Physical Activity Monitoring Paediatric Type 1 Diabetes
Condition: Diabetes Mellitus, Type 1
MeSH terms: Diabetes Mellitus; Diabetes Mellitus, Type 1
Study type: Interventional

Summary: 
      Physical activity (PA) can have positive health outcomes for children with type 1 diabetes
      (T1DM), yet being physically active can have unwanted side effects due to fluctuations in
      blood glucose (BG) level. Children and parents need support to help understand the
      relationship between PA and BG level, and how to use PA as a vehicle to better manage the
      condition. Using PA monitoring could help HCPs raise awareness about PA, discuss PA and
      facilitate diabetes management. This research will explore the feasibility and acceptability
      of PA monitoring as a clinical tool to help the management of paediatric T1DM.
    

Detailed description: 
      Physical activity (PA) can have positive health outcomes for children with type 1 diabetes
      (T1DM) such as improved diabetes control, lipid profile and body composition, yet activity
      levels are low. The unpredictable nature of children's everyday activity causes fluctuations
      in blood glucose (BG) level. Low and high BG level are side-effects of PA, have significant
      symptoms and can cause a range of chronic complications. Parents typically have
      responsibility for diabetes management in preadolescent children and perceive PA as a
      challenge due to constant concerns about BG levels (Quirk et al., 2015).

      Children and parents need support to help understand the relationship between PA and BG
      control and how to use PA as a vehicle through which to better manage the condition. T1DM
      healthcare professionals (HCPs) perceive a lack of i) competence, ii) confidence and iii)
      time to provide PA advice and education in the clinical setting. HCPs perceive a need for
      evidence-based resources to facilitate PA discussion, education and promotion (Quirk et al.,
      2015). Physical activity monitoring is already a widely recognised and accepted tool, with
      potential utility in paediatric diabetes.

      One such approach could be that HCPs graphically convey children's PA levels and use this to
      raise awareness and promote discussion about daily PA level. In those using constant glucose
      monitoring devices, daily BG values could be graphically documented to help explain the
      relationship between PA and BG level. These devices have shown acceptability among children
      with T1DM. However, whether they can facilitate PA discussion and education is unknown.

      This research will explore parents, children and HCPs' perceptions of PA monitoring in
      clinical practice. A PA monitoring programme will be developed, implemented in a small cohort
      of children with T1DM and evaluated for feasibility and acceptability. In the future,
      'physical activity clinical champions' could be trained to use activity monitoring for PA
      education and promotion in clinic settings.
    

Intervention name(s): physical activity monitor and feedback
Intervention type(s): Behavioral
Intervention description(s): Children will wear a Runscribe accelerometer for two weeks (children in Arm 2 will also wear a CGM). Runscribe will measure activity levels. Activity data will be downloaded by a researcher, analysed and graphs of daily activity levels prepared. At the child's next routine clinic appointment, child and parent will have 1:1 session with researcher acting as 'physical activity champion'. Session content will be informed by Phase 1, but will involve educational support around PA (including barriers and facilitators to participation) and individualised feedback on PA level). Individualised feedback will involve review of daily PA graphs - addressing times of high and low activity levels. For participants in Arm 2, there will also be review of daily line graphs showing BG trends. As part of standard clinical care, CGM data gets downloaded at routine clinic appointments and is visible on the patient's clinic notes in daily graph form.
Allocation: Non-Randomized
Intervention model: Parallel Assignment
Masking: None (Open Label)
Primary purpose: Other
Keywords: type 1 diabetes mellitus; physical activity; children; constant glucose monitoring