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Paed Diabetes – Helps improve diabetes control (reduces HbA1C)

Evidence Summary

There are a number of high quality systematic reviews which investigated the effects of physical activity on glycaemic control in children and adolescents with Type 1 Diabetes. Quirk et al (1) looked at physical activity interventions in children and young people with Type 1 diabetes mellitus. The review looked at 10 randomised and 16 non-randomized studies. Meta-analyses of these studies showed potential benefits of physical activity on. HbA1c (11 studies, 345 participants, standardized mean difference -0.52, 95% CI -0.97 to -0.07; P = 0.02) . The effect size remained significant and increased when studies with >3 days per week were included. The effect size from this meta-analysis (-0.52) would give a reduction in HbA1c of 8.5 mmol/mol (0.78%).

Aljawarneh et al. (2) looked at the effects of physical activity on physiological and biochemical outcomes in children and adolescents with Type 1 diabetes. The review looked at eight interventional and 19 observational studies. There were a total of 8,263 participants across all studies. A consistent agreement among the studies revealed a considerable benefit of regular habitual PA of light to moderate intensity on blood glucose regulation.

Some studies showed improvement in glycaemic control with increased levels of daily PA in adolescents with T1D (Schweiger et al. (3). McMillan et al. (4) looked at physical activity and sedentary behaviour intervention studies in youth with type 1 diabetes. The review included 11 RCTs with a total of 491 participants. Meta-analysis of 10 studies showed the interventions have a significant beneficial reduction of HbA1c (%), indicating an improvement in glycaemic control [WMD, −0.85% (95% CI, −1.45 to −0.25%)].

A review by Tully et al. (5) showed significant association of better glycaemic control and higher PA frequency, longer duration of PA engagement, and less sedentary behaviour for youth with T1D, regardless of the type of PA (i.e., aerobic, strength, and/or endurance).
A review by Yardley et al. (6) looking at vigorous intensity exercise for glycaemic control in patients with T1DM showed clinically meaningful 0.4% to 1.2% absolute reductions in HbA1C level.

Beraki et al. (7) and Martinez Ramonde et al. (8) showed that physical activity achieves better glycaemic control. In addition, Martinez Ramonde et al. (8) showed that physical activity was associated with lower insulin needs, and higher C-peptide levels at T1DM onset.

A review by Galassetti et al. (9) referred to a paper by Zoppini et al. (10) which showed that there is an improvement in glycaemic control in young T1DM subjects. It also looked at an article by Roberts et al. (11) which showed no improvement in HbA1c.

A case control study by M. Cuenca-Garcıa et al. (12) consisting of 97 young people aged 8 to 16 years showed a strong relationship between moderate to vigorous intensity physical activity and a beneficial decrease in the level of HbA1c.

A systematic review of observational studies (n = 44) was conducted and showed an inverse association between physical fitness and glycaemic control and lipid profile in adolescents with T1D (13). Other studies by Aman et al. (14) and Galler et al. (15) did not show any association between increased levels of daily PA in adolescents with T1DM and improvement in glycaemic control.
A review by Yardley et al. (16) showed that results from quasi-experimental and randomized controlled trials have yielded mixed results on the efficacy of physical activity in improving glycaemic control. Salem et al. (17) and Campaigne et al. (18) showed a clinically meaningful 0.4% to 1.2% absolute reductions in HbA1C level in patients with type 1 diabetes whose blood glucose control at enrolment was fair to poor. In contrast, a significant proportion of quasi-experimental studies and some randomized controlled trials showed little effect of physical activity on HbA1C levels. (Huttunen et al. (19), Landt et al. (20) and Tunar et al.(21).

Quality of Evidence
Grade A – High Quality – as evidence is from multiple high quality studies
Strength of Recommendation
Grade 2 – Moderate strength of recommendation – outcomes of the studies are mixed.
Conclusion
There is mixed evidence on the effects of physical activity on HbA1c in children and adolescents with T1DM. This could be due to confounders such as dietary changes and insulin dosages. However, regular physical activity may help diabetes control when in combination with dietary and insulin adjustments. Also none of the studies demonstrated unsafe findings.
References

  1. Quirk H, Blake H, Tennyson R et al. Physical activity interventions in children and young people with Type 1 diabetes mellitus: a systematic review with meta-analysis. Diabetes Med 2014;31(10):1163-73
  2. Aljawarneh YM, Wardell DW, Wood GL et al A Systematic Review of Physical Activity and Exercise on Physiological and Biochemical Outcomes in Children and Adolescents With Type 1 Diabetes. Journal of Nursing Scholarship. 2019;51(3):337-345
  3. Schweiger B, Klingensmith G, Snell-Bergeon JK Physical activity in adolescent females with type 1 diabetes. Int J Pediatr 2010;328318
  4. MacMillan F, Kirk A, Mutrie N. et al. A systematic review of physical activity and sedentary behaviour intervention studies in youth with type 1 diabetes: study characteristics, intervention design and efficacy. Pediatr Diabetes 2014;15(3):175-89
  5. Tully C, Aronow L, Maxkey E et al. Physical Activity in Youth With Type 1 Diabetes: a Review. Curr Diab Rep 2016;16(9):85
  6. Yardley J, Mollard R, MacIntosh A, et. Al Vigorous intensity exercise for glycaemic control in patients with type 1 diabetes. Can J Diabetes 2013;37(6):427-32
  7. Beraki, Å., Magnuson, A., Särnblad, S. et al Increase in physical activity is associated with lower HbA1c levels in children and adolescents with type 1 diabetes: Results from a cross-sectional study based on the Swedish pediatric diabetes quality registry (SWEDIABKIDS). Diabetes Research and Clinical Practice. (2014); 105(1):119-125.
  8. Martinez Ramonde T, Alonso N, Cordido F et al. Importance of exercise in the control of metabolic and inflammatory parameters at the moment of onset in type 1 diabetic subjects. Exp Clin Endocrinol Diabetes. 2014;122(6):334-40
  9. Galassetti P, Ridell MC. Exercise and type 1 diabetes (T1DM). Compr Physiol 2013;3(3):1309-36
  10. Zoppini G, Carlini M, Muggeo M. Self-reported exercise and quality of life in young type 1 diabetic subjects. Diabetes Nutr Metab 2003;16(1):77-80
  11. Roberts L, Jones TW, Fournier PA. Exercise training and glycemic control in adolescents with poorly controlled type 1 diabetes mellitus. J Pediatr Endocrinol Metab 2002;15(5):621-627
  12. Cuenca-Garcia M, Jago R, Shield JP et al. How does physical activity and fitness influence glycaemic control in young people with Type 1 diabetes? Diabetes Med 2012;29(10):e369-79
  13. Angela DL, Ma X., David MM et al. Physical activity, sedentary behaviors, physical fitness, and their relation to health outcomes in youth with type 1 and type 2 diabetes: A review of the epidemiologic literature. J Sport Health Sci 2013;2(1)2:1–38
  14. Aman J Skinner TC, de Beaufort CE, Swift PGF et al. Associations between physical activity, sedentary behavior, and glycemic control in a large cohort of adolescents with type 1 diabetes: The Hvidoere study group on childhood diabetes. Pediatr Diabetes, 2009;10(4):234–239
  15. Galler A, Lindau M, Ernert A et al. Associations between media consumption habits, physical activity, socioeconomic status, and glycemic control in children, adolescents, and young adults with type 1 diabetes. Diabetes Care 2011;34(11):2356–2359.
  16. Yardley J, Mollard R, MacIntosh A, et. Al Vigorous intensity exercise for glycaemic control in patients with type 1 diabetes. Can J Diabetes 2013;37(6):427-32
  17. Salem MA, Aboelasrar MA, Elbarbary NS et al. Is exercise a therapeutic tool for improvement of cardiovascular risk factors in adolescents with type 1 diabetes mellitus? A randomised controlled trial. Diabetol Metab Syndr 2010;2(1):47.
  18. Campaigne BN, Gilliam TB, Spencer ML, et al. Effects of a physical activity program on metabolic control and cardiovascular fitness in children with insulin-dependent diabetes mellitus. Diabetes Care 1984;7(1):57-62.
  19. Huttunen NP, Lankela SL, Knip M, et al. Effect of once-a-week training program on physical fitness and metabolic control in children with IDDM. Diabetes Care 1989;12(10):737-40.
  20. Landt KW, Campaigne BN, James FW et al. Effects of exercise training on insulin sensitivity in adolescents with type I diabetes. Diabetes Care 1985;8(5):461-5.
  21. Tunar M, Ozen S, Goksen D, et al. The effects of Pilates on metabolic control and physical performance in adolescents with type 1 diabetes mellitus. J Diabetes Complications 2012;26(4):348-51.

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