Exercise as it relates to Disease/The Relationship between physical activity and poor Glycemic control in type 1 diabetic women

This is a critic of how exercise and relates to type 1 diabetes paper. This critic has been written as a university assignment for the University of Canberra.

The Paper: Waden J, Tikkianen H, Forsblom C, Fagerudd J, Pettersson-Fernholm K, Lakka T & Riska R. (2005). Leisure Time Physcail Activity Is Associated With Poor Glycemic Contorl in Type 1 Diabetic Women. Diabetes Care. 28, 777-782.

What Is The Background To This Research?
What is Diabetes

Diabetes occurs when the body does not make insulin or the insulin that is produced by the pancreas does not work properly which can lead to an increase in blood glucose levels. There are 3 types of diabetes, type 1, type 2 and gestational diabetes. Type 1 diabetes accounts for 10-15% of all diabetes diagnosis. Type 1 diabetes is defined as an autoimmune disease where beta cells in the pancreas are destroyed and can no longer produce insulin. Symptoms of type 1 diabetes can be life threatening, these can include extreme thirst, frequent urination, blurred vision, muscle ramps etc. Type 2 diabetes is effects 85-90% of all people diagnosed with diabetes. It occurs when beta cells in the pancreas still function and produce insulin but this insulin does not work effectively or there is an insufficient amount of insulin produced. This will impact the blood glucose levels. Type 2 diabetes is a result of genetics or environmental factors. Gestational diabetes is accounted for 5-7% of people with diabetes. It occurs with the hormones during pregnancy too much insulin and the body in unable to move this insulin around the bloodstream. This then elevates blood glucose levels. Within this article critic we will be focusing on type 1 diabetes.

Treatment for diabetes varies depending on the type. Type 1 diabetes treatment includes insulin injection on a daily basis. Type 2 diabetes treatment include eating healthy and regular physical activity whilst also commencing medication and insulin to stay healthy and prevent complications.

Throughout previous studies, researchers have emphasized the importance of physical activity in preventing type 2 diabetes. Within these studies, they have shown that a progression for the state of impaired glucose tolerance can be inhibited by changing dietary habits and/or increasing physical activity. Type 1 diabetics patients have peripheral insulin resistance that can be improved by increasing physical activity and rendered to improve glycaemic control of type 1 diabetic patients.

Although recent studies have failed to show any significant improvements in glycaemic control by physical activity in type 1 diabetes. Only very few studies have showed a positive effect on glycaemic control. The aim of this study is to investigate the assassination between leisure time physical activity and glycaemic control insulin dose and estimated insulin sensitivity in a large cohort of adults type 1 diabetics patients by qualifying physical activity with detailed and validated questionnaires.

Where Is The Research From?
This study has been carried out by The FinnDiane Study group. The study was conducted by various Universities and Healthcare Centres listed below:
 * Folkhalasn institute of genetics
 * Folkshlasn research centre
 * Department of medicine Helsinki university, Helsinki, Finland
 * Division of Neurology, Helsinki University Central hospital, Helsinki, Finland
 * department of sports and exercise medicine, university of Helsinki, Helsinki, Finland
 * Pennington biomedical research centre, Baton Rouge, Louisiana

What Kind Of Research Was This?
This study is a cross-sectional study. A cross sectional study compares different population groups at the same time. It is purely descriptive and used to assess the frequency and distribution of a particular disease. Mainly used within a health care research. Qualitative data is used through a questionnaire for people with type 1 diabetes.

What Did The Research Involve?
This research involved 1,030 type 1 diabetic patients, 482 males and 548 females, completed a valid 12month questionnaire regard leisure time and physical activity. Patients were defined as diagnosed with type 1 diabetes before the age of 35years, using permeant insulin treatment within a year of diagnosis. Patients that had end stage renal disease were excluded from this study. 624 out of 1,030 patients had normal albumin excretion rate and free from cardiovascular complications. Patients were separated into different groups. These groups include sedentary exercise, < 10 METS h/week, moderate activity, 10-40 METS h/week, and active, >40 METS h/week. Anthropometric such as height, weight, waist and hip circumference, and blood pressure was collected. Information about smoking status, work status, and medication was also collected.

What Were The Basic Results?
The researchers placed results in a table and compared each group, sedentary, moderately active and active, they then compared females patient to males to determine whether activity effect glycemic control the same in both genders. Results from this study have revealed that female patients that were sedentary had a high HbA1c than those who were moderately active and active. Sedentary female patients also had a lower estimated glucose disposal rate than active patients. Within these results age, smoking status, insulin dose, social class and retinopathy and cardiovascular complications did not have any explanation. Low levels of leisure time and physical activity was associated with poor glycemic control in type 1 diabetic women. Men seem to use less insulin when physically active. An increase in leisure time and physical activity levels is associated with an increase in estimated insulin sensitivity.

What Conclusions We Take Away From This Research?
This study publish by The FinnDianne Study demonstrated the effect on exercise and the estimated rate of glucose disposal but needs to further investigate the relationship. Exercise is recommended as a crucial component in the management of diabetes. However, there is no convincing evidence that physical activity has a positive effect on glycaemic control in type 1 diabetics patients. This study does display evidence that low levels of leisure time and physical activity can lead to poor glycaemic control. There was a significant difference between males and females within the study, which demonstrated that glycaemic control within female type 1 diabetics is an issue.

There is still a need for further research to determine the evidence on physical activity during type 1 diabetics. It is recommended that research do this using a longitudinal study instead of a cross-sectional study. A cross-sectional study design has limited interpretation of the results as we do not get the full effect on leisure time and physical activity and the relations with glycaemic control.

Practical Advice
From previous studies, we know that physical activity is a main component when managing type 2 diabetes, however, type 1 diabetics and relationship is still unclear. It is recommended that patients participate in 30mins 5days/week is moderate activity. This will increase insulin regulation within the body. High intensity exercise can have no effect or the opposite effect. Before taking part in such exercise it is important to consult with a health care professional for an exercise screening to ensure it is safe to continue to participant in physical activity. Further studies focusing mainly on female glycaemic control is needed to investigate more evidence on the effect of exercise.

Further Information/resource
For further information on diabetes and the benefits on exercise, click the following links below:
 * Australian Government, Department of health- Diabetes: http://www.health.gov.au/internet/main/publishing.nsf/content/chronic-diabetes
 * Diabetes Australian: https://www.diabetesaustralia.com.au/
 * Diabetes South Australia: http://www.diabetessa.com.au/
 * Exercise and Diabetes: http://www.diabetes.co.uk/exercise-for-diabetics.html
 * Difference between a Cross-sectional Study and a Longitudinal Study: https://www.iwh.on.ca/wrmb/cross-sectional-vs-longitudinal-studies