Establishing the multidisciplinary Imperial Physical Activity and Diabetes clinic

Abstract

Increasing numbers of people with diabetes are adopting exercise programmes. Fear of hypoglycaemia, and hypoglycaemia itself, are major issues for many people with diabetes undertaking physical activity. The risk of hypoglycaemia is exacerbated by endurance exercise. In addition, soft tissue injuries are more common in people with diabetes. We have established a multidisciplinary physical activity and diabetes clinic with the aim of empowering, educating and enabling people with diabetes to enjoy sport and exercise without fear of hypoglycaemia or frustration at glycaemic variability or soft tissue injuries. The multidisciplinary team (MDT) includes a diabetologist, sports and exercise physician, radiologist, dietitian, diabetes specialist nurse, and psychologist. Between October 2015 and September 2017, we undertook 19 clinics and saw 66 patients (48 new and 18 follow‐up). Of the 48 new referrals (median age 35; range 20–72) 47 had type 1 diabetes and 27 (56%) used an insulin pump. Attendees had a median 18 years of diabetes (range 1–50). Diabetes distress was variable (median PAID score 18; range 0–64). Twenty‐five patients attended for glycaemic management, 15 for musculoskeletal issues and eight for both. Sixteen (33%) required physiotherapy and nine (19%) were referred for joint imaging. It is possible to establish a new service to support physical activity in diabetes. To meet demand and enhance the MDT, physiotherapy will be added. A means of assessing the effects of diabetes on physical activity and outcome measures that matter to people with diabetes must be developed. Copyright © 2018 John Wiley & Sons.

Nutritional support for a person with type 1 diabetes undertaking endurance swimming

“…Adults with T1DM who exercise regularly tend to have a lower HbA1c, lower blood pressure, blood lipids and BMI than those who do not so should be encouraged to exercise, but may require help and support to do this safely ( 4 , 5 ).…”