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Paed Diabetes – Improves cardiovascular fitness and reduces overall mortality

Evidence Summary
High quality systematic reviews showed the beneficial effect of exercise on cardiorespiratory fitness. 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. 19 studies measured changes in various markers of fitness, 14 of which reported a beneficial effect of the intervention on some area of fitness, such as improved cardiovascular fitness. Three studies (66 participants) were pooled in a meta-analysis which found a nonsignificant effect of physical activity on maximal oxygen uptake (VO2 max) [standardized mean difference 0.24; P = 0.33
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. Both observational and interventional studies showed considerable agreement that supervised regular moderate to vigorous physical activity (MVPA) is more effective on cardiorespiratory fitness than habitual PA.
The international society for paediatric and adolescent diabetes clinical practice consensus guidelines from 2014 and 2018 state that even if glucose targets, as measured by HbA1c are not achieved, regular physical activity is associated with reduced early mortality in the adult population (3). A cross sectional analysis by Beraki et al. (4) demonstrated that physical activity prevents long term cardiovascular complications by improving blood pressure, lipid profiles, and endothelial functioning. This is important given that children with T1D have twice the risk of developing CVD during their lifetime as compared to those individuals without diabetes. A review by Galassetti et al. (5) referred to studies by Moy et al. (6) and Reddigan et al. (7) which showed reduced early mortality.

Quality of Evidence
Grade B – moderate quality – as there is a mixture of high quality evidence and some low quality evidence.
Strength of Recommendation
Grade 2 – moderate recommendation as cardiovascular fitness and early mortality not always well defined.
Conclusion
Physical activity interventions in children and young people with Type 1 diabetes mellitus can improve cardiorespiratory fitness with moderate to vigorous physical activity being more effective than habitual PA.
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. Adolfsson P, Riddell C, Taplin et al. ISPAD Clinical Practice Consensus Guidelines 2018 Compendium. Exercise in children and adolescents with diabetes. Pediatric Diabetes. 2018; 19(27): 205-226
  4. 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.
  5. Galassetti P, Ridell MC. Exercise and type 1 diabetes (T1DM). Compr Physiol 2013;3(3):1309-36
  6. Moy CS, Songer TJ, LaPorte RE et al. Insulin-dependent diabetes mellitus, physical activity, and death. Am J Epidemiol 1993;137(1):74-81
  7. Reddigan JI, Riddell MC, Kuk JL. The joint association of physical activity and glycaemic control in predicting cardiovascular death and all-cause mortality in the US population. Diabetologia 2012;55(3)632-635

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