Physical activity and cardiometabolic health in adolescents with type 2 diabetes: a cross-sectional study

Abstract

IntroductionYouth living with type 2 diabetes display increased risk of cardiovascular disease (CVD). It is unclear if regular physical activity (PA) modifies this risk.Research design and methodsWe compared CVD risk factors in a cross-sectional study of 164 youth with type 2 diabetes stratified according to weekly vigorous-intensity PA. Outcomes were hemoglobin A1c (HbA1c), ambulatory blood pressure (BP; ambulatory 24-hour readings), plasma lipoproteins, and albuminuria. The main exposure, vigorous-intensity PA, was quantified with the Adolescent Physical Activity Recall Questionnaire.ResultsYouth were 15±3 years, and 78% lived rurally and 68% were female, with a mean body mass index (BMI) Z-score of 2.4±1.1 and a mean HbA1c of 9.6% ±2.6%. Youth who participated in regular vigorous-intensity PA (40%; n=67) achieved nearly twice the dose of PA than peers who did not (62 vs 34 metabolic equivalent score-hour/week, p=0.001). After adjusting for duration of diabetes, BMI Z-score, sex, and smoking, youth who engaged in vigorous-intensity PA displayed lower HbA1c (9.1% vs 9.9%, p=0.052), diastolic BP (70 mm Hg vs 73 mm Hg, p=0.002), diastolic load (20% vs 26%, p=0.023), and mean arterial pressure (87.3 mm Hg vs 90.3 mm Hg, p<0.01), compared with youth who did not. Compared with youth who did not participate in regular vigorous-intensity PA, those who did also displayed lower odds of albuminuria after adjusting for duration of diabetes, sex, smoking, rural residence, and BMI Z-score (adjusted OR: 0.40, 95% CI 0.19 to 0.84).ConclusionsAmong youth with type 2 diabetes, participation in vigorous-intensity PA is associated with lower CVD risk.

ISPAD Clinical Practice Consensus Guidelines 2022: Exercise in children and adolescents with diabetes

“…The largest study ( n = 588) relied on surveys delivered during clinic visits and found that adolescents with T2D who report being active on three or more days per week display lower HbA1c levels and higher high density lipoprotein cholesterol, compared to less active adolescents 77 . A recent observational study from Canada found that that physically active adolescents with T2D were 40% less likely to have albuminuria (aOR: 0.60; 95% CI: 0.19, 0.84) and 50% less likely to have HbA1clevels above 8.0% (>60 mmol/mol; aOR: 0.50; 95% CI: 0.26, 0.98) 17 . Adolescents with T2D who engaged in regular vigorous intensity activity also observed a trend towards lower odds of nocturnal hypertension (aOR: 0.54; 95% CI: 0.27, 1.07).…”

“…76 For youth with T2D, there is little evidence for the influence of duration, type, or intensity of exercise on acute glycemic excursions or glucose time-in-range. Cross-sectional studies suggest that more frequent bouts of structured PA, 77 particularly vigorous intensity structured activity 17 are associated with improved glycemia and cardiometabolic risk factors.…”

“…84 For youth with diabetes, doing regular PA, prolonged periods of hyperglycemia caused by exercise, or the fear of developing hypoglycemia from exercise may negatively influence achieving overall glycemic management targets. Nonetheless, similar to youth with T2D, 17,77 days with increased PA may improve the likelihood of achieving glycemic targets in youth with T1D compared to days with inactivity. 85 There are currently no data on exercise performance and glycemia in youth with T2D.…”

“…Regular PA is one of the cornerstones of diabetes management 17,18 . Despite this, over the years, PA levels in children have decreased in many countries with <10% of the global population of youth meeting the current 24‐Hour Movement Guidelines 19 .…”

The relationship between physical activity and diabetes in middle-aged and elderly people

“…[ 6 ] Persistent hyperglycemia will damage different organs and systems of the body. [ 7 ] For example, the incidence of lower limb amputation, myocardial infarction, visual impairment, and renal failure in patients with diabetes is higher than that in normal people. Physical dysfunction, decreased physical control ability, falls, urinary incontinence, pain, depression, and dementia are also very common among the elderly with diabetes.…”