# Exercise as it relates to Disease/Effects of Physical Activity on Blood Glucose Control for Pediatric Type 1 Diabetics

This Wikibooks page is critiquing the article Effects of Regular Physical Activity on Control of Glycemia in Pediatric Patients With Type 1 Diabetes Mellitus

## Background to the Research
##### Type 1 Diabetes

Type 1 Diabetes Mellitus (T1DM) is an autoimmune disease in which the Beta cells of the pancreas are attacked and lose their ability to produce insulin in the body. Insulin is responsible for regulating blood glucose levels.,, The cause is not yet understood by doctors nor can it be prevented and there is also no current cure for this condition.,,
It is widely recognized and understood that physical activity has many health benefits for the people that undertake it. One such health benefit is the decrease of blood glucose levels caused by the increase in insulin sensitivity and the glucose uptake in muscles that is a direct outcome of a period of physical activity.,
This is a subsequent effect for both people with diabetes and without, but for the people with diabetes it can have the potential to endanger them via the onset of a hypoglycaemic incident.,
The HbA1c test, measures for the average blood glucose level (BGL) over a 3-month period, and is used as a marker for the patient’s health and level of glucose control.
Previous studies have tried to assess the link between exercise and BGL but have failed to find a link, and results have been controversial. This may be down to the methodological approach or lack of patient numbers in these studies. This article is using a large cohort of 19,143 patients to assess the relationship between regular physical activity (RPA) and the control of blood glucose levels (HbA1c), and whether there was an associated risk of hypoglycaemia incidences.

## The Current Study
##### Where is the Research from?

Information was collected between January 1997 to December 2004 from 179 paediatric diabetes clinics in Germany and Austria, then analysed and provided by the Paediatric Quality Initiative. Funding and support for this research came from sources including;
* The German Federal Ministry of Health;
* Novo Nordisk, a healthcare company leading the way in diabetes care around the world for over 90 years;
* The Dr Burger-Busing Foundation; and
* The German Diabetes Foundation.
With backing from sources such as the top federal government department on health, credibility is given to the results.

##### What kind of research was this?

The research conducted was a cross-sectional analysis taken from a population of 19,143 patients over the course of January 1997 to December 2004, to compare the control of glycaemia and the rate of hypoglycaemia by the frequency of regular physical activity (RPA).
The timeframe for the collection period of data extended over 7 years and is at least 13 years old. It’s hard to know if this would influence the results, but a more recent study would be interesting to compare the findings. The study was an observational design, meaning there was no intervention from doctors on the patients. Because it was taken from 179 clinics across 2 countries it is hard for the data to be impacted by specific doctors trying to influence their patient’s answers.

##### What did the research involve?

19,143 patients with T1DM aged 3 to 20 years at their visit to the Diabetic Endocrinologist, were asked about their RPA and frequency of RPA. RPA was considered PA that lasted for a minimum of 30 minutes at least once a week. School sports were not included, and only patients with a continuous record of a year were included. Patients were then grouped by their frequency of RPA;
* RPA0 = none;
* RPA1 = 1 or 2 times a week; and
* RPA2 = 3 or more times a week.
Patients were also broken into groups based on age in years;
* Age 3-8.9;
* Age 9-14.9; and
* Age >15.
The data that was sent to the Paediatric Quality Initiative for central analysis was reviewed twice a year for their credibility, and unreliable data was reconfirmed with the clinics before being accepted.
There are a number of limitations of this study, including:
* The definition of physical activity, this was taken from the DPV questionnaire;
* Self-reported data by the patient or the patient’s parent in case of young children; and
* It only reflects the frequency of the exercise and does not consider the type nor the intensity.
These limitations may weaken the association between exercise and blood glycaemic levels.

##### What were the basic results?

The results of this study show the following:
* The groups with more frequent levels of RPA had a lower HbA1C level.
* RPA0 had a reading of 8.4% compared to 8.1% in the RPA2 group.
* This was shown to be the case for both sexes and in all age groups.
* After multiple regression analysis was undertaken on all the variables, it was found that RPA was one of the most important factors contributing to the HbA1C levels.
* There was no link found between the frequency of RPA and the occurrence of severe hypoglycaemia.
Since there were many participants in this study, it reduces statistical variance and the results will hold a stronger significance.

##### What conclusions can we take from this research?

The research taken by the 179 clinics in Germany and Austria, then analysed by the Paediatric Quality Initiative, shows RPA is a large contributor to the health of an individual with Type 1 Diabetes, and exercise should be endorsed and prescribed to these individuals. This is supported by the results in better control of blood glucose levels, including the lower HbA1c tests, and the fact there is no elevated risk of hypoglycaemia or loss of consciousness in patients with a high frequency of RPA.

##### Practical advice

Although physical activity is highly encouraged for the better health of these individuals, they should take consideration when either starting or increasing their efforts in physical activity. They should consult with their doctor and take extra blood glucose tests before, during and after, while also taking note of their intensity to monitor the training load and understand how the changes will develop in their bodies.

##### Further information/resources

* Diabetes Australia, Not-For-Profit organization providing services for people with Diabetes.
* Juvenile Diabetes Research Foundation, Not-For-Profit organization raising funds for research into Type 1 Diabetes.
* Garvan Institute, Leading medical research organization, including Diabetes research.
* Exercise and Sport in Diabetes, here is a link to an in-depth pdf booklet containing information about the physiological effects and how to exercise safely with Diabetes.

### Reference List

* ↑ Herbst A, Bachran R, Kapellen T, Holl R. Effects of Regular Physical Activity on Control of Glycemia in Pediatric Patients With Type 1 Diabetes Mellitus [Internet]. The Jama Network. 2006 [cited 8 September 2017]. Available from: http://jamanetwork.com/journals/jamapediatrics/fullarticle/205056
* 1 2 Type 1 Diabetes Facts - JDRF [Internet]. JDRF. 2017 [cited 7 September 2017]. Available from: http://www.jdrf.org/about/fact-sheets/type-1-diabetes-facts/
* 1 2 About Type 1 Diabetes [Internet]. JDRF. 2017 [cited 7 September 2017]. Available from: https://www.jdrf.org.au/file/jdrf-documents/fact-sheets/FactSheet_About-T1D_Web.pdf
* 1 2 3 4 Increasing Insulin Sensitivity - Diabetes Self-Management [Internet]. Diabetes Self-Management. 2017 [cited 10 September 2017]. Available from: https://www.diabetesselfmanagement.com/managing-diabetes/treatment-approaches/increasing-insulin-sensitivity/
* 1 2 Borghouts L, Keizer H. Exercise and Insulin Sensitivity: A Review. International Journal of Sports Medicine [Internet]. 2000 [cited 11 September 2017];21(1):1-12. Available from: https://www.thieme-connect.de/products/ejournals/html/10.1055/s-2000-8847
* ↑ Diabetes Australia [Internet]. Diabetesaustralia.com.au. 2017 [cited 18 September 2017]. Available from: https://www.diabetesaustralia.com.au/
* ↑ JDRF Homepage - JDRF Australia [Internet]. Jdrf.org.au. 2017 [cited 19 September 2017]. Available from: https://www.jdrf.org.au/
* ↑ Diabetes and Metabolism [Internet]. Garvan Institute of Medical Research. 2017 [cited 19 September 2017]. Available from: https://www.garvan.org.au/research/diabetes-metabolism
* ↑ Nagi D. Exercise and Sport in Diabetes. 2nd ed. United Kingdom: Wiley; 2005.