Optimizing Physical Activity for Glycemic Control in Type 1 Diabetes: Strategies and Risks
DOI:
https://doi.org/10.12775/QS.2024.19.54103Keywords
diabetes mellitus type 1, physical activity, exercise-induced hypoglycemia, cardiovascular benefits, insulin managementAbstract
Type 1 diabetes mellitus (T1DM) is a chronic autoimmune condition characterized by the destruction of insulin-producing beta cells in the pancreas, necessitating lifelong insulin therapy. This study explores the impact of physical activity on glycemic control and overall health in individuals with T1DM. Despite its proven benefits, including improved cardiovascular health, lower HbA1c levels, and reduced insulin requirements, over 60% of T1DM patients do not engage in regular exercise. Different types of physical activities—such as aerobic, anaerobic, and high-intensity interval training (HIIT)—affect metabolic responses differently. Aerobic exercises and HIIT have shown significant improvements in health-related quality of life (HRQoL) and reduced incidence of severe complications, such as diabetic ketoacidosis. However, exercise-induced hypoglycemia remains a significant risk, especially if exercise follows recent severe hypoglycemic episodes. Proper management strategies include adjusting insulin doses, monitoring glucose levels, and carbohydrate intake. The study highlights the importance of tailored exercise plans and preventive measures to mitigate risks such as nocturnal hypoglycemia and elevated ketones. Ultimately, effective integration of physical activity into diabetes management can lead to enhanced overall health and quality of life for individuals with T1DM.
References
Alarcón-Gómez, J., I. Chulvi-Medrano, F. Martin-Rivera, and J. Calatayud. 2021. "Effect of High-Intensity Interval Training on Quality of Life, Sleep Quality, Exercise Motivation and Enjoyment in Sedentary People with Type 1 Diabetes Mellitus." Int J Environ Res Public Health 18 (23). https://doi.org/10.3390/ijerph182312612.
Batacan, R. B., Jr., M. J. Duncan, V. J. Dalbo, P. S. Tucker, and A. S. Fenning. 2017. "Effects of high-intensity interval training on cardiometabolic health: a systematic review and meta-analysis of intervention studies." Br J Sports Med 51 (6): 494-503. https://doi.org/10.1136/bjsports-2015-095841.
Berger, M., P. Berchtold, H. J. Cüppers, H. Drost, H. K. Kley, W. A. Müller, W. Wiegelmann, H. Zimmerman-Telschow, F. A. Gries, H. L. Krüskemper, and H. Zimmermann. 1977. "Metabolic and hormonal effects of muscular exercise in juvenile type diabetics." Diabetologia 13 (4): 355-65. https://doi.org/10.1007/bf01223279.
Biankin, S. A., A. B. Jenkins, L. V. Campbell, K. L. Choi, Q. G. Forrest, and D. J. Chisholm. 2003. "Target-seeking behavior of plasma glucose with exercise in type 1 diabetes." Diabetes Care 26 (2): 297-301. https://doi.org/10.2337/diacare.26.2.297.
Bohn, B., A. Herbst, M. Pfeifer, D. Krakow, S. Zimny, F. Kopp, A. Melmer, J. M. Steinacker, and R. W. Holl. 2015. "Impact of Physical Activity on Glycemic Control and Prevalence of Cardiovascular Risk Factors in Adults With Type 1 Diabetes: A Cross-sectional Multicenter Study of 18,028 Patients." Diabetes Care 38 (8): 1536-43. https://doi.org/10.2337/dc15-0030.
Brazeau, A. S. 2008. "Barriers to physical activity among patients with type 1 diabetes." Diabetes care 31 (11): 2108–2109. https://doi.org/10.2337/dc08-0720.
Buchheit, M., and P. B. Laursen. 2013. "High-intensity interval training, solutions to the programming puzzle. Part II: anaerobic energy, neuromuscular load and practical applications." Sports Med 43 (10): 927-54. https://doi.org/10.1007/s40279-013-0066-5.
Campbell, M. D., M. Walker, R. M. Bracken, D. Turner, E. J. Stevenson, J. T. Gonzalez, J. A. Shaw, and D. J. West. 2015. "Insulin therapy and dietary adjustments to normalize glycemia and prevent nocturnal hypoglycemia after evening exercise in type 1 diabetes: a randomized controlled trial." BMJ Open Diabetes Res Care 3 (1): e000085. https://doi.org/10.1136/bmjdrc-2015-000085.
Campbell, M. D., M. Walker, M. I. Trenell, D. G. Jakovljevic, E. J. Stevenson, R. M. Bracken, S. C. Bain, and D. J. West. 2013. "Large pre- and postexercise rapid-acting insulin reductions preserve glycemia and prevent early- but not late-onset hypoglycemia in patients with type 1 diabetes." Diabetes Care 36 (8): 2217-24. https://doi.org/10.2337/dc12-2467.
Campbell, M. D., M. Walker, M. I. Trenell, S. Luzio, G. Dunseath, D. Tuner, R. M. Bracken, S. C. Bain, M. Russell, E. J. Stevenson, and D. J. West. 2014. "Metabolic implications when employing heavy pre- and post-exercise rapid-acting insulin reductions to prevent hypoglycaemia in type 1 diabetes patients: a randomised clinical trial." PLoS One 9 (5): e97143. https://doi.org/10.1371/journal.pone.0097143.
Cockcroft, E. J., P. Narendran, and R. C. Andrews. 2020. "Exercise-induced hypoglycaemia in type 1 diabetes." Exp Physiol 105 (4): 590-599. https://doi.org/10.1113/ep088219.
Colberg, S. R., R. J. Sigal, J. E. Yardley, M. C. Riddell, D. W. Dunstan, P. C. Dempsey, E. S. Horton, K. Castorino, and D. F. Tate. 2016. "Physical Activity/Exercise and Diabetes: A Position Statement of the American Diabetes Association." Diabetes Care 39 (11): 2065-2079. https://doi.org/10.2337/dc16-1728.
Cryer, P. E. 2008. "Hypoglycemia: still the limiting factor in the glycemic management of diabetes." Endocr Pract 14 (6): 750-6. https://doi.org/10.4158/ep.14.6.750.
Czenczek-Lewandowska, E., J. Grzegorczyk, and A. Mazur. 2018. "Physical activity in children and adolescents with type 1 diabetes and contem-porary methods of its assessment." Pediatr Endocrinol Diabetes Metab 24 (4): 179-184. https://doi.org/10.5114/pedm.2018.83364.
D'Hooge, R., T. Hellinckx, C. Van Laethem, S. Stegen, J. De Schepper, S. Van Aken, D. Dewolf, and P. Calders. 2011. "Influence of combined aerobic and resistance training on metabolic control, cardiovascular fitness and quality of life in adolescents with type 1 diabetes: a randomized controlled trial." Clin Rehabil 25 (4): 349-59. https://doi.org/10.1177/0269215510386254.
Dubé, M. C., S. J. Weisnagel, D. Prud'homme, and C. Lavoie. 2006. "Is early and late post-meal exercise so different in type 1 diabetic lispro users?" Diabetes Res Clin Pract 72 (2): 128-34. https://doi.org/10.1016/j.diabres.2005.09.017.
Franc, S., A. Daoudi, A. Pochat, M. H. Petit, C. Randazzo, C. Petit, M. Duclos, A. Penfornis, E. Pussard, D. Not, E. Heyman, F. Koukoui, C. Simon, and G. Charpentier. 2015. "Insulin-based strategies to prevent hypoglycaemia during and after exercise in adult patients with type 1 diabetes on pump therapy: the DIABRASPORT randomized study." Diabetes Obes Metab 17 (12): 1150-7. https://doi.org/10.1111/dom.12552.
Galassetti, P., and M. C. Riddell. 2013. "Exercise and type 1 diabetes (T1DM)." Compr Physiol 3 (3): 1309-36. https://doi.org/10.1002/cphy.c110040.
Gomez, A. M., C. Gomez, P. Aschner, A. Veloza, O. Muñoz, C. Rubio, and S. Vallejo. 2015. "Effects of performing morning versus afternoon exercise on glycemic control and hypoglycemia frequency in type 1 diabetes patients on sensor-augmented insulin pump therapy." J Diabetes Sci Technol 9 (3): 619-24. https://doi.org/10.1177/1932296814566233.
Janghorbani, M., R. M. Van Dam, W. C. Willett, and F. B. Hu. 2007. "Systematic review of type 1 and type 2 diabetes mellitus and risk of fracture." Am J Epidemiol 166 (5): 495-505. https://doi.org/10.1093/aje/kwm106.
Justine, M., A. Azizan, V. Hassan, Z. Salleh, and H. Manaf. 2013. "Barriers to participation in physical activity and exercise among middle-aged and elderly individuals." Singapore Med J 54 (10): 581-6. https://doi.org/10.11622/smedj.2013203.
Katz, M., E. Giani, and L. Laffel. 2015. "Challenges and Opportunities in the Management of Cardiovascular Risk Factors in Youth With Type 1 Diabetes: Lifestyle and Beyond." Curr Diab Rep 15 (12): 119. https://doi.org/10.1007/s11892-015-0692-4.
Metcalf, K. M., A. Singhvi, E. Tsalikian, M. J. Tansey, M. B. Zimmerman, D. W. Esliger, and K. F. Janz. 2014. "Effects of moderate-to-vigorous intensity physical activity on overnight and next-day hypoglycemia in active adolescents with type 1 diabetes." Diabetes Care 37 (5): 1272-8. https://doi.org/10.2337/dc13-1973.
Michaliszyn, S. F., and M. S. Faulkner. 2010. "Physical activity and sedentary behavior in adolescents with type 1 diabetes." Res Nurs Health 33 (5): 441-9. https://doi.org/10.1002/nur.20393.
Miller, R. G., H. D. Mahajan, T. Costacou, A. Sekikawa, S. J. Anderson, and T. J. Orchard. 2016. "A Contemporary Estimate of Total Mortality and Cardiovascular Disease Risk in Young Adults With Type 1 Diabetes: The Pittsburgh Epidemiology of Diabetes Complications Study." Diabetes Care 39 (12): 2296-2303. https://doi.org/10.2337/dc16-1162.
Pierre-Louis, B., A. K. Guddati, M. Khyzar Hayat Syed, V. E. Gorospe, M. Manguerra, C. Bagchi, W. S. Aronow, and C. Ahn. 2014. "Exercise capacity as an independent risk factor for adverse cardiovascular outcomes among nondiabetic and diabetic patients." Arch Med Sci 10 (1): 25-32. https://doi.org/10.5114/aoms.2014.40731.
Quirk, H., H. Blake, R. Tennyson, T. L. Randell, and C. Glazebrook. 2014. "Physical activity interventions in children and young people with Type 1 diabetes mellitus: a systematic review with meta-analysis." Diabet Med 31 (10): 1163-73. https://doi.org/10.1111/dme.12531.
Reddy, R., J. El Youssef, K. Winters-Stone, D. Branigan, J. Leitschuh, J. Castle, and P. G. Jacobs. 2018. "The effect of exercise on sleep in adults with type 1 diabetes." Diabetes Obes Metab 20 (2): 443-447. https://doi.org/10.1111/dom.13065.
Riddell, M. C., I. W. Gallen, C. E. Smart, C. E. Taplin, P. Adolfsson, A. N. Lumb, A. Kowalski, R. Rabasa-Lhoret, R. J. McCrimmon, C. Hume, F. Annan, P. A. Fournier, C. Graham, B. Bode, P. Galassetti, T. W. Jones, I. S. Millán, T. Heise, A. L. Peters, ..., and L. M. Laffel. 2017. "Exercise management in type 1 diabetes: a consensus statement." Lancet Diabetes Endocrinol 5 (5): 377-390. https://doi.org/10.1016/s2213-8587(17)30014-1.
Robertson, K., M. C. Riddell, B. C. Guinhouya, P. Adolfsson, and R. Hanas. 2014. "ISPAD Clinical Practice Consensus Guidelines 2014. Exercise in children and adolescents with diabetes." Pediatr Diabetes 15 Suppl 20: 203-23. https://doi.org/10.1111/pedi.12176.
Roy-Fleming, A., N. Taleb, V. Messier, C. Suppère, C. Cameli, S. Elbekri, M. R. Smaoui, M. Ladouceur, L. Legault, and R. Rabasa-Lhoret. 2019. "Timing of insulin basal rate reduction to reduce hypoglycemia during late post-prandial exercise in adults with type 1 diabetes using insulin pump therapy: A randomized crossover trial." Diabetes Metab 45 (3): 294-300. https://doi.org/10.1016/j.diabet.2018.08.002.
Sideraviciūte, S., A. Gailiūniene, K. Visagurskiene, and D. Vizbaraite. 2006. "The effect of long-term swimming program on glycemia control in 14-19-year aged healthy girls and girls with type 1 diabetes mellitus." Medicina (Kaunas) 42 (6): 513-8.
Soedamah-Muthu, S. S., J. H. Fuller, H. E. Mulnier, V. S. Raleigh, R. A. Lawrenson, and H. M. Colhoun. 2006. "High risk of cardiovascular disease in patients with type 1 diabetes in the U.K.: a cohort study using the general practice research database." Diabetes Care 29 (4): 798-804. https://doi.org/10.2337/diacare.29.04.06.dc05-1433.
Tansey, M. J., E. Tsalikian, R. W. Beck, N. Mauras, B. A. Buckingham, S. A. Weinzimer, K. F. Janz, C. Kollman, D. Xing, K. J. Ruedy, M. W. Steffes, T. M. Borland, R. J. Singh, and W. V. Tamborlane. 2006. "The effects of aerobic exercise on glucose and counterregulatory hormone concentrations in children with type 1 diabetes." Diabetes Care 29 (1): 20-5. https://doi.org/10.2337/diacare.29.1.20.
Taplin, C. E., E. Cobry, L. Messer, K. McFann, H. P. Chase, and R. Fiallo-Scharer. 2010. "Preventing post-exercise nocturnal hypoglycemia in children with type 1 diabetes." J Pediatr 157 (5): 784-8.e1. https://doi.org/10.1016/j.jpeds.2010.06.004.
Wewege, M., R. van den Berg, R. E. Ward, and A. Keech. 2017. "The effects of high-intensity interval training vs. moderate-intensity continuous training on body composition in overweight and obese adults: a systematic review and meta-analysis." Obes Rev 18 (6): 635-646. https://doi.org/10.1111/obr.12532.
WHO. 2020. "Guidelines on Physical Activity and Sedentary Behaviour. Geneva: World Health Organization; RECOMMENDATIONS.". https://www.ncbi.nlm.nih.gov/books/NBK566046/.
Yardley, J. E., J. Hay, A. M. Abou-Setta, S. D. Marks, and J. McGavock. 2014. "A systematic review and meta-analysis of exercise interventions in adults with type 1 diabetes." Diabetes Res Clin Pract 106 (3): 393-400. https://doi.org/10.1016/j.diabres.2014.09.038.
Zaharieva, D. P., L. A. Miadovnik, C. P. Rowan, R. J. Gumieniak, V. K. Jamnik, and M. C. Riddell. 2016. "Effects of acute caffeine supplementation on reducing exercise-associated hypoglycaemia in individuals with Type 1 diabetes mellitus." Diabet Med 33 (4): 488-96. https://doi.org/10.1111/dme.12857.
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2024 Paulina Przybysz, Maja Kucharska, Adrian Kruszewski, Monika Szyszka, Kacper Kwiliński, Natalia Paduszyńska, Anna Dąbrowska, Karolina Błaszczak, Barbara Wawrzyńska
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.
Stats
Number of views and downloads: 246
Number of citations: 0