ISPAD Clinical Practice Consensus Guidelines 2018: Exercise in children and adolescents with diabetes

Adolfsson, Peter; Riddell, Michael C.; Taplin, Craig E.; Davis, Elizabeth A.; Fournier, Paul A.; Annan, Francesca; Scaramuzza, Andrea; Hasnani, Dhruvi; Hofer, Sabine E.

doi:10.1111/pedi.12755

Cited by 161 publications

(260 citation statements)

References 146 publications

(295 reference statements)

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“…Just 8% of adolescents engage in MVPA at the recommended level of 60 minutes per day, and adolescents with type 1 diabetes report inadequate patterns of MVPA similar to those without chronic conditions . For adolescents with type 1 diabetes, maintaining the recommended level of regular MVPA is even more important because of the effects regular MVPA can have on keeping glycemic levels as close to normal as possible and preventing and/or delaying microvascular complications and cardiovascular disease …”

Section: Introductionmentioning

confidence: 99%

“…Regular MVPA led also to health benefits including better glycemic control, body composition, lipid profiles, and cardiopulmonary fitness . The 2018 International Society for Pediatric and Adolescent Diabetes (ISPAD) Clinical Practice Consensus Guideline for Exercise in Children and Adolescents with Diabetes presents evidence‐based guidelines but emphasizes the lack of data on how to successfully and safely promote them among those who are sedentary …”

Section: Introductionmentioning

confidence: 99%

“…7 For adolescents with type 1 diabetes, maintaining the recommended level of regular MVPA is even more important because of the effects regular MVPA can have on keeping glycemic levels as close to normal as possible and preventing and/or delaying microvascular complications and cardiovascular disease. 8,9 Among the challenges of engaging in regular MVPA for adolescents with type 1 diabetes are the need for monitoring blood glucose levels and adjusting diet and insulin before, during, and after MVPA.…”

mentioning

confidence: 99%

“…15 The 2018 International Society for Pediatric and Adolescent Diabetes (ISPAD) Clinical Practice Consensus Guideline for Exercise in Children and Adolescents with Diabetes presents evidence-based guidelines but emphasizes the lack of data on how to successfully and safely promote them among those who are sedentary. 9 To our knowledge, only three prior trials have been focused on increasing unsupervised MVPA behavior by fostering autonomy regarding MVPA goals and related self-management and decisionmaking skills. Marrero et al 16 provided three educational sessions that included 45 minutes of supervised MVPA and related selfmanagement instruction to sedentary adolescents with type 1 diabetes, followed by 12 weeks when they were instructed to perform the same routine independently three times per week guided by a collection of videos from which they could select MVPA routines according to personal preference and abilities.…”

mentioning

confidence: 99%

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Feasibility and safety of a group physical activity program for youth with type 1 diabetes

et al. 2019

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Background/Objective Many adolescents with type 1 diabetes do not achieve 60 minutes of daily moderate‐to‐vigorous intensity physical activity (MVPA). Recognizing the importance of peer influence during adolescence, we evaluated the feasibility and safety of a group MVPA intervention for this population. Methods Eighteen adolescents with type 1 diabetes (age 14.1 ± 2 .3 years, female 67%, black or Latino 67%, median body mass index 92%‘ile, A1c 79.9 ± 25.1 mmol/mol, 9.5 ± 2.3%). Intervention sessions (35 minutes MVPA and 45 minutes discussion) occurred 1×/week for 12 weeks. Feasibility and safety metrics were enrollment, completion of intervention and assessments, cost, and hypoglycemia rates. Participants completed MVPA (accelerometry), and exploratory nutritional, psychosocial, clinical, and fitness variable assessments at baseline, 3 months, and 7 months. Hedges' effect sizes were calculated. Results Enrollment was 16%, and intervention completion was 56%. Assessment completion at 7 months was 67% for MVPA, nutrition, and fitness, 83% for psychosocial assessments, and 94% for clinical assessments. Cost was $1241 per completing participant. One episode of mild hypoglycemia occurred during the sessions (0.6%). Self‐reported daily fruit/vegetable servings (d = −0.72) and diabetes self‐management behaviors decreased over time (d = −0.40). In the 10 completers, endurance run score improved (d = 0.49) from low baseline levels, while systolic blood pressure decreased (d = −0.75) and low‐density lipoprotein increased (d = 0.49) but stayed within normal ranges. Conclusions The protocol for the group MVPA intervention was safe and had some feasibility metrics meriting further investigation. MVPA levels and glycemic control remained suboptimal, suggesting the need for more intensive interventions for this population.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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confidence: 99%

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confidence: 99%

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Feasibility and safety of a group physical activity program for youth with type 1 diabetes

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“…Basal insulin delivery should be reduced by about 20% overnight to protect against postexercise, late-onset hypoglycemia (6). Being able to identify children with T1D at risk for nocturnal hypoglycemia based on daily activity levels would help make activity-based changes to evening insulin levels more intuitive for patients and practitioners.…”

Section: Commentmentioning

confidence: 99%

Advances in Exercise, Physical Activity, and Diabetes

Zaharieva

McGaugh

Davis

et al. 2020

Diabetes Technology & Therapeutics

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Cardiorespiratory Fitness and Physical Activity in Pediatric Diabetes

Steiman De Visser,

Fast,

Brunton

et al. 2024

JAMA Netw Open

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ImportanceIt is unclear whether cardiorespiratory fitness (CRF) and physical activity are lower among youths with type 1 diabetes (T1D) and type 2 diabetes (T2D) compared with youths without diabetes.ObjectiveTo describe the magnitude, precision, and constancy of the differences in CRF and physical activity among youths with and without diabetes.Data SourcesMEDLINE, Embase, CINAHL, and SPORTDiscus were searched from January 1, 2000, to May 1, 2022, for eligible studies.Study SelectionObservational studies with measures of CRF and physical activity in children and adolescents aged 18 years or younger with T1D or T2D and a control group were included.Data Extraction and SynthesisData extraction was completed by 2 independent reviewers. A random-effects meta-analysis model was used to estimate differences in main outcomes. The pooled effect estimate was measured as standardized mean differences (SMDs) with 95% CIs. The Preferred Reporting Items for Systematic Review and Meta-Analyses guideline was followed.Main Outcomes and MeasuresThe main outcomes were objectively measured CRF obtained from a graded maximal exercise test and subjective or objective measures of physical activity. Subgroup analyses were performed for weight status and measurement type for outcome measures.ResultsOf 7857 unique citations retrieved, 9 studies (755 participants) with measures of CRF and 9 studies (1233 participants) with measures of physical activity for youths with T2D were included; for youths with T1D, 23 studies with measures of CRF (2082 participants) and 36 studies with measures of PA (12 196 participants) were included. Random-effects models revealed that directly measured CRF was lower in youths with T2D (SMD, −1.06; 95% CI, −1.57 to −0.56; I2 = 84%; 9 studies; 755 participants) and in youths with T1D (SMD, −0.39; 95% CI, −0.70 to −0.09; I2 = 89%; 22 studies; 2082 participants) compared with controls. Random-effects models revealed that daily physical activity was marginally lower in youths with T1D (SMD, −0.29; 95% CI, −0.46 to −0.11; I2 = 89%; 31 studies; 12 196 participants) but not different among youths with T2D (SMD, −0.56; 95% CI, −1.28 to 0.16; I2 = 91%; 9 studies; 1233 participants) compared with controls. When analyses were restricted to studies with objective measures, physical activity was significantly lower in youths with T2D (SMD, −0.71; 95% CI, −1.36 to −0.05; I2 = 23%; 3 studies; 332 participants) and T1D (SMD, −0.67; 95% CI, −1.17 to −0.17; I2 = 93%; 12 studies; 1357 participants) compared with controls.Conclusions and RelevanceThese findings suggest that deficits in CRF may be larger and more consistent in youths with T2D compared with youths with T1D, suggesting an increased risk for cardiovascular disease–related morbidity in adolescents with diabetes, particularly among those with T2D. The findings reinforce calls for novel interventions to empower youths living with diabetes to engage in regular physical activity and increase their CRF.

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ISPAD Clinical Practice Consensus Guidelines 2018: Exercise in children and adolescents with diabetes

Cited by 161 publications

References 146 publications

Feasibility and safety of a group physical activity program for youth with type 1 diabetes

Feasibility and safety of a group physical activity program for youth with type 1 diabetes

Advances in Exercise, Physical Activity, and Diabetes

Cardiorespiratory Fitness and Physical Activity in Pediatric Diabetes

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