Filling gaps in type 1 diabetes and exercise research: a scoping review and priority-setting project

Abstract

Our team examined the characteristics of patient engagement (PE) practices in exercise-based randomized trials in type 1 diabetes (T1D), and facilitated T1D stakeholders in determining the top 10 list of priorities for exercise research. Two methodological approaches were employed: a scoping review and a modified James Lind Alliance priority-setting partnership. Published (Medline, Embase, CINAHL and Central databases) and grey literature (www.clinicaltrials.gov) were searched to identify randomized controlled trials of exercise interventions lasting minimum 4 weeks and available in English. We extracted information on PE and patient-reported outcomes (PROs) to identify if patient perspectives had been implemented. Based on results, we set out to determine exercise research priorities as a first step towards a patient-engaged research agenda. An online survey was distributed across Canada to collect research questions from patients, caregivers and healthcare providers. We qualitatively analyzed submitted questions and compiled a long list that a 12-person stakeholder steering committee used to identify the top 10 priority research questions. Of 9962 identified sources, 19 published trials and 4 trial registrations fulfilled inclusion criteria. No evidence of PE existed in any included study. Most commonly measured PROs were frequency of hypoglycemia (n=7) and quality of life (n=4). The priority-setting survey yielded 194 submitted research questions. Steering committee rankings identified 10 priorities focused on lifestyle factors and exercise modifications to maintain short-term glycemic control. Recent exercise-based randomized trials in T1D have not included PE and PROs. Patient priorities for exercise research have yet to be addressed with adequately designed clinical trials.

Lessons learned from the continuous glucose monitoring metrics in pediatric patients with type 1 diabetes under COVID-19 lockdown

“…Particularly in the management of T1D, adherence to the therapeutic regimen can be adversely affected by changes in daily routine [9,10]. Moreover, glycemic control is affected by engaging in regular physical activity and psychological well-being [11]. The major focus during the COVID-19 outbreak is the prevention of infection spread, thus neglecting the impact of lockdown on other health aspects.…”

Beyond A1c: What outcomes matter to persons living with type 1 diabetes when it comes to adopting digital health interventions for self-management support (Preprint)

“…Focus group transcripts were analyzed using an inductive, interpretivist approach [27], in which we developed a thematic framework that encapsulated our interpretations of the data set [22]. We defined themes [28], looking for patterns within and across focus group transcripts [30,31]. Building themes from the perspective of participants [22,27], allowed us to devise a conceptual framework that reflects/portrays what life with T1D is like for them, and commonalities in their firsthand accounts.…”

“…We created a semi-structured focus group guide without predetermined hypotheses, rather we wanted to ground our analysis in the discussions with participants [27] and identify patient-oriented outcomes that would reflect their unique perspectives and experiences [28]. The focus group guide was developed by endocrinologists, qualitative researchers with prior experience in T1D, and individuals with lived experience of T1D (B.M, J.A.P., C.P., G.L.B., with input from the Patient Advisory Committee) (Appendix 1).…”