Levels of Physical Activity in Children and Adolescents with Type 1 Diabetes in Relation to the Healthy Comparators and to the Method of Insulin Therapy Used

Quality of life and physical activity in type 1 diabetes

INTRODUCTION

T1 Diabetes (T1D) is one of the most common chronic diseases in children and young people [1] with almost 34 000 aged 18 years or less living with T1D [2]. Physical activity is promoted as one of a number of management tools for people living with diabetes, being associated with significant health benefits including improved glycaemic control. The benefits of physical activity on quality of life in children with T1D is unclear with confounding effects of disease duration and co-morbidities in studies.

AIM

To determine the effect of physical activity interventions on quality of life of children with type 1 diabetes.

METHODS

A systematic review was conducted and reported in line with PRISMA 2009 guidance. The CINAHL, Embase, International Pharmaceutical Abstracts, Medline, PubMed and PsychINFO databases were searched for the period January 1994 to March 2025. Papers were included in the present review if they included a study intervention in children under 19 years of age that was more than a single exercise session and had a control group (with or without T1D) as a comparator group. The primary outcome measure was Quality of Life (QoL) indicators.

RESULTS

We assessed 3020 records, of which three randomised controlled trials (RCT) published between 2007 and 2020 met study inclusion criteria. There was significant heterogeneity in study design, methods and reporting. Benefits of physical activity were not consistently seen across studies.

CONCLUSION

There remains limited data on QoL outcomes or even a standardisation for measuring QoL in this cohort as seen by the various validated tools used across studies. There continues to be a need for further work to understand the additional framework (psychological underpinning) to cause longer term impactful changes on both physical and psychological health in children with T1D.

A mixed methods exploration of the experiences of physical activity providers in supporting children and adolescents with type 1 diabetes in the UK

Children and adolescents with type 1 diabetes mellitus (T1D) are less active than recommended and than their peers without T1D. Several barriers to physical activity have been reported, including lack of confidence in the support received from those who facilitate physical activity such as sports coaches and PE teachers (physical activity providers). This study aims to explore the experiences and needs of physical activity providers in supporting children and adolescents with T1D to engage in structured physical activity. A mixed-methods study, including an online survey and semi-structured interviews, was conducted to provide a broad understanding of the current context along with more in-depth exploration of strategies implemented. Thirty-four participants completed the survey and nine participated in semi-structured interviews. Survey data were summarised descriptively. Qualitative data were analysed using a reflective thematic approach. Fewer than one-third of respondents had received T1D-related training, and only 12% were aware of relevant policies at their institution. Despite moderate confidence among half of the respondents in supporting children and adolescents with T1D, nearly all expressed a need for specific training. Two overarching themes emerged from the interviews: the existing context within which providers operate and effective strategies to support T1D-related physical activity.

CONCLUSION

Findings suggest improvements can be made to (1) training for physical activity providers to allow them to better support children and adolescents with T1D to participate in physical activity and (2) policies to help ensure a supportive and safe environment for children and adolescents with T1D.

WHAT IS KNOWN

• Children and adolescents with type 1 diabetes are less physically active than peers, partly due to limited support and knowledge among physical activity providers.

WHAT IS NEW

• Most physical activity providers lack formal training on type 1 diabetes and rely on ad hoc communication with families or clinical teams for support. • There is a clear need for targeted training and policy development to improve safe and inclusive physical activity for children and adolescents with type 1 diabetes.

Exploring Factors That Influence Postexercise Glycemia in Youth With Type 1 Diabetes in the Real World: The Type 1 Diabetes Exercise Initiative Pediatric (T1DEXIP) Study

OBJECTIVE

To explore 24-h postexercise glycemia and hypoglycemia risk, data from the Type 1 Diabetes Exercise Initiative Pediatric (T1DEXIP) study were analyzed to examine factors that may influence glycemia.

RESEARCH DESIGN AND METHODS

This was a real-world observational study with participant self-reported physical activity, food intake, and insulin dosing (multiple daily injection users). Heart rate, continuous glucose data, and available pump data were collected.

RESULTS

A total of 251 adolescents (42% females), with a mean ± SD age of 14 ± 2 years, and hemoglobin A1c (HbA1c) of 7.1 ± 1.3% (54 ± 14.2 mmol/mol), recorded 3,319 activities over ∼10 days. Trends for lower mean glucose after exercise were observed in those with shorter disease duration and lower HbA1c; no difference by insulin delivery modality was identified. Larger glucose drops during exercise were associated with lower postexercise mean glucose levels, immediately after activity (P < 0.001) and 12 to <16 h later (P = 0.02). Hypoglycemia occurred on 14% of nights following exercise versus 12% after sedentary days. On nights following exercise, more hypoglycemia occurred when average total activity was ≥60 min/day (17% vs. 8% of nights, P = 0.01) and on days with longer individual exercise sessions. Higher nocturnal hypoglycemia rates were also observed in those with longer disease duration, lower HbA1c, conventional pump use, and if time below range was ≥4% in the previous 24 h.

CONCLUSIONS

In this large real-world pediatric exercise study, nocturnal hypoglycemia was higher on nights when average activity duration was higher. Characterizing both participant- and event-level factors that impact glucose in the postexercise recovery period may support development of new guidelines, decision support tools, and refine insulin delivery algorithms to better support exercise in youth with diabetes.

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.

Level, types and determinants of physical activity in children with type 1 diabetes and their parents: A cross-sectional study

AIM

The aim of the study was to describe the level, types and determinants of leisure time PA and exercise among children with type 1 diabetes and their parents.

METHODS

One hundred twenty children aged 6-18 years with type 1 diabetes and 113 parents (n = 113) participated to this questionnaire-based study at Northern Ostrobothnia District Hospital in Oulu, western Finland. All participants gave informed consent before entering this study.

RESULTS

Twenty-three per cent of the children exercised briskly for at least 7 h a week which corresponds to 60 min per day. The total PA occasions children had with a parent accounted for the children's total number of PA occasions in a week (β = 0.83, 95% CI 0.20-1.47) and total weekly hours of PA (β = 0.90, 95% CI 0.07-1.73). There was a positive association between total weekly hours of brisk PA and HbA1 c (β = 0.65, 95% CI 0.02-0.13), while there was no such association with light PA (β = 0.42, 95% CI -0.04-0.87). Laziness, fear of unexpected glycaemic variability and tiredness were the most frequent barriers to PA in children.

CONCLUSION

Most of the children with type 1 diabetes did not reach generally recommended 60 min of brisk PA a day. Exercising with a parent was positively associated with children's weekly frequency and total hours of PA.

Developing type 1 diabetes resources: a qualitative study to identify resources needed to upskill and support community sport coaches

Introduction

Community sport coaches in Western Australia lack an understanding, the confidence, and knowledge in supporting young people with Type 1 diabetes (T1D). This study aims to identify what T1D educational resources are required to upskill coaches in Western Australia.

Methods

Semi-structured online interviews were conducted with i) young people living with T1D, ii) parents of young people living with T1D and iii) community sport coaches. The questions explored i) past experiences of T1D management in community sport ii) the T1D information coaches should be expected to know about and iii) the format of resources to be developed. Thematic analysis of interview transcripts was performed, and the themes identified were used to guide resource development.

Results

Thirty-two participants (16 young people living with T1D, 8 parents, 8 coaches) were interviewed. From the interviews, young people wanted coaches to have a better understanding of what T1D is and the effect it has on their sporting performance, parents wanted a resource that explains T1D to coaches, and sports coaches wanted to know the actions to best support a player living with T1D. All groups identified that signs and symptoms of hypoglycaemia and hyperglycaemia needed to be a key component of the resource. Sports coaches wanted a resource that is simple, quick to read and available in a variety of different formats.

Conclusion

The interviews resulted in valuable information gained from all groups and have reinforced the need for the development of specific resources to increase community knowledge and provide support for players with T1D, parents and sport coaches.

An Overview of Diet and Physical Activity for Healthy Weight in Adolescents and Young Adults with Type 1 Diabetes: Lessons Learned from the ACT1ON Consortium

The prevalence of overweight and obesity in young people with type 1 diabetes (T1D) now parallels that of the general population. Excess adiposity increases the risk of cardiovascular disease, which is already elevated up to 10-fold in T1D, underscoring a compelling need to address weight management as part of routine T1D care. Sustainable weight management requires both diet and physical activity (PA). Diet and PA approaches must be optimized towards the underlying metabolic and behavioral challenges unique to T1D to support glycemic control throughout the day. Diet strategies for people with T1D need to take into consideration glycemic management, metabolic status, clinical goals, personal preferences, and sociocultural considerations. A major barrier to weight management in this high-risk population is the challenge of integrating regular PA with day-to-day management of T1D. Specifically, exercise poses a substantial challenge due to the increased risk of hypoglycemia and/or hyperglycemia. Indeed, about two-thirds of individuals with T1D do not engage in the recommended amount of PA. Hypoglycemia presents a serious health risk, yet prevention and treatment often necessitates the consumption of additional calories, which may prohibit weight loss over time. Exercising safely is a concern and challenge with weight management and maintaining cardiometabolic health for individuals living with T1D and many healthcare professionals. Thus, a tremendous opportunity exists to improve exercise participation and cardiometabolic outcomes in this population. This article will review dietary strategies, the role of combined PA and diet for weight management, current resources for PA and glucose management, barriers to PA adherence in adults with T1D, as well as findings and lessons learned from the Advancing Care for Type 1 Diabetes and Obesity Network (ACT1ON).

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.

Impact of Sleep and Activity on Glycemic Control and Quality of Life in Haitian Children and Youth with Type 1 Diabetes

Background

Sleep and physical activity affect overall health. In youth with type 1 diabetes (T1DM), they may improve glycemic control. Data from low-income countries are lacking.

Objective

To describe sleep and activity in Haitian children and youth with T1DM, and examine their impact on glycemic control, health-related quality of life (HRQL), and life satisfaction (LS).

Methods

This cross-sectional study in Haiti included people with T1DM aged 8-25 years. Wristbands (Mi Band 3) tracked activity (step count and activity time) and sleep (sleep duration, light sleep, and deep sleep). The Diabetes Quality of Life in Youth (DQOLY) questionnaire was used to evaluate HRQL and LS. Point-of-care (POC) hemoglobin A1c values were recorded. Linear regression was used to assess the relationship between sleep, activity, HbA1c, HRQL, and LS.

Results

We included 66 participants (59% female, mean age 17.8 ± 4.8 years, mean diabetes duration 3.7 ± 3.4 years, and mean BMI Z-score -0.86 ± 1.1). Mean HRQL was 63/100, and mean LS was 65/100. Mean HbA1c was 11.3%. Maximum HbA1c measure was 14% on the POC machine, and 23 participants (35%) had HbA1c recorded as 14%. Mean daily step count was 7,508 ± 3,087, and mean sleep duration was 7 h31 ± 1 h17. When excluding participants with HbA1c ≥ 14%, shorter sleep duration was significantly associated with higher HbA1c (p = 0.024). Sleep duration and step count were not associated with HRQL or LS.

Conclusions

Children and youth with T1DM in Haiti have poor glycemic control and low HRQL and LS. Their sleep and activity habits are similar to peers. While activity did not affect HbA1c, HRQL, or LS, shorter sleep duration was associated with higher HbA1c in participants with HbA1c < 14%. Prospective studies with larger sample sizes are needed to validate our findings.

A High Protein Diet Is Associated with Improved Glycemic Control Following Exercise among Adolescents with Type 1 Diabetes

Nutritional strategies are needed to aid people with type 1 diabetes (T1D) in managing glycemia following exercise. Secondary analyses were conducted from a randomized trial of an adaptive behavioral intervention to assess the relationship between post-exercise and daily protein (g/kg) intake on glycemia following moderate-to-vigorous physical activity (MVPA) among adolescents with T1D. Adolescents (n = 112) with T1D, 14.5 (13.8, 15.7) years of age, and 36.6% overweight or obese, provided measures of glycemia using continuous glucose monitoring (percent time above range [TAR, >180 mg/dL], time-in-range [TIR, 70-180 mg/dL], time-below-range [TBR, <70 mg/dL]), self-reported physical activity (previous day physical activity recalls), and 24 h dietary recall data at baseline and 6 months post-intervention. Mixed effects regression models adjusted for design (randomization assignment, study site), demographic, clinical, anthropometric, dietary, physical activity, and timing covariates estimated the association between post-exercise and daily protein intake on TAR, TIR, and TBR from the cessation of MVPA bouts until the following morning. Daily protein intakes of ≥1.2 g/kg/day were associated with 6.9% (p = 0.03) greater TIR and -8.0% (p = 0.02) less TAR following exercise, however, no association was observed between post-exercise protein intake and post-exercise glycemia. Following current sports nutrition guidelines for daily protein intake may promote improved glycemia following exercise among adolescents with T1D.

Factors affecting the support for physical activity in children and adolescents with type 1 diabetes mellitus: a national survey of health care professionals' perceptions

BACKGROUND

Many children and adolescents with Type 1 Diabetes Mellitus (T1DM) don't meet the recommended levels of physical activity. Healthcare professionals (HCPs) have a key role in supporting and encouraging children and adolescents with T1DM to be physically active. This study aims to understand the perspectives of HCPs in relation to supporting physical activity and implementing guidelines relating to physical activity.

METHODS

An online mixed methods survey was circulated to HCPs in pediatric diabetes units in England and Wales. Participants were asked about how they support physical activity in their clinic and their perceptions of barriers/enablers of providing physical activity support to children and adolescents with T1DM. Quantitative data were analysed descriptively. An deductive thematic approach was applied to the free text responses using the Capability Opportunity Motivation model of Behaviour (COM-B) as a framework.

RESULTS

Responses were received from 114 individuals at 77 different pediatric diabetes units (45% of pediatric diabetes units in England and Wales). HCPs surveyed felt that the promotion of physical activity is important (90%) and advised patients to increase levels of physical activity (88%). 19% of the respondents felt they did not have sufficient knowledge to provide support. HCPs reported limited knowledge and confidence, time and resources as barriers to providing support. They also felt the current guidance was too complicated with few practical solutions.

CONCLUSION

Pediatric HCPs need training and support to be able to encourage and support children and adolescents with T1D to be a physical activity. In addition, resources that provide simple and practical advice to manage glucose around exercise are needed.

Barriers to Physical Activity in Children and Adults Living With Type 1 Diabetes: A Complex Link With Real-life Glycemic Excursions

OBJECTIVES

Ever since the first research on barriers to physical activity (PA) highlighting fear of hypoglycemia as a major barrier, many studies have attempted to understand their demographic and behavioural determinants. However, no research has been conducted on whether these perceived barriers toward PA are based on real-life-experienced adverse glycemic effects of exercise.

METHODS

Sixty-two adults and 53 children/adolescents living with type 1 diabetes, along with their parents, completed the Barriers to Physical Activity in Type 1 Diabetes-1 (BAPAD-1) questionnaire on barriers to PA. Continuous glucose-monitoring data were collected during 1 week of everyday life for 26 adults and 33 children/adolescents. Multiple linear regressions were used to explore links between BAPAD-1 scores and glycemic excursions experienced during and after everyday-life self-reported PA sessions, controlling for behavioural (accelerometry) and demographic confounders.

RESULTS

In children/adolescents, the more time spent in hypoglycemia on nights after PA sessions, the more they reported hypoglycemic risk as a barrier (ß=+0.365, p=0.034). Conversely, in adults, the higher the proportion of PA sessions accompanied by a drop in blood glucose, the less hypoglycemia was a barrier (ß=-0.046, p=0.004). In parents, BAPAD-1 scores were unrelated to children/adolescents' everyday-life exercise-induced hypo/hyperglycemia.

CONCLUSIONS

In children/adolescents, fear of hypoglycemia was predominant in those exposed to nocturnal hypoglycemia associated with PA sessions. In adults, fewer barriers may mean they accept a bigger drop in their glycemia during PA. This shows the importance of finding and promoting age-specific solutions to prevent exercise-induced hypoglycemia.

Hypoglycemia and glycemic variability of people with type 1 diabetes with lower and higher physical activity loads in free-living conditions using continuous subcutaneous insulin infusion with predictive low-glucose suspend system

INTRODUCTION

Maintaining glycemic control during and after physical activity (PA) is a major challenge in type 1 diabetes (T1D). This study compared the glycemic variability and exercise-related diabetic management strategies of adults with T1D achieving higher and lower PA loads in nighttime-daytime and active- sedentary behavior hours in free-living conditions.

RESEARCH DESIGN AND METHODS

Active adults (n=28) with T1D (ages: 35±10 years; diabetes duration: 21±11 years; body mass index: 24.8±3.4 kg/m2; glycated hemoglobin A1c: 6.9±0.6%) on continuous subcutaneous insulin delivery system with predictive low glucose suspend system and glucose monitoring, performed different types, duration and intensity of PA under free-living conditions, tracked by accelerometer over 14 days. Participants were equally divided into lower load (LL) and higher load (HL) by median of daily counts per minute (61122). Glycemic variability was studied monitoring predefined time in glycemic ranges (time in range (TIR), time above range (TAR) and time below range (TBR)), coefficient of variation (CV) and mean amplitude of glycemic excursions (MAGE). Parameters were studied in defined hours timeframes (nighttime-daytime and active-sedentary behavior). Self-reported diabetes management strategies were analysed during and post-PA.

RESULTS

Higher glycemic variability (CV) was observed in sedentary hours compared with active hours in the LL group (p≤0.05). HL group showed an increment in glycemic variability (MAGE) during nighttime versus daytime (p≤0.05). There were no differences in TIR and TAR across all timeframes between HL and LL groups. The HL group had significantly more TBR during night hours than the LL group (p≤0.05). Both groups showed TBR above recommended values. All participants used fewer post-PA management strategies than during PA (p≤0.05).

CONCLUSION

Active people with T1D are able to maintain glycemic variability, TIR and TAR within recommended values regardless of PA loads. However, the high prevalence of TBR and the less use of post-PA management strategies highlights the potential need to increase awareness on actions to avoid glycemic excursions and hypoglycemia after exercise completion.

Lifestyle and physical fitness in adolescents with type 1 diabetes and obesity

Background

The association between Type 1 Diabetes Mellitus (T1DM) and obesity (Ob) is no longer unexpected due to unhealthy lifestyle mostly in adolescents. We compared clinical-biochemical characteristics, adherence to the Mediterranean Diet (MD), lifestyle habits and physical fitness across different weight categories of T1DM adolescents from Campania Region. As second aim, we assessed the relationship among lifestyle and physical fitness in these patients.

Methods

74 adolescents (35M; 39F; 13-18 y), with T1DM diagnosed at least 6 mo before the study, were enrolled at the Regional Center for Pediatric Diabetology of Vanvitelli University of Naples. Height, weight, Body Mass Index (BMI), BMI z-score, and Clinical Biochemical health-related parameters were determined. MD adherence, physical activity (PA) amount and sedentary habits were assessed by questionnaires. Handgrip strength, 2-Min Step test (2-MST) cardiorespiratory endurance and Timed up and go test (TUG) for agility and balance were used for physical fitness evaluation.

Results

Our sample included 22 normal weight (NW), 37 overweight (OW) and 15 with Obese (Ob) adolescents. Across the three groups, adolescents showed similar Clinical-Biochemical parameters, MD adherence, PA amount, mostly walking (9.3 h/w), daily video exposure (8.5 h/d) and similar handgrip or 2-MST performance. Better performance was observed in NW compared to OW or Ob for TUG (7 vs 8 vs 9 s; p < 0.05). A positive correlation was found between TUG test and BMI, while no correlation was found between HbA1c (glycated haemoglobin) and BMI z score or 2-MST.

Conclusions

T1DM adolescents did not meet the recommendations for active lifestyle, despite a medium/good adherence to MD, in particular in NW and OW youths. Sedentary habits correlated with a poor HbA1c. Further, reduced agility and balance were observed in adolescents with obesity compared to NW participants.Future research should be aimed to examine wider samples and to design health promotion interventions for T1DM adolescents.

Dietary Intake and Physical Activity of Thai Children and Adolescents with Type 1 Diabetes Mellitus

Appropriate dietary intake and physical activity (PA) are essential for glycemic control and optimal growth in youth with type 1 diabetes (T1D). Thus, this study aimed to compare dietary intake and PA between youth with T1D and healthy controls. One hundred Thai youth with T1D and 100 age-matched healthy participants were recruited. A 3-day food record was completed and converted into nutrient intake data. PA data were collected via interview. Participants with T1D had a significantly higher mean ± SD carbohydrate (50.8 ± 6.8% vs. 46.2 ± 7.5%, p < 0.01), lower fat (32.4 ± 5.9% vs. 35.9 ± 6.4%, p < 0.01), and lower protein (16.8 ± 2.6% vs. 17.9 ± 3.5%, p = 0.01) intake compared to controls. Fifty percent of T1D participants and 41% of control participants consumed saturated fat more than recommendations (p = 0.20). Participants with T1D had a higher median (IQR) calcium intake compared to controls (474 (297−700) vs. 328 (167−447) mg/day, p < 0.01). Both groups consumed less fiber and more sodium compared to recommendations. Both groups had inadequate PA. Participants with T1D had significantly less PA compared to controls (25 (13−48) vs. 34 (14−77) minutes/day, p = 0.04). In addition to the need for counseling that promotes consumption of more dietary fiber and calcium and less saturated fat and sodium, the benefits of performing regular exercise need to be emphasized among youth with T1D.

The Role of Exercise on Cardiometabolic Profile and Body Composition in Youth with Type 1 Diabetes

Exercise has a direct positive effect on glycemic control by promoting insulin secretion from β-pancreatic islet-cells and by increasing skeletal muscle glucose uptake. The reduction in daily insulin needs and the optimization of glycemic control improves the patient's quality of life, self-esteem, mental wellness, as well as diabetes-related mobility and mortality. The aim of this study was to investigate the effect of physical activity in children and adolescents with type-1 diabetes (T1D) on diabetic control, cardiovascular, and biochemical profiles; hs-CRP; IL6; leptin; and adiponectin levels of the population under study. This is a prospective cross-sectional study that involved 80 participants (36 boys and 44 girls) with T1D, who were aged 6-21 years and who attended the Diabetes and Metabolism Clinic of the 2nd Pediatric Department, University of Athens, "P & A Kyriakou" Children's Hospital of Athens. Twenty (25%) children were above the 75th percentile regarding total levels of physical activity, while 40 (50%) and 20 (25%) were between the 25th and 75th percentile, as well as below the 25th percentile, respectively. In the group with an intermediate level of exercise, physical activity was negatively associated with the participant's family situation (traditional, single parent, grandparent, with others, or by himself/herself) (p = 0.013), ferritin (p = 0.031), lipoprotein(a) [Lp(a)] (p = 0.016), and squared leptin levels (p = 0.040). Whereas in the groups with extreme vs. no exercise there was a negative association with the number of daily glucose measurements (p = 0.047). However, in the group with non-vigorous exercise, physical activity was positively associated with high density lipoprotein-c (HDL-c) levels (p = 0.048). The findings of this study are indicative of the beneficial role of exercise on children and adolescents with T1D, which is achieved by primarily improving their cardiometabolic profile through the amelioration of lipid profile [HDL-c, Lp(a)] and leptin levels, as well as by reducing chronic systemic inflammatory response (ferritin) and ultimately decreasing the overall diabetes morbidity.

Letting the World See through Your Eyes: Using Photovoice to Explore the Role of Technology in Physical Activity for Adolescents Living with Type 1 Diabetes

This paper qualitatively explores how technologies and physical activity are experienced by adolescents with type 1 diabetes. Type 1 diabetes is a life-threatening autoimmune condition, which is highly prevalent in young children. Physical activity is underutilised as part of treatment goals due to multifactorial challenges and lack of education in both the family setting and across society as a whole. Using photovoice methodology, 29 participants (parents and adolescents), individually or as dyads, shared and described in reflective journal format examples of technology and physical activity in their lives. In total, 120 personal photographs with accompanying narratives were provided. The data were thematically coded by the researcher and then collaboratively with participants. Four key themes (and 12 subthemes) were generated including: (i) benefits of technology; (ii) complexity and difficulty; (iii) emotional impact; (iv) reliance and risk. Findings demonstrate that current technology does not address the complex needs of adolescents with type 1 diabetes to enable participation in physical activity without life risk. We conclude from our findings that future technologies for supporting engagement in physical activity as part of diabetes management need to be: more interoperable, personalised and integrated better with ongoing education and support.

Strengths and Challenges of Closed-Loop Insulin Delivery During Exercise in People With Type 1 Diabetes: Potential Future Directions

Exercise has many physical and psychological benefits and is recommended for people with type 1 diabetes; however, there are many barriers to exercise, including glycemic instability and fear of hypoglycemia. Closed-loop (CL) systems have shown benefit in the overall glycemic management of type 1 diabetes, including improving HbA1c levels and reducing the incidence of nocturnal hypoglycemia; however, these systems are challenged by the rapidly changing insulin needs with exercise. This commentary focuses on the principles, strengths, and challenges of CL in the management of exercise, and discusses potential approaches, including the use of additional physiological signals, to address their shortcomings in the pursuit of fully automated CL systems.

Using compositional analysis to explore the relationship between physical activity and cardiovascular health in children and adolescents with and without type 1 diabetes

OBJECTIVE

The aim of this study was to use a compositional analysis approach to account for the inherent co-dependencies between behaviors and to explore how daily movement behaviors influence cardiovascular health in children with and without T1D.

RESEARCH DESIGN AND METHODS

Augmentation index, pulse wave velocity (PWV) and heart rate variability were measured in 20 children with (11.9 ± 1.6 years) and 17 children without T1D (11.6 ± 2.2 years). Subsequently, physical activity and sleep were assessed at 20 Hz for 28 consecutive days using a wrist-worn accelerometer. Compositional analyses were utilized to explore the relative effects of each movement behavior and the overall movement complex on cardiovascular parameters, with predictive modeling used to explore the effects of reallocating 20 min between behaviors.

RESULTS

Arterial stiffness markers were most influenced by the total movement composition, whereas autonomic function was most influenced by sedentary time and sleep relative to all other behaviors. Reallocation of time from moderate-to-vigorous physical activity (MVPA) to any other behavior was predicted to negatively affect all cardiovascular measures, independent of disease status, whereas reallocating time to MVPA was consistently predicted to improve all outcome measures. Additionally, the same intensity of physical activity appeared to be more potent for cardiovascular health in T1D children compared to nondiabetic peers.

CONCLUSIONS

Intensity, rather than volume, of physical activity may be key in reducing risk of premature adverse changes in cardiovascular health, whereas increasing time in MVPA could potentially the slow progression of cardiovascular aging in children with diabetes.

A Randomized Crossover Trial Comparing Glucose Control During Moderate-Intensity, High-Intensity, and Resistance Exercise With Hybrid Closed-Loop Insulin Delivery While Profiling Potential Additional Signals in Adults With Type 1 Diabetes

OBJECTIVE

To compare glucose control with hybrid closed-loop (HCL) when challenged by high intensity exercise (HIE), moderate intensity exercise (MIE), and resistance exercise (RE) while profiling counterregulatory hormones, lactate, ketones, and kinetic data in adults with type 1 diabetes.

RESEARCH DESIGN AND METHODS

This study was an open-label multisite randomized crossover trial. Adults with type 1 diabetes undertook 40 min of HIE, MIE, and RE in random order while using HCL (Medtronic MiniMed 670G) with a temporary target set 2 h prior to and during exercise and 15 g carbohydrates if pre-exercise glucose was <126 mg/dL to prevent hypoglycemia. Primary outcome was median (interquartile range) continuous glucose monitoring time-in-range (TIR; 70-180 mg/dL) for 14 h post-exercise commencement. Accelerometer data and venous glucose, ketones, lactate, and counterregulatory hormones were measured for 280 min post-exercise commencement.

RESULTS

Median TIR was 81% (67, 93%), 91% (80, 94%), and 80% (73, 89%) for 0-14 h post-exercise commencement for HIE, MIE, and RE, respectively (n = 30), with no difference between exercise types (MIE vs. HIE; P = 0.11, MIE vs. RE, P = 0.11; and HIE vs. RE, P = 0.90). Time-below-range was 0% for all exercise bouts. For HIE and RE compared with MIE, there were greater increases, respectively, in noradrenaline (P = 0.01 and P = 0.004), cortisol (P < 0.001 and P = 0.001), lactate (P ≤ 0.001 and P ≤ 0.001), and heart rate (P = 0.007 and P = 0.015). During HIE compared with MIE, there were greater increases in growth hormone (P = 0.024).

CONCLUSIONS

Under controlled conditions, HCL provided satisfactory glucose control with no difference between exercise type. Lactate, counterregulatory hormones, and kinetic data differentiate type and intensity of exercise, and their measurement may help inform insulin needs during exercise. However, their potential utility as modulators of insulin dosing will be limited by the pharmacokinetics of subcutaneous insulin delivery.

Pathways of emotional autonomy, problem-solving ability, self-efficacy, and self-management on the glycemic control of adolescents with type 1 diabetes: A prospective study

This prospective study tested a model to depict associations between a number of individual characteristics and 6-month glycated hemoglobin (HbA1c) levels in adolescents with type 1 diabetes (T1D). Adolescents (N = 232) aged 10-19 years with T1D were recruited from a medical center in Taiwan. Demographic characteristics, emotional autonomy, problem-solving ability, self-efficacy at baseline, and self-management information three months after baseline were collected using a self-reported questionnaire. HbA1c levels 6 months after study commencement were obtained from medical records. Structural equation modeling was used to test the model. Higher baseline self-efficacy and self-management at 3 months were directly associated with lower 6-month HbA1c levels. Higher baseline problem-solving ability and self-efficacy were directly associated with higher 3-month self-management, and higher baseline problem-solving ability was directly associated with higher baseline self-efficacy. Higher baseline emotional autonomy was directly associated with lower 6-month HbA1c levels but indirectly associated with higher 6-month HbA1c levels through the mediation of lower problem-solving ability, self-efficacy, and 3-month self-management. Findings indicate that improving self-management is essential to improving subsequent glycemic control, which might be achieved by enhancing problem-solving ability and self-efficacy. Strengthening problem-solving ability could diminish the negative impact of emotional autonomy on subsequent glycemic control in adolescents with T1D.

Effects of 12 weeks of recreational football (soccer) with caloric control on glycemia and cardiovascular health of adolescent boys with type 1 diabetes

OBJECTIVE

To determine the effects of recreational football combined with caloric control on glycemia and cardiovascular health of adolescent boys with type 1 diabetes.

BACKGROUND

Though 12 weeks of physical activity alone improves the health of people with type 1 diabetes, there is little evidence that physical activity alone can improve glycemia in 12 weeks.

RESEARCH DESIGN AND METHODS

The participants were divided into four groups as follows: football with diet, football-only, diet-only, and the control groups. Each group consisted of 10 participants. The football with diet and the football-only groups had 1.5 h of football twice a week for 12 weeks. The following outcomes were measured before and after 12 weeks: Glycated hemoglobin, fasting blood glucose, total cholesterol, high-density lipoprotein, low-density lipoprotein, triglycerides, and resting blood pressures. Changes were considered significant when p ≤ 0.050 and common language effect size ≤42% or common language effect size ≥58%.

RESULTS

Glycated hemoglobin decreased in the football with diet group (mean change (standard deviation) = -0.9 (1.0) %, p = 0.019, and common language effect size = 31.5%) and was different from the control group (p = 2.4 × 10^-4 and common language effect size = 95.5%.). However, none of the intervention groups showed a clear change in blood lipids nor blood pressure.

CONCLUSIONS

12 weeks of combined football with diet intervention provides the greatest improvement in glycemia in adolescent boys with type 1 diabetes.

Physical Activity in Adolescents with and without Type 1 Diabetes during the New Zealand COVID-19 Pandemic Lockdown of 2020

Physical activity (PA) is an important part of lifestyle management for adolescents with Type 1 diabetes (T1D). Opportunities for PA were reduced by COVID-19 restrictions. Therefore, the purpose of this cross-sectional study was to compare PA among adolescents with and without T1D during the first New Zealand (NZ) COVID-19 lockdown. PA levels of adolescents aged 11-18 years with T1D (n = 33) and healthy controls (n = 34) were assessed through self-reported and parent proxy-reported questionnaires. Overall, PA levels during lockdown were below recommended levels. PA levels did not differ between T1D and control participants (p = 0.212) nor between genders (p = 0.149). Younger adolescents tended to be more active than older adolescents (p = 0.079). PA level was negatively associated with BMI z-score (r = -0.29, p = 0.026) but was not associated with socioeconomic status (SES) or T1D-related parameters. In the T1D group, higher HbA1c was associated with lower school decile (r = -0.58, p < 0.001) and higher BMI z-score (r = 0.68, p < 0.001). Overall, young people were insufficiently active during lockdown, and some sub-groups were more affected than others by the restrictions. Pandemics are likely to be part of our future, and further studies are needed to understand their impact on the health and wellbeing of adolescents.

Minimizing the Risk of Exercise-Induced Glucose Fluctuations in People Living With Type 1 Diabetes Using Continuous Subcutaneous Insulin Infusion: An Overview of Strategies

Physical activity (PA) is important for individuals living with type 1 diabetes (T1D) due to its various health benefits. Nonetheless, maintaining adequate glycemic control around PA remains a challenge for many individuals living with T1D because of the difficulty in properly managing circulating insulin levels around PA. Although the most common problem is increased incidence of hypoglycemia during and after most types of PA, hyperglycemia can also occur. Accordingly, a large proportion of people living with T1D are sedentary partly due to the fear of PA-associated hypoglycemia. Continuous subcutaneous insulin infusion (CSII) offers a higher precision and flexibility to adjust insulin basal rates and boluses according to the individual's specific needs around PA practice. Indeed, for physically active patients with T1D, CSII can be a preferred option to facilitate glucose regulation. To our knowledge, there are no guidelines to manage exercise-induced hypoglycemia during PA, specifically for individuals living with T1D and using CSII. In this review, we highlight the current state of knowledge on exercise-related glucose variations, especially hypoglycemic risk and its underlying physiology. We also detail the current recommendations for insulin modulations according to the different PA modalities (type, intensity, duration, frequency) in individuals living with T1D using CSII.

Continuous Blood Glucose Monitoring Increases Vigorous Physical Activity Levels and Is Associated With Reduced Hypoglycemia Avoidance Behavior In Youth With Type 1 Diabetes

The primary goal of this study was to explore physical activity (PA) levels, hypoglycemia fear scores and hypoglycemia episodes according to insulin administration and blood glucose monitoring methods in youth with type 1 diabetes (T1D). A self-administered questionnaire was completed by 28 children and 33 adolescents with T1D, and their PA was assessed. Hypoglycemia episodes, fear of hypoglycemia scores, insulin therapy (pump vs. injection) and blood glucose monitoring (continuous blood glucose monitors [CGMs] vs. blood glucose meters) methods are reported in the present work. There were no significant differences in the number of hypoglycemic episodes, child hypoglycemia fear survey behavior or total scores, or any components of the PA profile between youth using injections and those using a pump. However, these variables differed significantly when compared according to blood glucose monitoring method (CGMs vs. blood glucose meters): 41.2 vs. 81.8, p<0.01; 1.03 ± 0.05 vs. 2.6 ± 0.63, p<0.01; 1.09 ± 0.43 vs. 2.94 ± 0.22, p<0.01; and 222 ± 18 vs. 49 ± 11, p<0.01 (for total time in vigorous PA in minutes per week), respectively. CGM use correlated significantly with VPA levels (β=0.6; p=0.04). Higher VPA levels were associated with higher child hypoglycemia fear survey behavior scores (β=0.52; p=0.04). The latter correlates negatively with the number of episodes of hypoglycemia in the past 12 months in all category groups. The type of insulin injection was not associated with more activity in youth with T1D. In contrast, CGM use may be associated with increased vigorous PA among T1D youth. Those with higher hypoglycemia fear survey behavior scores engaged in more VPA and had fewer hypoglycemia episodes. Although CGM use ensures continuous monitoring of glycemia during exercise, increasing hypoglycemia avoidance behavior is still a necessary part of exercise management strategies in active youth with T1D.

Exercise and sport - challenges and benefits for the children and adolescents with type 1 diabetes

"Regular physical activity is able to replace almost every drug, but all drugs taken together will not replace exercise" This statement was written in XVI century by Wojciech Oczko (1537-1599) royal doctor of Polish Kings. Despite medical advances over 500 years, this sentence is still relevant today. In the hundred years since the discovery of insulin, enormous progress has also been made in the pharmacological treatment of type 1 diabetes mellitus (T1DM). In the last decades new formulations of insulin, new methods of insulin delivery, e.g., advanced closed-loop hybrid systems have significantly improved glucose control. However, we must remember that good glycemic control is a key, but not one factor in preventing the development of chronic diabetes complications. Regular physical activity is associated with greater insulin sensitivity, increased  fitness,  better lipid profile and blood pressure [1]. It extends remission duration in children with new onset diabetes mellitus [2]. It significantly decreases risk of premature cardiovascular morbidity and all-cause mortality. Regular physical activity has not only health but also social benefits for children and adolescents with diabetes mellitus, so it is one of the fundamental parts of diabetes management and should be encouraged [3].

Effect of Dog-Assisted Therapy on Psychomotor Development of Children with Intellectual Disability

BACKGROUND

Although dog-assisted therapy (DAT) has been used for years, there is still a scarcity of research findings confirming efficacy of the method. The current study was designed to assess effects of DAT on psychomotor development of children with mild intellectual disabilities.

MATERIAL AND METHOD

The study involved 60 children with mild intellectual disabilities, aged 10-13 years, divided into a group participating in a 10-month DAT program, and the control group. Four tests were applied, i.e., finger identification, postural imitation, kinaesthesia, and Bourdon-Wiersma Dot Cancellation Test. The examinations were carried out before the start and at the end of the DAT, and at a two-month follow-up.

RESULTS

The results obtained by the DAT group in all the four tests, at all the three timepoints, were not the same (p < 0.001). No statistically significant differences were found in the measurement at the end of the therapy between the DAT group and the controls. On the other hand, the DAT group achieved significantly better scores (p = 0.001 and p = 0.001), compared to the control, in the follow-up measurements two months after the end of the therapy in postural imitation and finger identification tests.

CONCLUSIONS

Some of the scores achieved by the children in the DAT group improved in the measurements performed over time. Two months after the therapy ended, the children in the DAT group presented greater gains in motor planning (postural imitation test) and in the sense of touch, attention, and concentration (finger identification test), compared to the control group. Although the measurement performed immediately after the therapy did not show significant differences between the DAT group and the controls, the examination carried out at the two-month follow-up identified long-term gains in the treatment group in the domain of motor planning (postural imitation test).

Roles of Emotional Autonomy, Problem-Solving Ability and Parent-Adolescent Relationships on Self-Management of Adolescents with Type 1 Diabetes in Taiwan

BACKGROUND

High emotional autonomy has a negative association, whereas good problem-solving ability and parent-adolescent relationships have positive association with self-management in adolescents with type 1 diabetes (T1D). Exploring roles of these variables is crucial to design specific interventions to improve self-management in such afflicted adolescents.

PURPOSE

To explore the roles of emotional autonomy, problem-solving ability and parent-adolescent relationships on self-management in adolescents with T1D.

DESIGN AND METHODS

Cross-sectional design was used in this study. A total of 242 adolescents with T1D were recruited from an outpatient clinic of a medical center by convenience sampling in Taiwan. Self-reported questionnaires were used to collect personal characteristics, self-management, emotional autonomy, problem-solving ability, and parent-adolescent relationships.

RESULTS

Hierarchical multiple regressions indicated that body mass index, problem-solving ability, father-adolescent relationship, and emotional autonomy were significant factors associated with self-management. The interactions of emotional autonomy with problem-solving ability and with parent-adolescents relationship were not significantly associated with self-management. The overall model explained 47.5% variance of self-management.

CONCLUSIONS

High emotional autonomy was significantly associated with poor self-management. Problem-solving ability and father-adolescent relationships could not moderate, but were independently and significantly associated with self-management in adolescents with T1D.

PRACTICE IMPLICATION

Healthcare providers should evaluate emotional autonomy earlier and provide more timely help to reduce any negative impact on self-management in adolescents with T1D. Improving problem-solving ability and encouraging fathers to develop optimal father-adolescents relationship might be promising strategies to enhance self-management in adolescents with T1D.

Strategies That Adolescents With Type 1 Diabetes Use in Relation to Exercise

Physical activity is an important element of type 1 diabetes management, and hypoglycemia is a known risk. There are few data on strategies adolescents use to mitigate this risk. We surveyed 66 adolescents with type 1 diabetes who were 12-18 years of age about blood glucose monitoring, carbohydrate intake, and insulin management before, during, and after exercise. The adolescents completed the International Physical Activity Questionnaire-Short Form and the Children's Hypoglycemia Fear Survey. We found that adolescents with type 1 diabetes do not generally follow guidelines about glucose monitoring or about food and insulin adjustment around exercise. More targeted education and interventions are needed to improve adolescents' uptake of recommended behaviors and improve outcomes.