Physical fitness in children with type 1 diabetes measured with six-minute walk test

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

Importance

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

Objective

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

Data Sources

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

Study Selection

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

Data Extraction and Synthesis

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

Main Outcomes and Measures

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

Results

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

Conclusions and Relevance

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

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

AIMS

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

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

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

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

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

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

Long-Term HbA1c, Physical Fitness, Nerve Conduction Velocities, and Quality of Life in Children with Type 1 Diabetes Mellitus-A Pilot Study

OBJECTIVE

The aim of this study was to examine a possible association of Hb_A1c, quality of life (QoL), fitness, and electrophysiological parameters in children with type 1 diabetes mellitus (T1DM).

METHODS

The study population (n = 34) consisted of patients with T1DM (n = 17) and an age-, sex-, and BMI-matched healthy control group (n = 17). Hb_A1c was obtained from patients with T1DM at time of diagnosis (T0), at 6 months (T6), at 12 months (T12), and at time of study inclusion (Tstudy). QoL was determined with a standardized questionnaire (KINDL-R). All children completed a 6-min walk test (6MWT) to evaluate their fitness level. Electrodiagnostic studies established upper and lower limb motor and sensory nerve conduction velocities (NCV).

RESULTS

Higher Hb_A1c (Tstudy) was associated with lower QoL showing in the subscales self-esteem, friends, and school. Higher Hb_A1c at (T6) and (T12) was associated with lower QoL in the subscale self-esteem. Based on various subscales, perceived problem areas differed significantly between children and their parents. No differences in fitness level and NCV were found between patients and controls except for a significantly slower median motor NCV in patients. Hb_A1c was not associated with NCVs at this early stage of disease.

CONCLUSIONS

Good metabolic control reflected by adequate Hb_A1c values seems to be important for a good QoL in children with T1DM. Early Hb_A1c might be associated with QoL during follow-up.

Effect of swimming program on glycemic control in male adolescents with type 1 diabetes mellitus

BACKGROUND

Regular physical activity and exercise is the third management for the child with diabetes mellitus after diet regime and insulin therapy. The aim of the study is to evaluate the effect of swimming on glycemic control for a male adolescent with type 1 diabetes mellitus. The study evaluates the effect of swimming on glycemic control for a male adolescent with type 1 diabetes mellitus.

METHODS

The quasi-experimental design was conducted on 40 male adolescents with typ1 diabetes, then divided into two groups; study and control groups. 20 adolescents participated in the swimming program (study group) and other 20 did not expose to exercise program (control group) for 10 weeks. a venous blood sample was received to evaluate glycemic control (HbA1c %), in pre and post 10 weeks to compare HbA1c % for both groups.

RESULTS

Mean age 13.45±1.46 years (study group), while for control group age 13.55±1.5 years, and mean and standard deviation for Hba1c % was 9.61±1.15%, 9.65±2.23% in the study and control group respectively. The study showed that there was a high significant difference between pre and post-test HbA1c in the study group (P value<0.00) also the same result was observed in the control group but negatively (P value<0.00) it means the Hb1c % was raised.

CONCLUSIONS

The study concluded that regular physical activity (swimming) had a positive effect on lowering Glycosylated hemoglobin (HbA1c).

Can a simple test of functional capacity add to the clinical assessment of diabetes?

AIM

To identify impairment in functional capacity associated with complicated and non-complicated diabetes using the 6-min walk distance test.

METHODS

We enrolled 111 adults, aged ≥40 years, with Type 2 diabetes from a hospital facility and 150 healthy control subjects of similar age and sex from a community site in Lima, Peru. All participants completed a 6-min walk test.

RESULTS

The mean age of the 261 participants was 58.3 years, and 43.3% were male. Among those with diabetes, 67 (60%) had non-complicated diabetes and 44 (40%) had complications such as peripheral neuropathy, retinopathy or nephropathy. The mean unadjusted 6-min walk distances were 376 m and 394 m in adults with and without diabetes complications, respectively, vs 469 m in control subjects (P<0.001). In multivariable regression, the subjects with diabetes complications walked 84 m less far (95% CI -104 to -63 m) and those without complications walked 60 m less far (-77 to -42 m) than did control subjects. When using HbA1c level as a covariate in multivariable regression, participants walked 13 m less far (-16.9 to -9.9 m) for each % increase in HbA1c .

CONCLUSIONS

The subjects with diabetes had lower functional capacity compared with healthy control subjects with similar characteristics. Differences in 6-min walk distance were even apparent in the subjects without diabetes complications. Potential mechanisms that could explain this finding are early cardiovascular disease or deconditioning.