Care of the Athlete With Type 1 Diabetes Mellitus: A Clinical Review

Abstract

ContextType 1 diabetes mellitus (T1DM) results from a highly specific immune-mediated destruction of pancreatic β cells, resulting in chronic hyperglycemia. For many years, one of the mainstays of therapy for patients with T1DM has been exercise balanced with appropriate medications and medical nutrition. Compared to healthy peers, athletes with T1DM experience nearly all the same health-related benefits from exercise. Despite these benefits, effective management of the T1DM athlete is a constant challenge due to various concerns such as the increased risk of hypoglycemia. This review seeks to summarize the available literature and aid clinicians in clinical decision-making for this patient population.Evidence AcquisitionPubMed searches were conducted for “type 1 diabetes mellitus AND athlete” along with “type 1 diabetes mellitus AND exercise” from database inception through November 2015. All articles identified by this search were reviewed if the article text was available in English and related to management of athletes with type 1 diabetes mellitus. Subsequent reference searches of retrieved articles yielded additional literature included in this review.ResultsThe majority of current literature available exists as recommendations, review articles, or proposed societal guidelines, with less prospective or higher-order treatment studies available. The available literature is presented objectively with an attempt to describe clinically relevant trends and findings in the management of athletes living with T1DM.ConclusionsManaging T1DM in the context of exercise or athletic competition is a challenging but important skill for athletes living with this disease. A proper understanding of the hormonal milieu during exercise, special nutritional needs, glycemic control, necessary insulin dosing adjustments, and prevention/management strategies for exercise-related complications can lead to successful care plans for these patients. Individualized management strategies should be created with close cooperation between the T1DM athlete and their healthcare team (including a physician and dietitian).

Association of olfactory function with the intensity of self-reported physical activity in adults with type 1 diabetes

“…The study of Danish pediatric cohort indicated high HbA 1c levels and elevated blood pressure as risk factors for progression of DR. 25 Owing to its beneficial influence on metabolic control, a regular physical activity is one of the treatment recommendations in diabetes. 8 However, we must emphasize that patients with proliferative DR are advised to avoid intensive physical activity, which is associated with the risk of vitreous hemorrhage, until the completion of laser therapy.…”

“…Subsequently, the activated AMPK elicits glucose transport and desirable lipid metabolism. 8 An inverse association between physical activity and retinopathy or microalbuminuria has been reported among adults with type 1 diabetes. 9 Moreover, a positive effect of regular aerobic exercise on laboratory parameters in type 2 diabetes patients with diabetic peripheral neuropathy was noted already after 8 weeks.…”

“…7 Additionally, physical activity decreases insulin resistance, which in turn lowers insulin needs and decreases glycated hemoglobin A 1c (HbA 1c ) levels. 8 The mechanisms of the healthy impact of physical activity include the phosphorylation of AMP -activated protein kinase (AMPK) that activates the enzyme. Subsequently, the activated AMPK elicits glucose transport and desirable lipid metabolism.…”

Characteristics of somatic build and physical activity and evaluation of hand grip strength in patients with type 1 diabetes

“…Chociaż ogólne zalecenia dotyczące przyjmowania przez sportowców składników odżywczych zostały zawarte w oświadczeniu wydanym po przyjęciu wspólnego stanowiska przez American Dietetic Association i Dietitians of Canada oraz American College of Sports Medicine [36], to każdy przypadek aktywnej fizycznie osoby z T1DM powinien być potraktowany indywidualnie z uwzględnieniem specyfiki realizowanych wysiłków fizycznych przy ścisłej współpracy z lekarzem i dietetykiem oraz innych osób wchodzą-cych w skład zespołu opieki zdrowotnej [37]. Wydaje się też, że wskazywanie korzystnych efektów wynikających z udziału w AF, zachęcanie do niej oraz zapewnianie możliwości bezpiecznego i atrakcyjnego uczestnictwa już od dzieciństwa, może sprzyjać w kontynuacji utrzymywania aktywnego trybu życia w wieku dorosłym, co jest niezmiernie ważne w profilaktyce długoterminowych powikłań [4,38].…”

“…Although general recommendations concerning nutrient intake by athletes are included in a common statement released by the American Dietetic Association, the Dietitians of Canada and the American College of Sports Medicine [36], every case of a physically active individual with T1DM should be treated individually in cooperation with a doctor, dietitian and other people being part of the healthcare team taking into account the specificity of physical effort [37]. Moreover, it seems that indicating benefits of physical activity, encouraging to take up sports and ensuring safe and active participation since childhood may help T1DM patients to continue an active lifestyle in adult life, which is really significant in the prevention of long-term complications [4,38].…”