Physical activity level and body composition among adults with type 1 diabetes

Physical activity and sedentary behaviour in relation to body composition, estimated insulin sensitivity and arterial stiffness in adults with type 1 diabetes

AIMS

To examine the association of daily PA levels and sedentary behaviour with body composition, estimated insulin sensitivity, and arterial stiffness in adults with type 1 diabetes (T1D).

METHODS

Cross-sectional study in adults with T1D (n = 54). PA levels (daily steps, and time in moderate-to-vigorous intensity PA (MVPA)) and sedentary behaviour were measured using accelerometry for 7 days (McRoberts® DynaPort MoveMonitor). Cardiopulmonary exercise test for VO2max. Anthropometrics were collected, and body composition (total and % of fat mass (FMtot, FM%), total and % of lean mass (LMtot, LM%), and estimated visceral adipose tissue (VAT)) volume was assessed with dual energy X-ray-absorptiometry (DXA). Estimates of insulin sensitivity were determined (estimated glucose disposal rate (eGDR) and total daily insulin dose). Arterial stiffness was assessed with carotid-femoral pulse wave velocity (cf-PWV (m/s); SphygmoCor®).

RESULTS

Lower 10-years HbA1c associated moderately with all PA measures. Favourable moderate associations were also found between PA measures and BMI, waist, VAT but not FM and LM. PA measures were favourably associated with a lower total daily insulin dose and higher eGDR. All PA parameters associated moderately with cf-PWV however not independent from traditional risk factors. VO2max inversely associated with cf-PWV independent of age, T1D duration and 24-hour mean blood pressure.

CONCLUSIONS

Higher levels of PA, lower sedentary behaviour and greater exercise capacity are favourably associated with long-term glycaemic control, body composition, insulin dosage, estimated insulin sensitivity and arterial stiffness in adults with T1D. Therefore, regular PA and limiting sedentary time should be encouraged to improve metabolic and cardiovascular health in this population. Future longitudinal studies should explore mutual interactions and synergistic effects of PA on these outcomes.

Association of physical activity and sports participation with insulin resistance and non-alcoholic fatty liver disease in people with type 1 diabetes

AIM

To evaluate the association between physical activity (PA) and sports participation with insulin resistance and non-alcoholic fatty liver disease (NAFLD) in people with type 1 diabetes (T1D).

METHODS

People with T1D from a secondary and tertiary care centre were included. Questionnaire-derived PA was expressed in metabolic equivalent of task hours per week (METh/week). Insulin sensitivity was calculated with the estimated glucose disposal rate (eGDR). NAFLD was assessed by transient elastography (TE). Multivariate linear and logistic regression models were conducted, adjusted for age, sex, diabetes duration and BMI.

RESULTS

In total, 254 participants were included (men 56%, age 44 ± 14 years, diabetes duration 24 ± 14 years, median BMI 24.8 kg/m2), of which 150 participants underwent TE. Total PA (median 50.7 METh/week) was not significantly associated with insulin resistance (median eGDR 7.31 mg/kg/min) (beta -0.00, 95% CI -0.01 to 0.00) or with NAFLD (OR 1.00, 95% CI 0.99-1.01). Participating in sports was significantly associated with eGDR (beta 0.94, 95% CI 0.48-1.41) and with NAFLD (OR 0.21, 95% CI 0.08-0.56).

CONCLUSIONS

In our T1D population, we could not find any dose-dependent association between PA, insulin resistance and NAFLD. People participating in sports had a lower degree of insulin resistance and lower odds for NAFLD.

People with type 1 diabetes exhibit lower exercise capacity compared to a control population with similar physical activity levels

AIMS

We aimed to assess physical activity (PA) levels, adherence to PA guidelines, and fitness capacity in individuals with type 1 diabetes (T1D) and control population.

METHODS

This cross-sectional study included 232 T1D and 248 controls. PA levels (IPAQ-SF questionnaire), adherence to guidelines (>150 min/week of moderate-to-vigorous PA), fitness capacity (VO2max, maximal incremental test on a cycle ergometer and 1RM test) were assessed, along with other clinical variables.

RESULTS

Total PA levels (T1D 2202 ± 1839 vs. controls 2357 ± 2189 METs/min/week), adherence (T1D 53.1 % vs controls 53.2 %), and sedentariness (T1D 27.3 % vs. controls 25.1 %) were similar between groups. However, participants with T1D exhibited significantly lower levels of VO2max (29.1 ± 10.5 vs. 32.5 ± 11.5 mlO2/kg/min, p < 0.001), work capacity (2.73 ± 1.03 vs. 3 ± 10 W/kg of body weight, p = 0.004) and strength capacity (2.29 ± 0.53 vs. 2.41 ± 0.79 kg/kg body weight in 1RM, p = 0.01) than controls, after adjusting for sex and age.

CONCLUSIONS

Individuals with T1D exhibit lower fitness capacity compared to a control population, regardless of age and sex, even when presenting similar levels of total physical activity and adherence to guidelines.

Interrupting prolonged sitting with frequent short bouts of light-intensity activity in people with type 1 diabetes improves glycaemic control without increasing hypoglycaemia: The SIT-LESS randomised controlled trial

AIM

To examine the impact of interrupting prolonged sitting with frequent short bouts of light-intensity activity on glycaemic control in people with type 1 diabetes (T1D).

MATERIALS AND METHODS

In total, 32 inactive adults with T1D [aged 27.9 ± 4.7 years, 15 men, diabetes duration 16.0 ± 6.9 years and glycated haemoglobin 8.4 ± 1.4% (68 ± 2.3 mmol/mol)] underwent two 7-h experimental conditions in a randomised crossover fashion with >7-day washout consisting of: uninterrupted sitting (SIT), or, interrupted sitting with 3-min bouts of self-paced walking at 30-min intervals (SIT-LESS). Standardised mixed-macronutrient meals were administered 3.5 h apart during each condition. Blinded continuous glucose monitoring captured interstitial glucose responses during the 7-h experimental period and for a further 48-h under free-living conditions.

RESULTS

SIT-LESS reduced total mean glucose (SIT 8.2 ± 2.6 vs. SIT-LESS 6.9 ± 1.7 mmol/L, p = .001) and increased time in range (3.9-10.0 mmol/L) by 13.7% (SIT 71.5 ± 9.5 vs. SIT-LESS 85.1 ± 7.1%, p = .002). Hyperglycaemia (>10.0 mmol/L) was reduced by 15.0% under SIT-LESS (SIT 24.2 ± 10.8 vs. SIT-LESS 9.2 ± 6.4%, p = .002), whereas hypoglycaemia exposure (<3.9 mmol/L) (SIT 4.6 ± 3.0 vs. SIT-LESS 6.0 ± 6.0%, p = .583) was comparable across conditions. SIT-LESS reduced glycaemic variability (coefficient of variation %) by 7.8% across the observation window (p = .021). These findings were consistent when assessing discrete time periods, with SIT-LESS improving experimental and free-living postprandial, whole-day and night-time glycaemic outcomes (p < .05).

CONCLUSIONS

Interrupting prolonged sitting with frequent short bouts of light-intensity activity improves acute postprandial and 48-h glycaemia in adults with T1D. This pragmatic strategy is an efficacious approach to reducing sedentariness and increasing physical activity levels without increasing risk of hypoglycaemia in T1D.

Barriers to Exercise in Adults With Type 1 Diabetes and Insulin Resistance

OBJECTIVE

Our aim in this study was to assess attitudes toward exercise and quality of life (QoL) in adults with type 1 diabetes (T1D) with and without insulin resistance (IR).

METHODS

We pooled baseline pretreatment data from a subset of individuals with T1D from 2 randomized controlled trials. Estimated glucose disposal rate (eGDR), a validated surrogate marker of IR, was calculated using an established formula to classify individuals according to IR status with a cutpoint of <6 mg/kg/min for the determination of IR. Self-reported barriers to exercise were obtained using a validated questionnaire, the Barriers to Physical Activity in T1D (BAPAD-1). In addition, QoL was determined using the 36-item Short Form (SF-36) questionnaire. Differences between dichotomized variables were assessed using the independent t test, Mann-Whitney U test, or Fisher exact test. Linear regression was employed to explore the association of eGDR with BAPAD-1 and QoL scores, with sequential adjustment for potential confounders.

RESULTS

Of the 85 individuals included in our study, 39 were classified as having IR. The mean BAPAD-1 total score was higher for individuals with IR (IR: 3.87±0.61; non-IR: 2.83±0.55; p<0.001). The highest exercise barrier scores for individuals with IR were risk of hypoglycemia (5.67±1.26) and risk of hyperglycemia (5.23±1.20), whereas the highest scoring exercise barrier scores for non-IR individuals were not diabetes-related, with low level of fitness (3.91±1.26) and physical health status, excluding diabetes (3.67±1.48), ranked highest. QoL scores were comparable between groups (p>0.05).

CONCLUSIONS

Risk of hypoglycemia was the greatest barrier to exercise in individuals with T1D with IR, whereas non-diabetes-related barriers to exercise were more salient in individuals with T1D without IR.

"How we do it": A qualitative study of strategies for adopting an exercise routine while living with type 1 diabetes

Introduction

For people living with type 1 diabetes (T1D) the challenge of increasing daily physical activity (PA) is compounded by the increased risks of hypoglycemia and glucose variability. Little information exists on the lived experience of overcoming these barriers and adopting and maintaining an active lifestyle while living with T1D.

Research Design and Methods

We conducted a patient-led qualitative study consisting of semi-structured interviews or focus groups with 22 individuals at least 16 years old living with T1D. We used existing patient co-researcher networks and snowball sampling to obtain a sample of individuals who reported being regularly physically active and had been diagnosed with T1D for at least one year. We used an interpretive description analysis to generate themes and strategies associated with maintaining an active lifestyle while living with T1D. We involved patient co-researchers in study design, data collection, and interpretation.

Results

14 self-identified women and 8 self-identified men (ages 19-62, median age 32 years) completed the study, led by either a researcher, or a patient co-researcher and research assistant regarding their strategies for maintaining an active lifestyle. We identified five themes that facilitate regular sustained PA: (1) Structure and organization are important to adopt safe PA in daily life "I can't do spontaneous exercise. I actually need a couple hours of warning minimum"; (2) Trial and error to learn how their body responds to PA and food "Once you put the time and effort into learning, you will have greater success"; (3) Psychosocial aspects of PA "…because it's not just your body, it's your soul, it's your mind that exercise is for"; (4) Diabetes technology and (5) Education and peer support. Strategies to overcome barriers included (1) Technology; (2) Integrating psychosocial facilitators; (3) Insulin and carbohydrate adjustments; and (4) Planning for exercise.

Conclusions

Living an active lifestyle with T1D is facilitated by dedicated structure and organization of routines, accepting the need for trial and error to understand the personalized glycemic responses to PA and careful use of food to prevent hypoglycemia. These themes could inform clinical practice guidelines or future trials that include PA interventions.

Physical Activity Reduces the Risk of Developing Diabetes and Diabetes Medication Use

Diabetes is a global public health challenge, exerting a large socioeconomic burden on healthcare systems. This study aimed to explore Diabetes prevalence and Diabetes medication use in diabetics regarding sex, age group, Physical Activity Level (PAL) and Body Mass Index (BMI) by studying possible differences and calculating the risks of developing Diabetes and Diabetes medication use in the population according to their PAL. A cross-sectional study was conducted using data extracted from the Spanish National Health Survey (ENSE2017). The sample was finally composed of 17,710 participants. A descriptive analysis was performed to characterise Diabetes prevalence and Diabetes medication use (Chi-square test and a z-test for independent proportions). Odds Ratios (OR) and 95% Confidence Intervals (CI) were calculated for Diabetes prevalence and Diabetes medication use according to the participants’ PAL. Both the Diabetes and Diabetes medication use was higher in men than in women, increasing with age and BMI, and decreasing with increasing PAL (p < 0.001). Higher prevalence levels were observed in the inactive group versus very active or active people (p < 0.001). Inactive people had a higher risk of Diabetes and use of Diabetes medication risk compared to the very active and active groups. Prevalence decreased the higher the PAL both in men and women.

Demographic and clinical characteristics of a Spanish population of people living with type 1 diabetes who practice nonprofessional sports: The DIABESPORT survey

AIM

To determine the characteristics of people with type 1 diabetes mellitus (T1D) who practice sports, the support they receive, and the way in which they manage their disease during sports.

METHODS

An observational cross-sectional study designed as a web-based survey released through social media was carried out, directed to physically active people with T1D.

RESULTS

A total of 342 subjects completed the survey (16 children; 67.5% males). The duration of living with T1D was 18.6 ± 11.4 years. The mean glycosylated hemoglobin concentration (HbA1c) was 6.7 ± 0.8%, and the mean time in range (TIR) was 72.9 ± 15.8%. Only 27.2% started sports activity following the diagnosis of T1D. The most frequently used basal insulin was insulin degludec (38.6%). The usual treatment modification before doing sports consisted of bolus reduction (42.5%) or only the adjustment of nutritional supplements (19.7%). In cases of long-acting insulin users, the basal dose usually remained unchanged during sports. One-quarter of the participants were insulin pump users, and of these, 12.5% always disconnected the pump during physical activities. Severe hypoglycemia on the day of physical activity was experienced by 5% of the participants in the last 6 months. One-third reported a lack of support from their physician, and 61% had learned to manage glycemic control during sports by themselves.

CONCLUSIONS

This study highlights the adjustments made by people living with T1D during sports practice, and the lack of support received from healthcare professionals.

Association of HbA1c with VO2max in Individuals with Type 1 Diabetes: A Systematic Review and Meta-Analysis

The aim of this systematic review and meta-analysis was to evaluate the association between glycemic control (HbA1c) and functional capacity (VO2max) in individuals with type 1 diabetes (T1DM). A systematic literature search was conducted in EMBASE, PubMed, Cochrane Central Register of Controlled Trials, and ISI Web of Knowledge for publications from January 1950 until July 2020. Randomized and observational controlled trials with a minimum number of three participants were included if cardio-pulmonary exercise tests to determine VO2max and HbA1c measurement has been performed. Pooled mean values were estimated for VO2max and HbA1c and weighted Pearson correlation and meta-regression were performed to assess the association between these parameters. We included 187 studies with a total of 3278 individuals with T1DM. The pooled mean HbA1c value was 8.1% (95%CI; 7.9−8.3%), and relative VO2max was 38.5 mL/min/kg (37.3−39.6). The pooled mean VO2max was significantly lower (36.9 vs. 40.7, p = 0.001) in studies reporting a mean HbA1c > 7.5% compared to studies with a mean HbA1c ≤ 7.5%. Weighted Pearson correlation coefficient was r = −0.19 (p < 0.001) between VO2max and HbA1c. Meta-regression adjusted for age and sex showed a significant decrease of −0.94 mL/min/kg in VO2max per HbA1c increase of 1% (p = 0.024). In conclusion, we were able to determine a statistically significant correlation between HbA1c and VO2max in individuals with T1DM. However, as the correlation was only weak, the association of HbA1c and VO2max might not be of clinical relevance in individuals with T1DM.

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

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

Physical activity, body mass index, and blood progranulin in older adults: cross-sectional associations in the MAPT study

Physical activity (PA) has been shown to moderate the negative effects of obesity on pro-inflammatory cytokines but its relationship with the adipokine progranulin (PGRN) remains poorly investigated. This study aimed to examine the cross-sectional main and interactive associations of body mass index (BMI) and PA level with circulating PGRN in older adults. Five-hundred and twelve subjects aged 70 years and over involved in the Multidomain Alzheimer Prevention Trial (MAPT) Study who underwent plasma PGRN measurements (ng/ml) were included. Self -reported PA levels were assessed using questionnaires. People were classified into three BMI categories: normal weight, overweight or obesity. Further categorization using PA tertiles was used to define highly active, moderately active and low active individuals. Multiple linear regressions were performed in order to test the associations of BMI, PA level, and their interaction with PGRN levels. Multiple linear regressions adjusted by age, sex, diabetes mellitus status, total cholesterol, creatinine level and MAPT group demonstrated significant interactive associations of BMI status and continuous PA such that in people without obesity, higher PA levels were associated with lower PGRN concentrations, while an opposite pattern was found in individuals with obesity. In addition, continuous BMI was positively associated with circulating PGRN in highly active individuals but not in their less active peers. This cross-sectional study demonstrated reverse patterns in older adults with obesity compared to those without obesity regarding the relationships between PA and PGRN levels. Longitudinal and experimental investigations are required to understand the mechanisms that underlie the present findings.

Physical Activity, Dietary Patterns, and Glycemic Management in Active Individuals with Type 1 Diabetes: An Online Survey

Individuals with type 1 diabetes (T1D) are able to balance their blood glucose levels while engaging in a wide variety of physical activities and sports. However, insulin use forces them to contend with many daily training and performance challenges involved with fine-tuning medication dosing, physical activity levels, and dietary patterns to optimize their participation and performance. The aim of this study was to ascertain which variables related to the diabetes management of physically active individuals with T1D have the greatest impact on overall blood glucose levels (reported as A1C) in a real-world setting. A total of 220 individuals with T1D completed an online survey to self-report information about their glycemic management, physical activity patterns, carbohydrate and dietary intake, use of diabetes technologies, and other variables that impact diabetes management and health. In analyzing many variables affecting glycemic management, the primary significant finding was that A1C values in lower, recommended ranges (<7%) were significantly predicted by a very-low carbohydrate intake dietary pattern, whereas the use of continuous glucose monitoring (CGM) devices had the greatest predictive ability when A1C was above recommended (≥7%). Various aspects of physical activity participation (including type, weekly time, frequency, and intensity) were not significantly associated with A1C for participants in this survey. In conclusion, when individuals with T1D are already physically active, dietary changes and more frequent monitoring of glucose may be most capable of further enhancing glycemic management.

Changes in Oxidative and Nitrosative Stress Indicators and Vascular Endothelial Growth Factor After Maximum-Intensity Exercise Assessing Aerobic Capacity in Males With Type 1 Diabetes Mellitus

In type 1 diabetes mellitus (T1DM), chronic hyperglycemia causes reactive oxygen and nitrogen species production. Exercise alters the oxidant-antioxidant balance. We evaluated the aerobic capacity and oxidant-antioxidant balance changes after maximum-intensity exercise in T1DM patients. The study involved 30 T1DM participants and 23 controls. The patients' average age was 23.4 ± 5.1 years, with a body mass index of 24.3 ± 3.1 kg m^-2 and with satisfactory glycemic control. Among the controls, the respective values equaled 24.7 ± 2.9 years and 22.9 ± 2.1 kg m^-2. Aerobic capacity was assessed with a treadmill test. Peak minute oxygen uptake was significantly lower in T1DM compared with the controls (44.7 ± 5.7 vs. 56.0 ± 7.3 mL kg^-1 min^-1). The total oxidant capacity measured by total oxidative status/total oxidative capacity (TOS/TOC) equaled 321.5 ± 151 μmol L^-1 before and 380.1 ± 153 μmol L^-1 after exercise in T1DM, and 164.1 ± 75 and 216.6 ± 75 μmol L^-1 in the controls (p < 0.05 for all comparisons). A significant difference in the ratio of total antioxidant status/total antioxidant capacity (TAS/TAC) between the groups after the treadmill test was observed (p < 0.05). Nitrosative stress indicators where significantly higher in the T1DM group both before and after the exercise. In conclusion, diabetic patients demonstrated a lower aerobic capacity. The TOS/TOC and nitrosative stress indicators were significantly higher in T1DM before and after the test.

Adherence to physical activity recommendations and barriers to physical activity participation among adults with type 1 diabetes

Background

Physical activity (PA) is important for those with type 1 diabetes (T1DM); however, accurate information on PA in people with T1DM is limited.

Aims

This study assessed adherence to PA guidelines using both objective and subjective PA measures and evaluated the relationship between accelerometer-measured PA and cardiovascular disease (CVD) risk factors. Barriers to PA were also assessed.

Methods

Using an observational cross-sectional design, PA was measured objectively over 7 days in 72 participants (34 males) using an accelerometer (ActiGraph) and subjectively using the International Physical Activity Questionnaire (IPAQ). Perceived barriers to PA were assessed using the Barriers to Physical Activity in Diabetes (type 1) scale. Multiple linear regression models assessed the influence of PA on HbA1c and CVD risk factors.

Results

Mean age ± SD was 40.9 ± 12.9 years, diabetes duration was 18 ± 11.6 years, and HbA1c was 65 ± 14 mmol/mol /8.0 ± 1.3%. Twenty-three (32%) participants exercised according to PA recommendations as measured by an accelerometer. Sixty-nine (97%) participants reported meeting the recommendations as per the IPAQ. Those meeting recommendations (accelerometry) had a lower HbA1c (p = 0.001), BMI (p = 0.032), waist circumference (p = 0.006), and fat mass (p = 0.032) and a greater number of hypoglycaemic events (p = 0.004). Fear of hypoglycaemia was the strongest barrier to PA (mean 3.4 ± 2.0).

Conclusion

The majority of participants failed to meet PA recommendations. Meeting the recommendations was associated with healthier CVD risk factor profiles. Individuals with T1DM possibly overestimate their PA using self-reported measures and require support and education to safely improve activity levels.

Can Resistance Exercise Be a Tool for Healthy Aging in Post-Menopausal Women with Type 1 Diabetes?

Due to improvements in diabetes care, people with type 1 diabetes (T1D) are living longer. Studies show that post-menopausal T1D women have a substantially elevated cardiovascular risk compared to those without T1D. As T1D may also accelerate age-related bone and muscle loss, the risk of frailty may be considerable for T1D women. Exercise and physical activity may be optimal preventative therapies to maintain health and prevent complications in this population: They are associated with improvements in, or maintenance of, cardiovascular health, bone mineral density, and muscle mass in older adults. Resistance exercise, in particular, may provide important protection against age-related frailty, due to its specific effects on bone and muscle. Fear of hypoglycemia can be a barrier to exercise in those with T1D, and resistance exercise may cause less hypoglycemia than aerobic exercise. There are currently no exercise studies involving older, post-menopausal women with T1D. As such, it is unknown whether current guidelines for insulin adjustment/carbohydrate intake for activity are appropriate for this population. This review focuses on existing knowledge about exercise in older adults and considers potential future directions around resistance exercise as a therapeutic intervention for post-menopausal T1D women.

Predictors of the maximal oxygen consumption in adult patients with type 1 diabetes treated with personal insulin pumps

AIMS/INTRODUCTION

Regular physical activity for adults with type 1 diabetes mellitus improves cardiorespiratory fitness (CF) and quality of life. The aim of our study was to evaluate clinical and biochemical features that might be associated with CF in a homogenous group of adults with type 1 diabetes mellitus who are all treated with a personal insulin pump (continuous subcutaneous insulin infusion).

MATERIALS AND METHODS

We assessed CF in 62 patients (74.2% of whom were men) who fulfilled the eligibility criteria. To determine maximal oxygen consumption, the march-running test on the treadmill was carried out. Two hours before the test, the patients consumed a defined meal covered by a dose of rapid acting insulin analog that was reduced by 25% from their regular dose. Basal insulin infusion was reduced by 50% for an hour. Additionally, the Perceived Stress Scale-10 questionnaire was used to measure the perception of stress.

RESULTS

There was no episode of severe hypoglycemia during or after the test. In the final model, independent predictors of maximal oxygen consumption were sex, body fat percentage, lactate at 20 min after CF test and Perceived Stress Scale-10 score. Of interest, neither short-term (continuous glucose monitoring) nor long-term (glycosylated hemoglobin) metabolic control parameters were predictors of CF.

CONCLUSIONS

In our selected homogenous group of patients with type 1 diabetes mellitus treated with personal insulin pumps, higher CF was associated with a lower percentage of body fat, male sex, higher lactate level after the CF test and the Perceived Stress Scale-10 score. The proposed protocol in our cohort proved to be safe with regard to glycemic control.

Evaluation of Web-Based and In-Person Methods to Recruit Adults With Type 1 Diabetes for a Mobile Exercise Intervention: Prospective Observational Study

BACKGROUND

Our clinical trial of a mobile exercise intervention for adults 18 to 65 years old with type 1 diabetes (T1D) occurred during COVID-19 social distancing restrictions, prompting us to test web-based recruitment methods previously underexplored for this demographic.

OBJECTIVE

Our objectives for this study were to (1) evaluate the effectiveness and cost of using social media news feed advertisements, a clinic-based approach method, and web-based snowball sampling to reach inadequately active adults with T1D and (2) compare characteristics of enrollees against normative data.

METHODS

Participants were recruited between November 2019 and August 2020. In method #1, Facebook and Instagram news feed advertisements ran for five 1-to-8-day windows targeting adults (18 to 64 years old) in the greater New Haven and Hartford, Connecticut, areas with one or more diabetes-related profile interest. If interested, participants completed a webform so that the research team could contact them for eligibility screening. In method #2, patients 18 to 24 years old with T1D were approached in person at clinical visits in November and December 2019. Those who were interested immediately completed eligibility screening. Older patients could not be approached due to clinic restrictions. In method #3, snowball sampling was conducted by physically active individuals with T1D contacting their peers on Facebook and via email for 48 days, with details to contact the research staff to express interest and complete eligibility screening. Other methods referred participants to the study similarly to snowball sampling.

RESULTS

In method #1, advertisements were displayed to 11,738 unique viewers and attracted 274 clickers (2.33%); 20 participants from this group (7.3%) volunteered, of whom 8 (40%) were eligible. Costs averaged US $1.20 per click and US $95.88 per eligible volunteer. Men had lower click rates than women (1.71% vs 3.17%; P<.001), but their responsiveness and eligibility rates did not differ. In method #2, we approached 40 patients; 32 of these patients (80%) inquired about the study, of whom 20 (63%) volunteered, and 2 of these volunteers (10%) were eligible. Costs including personnel for in-person approaches averaged US $21.01 per inquirer and US $479.79 per eligible volunteer. In method #3, snowball sampling generated 13 inquirers; 12 of these inquirers (92%) volunteered, of whom 8 (67%) were eligible. Incremental costs to attract inquirers were negligible, and total costs averaged US $20.59 per eligible volunteer. Other methods yielded 7 inquirers; 5 of these inquirers (71%) volunteered, of whom 2 (40%) were eligible. Incremental costs to attract inquirers were negligible, and total costs averaged US $34.94 per eligible volunteer. Demographic overrepresentations emerged in the overall cohort (ie, optimal glycemic control, obesity, and low exercise), among those recruited by news feed advertisements (ie, obesity and older age), and among those recruited by snowball sampling (ie, optimal glycemic control and low exercise).

CONCLUSIONS

Web-based advertising and recruitment strategies are a promising means to attract adults with T1D to clinical trials and exercise interventions, with costs comparing favorably to prior trials despite targeting an uncommon condition (ie, T1D) and commitment to an intervention. These strategies should be tailored in future studies to increase access to higher-risk participants.

TRIAL REGISTRATION

ClinicalTrials.gov NCT04204733; https://clinicaltrials.gov/ct2/show/NCT04204733.

Comparison of two carbohydrate intake strategies to improve glucose control during exercise in adolescents and adults with type 1 diabetes

BACKGROUND AND AIMS

During aerobic physical activity (PA), hypoglycemia is common in people with type 1 diabetes (T1D). Few studies have compared the effectiveness of different carbohydrate (CHO) intake strategies to prevent PA-induced hypoglycemia. Our objective was to compare the efficacy of two CHO intake strategies, same total amount but different CHO intake timing, to maintain glucose levels in the target range (4.0-10.0 mmol/L) during PA in people with T1D.

METHODS AND RESULTS

An open-label, randomized, crossover study in 33 participants (21 adults; 12 adolescents). Participants practiced 60 min PA sessions (ergocyle) at 60% VO_2peak 3.5 h after lunch comparing an intake of 0.5 g of CHO per kg of body weight applied in a pre-PA single CHO intake (SCI) or in a distributed CHO intake (DCI) before and during PA. The percentage of time spent in glucose level target range during PA was not different between the two strategies (SCI: 75 ± 35%; DCI: 87 ± 26%; P = 0.12). Hypoglycemia (<4.0 mmol/L) occurred in 4 participants (12%) with SCI compared to 6 participants (18%) with DCI (P = 0.42). The SCI strategy led to a higher increase (P = 0.01) and variability of glucose levels (P = 0.04) compared with DCI.

CONCLUSIONS

In people living with T1D, for a 60 min moderate aerobic PA in the post-absorptive condition, a 0.5 g/kg CHO intake helped most participants maintain acceptable glycemic control with both strategies. No clinically significant difference was observed between the SCI and DCI strategies. ClinicalTrials.gov Identifier: NCT03214107 (July 11, 2017).

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

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

Bolus insulin dose depends on previous-day race intensity during 5 days of professional road-cycle racing in athletes with type 1 diabetes: A prospective observational study

AIMS

To assess insulin therapy, macronutrient intake and glycaemia in professional cyclists with type 1 diabetes (T1D) over a 5-day Union Cycliste Internationale road-cycle race.

MATERIAL AND METHODS

In this prospective observational study, seven professional cyclists with T1D (age 28 ± 4 years, body mass index 20.9 ± 0.9 kg/m² , glycated haemoglobin concentration 56 ± 7 mmol/mol [7.3% ± 0.6%]) were monitored during a five-stage professional road cycling race. Real-time continuous glucose monitoring (rtCGM) data, smart insulin pen dose data and macronutrient intake were assessed by means of repeated-measure one-way ANOVA and post hoc testing. Associations between exercise physiological markers and rtCGM data, insulin doses and macronutrient intake were assessed via linear regression modelling (P ≤ 0.05).

RESULTS

Bolus insulin dose was significantly reduced over the 5-day period (P = 0.03), while carbohydrate intake (P = 0.24) and basal insulin doses remained unchanged (P = 0.64). A higher mean previous-day race intensity was associated with a lower mean sensor glucose level (P = 0.03), less time above range level 2 (>13.9 mmol/L [250 mg/dL]; P = 0.05) and lower doses of bolus insulin (P = 0.04) on the subsequent day. No significant associations were found for any other glycaemic range and glycaemic variability (P > 0.05).

CONCLUSIONS

This is the first study to demonstrate the influence of previous-day race intensity on subsequent bolus insulin dose requirements in professional cyclists with T1D. These data may help inform therapeutic strategies to ensure safe exercise performance.

Improved glycaemic variability and basal insulin dose reduction during a running competition in recreationally active adults with type 1 diabetes-A single-centre, prospective, controlled observational study

INTRODUCTION

To investigate the glycaemic response, macronutrient intake and insulin management in people with type 1 diabetes (T1D) compared to healthy individuals around a running competition.

MATERIAL AND METHODS

This was a single-centre, prospective, controlled observational study performed in individuals with T1D and healthy people. 24 people (12 T1D) were included in this study (age: T1D 41±12 vs. healthy 38±6 years, females: 3 vs. 6, BMI: 25.53.0 vs. 22.9±2.8 kg/m2). Both groups received an intermittently scanned continuous glucose monitoring (isCGM; FreeStyle Libre 1, Abbott, USA) system to assess glycaemia 24 hours before, during and 24 hours after a running competition. During this period, participants recorded their food intake and insulin administration. Data were analysed via ANOVA and mixed model analyses with post-hoc testing (p≤0.05).

RESULTS

For overall glycaemic ranges in comparison of groups, significant differences were found for time in range (T1D 63±21% vs. healthy 89±13%, p = 0.001), time above range (TAR) 1 (T1D 21±15% vs. healthy 0±0%, p<0.001) and TAR 2 (T1D 8 [0-16%] vs. healthy 0±0%, p<0.001). When glycaemic variability was assessed, people with T1D had a higher glycaemic variability compared to healthy individuals (p<0.0001). Basal insulin dose was significantly reduced when compared against the regular pre-study basal insulin dose (pre-study 22±6 vs. pre-competition day 11±9 (-50±41%), p = 0.02; competition day 15±5 (-32± 1%)).

CONCLUSION

People with T1D have impaired glucose responses around a running competition compared to healthy individuals. However, basal insulin dose reductions were sufficient to prevent further dysglycaemia.

CLINICAL TRIAL ID

drks.de; DRKS00019886.

Nutrition and Exercise Performance in Adults With Type 1 Diabetes

The best nutritional practices for exercise and sports performance are largely activity specific. The presence of type 1 diabetes undeniably bestows additional factors to consider to manage exercise and ensure adequate nutrients and fuels are available for optimal performance. Whether participating in sports or physical activity on a recreational basis or striving to achieve a high level of athletic performance, individuals with type 1 diabetes must pay attention to their nutritional and dietary patterns, including intake of macronutrients, micronutrients, fluids and supplements, such as caffeine to maintain metabolic and glycemic balance. Performance aside, nutritional recommendations may also differ on an individual basis relative to exercise, glycemic management and body weight goals. Balancing all these dietary factors can be challenging for individuals with type 1 diabetes, and many related aspects have yet to be fully researched in this population.

Regular physical activity as a physiological factor contributing to extend partial remission time in children with new onset diabetes mellitus-Two years observation

BACKGROUND

Beneficial effects of physical activity (PA) are confirmed in patients with all types of long-lasting diabetes. The possibility of PA to be a factor prolonging remission phase in children with new-onset type 1 diabetes (T1D) has not yet been thoroughly studied.

OBJECTIVE

The aim of the study was to elucidate the influence of regular PA on prevalence of partial remission (PR), metabolic control, daily insulin requirement (DIR), and C-peptide secretion in children newly diagnosed with T1D.

METHODS

A total of 125 children diagnosed with T1D were studied prospectively for 2 years. Patients were controlled every 3 months and advised with PA according to ISPAD recommendations. Anthropometric parameters, HbA1c, C-peptide level and DIR were analyzed. Patients' PA level was assessed using a self-designed questionnaire.

RESULTS

We classified 43% of participants as physically-active. In this group, lower HbA1c after 2 years, lower DIR after 3, 6 months, and after 2 years (all P < .05) were found. At discharge from hospital, the prevalence of DIR < 0.5 U/kg/24 h with near normoglycemia was similar in both groups. Then, we observed higher PR prevalence in active group lasting over time and resulting in 44% vs 13% after 2 years (P < .001). C-peptide after 2 years was comparable in both groups, with higher prevalence of clinically significant levels (>0.2 nmoL/L) in active group: 79.6% vs 61.4% (P = .029).

CONCLUSIONS

These data support the view that regular PA may essentially contribute to extending PR time in pediatric diabetes, and may therefore lead to a better long-term metabolic control of the disease.

Improving Clinical Outcomes in Newly Diagnosed Pediatric Type 1 Diabetes: Teamwork, Targets, Technology, and Tight Control-The 4T Study

Many youth with type 1 diabetes (T1D) do not achieve hemoglobin A1c (HbA1c) targets. The mean HbA1c of youth in the USA is higher than much of the developed world. Mean HbA1c in other nations has been successfully modified following benchmarking and quality improvement methods. In this review, we describe the novel 4T approach-teamwork, targets, technology, and tight control-to diabetes management in youth with new-onset T1D. In this program, the diabetes care team (physicians, nurse practitioners, certified diabetes educators, dieticians, social workers, psychologists, and exercise physiologists) work closely to deliver diabetes education from diagnosis. Part of the education curriculum involves early integration of technology, specifically continuous glucose monitoring (CGM), and developing a curriculum around using the CGM to maintain tight control and optimize quality of life.

Leisure time physical activity is associated with better metabolic control in adults with type 1 and type 2 diabetes mellitus: A cross-sectional study from two public hospitals in Chile

AIM

To examine the association between leisure time physical activity (LTPA) and metabolic control, in adults with diabetes mellitus (DM).

METHODS

A cross-sectional study was conducted in two hospitals (Santiago, Chile) with 101 type 1 (mean 34.4±12.3 years) and 100 type 2 DM (mean 57.8±5.2 years) adults. Glycated hemoglobin level (A1C) was obtained, and LTPA levels were estimated through the Global Physical Activity Questionnaire. Multiple linear regression models were fitted evaluating the independent effect of LTPA, sociodemographic, cardiovascular risk factors and other types of physical activity (PA) on metabolic control.

RESULTS

DM participants which reported no LTPA had higher levels of A1C (type 1 mean A1C: 8.8±1.5% and type 2 mean A1C: 9.2±1.4%) compared to those who fulfilled PA recommendations of ≥150min/week (type 1 mean A1C: 8.0±1.6% and type 2 mean A1C: 8.1±1.4%). Regression analysis showed that A1C levels were negatively associated with ≥150min/week on LTPA in type 1 (b=-0.25; 95%CI -0.16 to -0.01) and type 2 DM (b=-0.24; 95%CI -0.29 to -0.02) participants.

CONCLUSION

Leisure time physical activity may be considered as an efficient and inexpensive non-pharmacological tool for DM treatment. Hence, healthcare professionals should educate and promote PA since primary-care diagnosis in addition to prevent disease-related complications.

Closed-Loop Control with Unannounced Exercise for Adults with Type 1 Diabetes using the Ensemble Model Predictive Control

This paper presents an individualized Ensemble Model Predictive Control (EnMPC) algorithm for blood glucose (BG) stabilization and hypoglycemia prevention in people with type 1 diabetes (T1D) who exercise regularly. The EnMPC formulation can be regarded as a simplified multi-stage MPC allowing for the consideration of N _en scenarios gathered from the patient's recent behavior. The patient's physical activity behavior is characterized by an exercise-specific input signal derived from the deconvolution of the patient's continuous glucose monitor (CGM), accounting for known inputs such as meal, and insulin pump records. The EnMPC controller was tested in a cohort of in silico patients with representative inter-subject and intra-subject variability from the FDA-accepted UVA/Padova simulation platform. Results show a significant improvement on hypoglycemia prevention after 30 min of mild to moderate exercise in comparison to a similarly tuned baseline controller (rMPC); with a reduction in hypoglycemia occurrences (< 70 mg/dL), from 3.08% ± 3.55 with rMPC to 0.78% ± 2.04 with EnMPC (P < 0.05).

Objective Measurement of Physical Activity in Adults With Newly Diagnosed Type 1 Diabetes and Healthy Individuals

Aims: Physical activity (PA) has many benefits in type 1 diabetes mellitus (type 1 DM). However, PA levels in people with type 1 DM have not previously been measured accurately. We aimed to compare objectively measured PA in adults recently diagnosed with type 1 DM and healthy adults.

Methods: Accelerometer data from 65 healthy adults [mean (SD) age 31 (13), 29% men] were compared with data from 50 people with type 1 DM [mean (SD) age 33 (10), 64% men], time since diagnosis <3months, HbA1c 76 ± 25 mmol/mol) in the EXTOD (Exercise for Type 1 Diabetes) pilot study. Briefly, EXTOD investigated the feasibility of recruiting recently diagnosed adults with type 1 DM into a yearlong exercise intervention. Multiple-regression models were used to investigate the association between diabetes status and activity outcomes.

Results: Adults recently diagnosed with type 1 DM spent on average a quarter less time in moderate-to-vigorous-physical-activity (MVPA) per day than healthy adults [after adjusting for confounders, predicted values: type 1 DM adults: [mean (SD)] 37.4 mins/day (9.1) Healthy adults: 52.9 mins/day (11.0)]. No difference in MVPA between the groups was seen at the weekend, but adults with type 1 DM spent more time in light physical activity (LPA), and less time in sedentary behavior. Time spent in sedentary or LPA during weekdays did not differ between groups.

Summary: Adults recently diagnosed with type 1 DM do less MVPA. Health care workers should encourage these people to engage in more PA. Further studies are needed to assess PA in people with type 1 DM of longer duration.

Preliminary Evaluation of a Cycling Cleat Designed for Diabetic Foot Ulcers

BACKGROUND

Offloading devices for diabetic foot ulcers (DFU) generally restrict exercise. In addition to traditional health benefits, exercise could benefit DFU by increasing blood flow and acting as thermotherapy. This study functionally evaluated a cycling cleat designed for forefoot DFU.

METHODS

Fifteen individuals at risk of developing a DFU used a recumbent stationary bicycle to complete one 5-minute cycling bout with the DFU cleat on their study foot and one 5-minute bout without it. Foot stress was evaluated by plantar pressure insoles during cycling. Laser Doppler perfusion monitored blood flow to the hallux. Infrared photographs measured foot temperature before and after each cycling bout.

RESULTS

The specialized cleat significantly reduced forefoot plantar pressure (9.9 kPa versus 62.6 kPa, P < .05) and pressure time integral (15.4 versus 76.4 kPa*sec, P < .05). Irrespective of footwear condition, perfusion to the hallux increased (3.97 ± 1.2 versus 6.9 ± 1.4 tissue perfusion units, P < .05) after exercise. Infrared images revealed no changes in foot temperature.

CONCLUSIONS

The specialized cleat allowed participants to exercise with minimal forefoot stress. The observed increase in perfusion suggests that healing might improve if patients with active DFU were to use the cleat. Potential thermotherapy for DFU was not supported by this study. Evaluation of the device among individuals with active DFU is now warranted.

Physiological and psychological challenges of increasing physical activity and exercise in patients at risk of diabetic foot ulcers: a critical review

Obesity and a sedentary lifestyle are common challenges among individuals at risk of diabetic foot ulcers. While substantial research exists on physical activity interventions in adults with diabetes, those at greatest risk for foot ulceration were often excluded or not well represented. Both at-risk patients and their clinicians may be hesitant to increase physical activity because of their perception of diabetic foot ulcer risks. Physical activity is not contraindicated for those at risk of diabetic foot ulcer, yet patients at risk present with unique barriers to initiating increases in physical activity. This review focuses upon the physiological and psychological challenges of increasing physical activity and exercise in patients at risk of diabetic foot ulcers. Offloading, diabetic peripheral neuropathy, depression, pain, self-efficacy and social support, diabetic foot ulcer risk-specific beliefs and emotions, and research to date on exercise interventions in this population are all discussed. Additionally, recommendations for implementing and researching physical activity interventions for individuals at risk for diabetic foot ulcer are provided. Copyright © 2016 John Wiley & Sons, Ltd.

Can somatostatin antagonism prevent hypoglycaemia during exercise in type 1 diabetes?

The prevention and management of exercise-induced hypoglycaemia remains a challenge for patients with type 1 diabetes. Strategies involving changes to insulin dosing and/or carbohydrate consumption in anticipation of or during different types of exercise have proved to be helpful but not sufficient to fully prevent the hypoglycaemic risk. Meanwhile, the defect in glucagon secretion in response to hypoglycaemia in diabetes and the contributory role of somatostatin to this dysregulation constitute an important therapeutic target. In this issue of Diabetologia (DOI 10.1007/s00125-016-3953-0 ), Leclair et al show that selective somatostatin receptor 2 antagonists can enhance glucagon secretion in rats with streptozotocin-induced diabetes during exercise. The implications of their interesting findings are discussed, as well as limitations and potential for clinical applications, together with other glucagon-based options for tackling exercise-induced hypoglycaemia in diabetes.

Lifestyle of patients with diabetes mellitus type 1: a systematic review

The aim of this review was to verify data concerning the relationship between the existent lifestyle and glycemic control in patients with Diabetes Mellitus Type 1 (DM1). The methods applied included the literature search strategy, selection of studies by means of inclusion and exclusion strategies, according to the characteristics of the studies. The search was conducted in the Lilacs, Medline, PubMed, Cochrame, SciELO and IBECS databases between in the period between 2005 and 2014. The articles selected were studies in humans, investing lifestyle, physical activities and glycemic levels. Of the 1798 studies initially identified, 11 met the eligibility criteria. Among the studies analyzed, 1 cohort; 1 longitudinal prospective, 1 case control and 8 transversal studies that approached the proposed theme were related. Regular physical activity was the variable that presented greatest relationship with the improvement in glycemic levels. Healthy active life, balanced diet, physical activities and education in diabetes improved the glycemic control of the DM1 patient. The results allowed the authors to conclude that a lifestyle based on physical activities interfered directly in the health of patients with DM1, in addition to contributing the glycemic control.

Prevalence and Predictors of Pre-Diabetes and Diabetes among Adults 18 Years or Older in Florida: A Multinomial Logistic Modeling Approach

BACKGROUND

Individuals with pre-diabetes and diabetes have increased risks of developing macro-vascular complications including heart disease and stroke; which are the leading causes of death globally. The objective of this study was to estimate the prevalence of pre-diabetes and diabetes, and to investigate their predictors among adults ≥18 years in Florida.

METHODS

Data covering the time period January-December 2013, were obtained from Florida's Behavioral Risk Factor Surveillance System (BRFSS). Survey design of the study was declared using SVYSET statement of STATA 13.1. Descriptive analyses were performed to estimate the prevalence of pre-diabetes and diabetes. Predictors of pre-diabetes and diabetes were investigated using multinomial logistic regression model. Model goodness-of-fit was evaluated using both the multinomial goodness-of-fit test proposed by Fagerland, Hosmer, and Bofin, as well as, the Hosmer-Lemeshow's goodness of fit test.

RESULTS

There were approximately 2,983 (7.3%) and 5,189 (12.1%) adults in Florida diagnosed with pre-diabetes and diabetes, respectively. Over half of the study respondents were white, married and over the age of 45 years while 36.4% reported being physically inactive, overweight (36.4%) or obese (26.4%), hypertensive (34.6%), hypercholesteremic (40.3%), and 26% were arthritic. Based on the final multivariable multinomial model, only being overweight (Relative Risk Ratio [RRR] = 1.85, 95% Confidence Interval [95% CI] = 1.41, 2.42), obese (RRR = 3.41, 95% CI = 2.61, 4.45), hypertensive (RRR = 1.69, 95% CI = 1.33, 2.15), hypercholesterolemic (RRR = 1.94, 95% CI = 1.55, 2.43), and arthritic (RRR = 1.24, 95% CI = 1.00, 1.55) had significant associations with pre-diabetes. However, more predictors had significant associations with diabetes and the strengths of associations tended to be higher than for the association with pre-diabetes. For instance, the relative risk ratios for the association between diabetes and being overweight (RRR = 2.00, 95% CI = 1.55, 2.57), or obese (RRR = 4.04, 95% CI = 3.22, 5.07), hypertensive (RRR = 2.66, 95% CI = 2.08, 3.41), hypercholesterolemic (RRR = 1.98, 95% CI = 1.61, 2.45) and arthritic (RRR = 1.28, 95% CI = 1.04, 1.58) were all further away from the null than their associations with pre-diabetes. Moreover, a number of variables such as age, income level, sex, and level of physical activity had significant association with diabetes but not pre-diabetes. The risk of diabetes increased with increasing age, lower income, in males, and with physical inactivity. Insufficient physical activity had no significant association with the risk of diabetes or pre-diabetes.

CONCLUSIONS

There is evidence of differences in the strength of association of the predictors across levels of diabetes status (pre-diabetes and diabetes) among adults ≥18 years in Florida. It is important to monitor populations at high risk for pre-diabetes and diabetes, so as to help guide health programming decisions and resource allocations to control the condition.

Impact of Physical Activity on Glycemic Control and Prevalence of Cardiovascular Risk Factors in Adults With Type 1 Diabetes: A Cross-sectional Multicenter Study of 18,028 Patients

OBJECTIVE

Physical activity (PA) can improve cardiovascular risk in the general population and in patients with type 2 diabetes. Studies also indicate an HbA(1c)-lowering effect in patients with type 2 diabetes. Since reports in patients with type 1 diabetes are scarce, this analysis aimed to investigate whether there is an association between PA and glycemic control or cardiovascular risk in subjects with type 1 diabetes.

RESEARCH DESIGN AND METHODS

A total of 18,028 adults (≥18 to <80 years of age) from Germany and Austria with type 1 diabetes from the Diabetes-Patienten-Verlaufsdokumentation (DPV) database were included. Patients were stratified according to their self-reported frequency of PA (PA0, inactive; PA1, one to two times per week; PA2, more than two times per week). Multivariable regression models were applied for glycemic control, diabetes-related comorbidities, and cardiovascular risk factors. Data were adjusted for sex, age, and diabetes duration. P values for trend were given. SAS 9.4 was used for statistical analysis.

RESULTS

An inverse association between PA and HbA(1c), diabetic ketoacidosis, BMI, dyslipidemia (all P < 0.0001), and hypertension (P = 0.0150), as well as between PA and retinopathy or microalbuminuria (both P < 0.0001), was present. Severe hypoglycemia (assistance required) did not differ in PA groups (P = 0.8989), whereas severe hypoglycemia with coma was inversely associated with PA (P < 0.0001).

CONCLUSIONS

PA seemed to be beneficial with respect to glycemic control, diabetes-related comorbidities, and cardiovascular risk factors without an increase of adverse events. Hence, our data underscore the recommendation for subjects with type 1 diabetes to perform regular PA.

In adult patients with type 1 diabetes healthy lifestyle associates with a better cardiometabolic profile

BACKGROUND/AIMS

Little is known about lifestyle habits of adults with type 1 diabetes (T1D) and their association with cardiometabolic risk (CMR) factors. The aims of the present study were to determine the prevalence of adults with T1D who adopted a healthy lifestyle and to explore the association between a healthy lifestyle and the cardiometabolic profile.

METHODS AND RESULTS

This is a cross-sectional analysis of 115 adults with T1D. Participants wore a motion sensor and completed a 3-day food record. The following CMR factors were assessed: body mass index, waist circumference, body composition (iDXA), glycated hemoglobin, lipids and blood pressure. Insulin resistance was estimated (estimated glucose disposal rate). Participants were classified according to the number of healthy lifestyle habits adopted (ranging from 0 to 3): regular physical activity (physical activity level ≥1.7), good diet quality (Canadian Healthy Eating Index score >80) and none-smoking status. The proportion of participants who adopted 3, 2, 1 or 0 lifestyle habits were 11%, 30%, 37%, and 23%, respectively. As the number of healthy lifestyle habits adopted increased, participants had significantly lower body mass index, waist circumference, body fat, total cholesterol, non-HDL-cholesterol, triglycerides and systolic blood pressure (p < 0.05). In addition, a trend for lower estimated insulin resistance was observed (p = 0.06). For each increase of one healthy lifestyle habit, body mass index decreased by 1.9 kg/m(2), waist circumference by 4.0 cm for men and 4.8 cm for women and trunk fat by 3.6% for men and 4.1% for women.

CONCLUSIONS

These results suggest the importance of a healthy lifestyle among adults with T1D in order to control CMR factors.

Physical activity and type 1 diabetes: time for a rewire?

While being physically active bestows many health benefits on individuals with type 1 diabetes, their overall blood glucose control is not enhanced without an effective balance of insulin dosing and food intake to maintain euglycemia before, during, and after exercise of all types. At present, a number of technological advances are already available to insulin users who desire to be physically active with optimal blood glucose control, although a number of limitations to those devices remain. In addition to continued improvements to existing technologies and introduction of new ones, finding ways to integrate all of the available data to optimize blood glucose control and performance during and following exercise will likely involve development of "smart" calculators, enhanced closed-loop systems that are able to use additional inputs and learn, and social aspects that allow devices to meet the needs of the users.

Lifestyle and cardiometabolic risk in adults with type 1 diabetes: a review

Over the past decades, there has been a major upward shift in the prevalence of cardiometabolic risk (CMR) factors (central obesity, insulin resistance, hypertension and dyslipidemia) in patients with type 1 diabetes, which could have either an additive or a synergistic effect on risk for cardiovascular disease. These metabolic changes are occurring in parallel to the worldwide obesity epidemic and the widespread use of intensive insulin therapy. Poor lifestyle habits (poor diet quality, sedentary behaviours and smoking) are known to be driving factors for increased CMR factors in the general population. The objective of this review is to explore the lifestyle habits of adults with type 1 diabetes and its potential association with CMR factors. Evidence suggests that adherence to dietary guidelines is low in subjects with type 1 diabetes with a high prevalence of patients consuming an atherogenic diet. Sedentary habits are also more prevalent than in the general population, possibly because of the additional contribution of exercise-induced hypoglycemic fear. Moreover, the prevalence of smokers is still significant in the population with type 1 diabetes. All of these behaviours could trigger a cascade of metabolic anomalies that may contribute to increased CMR factors in patients with type 1 diabetes. The intensification of insulin treatment leading to new daily challenges (e.g. carbohydrates counting, increase of hypoglycemia) could contribute to the adoption of poor lifestyle habits. Preventive measures, such as identification of patients at high risk and promotion of lifestyle changes, should be encouraged. The most appropriate therapeutic measures remain to be established.

A pilot program for physical exercise promotion in adults with type 1 diabetes: the PEP-1 program

Physical inactivity is highly common in adults with type 1 diabetes (T1D) as specific barriers (i.e., hypoglycemia) may prevent them from being active. The objective of this study was to examine the efficacy of the Physical Exercise Promotion program in type 1 diabetes (PEP-1) program, a group program of physical activity (PA) promotion (intervention) compared with an information leaflet (control), to improve total energy expenditure (TEE) in adults with T1D after 12 weeks. TEE was measured with a motion sensor over a 7-day period at inclusion, after the program (12 weeks) and 1-year after inclusion. The 12 weekly sessions of the program included a 30-min information session (glycemic control and PA) and 60 min of PA. A total of 48 adults, aged 18 to 65 years with a reported PA practice <150 min per week, were recruited (45.8% men; aged 44.6 ± 13.3 years; 8.0% ± 1.1% glycated hemoglobin (A1c)) and randomized in this pilot trial. Ninety percent of participants completed the program and 88% completed the 1-year follow-up. No change was observed for TEE and A1c in both groups. After the 12-week program, the mean peak oxygen uptake increased (14%; p = 0.003) in the intervention group; however, at the 1-year follow-up, it was no longer different from baseline. In the control group, no difference was observed for the peak oxygen uptake. These results suggest that the PEP-1 pilot program could increase cardiorespiratory fitness. However, this benefit is not sustained over a long-term period. The PEP-1 program did not increase TEE in patients with T1D and other strategies remain necessary to counteract physical inactivity in this population.