Studies would indicate a reduction in hemoglobin A1c levels following moderate and/or vigorous physical activity (PA) for people managing diabetes. However, prior investigations rarely looked at glucose variability in an adolescent population. Purpose: The purpose of this investigation was to test the relationship between physical activity intensity levels and glucose variability in a sample of adolescents with type 1 diabetes mellitus, and if the amount of time accumulated for each intensity level is predictive of changes in glucose variability. Methods: Glucose variability was determined using continuous glucose monitor data and physical activity intensity time was retrieved through Fitabase®. Both glucose and physical activity data were collected over a two-week timeframe. Data analysis was completed using Pearson’s correlation and a simple linear regression with a p-value of 0.05 to determine significance. Results: A significant inverse relationship was observed (p = 0.04) between glucose variability and average minutes of daily moderate-intensity activity (r = −0.59), as well as moderate and vigorous physical activity (MVPA) combined (r = −0.86; p = 0.03). A simple linear regression indicated that only MVPA was a significant predictor of glucose variability (β = −0.12; 95% CI: −0.23–−0.01, p = 0.03). Conclusion: These data demonstrated that the total amount of daily physical activity is important when properly managing type 1 diabetes mellitus, but time spent in MVPA over two weeks may have an inverse relationship with glucose variability in children and adolescents over a span of two weeks.
Background: Continuous glucose monitors (CGMs) are widely used for individuals with diabetes mellitus, particularly those with type 1 diabetes (T1D). Advancements in CGM technology allow for glycemic assessment without capillary glucose measurements as many come factory calibrated. However, exercise, an essential component of diabetes care, has been reported to alter accuracy of earlier generation CGM. Considering the importance of physical activity for individuals with T1D and the progression of CGM technology, we aimed to investigate the accuracy of the Dexcom G6 during physical activity. Methods: Adolescents (ages 13-20 years) exercised on a treadmill for 40 minutes, with a 10-minute break at minute 20. We obtained paired CGM and glucometer measurements before and every 10 minutes during and after exercise. Accuracy analysis was determined by mean absolute relative difference (MARD), mean absolute difference (MAD), and Clarke Error Grid Analyses. Results: Mean absolute relative difference and MAD increased during exercise (14%-33% and 24.3-34 mg/dL) but improved after exercise. We noted certain CGM locations produced greater changes in accuracy as MARD and MAD increased markedly when the CGM was on the buttocks (18%-46% and 30-41 mg/dL). We also noted decreased odds of Zone A in the Clarke error grid when the CGM was on the buttocks compared to the abdomen (odds ratio [OR]: 0.146; P = 0.0003; 95% CI = 0.052-0.415). Conclusions: This CGM system showed alterations in accuracy during exercise. Our findings additionally suggest interstitial fluid changes in muscles during exercise alter accuracy of CGM; however, additional research is required.
Subcutaneous fat necrosis (SCFN) is an unusual source of hypercalcemia in neonates. This condition is self-limiting; however, hypercalcemia can occur as a sequela. Severe hypercalcemia can result in increased morbidity and mortality. Several modalities of treatment for hypercalcemia subsequent to SCFN have been explored, including the use of bisphosphonates, particularly pamidronate. We briefly review SCFN, recognition of this uncommon dermatological phenomenon, as well as hypercalcemia resultant from SCFN and its current management strategy. Furthermore, we report a case series of two patients treated successfully with intravenous pamidronate in conjunction with other treatment modalities.
Studies have consistently shown improvements in daily glucose and hemoglobin A1c (HbA1c) for both type 1 and type 2 diabetes with increased moderate and/or vigorous physical activity (PA). A limitation with prior investigations is that they only tested this relationship in adult populations and seldom looked at glucose variability (GV). Whether or not similar results would be observed in a pediatric population with type 1 diabetes (T1D) is unknown. Purpose: The purpose of this investigation was to test the relationship between GV and intensity of PA, and if duration of activity is predictive of changes in GV in a sample of teenagers with T1D. Methods: Data for this investigation were used from an ongoing study at a local pediatric Diabetes Center. Participants who wore a continuous glucose monitor (CGM) and Fitbit consecutively for a period of two weeks or more were included in the data analysis. GV was determined using 2-weeks of CGM data and PA intensity time was retrieved through Fitabase. Pearson’s correlation and a simple linear regression were used for final analysis with a p-value of 0.05 to determine significance. Results: Minutes of daily moderate intensity activity had a significant inverse relationship (r= -0.59; p = 0.04) with GV, whereas moderate and vigorous PA (MVPA) combined showed a stronger inverse relationship (r= -0.86; p = 0.03). When placed in a simple linear regression only MVPA significantly predicted changes in glucose variability (β= -0.12, p=0.03). Conclusion: These data show that not only is duration of PA an important factor when it comes to managing diabetes, but that more attention should be paid to the time spent at various intensity levels. Although more research is needed to determine feasibility it could be of great benefit for individuals managing diabetes to incorporate an activity monitor into their daily routine to share with their diabetes care team to better understand how PA levels impact their blood glucose. Disclosure J.R. Jaggers: None. K. King: None. T.E. McKay: None. R.J. Dyess: None. K.A. Wintergerst: None.
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