Association of physical activity patterns with nocturnal hypoglycemia events in youth with type 1 diabetes.

AIMS: This study sought to elucidate the interactions among physical activity (PA) patterns, mean glucose concentrations, and the incidence of nocturnal hypoglycemia events in children and adolescents with type 1 diabetes, examining the moderating influence of daily dosage on these associations. MATERIAL AND METHODS: Eighty-two participants aged 6 to 18 years (43.9% girls) from the Diactive-1 Cohort Study, diagnosed with type 1 diabetes, were included. Data collection involved continuous glucose monitoring, accelerometry to assess real-world PA, as well as documentation of daily insulin doses and carbohydrate counting over the same seven days. RESULTS: A total of 19 participants experienced at least one nocturnal hypoglycemia event over a span of 574 measurement days (106 days with and 451 days without nocturnal hypoglycemia). Higher levels of vigorous PA (VPA) were associated with lower same-day mean glucose levels (p = 0.014). Additionally, higher levels of moderate PA (p = 0.023), VPA (p = 0.011), and moderate-to-vigorous PA (p = 0.010) were associated with a greater number of nocturnal hypoglycemia events. Specifically, a significant association was identified between VPA and nocturnal hypoglycemia events when the daily insulin dose were at or above 1.04 units per kilogram of body weight per day (p = 0.016). CONCLUSIONS: Daily VPA is associated with glucose reductions, potentially leading to more hypoglycemic episodes, particularly when there's an excess of daily insulin. This highlights the need for careful insulin management in children and adolescents with type 1 diabetes engaging in VPA.

Nonpharmacological interventions on glycated haemoglobin in youth with type 1 diabetes: a Bayesian network meta-analysis.

The available evidence on the impact of specific non-pharmacological interventions on glycaemic control is currently limited. Consequently, there is a need to determine which interventions could provide the most significant benefits for the metabolic health of young individuals with type 1 diabetes mellitus. The aim of this study was to identify optimal nonpharmacological interventions on glycaemic control, measured by glycated haemoglobin (HbA1c), in children and adolescents with type 1 diabetes. Systematic searches were conducted in PubMed, Web of Science, Scopus, and SPORTDiscus from inception to July 1, 2023. Randomised clinical trials (RCT) investigating nonpharmacological interventions (e.g., physical activity, nutrition, and behavioural therapies) were included. Primary outcome was change in HbA1c levels. Secondary outcome was change in daily insulin dose requirement. Seventy-four RCT with 6,815 participants (49.43% girls) involving 20 interventions were analysed using a network meta-analysis. Most interventions showed greater efficacy than standard care. However, multicomponent exercise, which includes aerobic and strength training (n = 214, standardised mean difference [SMD] =- 0.63, 95% credible interval [95% CrI] - 1.09 to - 0.16) and nutritional supplements (n = 146, SMD =- 0.49, - 0 .92 to - 0.07) demonstrated the greatest HbA1c reductions. These interventions also led to the larger decreases in daily insulin needs (n = 119, SMD =- 0.79, 95% CrI -  1.19 to - 0.34) and (n = 57, SMD =- 0.62, 95% CrI -  1.18 to - 0.12, respectively). The current study underscores non-pharmacological options such as multicomponent exercise and nutritional supplements, showcasing their potential to significantly improve HbA1c in youth with type 1 diabetes. Although additional research to confirm their efficacy is required, these approaches could be considered as potential adjuvant therapeutic options in the management of type 1 diabetes among children and adolescents.

Comprehensive management of children and adolescents with type 1 diabetes mellitus through personalized physical exercise and education using an mHealth system: The Diactive-1 study protocol.

Introduction: The use of new technologies presents an opportunity to promote physical activity, especially among young people with type 1 diabetes (T1DM), who tend to be less active compared to their healthy counterparts. The aim of this study is to investigate the impact of a personalized resistance exercise program, facilitated by the Diactive-1 App, on insulin requirements among children and adolescents diagnosed with T1DM. Methods and analysis: A minimum of 52 children and adolescents aged 8-18 years, who were diagnosed with T1DM at least 6 months ago, will be randomly assigned to either a group engaging in an individualized resistance exercise program at least 3 times per week over a 24-week period or a waiting-list control group. The primary outcome will be the daily insulin dose requirement. The secondary outcomes will include glycemic control, cardiometabolic profile, body composition, vascular function, physical fitness, 24-hour movement behaviors, diet, and psychological parameters. The usability of the app will also be assessed. Ethics and dissemination: Ethical approval to conduct this study has been granted by the University Hospital of Navarra Research Board (PI_2020/140). Parents or legal guardians of minors participating in the study will provide written consent, while children and adolescents will sign an assent form to indicate their voluntary agreement. The trial's main findings will be shared through conference presentations, peer-reviewed publications, and communication directly with participating families. This study aims to offer valuable insights into the holistic management of children and adolescents with T1DM by utilizing personalized exercise interventions through an mHealth system. Trial registration: NCT06048757.

Incidence of type 1 diabetes mellitus in children and adolescents under 20 years of age across 55 countries from 2000 to 2022: A systematic review with meta-analysis.

AIMS: The aim of this study was to determine the global incidence of type 1 diabetes mellitus (T1DM) in children and adolescents under 20 years of age from 2000 to 2022. MATERIALS AND METHODS: Two reviewers searched three electronic databases (PubMed, Web of Science, and CINAHL) for studies published between January 2000 and November 2022. Pooled estimates of T1DM incidence with a 95% confidence interval (CI) per 100,000 person-years were calculated by country/region, sex, age, and COVID-19 pandemic period (pre-COVID-19 and pandemic). RESULTS: The study included 126 studies from 55 countries and 18 regions. The incidence rate (IR) of T1DM from 2000 to 2022 was 14.07 (95%CI, 12.15-16.29) per 100,000 person-years. Finland and high-income North America had the highest IR, with 56.81 (95%CI, 55.91-57.73) and 28.77 (95%CI, 26.59-31.13) per 100,000 person-years, respectively. The IR was 13.37 (95%CI, 10.60-16.88) per 100,000 person-years in boys and 13.87 (95%CI, 11.51-16.70) per 100,000 person-years in girls. There were statistically significant differences among different age ranges: 0-4 versus 5-9 and 10-14 years old (p < 0.001); 5-9 versus 15-19 (p < 0.001) and 10-14 versus 15-19 years old (p = 0.003). Finally, during the pandemic period (2020-2022), the IR was 24.84 (95%CI, 17.16-35.96) per 100,000 person-years, which was higher but not significant compared with the prepandemic period (2017-2019) of 13.56 (95%CI, 7.49-24.56) per 100,000 person-years (p = 0.090). CONCLUSIONS: The IR of T1DM in children and adolescents under 20 years of age is substantial, especially during the pandemic period, although it varies across regions. More reliable data from additional countries are needed to determine the worldwide incidence of T1DM.

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, 2,452 with type 1 diabetes). Youth with type 1 diabetes were less physically active (Cohen's d = -0.23, 95%CI - 0.42 to -0.04), more sedentary (Cohen's d = 0.33, 95%CI 0.06 to 0.61), and had lower cardiorespiratory fitness (Cohen's 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.

Is fear of hypoglycemia a major barrier to an active lifestyle in children and adolescents with type 1 diabetes? The Diactive-1 Study.

Studies on fear of hypoglycemia as a barrier to physical activity among youth with type 1 diabetes (T1D) have been limited and controversial, most of which used self-reported assessment. The aim of the study was to evaluate the relationship between fear of hypoglycemia and physical activity and glycemic metrics in children and adolescents with T1D. Seventy-four participants (6-18 years of age; 44.6% females) with T1D were included in the study. Physical activity was assessed through accelerometry on nine consecutive days, and blood glucose metrics were simultaneously tracked using continuous glucose monitoring (time-in-range and hypoglycemic events). A closed question was used to evaluate the avoidance of physical activity due to fear of hypoglycemia. Fifteen participants (20%) reported avoiding physical activity due to fear of hypoglycemia. The group reporting no fear of hypoglycemia showed lower total physical activity (-35.33 min/day, 95% confidence interval [CI] (-77.57 to -1.47)) and light physical activity (-29.81 min/day, 95% CI -64.01 to -2.75) and higher sedentary time (77.95 min/day, 95% CI 26.46-136.87) per day compared with those with fear of hypoglycemia. No difference was found between those patients with fear of hypoglycemia in terms of meeting the recommendations of glycated hemoglobin, glucose coefficient of variation, and time-in-range when compared to those with no fear of hypoglycemia. In conclusion, children and adolescents with fear of hypoglycemia were more active, less sedentary, and had similar glycemic metrics to those without fear. Our results therefore suggest that fear of hypoglycemia may be less of a barrier to an active lifestyle than previously believed.

Effects of exercise training on glycaemic control in youths with type 1 diabetes: A systematic review and meta-analysis of randomised controlled trials.

The aim of the study is to evaluate whether exercise interventions are associated with improved glycaemic control in children and adolescents with type 1 diabetes mellitus (T1DM), and to examine its relationship with the characteristics of the intervention (i.e. type, intensity, length, and duration of the sessions). Eligible criteria were randomised controlled trials of youth aged 6-18 years with T1DM, participating in an exercise-based intervention where glycaemic control is measured (i.e. glycated haemoglobin [HbA1c]). Pooled effect sizes (Hedges'g) were calculated using random-effects inverse-variance analyses. Fourteen studies enrolling 509 patients were analysed. Effect size was expressed as Hedges' g to correct for possible small sample bias. Overall, HbA1c levels in the exercise group (g = -0.38 95% confidence interval [CI], -0.66 to -0.11; mean difference [MD] = -0.62%) were reduced compared with the control group. Concurrent training (g = -0.63 95%CI, -1.05 to -0.21), high-intensity exercise (g = -0.43 95%CI, -0.83 to -0.03), interventions ≥24 weeks (g = -0.92 95%CI, -1.44 to -0.40), and sessions ≥60 minutes (g = -0.71 95%CI, -1.05 to -0.08) showed larger changes (MD = -0.66% to 1.30%). In conclusion, our study suggests that programmes longer than 24 weeks with at least 60 min/session of high-intensity concurrent exercise may serve as a supportive therapy to metabolic control in youth with T1DM.HighlightsExercise training has a moderate effect on the reduction of glycated haemoglobin (HbA1c) and insulin dose per day in youths with type 1 diabetes.Exercise training moderately increases cardiorespiratory fitness youths with type 1 diabetes.Reductions in HbA1c are stronger with high-intensity and concurrent training (i.e. aerobic and strength) interventions, and longer programmes.

Association Between Physical Activity, Sedentary Behavior and Physical Fitness and Glycated Hemoglobin in Youth with Type 1 Diabetes: A Systematic Review and Meta-analysis.

BACKGROUND: Scientific literature suggests poor glycemic control in youth with type 1 diabetes (T1D) and physical inactivity, sedentary behavior and low physical fitness levels, although results are not entirely consistent. OBJECTIVE: To meta-analyze the association between glycated hemoglobin and physical activity, sedentary behavior, and physical fitness in children and adolescents with T1D. METHODS: Our meta-analysis was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Guidelines (PRISMA). Three databases were searched for studies. All studies meeting the following criteria were included: (1) Population: children and adolescents with a mean age between 3 and 18 years diagnosed with T1D; (2) Exposition: physical activity and/or sedentary behavior and/or cardiorespiratory fitness and/or muscular fitness; (3) Outcome: glycated hemoglobin; (4) Study design: cross-sectional, longitudinal, and case-control studies. Pooled effects were calculated using a random effects inverse-variance model with the Hartung-Knapp-Sidik-Jonkman adjustment. RESULTS: Thirty-seven studies were included, accounting for a total of 34,863 youths with T1D (51.9% girls). Twenty-nine studies evaluated physical activity, eight sedentary behavior, 14 cardiorespiratory fitness, and two muscular fitness. A negative association between physical activity (r = - 0.09, 95% CI - 0.14 to - 0.04; I2 = 63.5%), cardiorespiratory fitness (r = - 0.31, 95% CI - 0.44 to - 0.19; I2 = 57.0%) and glycated hemoglobin was found. Also, the association with sedentary behavior was positive (r = 0.20, 95% CI 0.04 to 0.35; I2 = 92.6%). All the associations were independent of the glycated hemoglobin levels and diabetes duration. CONCLUSIONS: Low levels of physical activity and cardiorespiratory fitness and extensive sedentary behavior may explain part of the variance in glycated hemoglobin and part of the risk for poor glycemic control in youth with T1D. PROSPERO: Registration number: CRD42021254362.

[Analysis of population survey for determining the factors associated with the control diabetes mellitus in Mexico]. / Análisis de una encuesta poblacional para determinar los factores asociados al control de la diabetes mellitus en México.

OBJECTIVE: Determine the influence of nutritional counseling, exercise, access to social healthcare and drugs, and the quality of medical care on the control of diabetics. MATERIAL AND METHODS: The information and blood samples were obtained in 2005. Glycemic control was defined as good if HbA1c was ≤7.0%, poor from 7.01%-9.50% and very poor if HbA1c >9.5%. Binary logistic regression models were used to determine the association of these factors with HbA1c>9.5%. RESULTS: Thirty percent of the patients with a medical diagnosis of diabetes had adequate metabolic control. CONCLUSIONS: Nutritional guidance was associated with an increase in the degree of control. A majority of diabetics have poor or very poor glycemic control. Strengthening the quality of and access to medical care for these patients is urgently needed.

Análisis de una encuesta poblacional para determinar los factores asociados al control de la diabetes mellitus en México / Analysis of population survey for determining the factors associated with the control diabetes mellitus in Mexico

OBJETIVO: Explorar la asociación entre recomendaciones dietéticas, ejercicio, acceso a seguridad social y medicamentos, y calidad de la atención médica con el grado de control glucémico en pacientes diabéticos. MATERIAL Y MÉTODOS: La información y muestras sanguíneas se obtuvieron en 2005. Se analizó la proporción de pacientes que se encontraban en buen control (<7 por ciento), mal control (7.01 por ciento - 9.5 por ciento) y descontrol severo (>9.5 por ciento), de acuerdo con su HbA1c. Fueron empleados modelos de regresión logística binaria para determinar la asociación entre los factores y niveles de glucemia. RESULTADOS: El 30 por ciento de los pacientes diabéticos se encontraban en buen control. CONCLUSIONES: Recibir consulta con un nutriólogo disminuye la posibilidad de descontrol severo. Un alto porcentaje de los pacientes diabéticos se encuentra en alto grado de descontrol, por lo que es urgente reforzar el acceso y calidad de la atención ofrecida a estos pacientes.

OBJECTIVE: Determine the influence of nutritional counseling, exercise, access to social healthcare and drugs, and the quality of medical care on the control of diabetics. MATERIAL AND METHODS: The information and blood samples were obtained in 2005. Glycemic control was defined as good if HbA1c was <7.0 percent, poor from 7.01 percent - 9.50 percent and very poor if HbA1c >9.5 percent. Binary logistic regression models were used to determine the association of these factors with HbA1c>9.5 percent. RESULTS: Thirty percent of the patients with a medical diagnosis of diabetes had adequate metabolic control. CONCLUSIONS: Nutritional guidance was associated with an increase in the degree of control. A majority of diabetics have poor or very poor glycemic control. Strengthening the quality of and access to medical care for these patients is urgently needed.