Exercise as it relates to Disease/Adherence to physical activity in young people with Type 1 diabetes

What is the background to this research?
Type 1 diabetes is an auto-immune condition in which the immune system is activated to destroy the cells in the pancreas which produce insulin(2). This health concern affected 20,700 children and young adults (aged 0–24) in Australia 2018(4). Due to the inability to produce their own insulin, problems may occur while exercising including the risk of hypoglycaemia (condition in which your blood glucose level is lower than normal) or hyperglycaemia (cause their blood glucose levels to increase)(2). These fluctuations of glucose levels can also cause fear towards physical activity which is a primary barrier for individuals with type 1 diabetes(5). This is problematic, especially with children and adolescents as physical activity plays a key role in the management of type 1 diabetes as well as their development(6). Considering these risks and barriers the article aims to investigate time spent exercising, adherence to the program for a safe exercise and ability of young people with diabetes to take appropriate measures to reduce potential risks(1).

Where is the research from?
This research was based at the Regional Centre for the management of diabetes in childhood of the University of Parma, Parma, Italy, however the individuals conducting the study used a variety of different facilities including Children’s Hospital and the General Hospital of Parma(1). The article had several authors including Maurizio Vanelli and Giovanni Chiari, both working at Department of Clinical and Experimental Medicine, University of Parma and have a combined 206 publications(1). Their skills and expertise include diabetes mellitus, blood glucose and nutrition(1). The other authors (Chiara Gelmetti, Anna Bernardini, Brunella Iovane, Rosa Vitale, Maria Katrin Errico) all have an affiliation with the University of Parma and have a combined 41 publications(1).

What kind of research was this?
A mixed research was used to complete the study as it included both qualitative and quantitative data. At the beginning of the research quantitative data was collected from the participants including age, sex, weight, height, BMI, duration of disease, mean HbA1c value(1). During the study both qualitative and quantitative data was collected including weekly time spent for physical activity, the type of exercise usually performed and the measures taken to reduce exercise risks have been collected by a structured questionnaire(1).

What did the research involve?
The study involved a random selection of 91 type 1 diabetes mellitus (50 boys, 41 girls), aged between 10-18 years and have had diabetes longer then 6 months without any association with chronic diseases (1). The clients age, sex, weight, height, BMI, duration of disease, mean HbA1c value were recorded and then an interview commenced to determine the clients(1): Apart from the initial interview/questionnaire, the information provided about the method of the study was minimal creating confusion and a misunderstanding of the process used in the study. However, it was mentioned that the patients glycated haemoglobin was taken every 3 months and in the follow up, guidelines were provided to perform a safe exercise e.g. avoid exercise during peak insulin action and consider reducing insulin dose when exercise is anticipated(1).
 * Weekly time spent for physical activity at school or in the spare time
 * The type of exercise usually performed
 * The measures taken to reduce exercise risks, in particular changes in insulin and food intake before and after exercise.

What were the basic results?
The mean of the HbA1c values collected from the 91 individuals over preceding 6 months was 8.4 ± 0.2%(1). However the study discovered that children that exercised less then 60 minutes a week had a mean HbA1c level higher then children exercising 120-360 minutes or 360-480 minutes a week as shown in the table below(1). This was then taken a step further and the physical activity was split into two categories competitive sports (soccer and volleyball) and spare time (walking and skating). The results found that children attending a competitive sport (at least 360 min per week) had a better glycemic control (HbA1c = 7.39 ± 0.6)(1). Throughout the study individuals did suffer from hyperglycaemia and hypoglycaemia episodes. Hypoglycaemia was recorded in 37.7% of individuals, higher then hypoerglycaemia(1). This was spread evenly throughout competitive sports and spare time. However only 50% of patients were using safe procedures including(1): Overall the results supported physical activity benefits individuals with type 1 diabetes however there was no information about safety procedures helping individuals avoid hyperglycaemia and hypoglycaemia episodes.
 * 29% monitored blood glucose levels before exercise
 * 41% monitored blood glucose levels after exercise
 * 30% monitored blood glucose levels before and after exercise
 * 32% of patients referred to change insulin dose according to blood glucose levels

What conclusions can we take from this research?
Overall the study was a success however the aim was not 100% fulfilled. The authors were successful in gathering a correlation that an increase in the amount of minutes exercised each week is beneficial towards individuals with type 1 diabetes and does decrease HbA1c levels. However they only reported that individuals should use safe practices to avoid hyperglycaemia and hypoglycaemia episodes and didn't go into detail which safe practices were effective.

Practical advice
During the interviewing stage the questionnaire was positive to receive information about the patients however the reliability of it is questionable due to the children and adolescence may not be 100% honest. The numbers received for the minutes participated in physical activity may have been unreliable as well due to dishonesty from patients however the results demonstrate a reasonable trend to rule this out. The method needed more detail to it as well due to confusion in what happened after the interviews. Finally more detail needed in the results in which safe practices were beneficial to the patients.

Further information/resources
Listed below are several links beneficial to individuals with type 1 diabetes:
 * Diabetes Austraila
 * Health direct
 * jdrf