneologic Town Hospital, Tenma-Nachikatuurachou, Japan
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26
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Frampton J, Cobbold B, Nozdrin M, Oo HTH, Wilson H, Murphy KG, Frost G, Chambers ES. The Effect of a Single Bout of Continuous Aerobic Exercise on Glucose, Insulin and Glucagon Concentrations Compared to Resting Conditions in Healthy Adults: A Systematic Review, Meta-Analysis and Meta-Regression. Sports Med 2021; 51:1949-1966. [PMID: 33905087 PMCID: PMC8363558 DOI: 10.1007/s40279-021-01473-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/08/2021] [Indexed: 01/26/2023]
Abstract
Background Elevated glucose and insulin levels are major risk factors in the development of cardiometabolic disease. Aerobic exercise is widely recommended to improve glycaemic control, yet its acute effect on glycaemia and glucoregulatory hormones has not been systematically reviewed and analysed in healthy adults. Objective To determine the effect of a single bout of continuous aerobic exercise on circulating glucose, insulin, and glucagon concentrations in healthy adults. Methods CENTRAL, CINAHL, Embase, Global Health, HMIC, Medline, PubMed, PsycINFO, ScienceDirect, Scopus and Web of Science databases were searched from inception to May 2020. Papers were included if they reported a randomised, crossover study measuring glucose and/or insulin and/or glucagon concentrations before and immediately after a single bout of continuous aerobic exercise (≥ 30 min) compared to a time-matched, resting control arm in healthy adults. The risk of bias and quality of evidence were assessed using the Cochrane Risk of Bias Tool and GRADE approach, respectively. Random-effects meta-analyses were performed for glucose, insulin, and glucagon. Sub-group meta-analyses and meta-regression were performed for categorical (metabolic state [postprandial or fasted], exercise mode [cycle ergometer or treadmill]) and continuous (age, body mass index, % males, maximal aerobic capacity, exercise duration, exercise intensity) covariates, respectively. Results 42 papers (51 studies) were considered eligible: glucose (45 studies, 391 participants), insulin (38 studies, 377 participants) and glucagon (5 studies, 47 participants). Acute aerobic exercise had no significant effect on glucose concentrations (mean difference: − 0.05 mmol/L; 95% CI, − 0.22 to 0.13 mmol/L; P = 0.589; I2: 91.08%, large heterogeneity; moderate-quality evidence). Acute aerobic exercise significantly decreased insulin concentrations (mean difference: − 18.07 pmol/L; 95% CI, − 30.47 to − 5.66 pmol/L; P = 0.004; I2: 95.39%, large heterogeneity; moderate-quality evidence) and significantly increased glucagon concentrations (mean difference: 24.60 ng/L; 95% CI, 16.25 to 32.95 ng/L; P < 0.001; I2: 79.36%, large heterogeneity; moderate-quality evidence). Sub-group meta-analyses identified that metabolic state modified glucose and insulin responses, in which aerobic exercise significantly decreased glucose (mean difference: − 0.27 mmol/L; 95% CI, − 0.55 to − 0.00 mmol/L; P = 0.049; I2: 89.72%, large heterogeneity) and insulin (mean difference: − 42.63 pmol/L; 95% CI, − 66.18 to − 19.09 pmol/L; P < 0.001; I2: 81.29%, large heterogeneity) concentrations in the postprandial but not fasted state. Meta-regression revealed that the glucose concentrations were also moderated by exercise duration and maximal aerobic capacity. Conclusions Acute aerobic exercise performed in the postprandial state decreases glucose and insulin concentrations in healthy adults. Acute aerobic exercise also increases glucagon concentrations irrespective of metabolic state. Therefore, aerobic exercise undertaken in the postprandial state is an effective strategy to improve acute glycaemic control in healthy adults, supporting the role of aerobic exercise in reducing cardiometabolic disease incidence. PROSPERO registration number CRD42020191345. Supplementary Information The online version contains supplementary material available at 10.1007/s40279-021-01473-2.
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Affiliation(s)
- James Frampton
- Section for Nutrition Research, Department of Metabolism, Digestion and Reproduction, Faculty of Medicine, Imperial College London, London, W12 0NN, UK.
- Section of Endocrinology and Investigative Medicine, Department of Metabolism, Digestion and Reproduction, Faculty of Medicine, Imperial College London, London, W12 0NN, UK.
| | - Benjamin Cobbold
- Section for Nutrition Research, Department of Metabolism, Digestion and Reproduction, Faculty of Medicine, Imperial College London, London, W12 0NN, UK
| | - Mikhail Nozdrin
- Section for Nutrition Research, Department of Metabolism, Digestion and Reproduction, Faculty of Medicine, Imperial College London, London, W12 0NN, UK
| | - Htet T H Oo
- Section for Nutrition Research, Department of Metabolism, Digestion and Reproduction, Faculty of Medicine, Imperial College London, London, W12 0NN, UK
| | - Holly Wilson
- Section for Nutrition Research, Department of Metabolism, Digestion and Reproduction, Faculty of Medicine, Imperial College London, London, W12 0NN, UK
| | - Kevin G Murphy
- Section of Endocrinology and Investigative Medicine, Department of Metabolism, Digestion and Reproduction, Faculty of Medicine, Imperial College London, London, W12 0NN, UK
| | - Gary Frost
- Section for Nutrition Research, Department of Metabolism, Digestion and Reproduction, Faculty of Medicine, Imperial College London, London, W12 0NN, UK
| | - Edward S Chambers
- Section for Nutrition Research, Department of Metabolism, Digestion and Reproduction, Faculty of Medicine, Imperial College London, London, W12 0NN, UK
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27
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Resistance exercise training improves glucose homeostasis by enhancing insulin secretion in C57BL/6 mice. Sci Rep 2021; 11:8574. [PMID: 33883630 PMCID: PMC8060292 DOI: 10.1038/s41598-021-88105-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Accepted: 04/06/2021] [Indexed: 01/14/2023] Open
Abstract
Resistance exercise exerts beneficial effects on glycemic control, which could be mediated by exercise-induced humoral factors released in the bloodstream. Here, we used C57Bl/6 healthy mice, submitted to resistance exercise training for 10 weeks. Trained mice presented higher muscle weight and maximum voluntary carrying capacity, combined with reduced body weight gain and fat deposition. Resistance training improved glucose tolerance and reduced glycemia, with no alterations in insulin sensitivity. In addition, trained mice displayed higher insulinemia in fed state, associated with increased glucose-stimulated insulin secretion. Islets from trained mice showed reduced expression of genes related to endoplasmic reticulum (ER) stress, associated with increased expression of Ins2. INS-1E beta-cells incubated with serum from trained mice displayed similar pattern of insulin secretion and gene expression than isolated islets from trained mice. When exposed to CPA (an ER stress inducer), the serum from trained mice partially preserved the secretory function of INS-1E cells, and prevented CPA-induced apoptosis. These data suggest that resistance training, in healthy mice, improves glucose homeostasis by enhancing insulin secretion, which could be driven, at least in part, by humoral factors.
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28
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Alodhayani A, Almutairi KM, Vinluan JM, Almigbal TH, Alonazi WB, Ali Batais M, Mohammed Alnassar M. Association between self-care management practices and glycemic control of patients with type 2 diabetes mellitus in Saud Arabia: A cross -sectional study. Saudi J Biol Sci 2021; 28:2460-2465. [PMID: 33911959 PMCID: PMC8071915 DOI: 10.1016/j.sjbs.2021.01.047] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Revised: 12/10/2020] [Accepted: 01/03/2021] [Indexed: 12/01/2022] Open
Abstract
OBJECTIVE In this cross-sectional study, we aimed to determine the association of self-care management practices and glycemic control of type 2 diabetes mellitus in Saudi Arabia. METHODS A total of 352 type 2 diabetes mellitus (T2DM) patients from two public tertiary hospitals in Saudi Arabia participated in this study. All T2DM patients were recruited and interviewed by a researcher between January to April 2018 from the outpatient diabetes clinics. All respondents answered a four-part questionnaire which includes demographics data, Diabetes Self-Management Questionnaire (DSMQ). Linear Regression was performed to assess the significance of predictors and compute the coefficient of determination. RESULTS The mean age of the participants was 51.89 ± 10.94. Of the 352 participants, 52% were obese (BMI: ≥30 kgm2) and 77% of the participants had glycated haemoglobin (HbA1c) over 7%. The analysis showed that subscale of Glucose management was the strongest predictor of Hba1c levels of participants' followed by physical activity. Gender and marital status emerged as significant predictors for their self-care management practices. Female patients had more self-care management practices than male patients (B 0.20; 95CI 0.10- 0.96 (p = 0.015). CONCLUSION This study provides an evidence on the self-care management of T2DM patients in Saudi Arabia. The high self-care management found in the study highlights that the patients are aware of the severity of and possible complications associated with T2DM.
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Affiliation(s)
- Abdulaziz Alodhayani
- Department of Family and Community Medicine College of Medicine, King Saud University, Saudi Arabia
| | - Khalid M. Almutairi
- Department of Community Health Science, College of Applied Medical Science, King Saud University, Saudi Arabia
| | - Jason M. Vinluan
- Department of Community Health Science, College of Applied Medical Science, King Saud University, Saudi Arabia
| | - Turky H. Almigbal
- Department of Family and Community Medicine College of Medicine, King Saud University, Saudi Arabia
| | - Wadi B. Alonazi
- College of Business Administration, King Saud University, Saudi Arabia
| | - Mohammed Ali Batais
- Department of Family and Community Medicine College of Medicine, King Saud University, Saudi Arabia
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29
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Diabetes, Sport und Bewegung. DIABETOLOGE 2021. [DOI: 10.1007/s11428-021-00745-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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30
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Esefeld K, Kress S, Behrens M, Zimmer P, Stumvoll M, Thurm U, Gehr B, Brinkmann C, Halle M. Diabetes, Sports and Exercise. Exp Clin Endocrinol Diabetes 2020; 129:S52-S59. [PMID: 33348380 DOI: 10.1055/a-1284-6097] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
- Katrin Esefeld
- Department of Preventive Sports Medicine and Sports Cardiology, Technical University Munich, Munich, Germany.,German Center for Cardiovascular Research (Deutsches Zentrum für Herzkreislaufforschung - DZHK), partner site Munich Heart Alliance (MHA), Munich, Germany
| | - Stephan Kress
- Diabetes, Sport and Physical Activity Working Group of the DDG, Germany.,Department of Internal Medicine I, Vinzentius Hospital Landau, Germany
| | - Meinolf Behrens
- Diabetes, Sport and Physical Activity Working Group of the DDG, Germany.,Diabetes Center Minden, Minden, Germany
| | - Peter Zimmer
- Diabetes, Sport and Physical Activity Working Group of the DDG, Germany
| | - Michael Stumvoll
- Medical Department III - Endocrinology, Nephrology, Rheumatology, University Hospital Leipzig, Leipzig, Germany
| | - Ulrike Thurm
- Diabetes, Sport and Physical Activity Working Group of the DDG, Germany
| | - Bernhard Gehr
- Diabetes, Sport and Physical Activity Working Group of the DDG, Germany.,m&i specialized clinic Bad Heilbrunn, Germany
| | - Christian Brinkmann
- Diabetes, Sport and Physical Activity Working Group of the DDG, Germany.,Institute of Cardiovascular Research and Sport Medicine, German Sport University Cologne, Cologne, Germany.,IST University of Applied Sciences Düsseldorf, Düsseldorf, Germany
| | - Martin Halle
- Department of Preventive Sports Medicine and Sports Cardiology, Technical University Munich, Munich, Germany.,Diabetes, Sport and Physical Activity Working Group of the DDG, Germany.,German Center for Cardiovascular Research (Deutsches Zentrum für Herzkreislaufforschung - DZHK), partner site Munich Heart Alliance (MHA), Munich, Germany
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31
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Benioudakis ES, Georgiou ED, Barouxi ED, Armagos AM, Koutsoumani V, Anastasiou-Veneti F, Koutsoumani E, Brokalaki M. The diabetes quality of life brief clinical inventory in combination with the management strategies in type 1 diabetes mellitus with or without the use of insulin pump. Diabetol Int 2020; 12:217-228. [PMID: 33786276 DOI: 10.1007/s13340-020-00477-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Accepted: 10/30/2020] [Indexed: 10/23/2022]
Abstract
Aims The aims of this study are to evaluate any differences in the Quality of life among Continuous Subcutaneous Insulin Infusion (CSII) and Multiple Dose Injection (MDI) insulin delivery, applying the Diabetes Quality of life Brief Clinical Inventory (DQoL-BCI) questionnaire, and assess the diabetes management strategies between the two groups. Methods One hundred and ten adult participants (male/female ratio 1:2.7) with type 1 diabetes were recruited in this online survey. Forty-eight of them were using CSII and the rest 62 (were using) MDI insulin delivery. A 23-item socio-demographic/diabetes management strategies questionnaire and the 15-item DQoL-BCI were administered. Results CSII users scored statistically, significantly better at the satisfaction treatment subscale (p = 0.032) of the DQoL-BCI and emerged that they were implemented more management strategies such as dietician guidance services (p = 0.002), carbohydrate education seminars (p = 0.03). Predictive factors were also detected regarding the HbA1c < 7% (53 mmol/mol) and β-coefficients in relation to DQoL-BCI questionnaire with the subscales of a negative impact and satisfaction treatment. Conclusion Diabetes self-management education plays a key role to a better compliance with the treatment. Client-centered multidisciplinary centers in T1DM education are essential so that they be applicable for all T1DM patients irrespective of the type of insulin delivery they used.
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Affiliation(s)
- Emmanouil S Benioudakis
- Department of Psychology, University of Crete, Rethimno, Greece.,Psychiatric Clinic, General Hospital of Chania, Chania, Greece
| | - Evangelos D Georgiou
- Statistical Methods in Medicine and Pharmacy, Athens University of Economics and Business, Athens, Greece.,Department of Psychology, University of Cyprus Centre for Field Studies, University of Cyprus, Nicosia, Cyprus
| | | | - Athanasios M Armagos
- Health Psychology, University of Crete, Rethimno, Greece.,Psychiatric Clinic, Naval Hospital of Athens (NNA), Athens, Greece
| | | | | | | | - Maria Brokalaki
- Nutrition and Dietetics, Technological Educational Institute of Crete, Sitia, Greece
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Esefeld K, Kress S, Behrens M, Zimmer P, Stumvoll M, Thurm U, Gehr B, Brinkmann C, Halle M. Diabetes, Sport und Bewegung. DIABETOL STOFFWECHS 2020. [DOI: 10.1055/a-1193-3901] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Affiliation(s)
- Katrin Esefeld
- Präventive und Rehabilitative Sportmedizin, Klinikum rechts der Isar, Technische Universität München, München
- Deutsches Zentrum für Herzkreislaufforschung (DZHK), partner site Munich Heart Alliance (MHA), München
| | - Stephan Kress
- AG Diabetes und Sport der DDG
- Medizinische Klinik Vinzentius-Krankenhaus Landau
| | | | | | - Michael Stumvoll
- Medizinische Klinik und Poliklinik III, Universitätsklinik Leipzig, Leipzig
| | | | - Bernhard Gehr
- AG Diabetes und Sport der DDG
- m&i Fachklinik Bad Heilbrunn
| | - Christian Brinkmann
- AG Diabetes und Sport der DDG
- Institut für Kreislaufforschung und Sportmedizin, Deutsche Sporthochschule Köln, Köln
- IST Hochschule Düsseldorf, Düsseldorf
| | - Martin Halle
- Präventive und Rehabilitative Sportmedizin, Klinikum rechts der Isar, Technische Universität München, München
- AG Diabetes und Sport der DDG
- Deutsches Zentrum für Herzkreislaufforschung (DZHK), partner site Munich Heart Alliance (MHA), München
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33
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Zinn S, Nelis P, Minnebeck K, Hinder J, Eter N, Brand SM, Gellner R, Vorona E, Alten F, Schmitz B. Effect of high-intensity interval training in patients with type 1 diabetes on physical fitness and retinal microvascular perfusion determined by optical coherence tomography angiography. Microvasc Res 2020; 132:104057. [DOI: 10.1016/j.mvr.2020.104057] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2020] [Revised: 08/03/2020] [Accepted: 08/08/2020] [Indexed: 12/01/2022]
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Romeres D, Olson K, Carter R, Cobelli C, Dalla Man C, Basu A, Basu R. Hyperglycemia But Not Hyperinsulinemia Is Favorable for Exercise in Type 1 Diabetes: A Pilot Study. Diabetes Care 2020; 43:2176-2182. [PMID: 32661106 PMCID: PMC7440891 DOI: 10.2337/dc20-0611] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Accepted: 06/09/2020] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To distinguish the effects of hyperglycemia and hyperinsulinemia on exercise-induced increases in Rd and endogenous glucose production (EGP) in type 1 diabetes. RESEARCH DESIGN AND METHODS We studied six participants without diabetes and six participants with type 1 diabetes on three visits in random order for the following: euglycemia, low insulin (EuLoI); euglycemia, high insulin (EuHiI); and hyperglycemia, low insulin (HyLoI). Glucose fluxes were measured using [6,6-2H2] glucose before, during, and after 60 min of exercise. RESULTS Rd increased (P < 0.01) with exercise within groups, while peak Rd during exercise was lower (P < 0.01) in participants with type 1 diabetes than participants without diabetes during all visits. In type 1 diabetes participants, EGP increased (P < 0.001) with exercise during EuLoI and HyLoI but not during EuHiI. This demonstrates that hyperinsulinemia, but not hyperglycemia, blunts the compensatory exercise-induced increase in EGP in type 1 diabetes. CONCLUSIONS The data from this pilot study indicate that 1) exercise-induced compensatory increase in EGP was inhibited in participants with type 1 diabetes with hyperinsulinemia but not with hyperglycemia; 2) in contrast, in participants without diabetes, exercise-induced increase in EGP was inhibited only during combined hyperinsulinemia and hyperglycemia. Taken together, these results suggest that low insulin coupled with euglycemia or modest hyperglycemia appear to be the most favorable milieu for type 1 diabetes during exercise.
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Affiliation(s)
- Davide Romeres
- Department of Information Engineering, University of Padova, Padova, Italy
| | - Karen Olson
- Division of Endocrinology, Center of Diabetes Technology, University of Virginia School of Medicine, Charlottesville, VA
| | - Rickey Carter
- Department of Health Sciences Research, Mayo Clinic, Jacksonville, FL
| | - Claudio Cobelli
- Department of Information Engineering, University of Padova, Padova, Italy
| | - Chiara Dalla Man
- Department of Information Engineering, University of Padova, Padova, Italy
| | - Ananda Basu
- Division of Endocrinology, Center of Diabetes Technology, University of Virginia School of Medicine, Charlottesville, VA
| | - Rita Basu
- Division of Endocrinology, Center of Diabetes Technology, University of Virginia School of Medicine, Charlottesville, VA
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35
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Wong CY, Al-Salami H, Dass CR. C2C12 cell model: its role in understanding of insulin resistance at the molecular level and pharmaceutical development at the preclinical stage. J Pharm Pharmacol 2020; 72:1667-1693. [PMID: 32812252 DOI: 10.1111/jphp.13359] [Citation(s) in RCA: 53] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Revised: 07/17/2020] [Accepted: 07/25/2020] [Indexed: 12/11/2022]
Abstract
OBJECTIVES The myoblast cell line, C2C12, has been utilised extensively in vitro as an examination model in understanding metabolic disease progression. Although it is indispensable in both preclinical and pharmaceutical research, a comprehensive review of its use in the investigation of insulin resistance progression and pharmaceutical development is not available. KEY FINDINGS C2C12 is a well-documented model, which can facilitate our understanding in glucose metabolism, insulin signalling mechanism, insulin resistance, oxidative stress, reactive oxygen species and glucose transporters at cellular and molecular levels. With the aid of the C2C12 model, recent studies revealed that insulin resistance has close relationship with various metabolic diseases in terms of disease progression, pathogenesis and therapeutic management. A holistic, safe and effective disease management is highly of interest. Therefore, significant efforts have been paid to explore novel drug compounds and natural herbs that can elicit therapeutic effects in the targeted sites at both cellular (e.g. mitochondria, glucose transporter) and molecular level (e.g. genes, signalling pathway). SUMMARY The use of C2C12 myoblast cell line is meaningful in pharmaceutical and biomedical research due to their expression of GLUT-4 and other features that are representative to human skeletal muscle cells. With the use of the C2C12 cell model, the impact of drug delivery systems (nanoparticles and quantum dots) on skeletal muscle, as well as the relationship between exercise, pancreatic β-cells and endothelial cells, was discovered.
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Affiliation(s)
- Chun Y Wong
- School of Pharmacy and Biomedical Science, Curtin University, Bentley, WA, Australia.,Curtin Health Innovation Research Institute, Bentley, WA, Australia
| | - Hani Al-Salami
- School of Pharmacy and Biomedical Science, Curtin University, Bentley, WA, Australia.,Curtin Health Innovation Research Institute, Bentley, WA, Australia.,Biotechnology and Drug Development Research Laboratory, Curtin University, Bentley, WA, Australia
| | - Crispin R Dass
- School of Pharmacy and Biomedical Science, Curtin University, Bentley, WA, Australia.,Curtin Health Innovation Research Institute, Bentley, WA, Australia
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36
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Araki E, Goto A, Kondo T, Noda M, Noto H, Origasa H, Osawa H, Taguchi A, Tanizawa Y, Tobe K, Yoshioka N. Japanese Clinical Practice Guideline for Diabetes 2019. Diabetol Int 2020; 11:165-223. [PMID: 32802702 PMCID: PMC7387396 DOI: 10.1007/s13340-020-00439-5] [Citation(s) in RCA: 235] [Impact Index Per Article: 58.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Indexed: 01/09/2023]
Affiliation(s)
- Eiichi Araki
- Department of Metabolic Medicine, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan
| | - Atsushi Goto
- Department of Health Data Science, Graduate School of Data Science, Yokohama City University, Yokohama, Japan
| | - Tatsuya Kondo
- Department of Diabetes, Metabolism and Endocrinology, Kumamoto University Hospital, Kumamoto, Japan
| | - Mitsuhiko Noda
- Department of Diabetes, Metabolism and Endocrinology, Ichikawa Hospital, International University of Health and Welfare, Ichikawa, Japan
| | - Hiroshi Noto
- Division of Endocrinology and Metabolism, St. Luke’s International Hospital, Tokyo, Japan
| | - Hideki Origasa
- Department of Biostatistics and Clinical Epidemiology, Graduate School of Medicine and Pharmaceutical Sciences, University of Toyama, Toyama, Japan
| | - Haruhiko Osawa
- Department of Diabetes and Molecular Genetics, Ehime University Graduate School of Medicine, Toon, Japan
| | - Akihiko Taguchi
- Department of Endocrinology, Metabolism, Hematological Science and Therapeutics, Graduate School of Medicine, Yamaguchi University, Ube, Japan
| | - Yukio Tanizawa
- Department of Endocrinology, Metabolism, Hematological Science and Therapeutics, Graduate School of Medicine, Yamaguchi University, Ube, Japan
| | - Kazuyuki Tobe
- First Department of Internal Medicine, Graduate School of Medicine and Pharmaceutical Sciences, University of Toyama, Toyama, Japan
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Araki E, Goto A, Kondo T, Noda M, Noto H, Origasa H, Osawa H, Taguchi A, Tanizawa Y, Tobe K, Yoshioka N. Japanese Clinical Practice Guideline for Diabetes 2019. J Diabetes Investig 2020; 11:1020-1076. [PMID: 33021749 PMCID: PMC7378414 DOI: 10.1111/jdi.13306] [Citation(s) in RCA: 161] [Impact Index Per Article: 40.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Accepted: 05/24/2020] [Indexed: 01/09/2023] Open
Affiliation(s)
- Eiichi Araki
- Department of Metabolic MedicineFaculty of Life SciencesKumamoto UniversityKumamotoJapan
| | - Atsushi Goto
- Department of Health Data ScienceGraduate School of Data ScienceYokohama City UniversityYokohamaJapan
| | - Tatsuya Kondo
- Department of Diabetes, Metabolism and EndocrinologyKumamoto University HospitalKumamotoJapan
| | - Mitsuhiko Noda
- Department of Diabetes, Metabolism and EndocrinologyIchikawa HospitalInternational University of Health and WelfareIchikawaJapan
| | - Hiroshi Noto
- Division of Endocrinology and MetabolismSt. Luke's International HospitalTokyoJapan
| | - Hideki Origasa
- Department of Biostatistics and Clinical EpidemiologyGraduate School of Medicine and Pharmaceutical SciencesUniversity of ToyamaToyamaJapan
| | - Haruhiko Osawa
- Department of Diabetes and Molecular GeneticsEhime University Graduate School of MedicineToonJapan
| | - Akihiko Taguchi
- Department of Endocrinology, Metabolism, Hematological Science and TherapeuticsGraduate School of MedicineYamaguchi UniversityUbeJapan
| | - Yukio Tanizawa
- Department of Endocrinology, Metabolism, Hematological Science and TherapeuticsGraduate School of MedicineYamaguchi UniversityUbeJapan
| | - Kazuyuki Tobe
- First Department of Internal MedicineGraduate School of Medicine and Pharmaceutical SciencesUniversity of ToyamaToyamaJapan
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Almigbal TH, Almutairi KM, Vinluan JM, Batais MA, Alodhayani A, Alonazi WB, Sheshah E, Alhoqail RI. Association of health literacy and self-management practices and psychological factor among patients with type 2 diabetes mellitus in Saudi Arabia. Saudi Med J 2020; 40:1158-1166. [PMID: 31707414 PMCID: PMC6901769 DOI: 10.15537/smj.2019.11.24585] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
Objectives: To determine the association between sociodemographic, clinical, and health literacy and the presence of depressed mood and their relationships to diabetes self-management among type 2 diabetes mellitus (T2DM) patients in Saudi Arabia. Methods: A total of 352 T2DM patients from 2 public tertiary hospitals in Saudi Arabia participated in this descriptive cross-sectional study between December 2016 and February 2017. All respondents answered a 4-part questionnaire, which includes demographic data, Diabetes Self-Management Questionnaire (DSMQ), 36-item test based Short Test of Functional Health Literacy in Adults, and a 2-item Patient Health Questionnaire (PHQ-2). The Chi-square test and logistic regression analysis were conducted to determine the relationship and significant predictors for self-management among T2DM patients. Results: The analysis showed that majority of the participants had low to marginal functional health literacy. The overall DSM-16 score was good, indicating more effective self-care, while 20% of the participants had a score of 2 or more in the PHQ-2 indicating presence of depressed mood. No significant association was found between DSM and health literacy among the study participants while age, gender, educational level, employment status, and level of the depressive symptom were significantly associated with differences in the level of functional literacy of the participants. Conclusion: The study shows that nearly half of the T2DM patients that exhibited low level of functional health literacy had low diabetes self-management. Our findings also show that gender significantly affects diabetes self-management in which odds are a lot higher among females than males with diabetes self-management. This study underscores the importance of proper counselling and education about diabetes control on both patients and family members.
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Affiliation(s)
- Turky H. Almigbal
- From the Department of Medicine (Almigbal, Batais, Alhoqail), Department of Community Health Science, College of Applied Medical Science (Almutairi, Vinluan), Department of Family and Community Medicine (Alodhayani), College of Medicine; from the College of Business Administration (Alonazi); and from the Department of Diabetes Center (Sheshah), King Salman Hospital, King Saud University, Riyadh, Kingdom of Saudi Arabia
- Address correspondence and reprint request to: Jason M. Vinluan, Department of Community Health Science, College of Applied Medical Science, King Saud University, Riyadh, Kingdom of Saudi Arabia. E-mail: ORCID ID: https://orcid.org/0000-0001-8670-3580
| | - Khalid M. Almutairi
- From the Department of Medicine (Almigbal, Batais, Alhoqail), Department of Community Health Science, College of Applied Medical Science (Almutairi, Vinluan), Department of Family and Community Medicine (Alodhayani), College of Medicine; from the College of Business Administration (Alonazi); and from the Department of Diabetes Center (Sheshah), King Salman Hospital, King Saud University, Riyadh, Kingdom of Saudi Arabia
| | - Jason M. Vinluan
- From the Department of Medicine (Almigbal, Batais, Alhoqail), Department of Community Health Science, College of Applied Medical Science (Almutairi, Vinluan), Department of Family and Community Medicine (Alodhayani), College of Medicine; from the College of Business Administration (Alonazi); and from the Department of Diabetes Center (Sheshah), King Salman Hospital, King Saud University, Riyadh, Kingdom of Saudi Arabia
- Address correspondence and reprint request to: Jason M. Vinluan, Department of Community Health Science, College of Applied Medical Science, King Saud University, Riyadh, Kingdom of Saudi Arabia. E-mail: ORCID ID: https://orcid.org/0000-0001-8670-3580
| | - Mohammed A. Batais
- Address correspondence and reprint request to: Jason M. Vinluan, Department of Community Health Science, College of Applied Medical Science, King Saud University, Riyadh, Kingdom of Saudi Arabia. E-mail: ORCID ID: https://orcid.org/0000-0001-8670-3580
| | - Abdulaziz Alodhayani
- From the Department of Medicine (Almigbal, Batais, Alhoqail), Department of Community Health Science, College of Applied Medical Science (Almutairi, Vinluan), Department of Family and Community Medicine (Alodhayani), College of Medicine; from the College of Business Administration (Alonazi); and from the Department of Diabetes Center (Sheshah), King Salman Hospital, King Saud University, Riyadh, Kingdom of Saudi Arabia
| | - Wadi B. Alonazi
- From the Department of Medicine (Almigbal, Batais, Alhoqail), Department of Community Health Science, College of Applied Medical Science (Almutairi, Vinluan), Department of Family and Community Medicine (Alodhayani), College of Medicine; from the College of Business Administration (Alonazi); and from the Department of Diabetes Center (Sheshah), King Salman Hospital, King Saud University, Riyadh, Kingdom of Saudi Arabia
| | - Eman Sheshah
- From the Department of Medicine (Almigbal, Batais, Alhoqail), Department of Community Health Science, College of Applied Medical Science (Almutairi, Vinluan), Department of Family and Community Medicine (Alodhayani), College of Medicine; from the College of Business Administration (Alonazi); and from the Department of Diabetes Center (Sheshah), King Salman Hospital, King Saud University, Riyadh, Kingdom of Saudi Arabia
| | - Razan I. Alhoqail
- From the Department of Medicine (Almigbal, Batais, Alhoqail), Department of Community Health Science, College of Applied Medical Science (Almutairi, Vinluan), Department of Family and Community Medicine (Alodhayani), College of Medicine; from the College of Business Administration (Alonazi); and from the Department of Diabetes Center (Sheshah), King Salman Hospital, King Saud University, Riyadh, Kingdom of Saudi Arabia
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Hasan R, Perez-Santiago D, Churilla JR, Montes B, Hossain J, Mauras N, Darmaun D. Can Short Bouts of Exercise ("Exercise Snacks") Improve Body Composition in Adolescents with Type 1 Diabetes? A Feasibility Study. Horm Res Paediatr 2020; 92:245-253. [PMID: 32007996 DOI: 10.1159/000505328] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Accepted: 12/07/2019] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Puberty is associated with a deterioration of blood glucose control in children with type 1 diabetes (T1D). The literature suggests that exercise improves homeostasis in adults with diabetes, but lack of time often precludes the performance of exercise. Besides, in earlier work, supplementation with glutamine, a nonessential amino acid, when administered prior to exercise, decreased overnight post-exercise blood glucose in adolescents with long-standing T1D, suggesting that glutamine increased insulin sensitivity or enhanced tissue glucose uptake. The purpose of the current study therefore was to determine the feasibility of a novel form of exercise ("exercise snacks," that is, short bouts of exercise spread throughout the day) with or without a supplemental amino acid, glutamine, and its impact on blood glucose homeostasis and body composition in adolescents with T1D. METHODS Twelve sedentary adolescents with T1D (HbA1c 8.1 ± 0.6%) performed exercise snacks (6 × 1 min of resistance-based activities) 3 times daily for 3 months; in addition, they were randomized to consume a drink containing either placebo or glutamine (0.5 g/kg/day). Continuous glucose monitoring, HbA1c, and dual X-ray absorptiometry were obtained before and after 3 months of each intervention. RESULTS Exercise snacks were easy to perform and well tolerated and were associated with a 2.2% loss of body fat mass when both groups were analyzed together (p = 0.015) after 3 months, whereas the change in lean body mass was not significant (p = 0.21). Metabolic control (HbA1c and glucose sensor data) was unchanged as result of the intervention regardless of group, and total daily insulin dose did not decrease. CONCLUSION Short bouts of exercise are sustainable over a 3-month period and can improve body composition in adolescents with poorly controlled T1D. Although metabolic control was unchanged as a result of the intervention regardless of group, this was a short-term intervention, hence assessment of metabolic impact will require long-term study.
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Affiliation(s)
- Reham Hasan
- Division of Pediatric Endocrinology, Diabetes and Metabolism, Nemours Children's Health System, Jacksonville, Florida, USA
| | - Deliamille Perez-Santiago
- Division of Pediatric Endocrinology, Diabetes and Metabolism, Nemours Children's Health System, Jacksonville, Florida, USA
| | - James R Churilla
- Department of Clinical and Applied Movement Sciences, University of North Florida, Jacksonville, Florida, USA
| | - Brittany Montes
- Department of Clinical and Applied Movement Sciences, University of North Florida, Jacksonville, Florida, USA
| | - Jobayer Hossain
- Department of Biostatistics, Nemours/Alfred. I. duPont Hospital for Children, Wilmington, Delaware, USA
| | - Nelly Mauras
- Division of Pediatric Endocrinology, Diabetes and Metabolism, Nemours Children's Health System, Jacksonville, Florida, USA
| | - Dominique Darmaun
- Division of Pediatric Endocrinology, Diabetes and Metabolism, Nemours Children's Health System, Jacksonville, Florida, USA, .,INRAE and University of Nantes, UMR 1280, CRNH-Ouest, Nantes, France,
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40
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41
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Suh J, Choi HS, Kwon A, Chae HW, Eom S, Kim HS. Once-weekly supervised combined training improves neurocognitive and psychobehavioral outcomes in young patients with type 1 diabetes mellitus. J Pediatr Endocrinol Metab 2019; 32:1341-1350. [PMID: 31689232 DOI: 10.1515/jpem-2019-0120] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Accepted: 08/28/2019] [Indexed: 11/15/2022]
Abstract
Background Previous studies investigating the beneficial effects of exercise in type 1 diabetes mellitus (T1DM) are relatively insufficient compared to studies on type 2 diabetes mellitus (T2DM), due to the fear of hypoglycemia. Recently, several researchers have reported that combined aerobic and resistance exercise prevents hypoglycemia during and after exercise. Furthermore, exercise has been shown to have beneficial effects on the psychological status of patients with various diseases. The aim of this study was to evaluate the effect of combined aerobic and resistance exercise in adolescents with T1DM. Methods Thirty-five type 1 diabetic patients were enrolled, and subjects were divided into either an exercise group or a control group. Thirty patients (20 patients in the exercise group, 10 patients in the control group) completed the study. The exercise program was performed for 1 h at a time, once a week, for 12 weeks. Study parameters were evaluated at baseline and 3 months after baseline evaluation. Results Combined aerobic and resistance exercise better controlled the body mass index (BMI), and also improved maximum muscular strength and maximum exercise intensity. On psychological tests, subjects' attention and quality of life showed improving tendency, while their stress and behavioral problems diminished. The number of exercise events increased in the training group, while the daily total insulin dose and glycated hemoglobin (HbA1c) level showed no significant changes. Conclusions A 12-week structured exercise program consisting of aerobic and resistance exercises improves cardiovascular, neurocognitive and psychobehavioral functions, and positively helps lifestyle modification in patients with T1DM.
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Affiliation(s)
- Junghwan Suh
- Department of Pediatrics, Severance Children's Hospital, Endocrine Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Han Saem Choi
- Department of Pediatrics, Severance Children's Hospital, Endocrine Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Ahreum Kwon
- Department of Pediatrics, Severance Children's Hospital, Endocrine Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Hyun Wook Chae
- Department of Pediatrics, Severance Children's Hospital, Endocrine Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Soyong Eom
- Epilepsy Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Ho-Seong Kim
- Department of Pediatrics, Severance Children's Hospital, Endocrine Research Institute, Yonsei University College of Medicine, Seoul, Korea
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42
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Moreau D, Chou E. The Acute Effect of High-Intensity Exercise on Executive Function: A Meta-Analysis. PERSPECTIVES ON PSYCHOLOGICAL SCIENCE 2019; 14:734-764. [DOI: 10.1177/1745691619850568] [Citation(s) in RCA: 68] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
High-intensity exercise has recently emerged as a potent alternative to aerobic regimens, with ramifications for health and brain function. As part of this trend, single sessions of intense exercise have been proposed as powerful, noninvasive means for transiently enhancing cognition. However, findings in this field remain mixed, and a thorough synthesis of the evidence is lacking. Here, we synthesized the literature in a meta-analysis of the acute effect of high-intensity exercise on executive function. We included a total of 1,177 participants and 147 effect sizes across 28 studies and found a small facilitating effect ( d = 0.24) of high-intensity exercise on executive function. However, this effect was significant only compared with rest ( d = 0.34); it was not significant when high-intensity exercise was compared with low-to-moderate intensity exercise ( d = 0.07). This suggests that intense and moderate exercise affect executive function in a comparable manner. We tested a number of moderators that together explained a significant proportion of the between-studies variance. Overall, our findings indicate that high-intensity cardiovascular exercise might be a viable alternative for eliciting acute cognitive gains. We discuss the potential of this line of research, identify a number of challenges and limitations it faces, and propose applications to individuals, society, and policies.
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Affiliation(s)
- David Moreau
- School of Psychology, The University of Auckland
- Centre for Brain Research, The University of Auckland
| | - Edward Chou
- School of Psychology, The University of Auckland
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Farinha JB, Boff W, Dos Santos GC, Boeno FP, Ramis TR, Vieira AF, Macedo RCO, Rodrigues-Krause J, Reischak-Oliveira A. Acute glycemic responses along 10-week high-intensity training protocols in type 1 diabetes patients. Diabetes Res Clin Pract 2019; 153:111-113. [PMID: 31195026 DOI: 10.1016/j.diabres.2019.06.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Revised: 05/08/2019] [Accepted: 06/03/2019] [Indexed: 10/26/2022]
Abstract
Glycemic fluctuations were compared throughout 10-week high-intensity training protocols in T1DM patients. Differences were compared using the rate of change in glycaemia during exercise (RoCE). HIIT sessions led to lower RoCE in most weeks than other training protocols. The occurrence of level 1 hypoglycemia along sessions were similar among interventions.
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Affiliation(s)
- Juliano Boufleur Farinha
- Program of Human Movement Sciences, Faculty of Physical Education, Physiotherapy and Dance (ESEFID), Federal University of Rio Grande do Sul (UFRGS), 750 Felizardo Street, Porto Alegre, Rio Grande do Sul 90690-200, Brazil.
| | - Winston Boff
- Institute for Children with Diabetes, Conceição Hospital Group, 529 Álvares Cabral Street, Porto Alegre 91350-250, Brazil
| | - Gabriela Cristina Dos Santos
- Program of Human Movement Sciences, Faculty of Physical Education, Physiotherapy and Dance (ESEFID), Federal University of Rio Grande do Sul (UFRGS), 750 Felizardo Street, Porto Alegre, Rio Grande do Sul 90690-200, Brazil
| | - Francesco Pinto Boeno
- Program of Human Movement Sciences, Faculty of Physical Education, Physiotherapy and Dance (ESEFID), Federal University of Rio Grande do Sul (UFRGS), 750 Felizardo Street, Porto Alegre, Rio Grande do Sul 90690-200, Brazil
| | - Thiago Rozales Ramis
- Program of Human Movement Sciences, Faculty of Physical Education, Physiotherapy and Dance (ESEFID), Federal University of Rio Grande do Sul (UFRGS), 750 Felizardo Street, Porto Alegre, Rio Grande do Sul 90690-200, Brazil
| | - Alexandra Ferreira Vieira
- Program of Human Movement Sciences, Faculty of Physical Education, Physiotherapy and Dance (ESEFID), Federal University of Rio Grande do Sul (UFRGS), 750 Felizardo Street, Porto Alegre, Rio Grande do Sul 90690-200, Brazil
| | - Rodrigo Cauduro Oliveira Macedo
- Program of Human Movement Sciences, Faculty of Physical Education, Physiotherapy and Dance (ESEFID), Federal University of Rio Grande do Sul (UFRGS), 750 Felizardo Street, Porto Alegre, Rio Grande do Sul 90690-200, Brazil
| | - Josianne Rodrigues-Krause
- Program of Human Movement Sciences, Faculty of Physical Education, Physiotherapy and Dance (ESEFID), Federal University of Rio Grande do Sul (UFRGS), 750 Felizardo Street, Porto Alegre, Rio Grande do Sul 90690-200, Brazil
| | - Alvaro Reischak-Oliveira
- Program of Human Movement Sciences, Faculty of Physical Education, Physiotherapy and Dance (ESEFID), Federal University of Rio Grande do Sul (UFRGS), 750 Felizardo Street, Porto Alegre, Rio Grande do Sul 90690-200, Brazil
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44
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Pongrac Barlovic D, Tikkanen-Dolenc H, Groop PH. Physical Activity in the Prevention of Development and Progression of Kidney Disease in Type 1 Diabetes. Curr Diab Rep 2019; 19:41. [PMID: 31152254 PMCID: PMC6544601 DOI: 10.1007/s11892-019-1157-y] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
PURPOSE OF REVIEW Physical activity is a fundamental part of lifestyle management in diabetes care. Although its benefits are very well recognized in the general population and in people with type 2 diabetes, much less is known about the effects of exercise in type 1 diabetes. In particular, exercise effects in relation to diabetic kidney disease (DKD) are understudied. Some uncertainties about physical activity recommendations stem from the fact that strenuous exercise may worsen albuminuria immediately after the activity. However, in middle-aged and older adults without diabetes, observational studies have suggested that physical activity is associated with a decreased risk of rapid kidney function deterioration. In this review, we focus on the role of physical activity in patients with DKD and type 1 diabetes. RECENT FINDINGS Hereby, we present data that show that in individuals at risk of DKD or with established DKD, regular moderate-to-vigorous physical activity was associated with reduced incidence and progression of DKD, as well as reduced risk of cardiovascular events and mortality. Therefore, regular moderate-to-vigorous exercise should become a central part of the management of individuals with type 1 diabetes, in the absence of contraindications and accompanied with all needed educational support for optimal diabetes management.
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Affiliation(s)
- Drazenka Pongrac Barlovic
- University Medical Center Ljubljana, Ljubljana, Slovenia
- Faculty of Medicine, University Ljubljana, Ljubljana, Slovenia
- Folkhälsan Institute of Genetics, Folkhälsan Research Center, Biomedicum Helsinki, University of Helsinki, Haartmaninkatu 8, P.O Box 63, FIN-00014 Helsinki, Finland
- Abdominal Center Nephrology, University of Helsinki and Helsinki University Central Hospital, Helsinki, Finland
- Research Programs Unit, Diabetes and Obesity, University of Helsinki, Helsinki, Finland
| | - Heidi Tikkanen-Dolenc
- Folkhälsan Institute of Genetics, Folkhälsan Research Center, Biomedicum Helsinki, University of Helsinki, Haartmaninkatu 8, P.O Box 63, FIN-00014 Helsinki, Finland
- Abdominal Center Nephrology, University of Helsinki and Helsinki University Central Hospital, Helsinki, Finland
- Research Programs Unit, Diabetes and Obesity, University of Helsinki, Helsinki, Finland
| | - Per-Henrik Groop
- Folkhälsan Institute of Genetics, Folkhälsan Research Center, Biomedicum Helsinki, University of Helsinki, Haartmaninkatu 8, P.O Box 63, FIN-00014 Helsinki, Finland
- Abdominal Center Nephrology, University of Helsinki and Helsinki University Central Hospital, Helsinki, Finland
- Research Programs Unit, Diabetes and Obesity, University of Helsinki, Helsinki, Finland
- Department of Diabetes, Central Clinical School, Monash University, Melbourne, Victoria Australia
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Cardiovascular Health Benefits of Exercise Training in Persons Living with Type 1 Diabetes: A Systematic Review and Meta-Analysis. J Clin Med 2019; 8:jcm8020253. [PMID: 30781593 PMCID: PMC6406966 DOI: 10.3390/jcm8020253] [Citation(s) in RCA: 53] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Revised: 02/07/2019] [Accepted: 02/13/2019] [Indexed: 02/07/2023] Open
Abstract
Exercise is advocated in the management of type 1 diabetes (T1D), but the effects of different forms of exercise training on cardiovascular risk factors in T1D still remain unclear. The aim of this study was to conduct a systematic review and meta-analysis on exercise training for cardiovascular risk factors in T1D. Six electronic databases were systematically searched for randomized or non-randomized controlled studies reporting associations between exercise training and cardiovascular risk factors in T1D. Weighted mean differences (WMD) of each cardiovascular risk factor between exercise groups and control groups were calculated using a random effects model. A total of 24 studies reported the effects of exercise training on cardiovascular risk factors. Exercise training increased maximal aerobic power (3.01 mL·kg−1·min−1, 95% confidence interval, CI, 0.94 to 6.38) and reduced glycated hemoglobin (HbA1c; −0.45%, 95% CI −0.73 to −0.17), daily insulin dosage (−0.88 U·kg−1, 95% CI −1.27 to −0.48), and total cholesterol (−0.38 mmol·L−1, 95% CI −0.71 to −0.04). Exercise training did not lead to consistent changes in body mass index (BMI), blood pressure, triglycerides, high-density lipoprotein cholesterol (HDL-C), or low-density lipoprotein cholesterol (LDL-C). In persons living with T1D, exercise training is associated with a beneficial cardiovascular profile, including improvements in lipid profile, glycemic control (decreased daily insulin dosage and HbA1c), and aerobic fitness.
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Minnock D, Krause M, Le Roux CW, De Vito G. Effects of acute exercise on glucose control in type 1 diabetes: A systematic review. TRANSLATIONAL SPORTS MEDICINE 2019. [DOI: 10.1002/tsm2.64] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- Dean Minnock
- Institute for Sport & Health, School of Public Health, Physiotherapy and Sports Science; University College Dublin; Dublin Ireland
| | - Mauricio Krause
- Laboratory of Inflammation, Metabolism and Exercise Research (LAPIMEX) and Laboratory of Cellular Physiology, Department of Physiology, Institute of Basic Health Sciences; Federal University of Rio Grande do Sul; Porto Alegre RS Brazil
| | - Carel W. Le Roux
- Diabetes Complications Research Centre; Conway Institute, University College Dublin; Dublin Ireland
| | - Giuseppe De Vito
- Institute for Sport & Health, School of Public Health, Physiotherapy and Sports Science; University College Dublin; Dublin Ireland
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Chetty T, Shetty V, Fournier PA, Adolfsson P, Jones TW, Davis EA. Exercise Management for Young People With Type 1 Diabetes: A Structured Approach to the Exercise Consultation. Front Endocrinol (Lausanne) 2019; 10:326. [PMID: 31258513 PMCID: PMC6587067 DOI: 10.3389/fendo.2019.00326] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2018] [Accepted: 05/07/2019] [Indexed: 12/11/2022] Open
Abstract
Regular physical activity during childhood is important for optimal physical and psychological development. For individuals with Type 1 Diabetes (T1D), physical activity offers many health benefits including improved glycemic control, cardiovascular function, blood lipid profiles, and psychological well-being. Despite these benefits, many young people with T1D do not meet physical activity recommendations. Barriers to engaging in a physically active lifestyle include fear of hypoglycemia, as well as insufficient knowledge in managing diabetes around exercise in both individuals and health care professionals. Diabetes and exercise management is complex, and many factors can influence an individual's glycemic response to exercise including exercise related factors (such as type, intensity and duration of the activity) and person specific factors (amount of insulin on board, person's stress/anxiety and fitness levels). International guidelines provide recommendations for clinical practice, however a gap remains in how to apply these guidelines to a pediatric exercise consultation. Consequently, it can be challenging for health care practitioners to advise young people with T1D how to approach exercise management in a busy clinic setting. This review provides a structured approach to the child/adolescent exercise consultation, based on a framework of questions, to assist the health care professional in formulating person-specific exercise management plans for young people with T1D.
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Affiliation(s)
- Tarini Chetty
- Children's Diabetes Centre, Perth Children's Hospital, Perth, WA, Australia
- *Correspondence: Tarini Chetty
| | - Vinutha Shetty
- Children's Diabetes Centre, Perth Children's Hospital, Perth, WA, Australia
- UWA Centre for Child Health Research, University of Western Australia, Perth, WA, Australia
| | - Paul Albert Fournier
- School of Human Sciences, University of Western Australia, Perth, WA, Australia
- Telethon Kids Institute, Perth Children's Hospital, Perth, WA, Australia
| | - Peter Adolfsson
- Department of Pediatrics, The Hospital of Halland, Kungsbacka, Sweden
- Institute of Clinical Sciences, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - Timothy William Jones
- Children's Diabetes Centre, Perth Children's Hospital, Perth, WA, Australia
- UWA Centre for Child Health Research, University of Western Australia, Perth, WA, Australia
- Telethon Kids Institute, Perth Children's Hospital, Perth, WA, Australia
| | - Elizabeth Ann Davis
- Children's Diabetes Centre, Perth Children's Hospital, Perth, WA, Australia
- UWA Centre for Child Health Research, University of Western Australia, Perth, WA, Australia
- Telethon Kids Institute, Perth Children's Hospital, Perth, WA, Australia
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48
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Farinha JB, Ramis TR, Vieira AF, Macedo RCO, Rodrigues-Krause J, Boeno FP, Schroeder HT, Müller CH, Boff W, Krause M, De Bittencourt PIH, Reischak-Oliveira A. Glycemic, inflammatory and oxidative stress responses to different high-intensity training protocols in type 1 diabetes: A randomized clinical trial. J Diabetes Complications 2018; 32:1124-1132. [PMID: 30270019 DOI: 10.1016/j.jdiacomp.2018.09.008] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2018] [Revised: 09/04/2018] [Accepted: 09/09/2018] [Indexed: 12/20/2022]
Abstract
AIMS To investigate the effects of high-intensity interval training (HIIT) and/or strength training (ST) on inflammatory, oxidative stress (OS) and glycemic parameters in type 1 diabetes (T1DM) patients. METHODS After a 4-week control period, volunteers were randomly assigned to 10-week HIIT, ST or ST + HIIT protocol, performed 3×/week. Blood biochemistry, anthropometric, strength and cardiopulmonary fitness variables were assessed. Outcomes were analyzed via generalized estimating equations (GEE), with Bonferroni post hoc analysis. RESULTS ST, HIIT and ST + HIIT improved glycemic (HbA1c and fasting glucose) and antioxidant parameters (total antioxidant capacity, catalase and superoxide dismutase activities), but not plasma inflammatory (C-reactive protein, TNF-α and IL-10) or OS markers (thiobarbituric acid-reactive substances, 8-hydroxy-2-deoxyguanosine and oxLDL) levels. Noteworthy, interventions reduced soluble receptors for advanced glycation end products levels. However, intracellular heat shock protein 70 content increased only after HIIT. While daily insulin dosage decreased only in the ST + HIIT group, all training models induced anthropometric and functional benefits. CONCLUSIONS Similar benefits afforded by ST, HIIT or ST + HIIT in T1DM people are associated with enhanced antioxidant systems and glucose-related parameter, even in a few weeks. From a practical clinical perspective, the performance of ST + HIIT may be advised for additional benefits regarding insulin dosage reduction.
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Affiliation(s)
- Juliano B Farinha
- School of Physical Education, Physiotherapy and Dance, Federal University of Rio Grande do Sul, Porto Alegre, Brazil.
| | - Thiago R Ramis
- School of Physical Education, Physiotherapy and Dance, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Alexandra F Vieira
- School of Physical Education, Physiotherapy and Dance, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Rodrigo C O Macedo
- School of Physical Education, Physiotherapy and Dance, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Josianne Rodrigues-Krause
- School of Physical Education, Physiotherapy and Dance, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Francesco P Boeno
- School of Physical Education, Physiotherapy and Dance, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Helena T Schroeder
- Department of Physiology, Institute of Basic Health Sciences, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Carlos Henrique Müller
- Department of Physiology, Institute of Basic Health Sciences, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Winston Boff
- Institute for Children with Diabetes, Porto Alegre, Brazil
| | - Maurício Krause
- Department of Physiology, Institute of Basic Health Sciences, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Paulo Ivo H De Bittencourt
- Department of Physiology, Institute of Basic Health Sciences, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Alvaro Reischak-Oliveira
- School of Physical Education, Physiotherapy and Dance, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
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Żebrowska A, Hall B, Maszczyk A, Banaś R, Urban J. Brain-derived neurotrophic factor, insulin like growth factor-1 and inflammatory cytokine responses to continuous and intermittent exercise in patients with type 1 diabetes. Diabetes Res Clin Pract 2018; 144:126-136. [PMID: 30179684 DOI: 10.1016/j.diabres.2018.08.018] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Revised: 08/14/2018] [Accepted: 08/29/2018] [Indexed: 11/23/2022]
Abstract
AIMS Type 1 diabetes mellitus (T1DM) is an important risk factor for cognitive decline and motor dysfunction due to progressive muscular atrophy. Chronic hyperglycemia may be responsible for impaired vascular function, loss of muscle mass, and morphological abnormalities in the myocytes. For the proper functioning of the neuromuscular system, two crucial growth factors are necessary: brain-derived neurotrophic factor (BDNF) and insulin-like growth factor-1 (IGF-1), whose reduced expressions have been implicated in progressive neuropathy and muscle atrophy in patients with T1DM. The aim of the study was to compare the effects of two different exercise regimes (continuous and intermittent) on BDNF, IGF-1, blood glucose and inflammatory cytokine responses in young adults with and without Type 1 diabetes. METHODS Fourteen patients (aged: 26.9 years) with T1DM and age-matched adults without diabetes participated in a 40 min continuous exercise (ExC, 50% of lactate threshold) and a high intensity intermittent exercise (ExInt, 120% of lactate threshold). During the study the patients performed self-monitoring of blood glucose levels (SMBG) under glycemic control. The effects of ExC and ExInt on BDNF, IGF-1, insulin like growth factor binding protein (IGFBP-3), insulin (INS), vascular endothelial growth factor (VEGF), transforming growth factor beta (TGF-β) and tumor necrosis factor alpha (TNF-α) were analyzed. RESULTS BDNF and IGF-1 baseline serum levels were significantly lower in the T1DM patients compared to the healthy controls, but we found that ExInt and ExC significantly increase the secretion of BDNF and IGF-1 levels. Significant increases in BDNF and TGF-β levels, higher blood glucose decline, and a lower incidence of hypoglycaemia in ExInt compared to ExC were observed. Lower IGFBP-3 concentrations were revealed in T1DM patients in response to ExInt compared to ExC, suggesting a positive effect on IGF-1/IGFBP-3 ratio and the bioavailability of IGF-1. CONCLUSIONS According to our results physical exercise has beneficial effects on serum BDNF and IGF-1 levels. A high-intensity intermittent exercise may be more effective at reducing the risk of exercise-induced glycaemic disorders in the T1DM patients as compared to continuous exercise.
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Affiliation(s)
- Aleksandra Żebrowska
- Department of Physiological and Medical Sciences, The Jerzy Kukuczka Academy of Physical Education, Mikołowska 72A, 40-063 Katowice, Poland.
| | - Barbara Hall
- School of Health Science, University of Salford, Allerton Building, Frederick Road Campus, Salford M6 6PU, England, United Kingdom
| | - Adam Maszczyk
- Department of Sports Theory, The Jerzy Kukuczka Academy of Physical Education, Mikołowska 72A, 40-063 Katowice, Poland.
| | - Rafał Banaś
- Hospital and Health Center, Hospital Road Box 507, Chetwynd, BC V0C 1J0, Canada
| | - Joanna Urban
- Department of Biological Science, Thompson Rivers University, 805 TRU Way, Kamloops, BC V2C 0C8, Canada.
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50
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Capillary glycaemia responses to strength exercises performed before or after high-intensity interval exercise in Type 1 diabetes under real-life settings. Complement Ther Med 2018; 40:116-119. [DOI: 10.1016/j.ctim.2018.08.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2018] [Revised: 07/10/2018] [Accepted: 08/16/2018] [Indexed: 02/01/2023] Open
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