Does Exercise Improve Glycaemic Control in Type 1 Diabetes? A Systematic Review and Meta-Analysis

Kennedy, Amy; Nirantharakumar, Krishnarajah; Chimen, Myriam; Pang, Terence; Hemming, Karla; Andrews, Robert C.; Narendran, Parth

doi:10.1371/journal.pone.0058861

Cited by 145 publications

(153 citation statements)

References 27 publications

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“…Our study detected improvements in mean HDL of 4.7% (8-30% in published studies), triglyceride of 10% (13-15% in published studies) and insulin resistance of 20% (up to 23% in published studies). In line with other studies, there was no improvement in glycaemic control with exercise [29].…”

Section: Discussionsupporting

confidence: 91%

Exercise to preserve β‐cell function in recent‐onset Type 1 diabetes mellitus (EXTOD) – a randomized controlled pilot trial

et al. 2017

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Aim Residual b-cell function is present at the time of diagnosis with Type 1 diabetes. Preserving this b-cell function reduces complications. We hypothesized that exercise preserves b-cell function in Type 1 diabetes and undertook a pilot trial to address the key uncertainties in designing a definitive trial to test this hypothesis.Methods A randomized controlled pilot trial in adults aged 16-60 years diagnosed with Type 1 diabetes within the previous 3 months was undertaken. Participants were assigned to control (usual care) or intervention (exercise consultation every month), in a 1 : 1 ratio for 12 months. The primary outcomes were recruitment rate, drop out, exercise adherence [weeks with ≥ 150 min of self-reported moderate to vigorous physical activity (MVPA)], and exercise uptake in the control group. The secondary outcomes were differences in insulin sensitivity and rate of loss of b-cell function between intervention and control at 6 and 12 months.Results Of 507 individuals who were approached, 58 (28 control, 30 intervention) entered the study and 41 completed it. Participants were largely white European males, BMI 24.8 AE 3.8 kg/m 2 , HbA 1c 75 AE 25 mmol/mol (9 AE 2%). Mean level of objectively measured MVPA increased in the intervention group (mean 243 to 273 min/week) and 61% of intervention participants reached the target of ≥ 150 min/week of self-reported MVPA on at least 42 weeks of the year. Physical activity levels fell slightly in the control group (mean 277 to 235 min of MVPA/week). There was exploratory evidence that intervention group became more insulin sensitive and required less insulin. However, the rate of loss of b-cell function appeared similar between the groups, although the change in insulin sensitivity may have affected this.Conclusion We show that it is possible to recruit and randomize people with newly diagnosed Type 1 diabetes to a trial of an exercise intervention, and increase and maintain their exercise levels for 12 months. Future trials need to incorporate measures of greater adherence to exercise training targets, and include more appropriate measures of b-cell function. (Clinical Trials

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Section: Discussionsupporting

confidence: 91%

Exercise to preserve β‐cell function in recent‐onset Type 1 diabetes mellitus (EXTOD) – a randomized controlled pilot trial

et al. 2017

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“…Yardley et al (2014) found a significant reduction in post-treatment HbA1c in four out of six studies but there was also one trial which showed no decrease at all [8]. Another even larger meta-analysis could not find evidence for a glycaemic benefit of exercise when followed by HbA1c [7], thus the issue remains unsolved.…”

Section: Discussionmentioning

confidence: 99%

“…Current literature is inconsistent whether exercise has a meaningful effect on HbA1c [6][7][8]. Beraki et al (2014) reported lower HbA1c levels in active persons with diabetes than in sedentary ones in a large cohort [6].…”

Section: Discussionmentioning

confidence: 99%

“…Beraki et al (2014) reported lower HbA1c levels in active persons with diabetes than in sedentary ones in a large cohort [6]. Additionally, two recent meta-analyses found different results of whether exercise improves glucose control or not [7,8]. Yardley et al (2014) found a significant reduction in post-treatment HbA1c in four out of six studies but there was also one trial which showed no decrease at all [8].…”

Section: Discussionmentioning

confidence: 99%

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Physical activity does not inevitably improve quality of life in young adults with type 1 diabetes

Häyrinen

Tarkka

2016

Diabetes Research and Clinical Practice

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“…The majority of research investigating the impact of exercise in persons with type 1 diabetes is limited to exercise durations for up to 2 hours per session [22,23]. As such, most information on glycemic control during and after prolonged physical activity (>2 h) can be considered as 'anecdotal evidence'.…”

Section: Discussionmentioning

confidence: 99%

Glycemic control during consecutive days with prolonged walking exercise in individuals with type 1 diabetes mellitus

Dijk

Eijsvogels

Nyakayiru

et al. 2016

Diabetes Research and Clinical Practice

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Running title: prolonged physical activity in type 1 diabetes Word count abstract: 239Word count main text: 3182 Tables: 1 Figures: 4 Trial number: NTR4061, www.trialregister.nl ABSTRACT Aims: Despite its general benefits for health, exercise complicates the maintenance of stable blood glucose concentrations in individuals with type 1 diabetes. The aim of the current study was to examine changes in food intake, insulin administration, and 24-h glycemic control in response to consecutive days with prolonged walking exercise (~8 h daily) in individuals with type 1 diabetes. Methods:Ten individuals with type 1 diabetes participating in the worlds' largest walking event were recruited for this observational study. Simultaneous measurements of 24-h glycemic control (continuous glucose monitoring), insulin administration and food intake were performed during a non-walking day (control) and during three subsequent days with prolonged walking exercise (daily distance 40 or 50 km). Results:Despite an increase in daily energy (31±18%; p<0.01) and carbohydrate (82±71g; p<0.01) intake during walking days, subjects lowered their insulin administration by 26±16% relative to the control day (p<0.01). Average 24-h blood glucose concentrations, the prevalence of hyperglycemia (blood glucose >10 mmol/L) and hypoglycemia (blood glucose <3.9 mmol/L) did not differ between the control day and walking days (p>0.05 for all variables). The prolonged walking exercise was associated with a modest increase in glycemic variability compared with the control day (p<0.05). Conclusion:Prolonged walking exercise allows for profound reductions in daily insulin administration in persons with type 1 diabetes, despite large increments in energy and carbohydrate intake. When taking such adjustments into account, prolonged moderate-intensity exercise does not necessarily impair 24-h glycemic control.

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Does Exercise Improve Glycaemic Control in Type 1 Diabetes? A Systematic Review and Meta-Analysis

Cited by 145 publications

References 27 publications

Exercise to preserve β‐cell function in recent‐onset Type 1 diabetes mellitus (EXTOD) – a randomized controlled pilot trial

Exercise to preserve β‐cell function in recent‐onset Type 1 diabetes mellitus (EXTOD) – a randomized controlled pilot trial

Physical activity does not inevitably improve quality of life in young adults with type 1 diabetes

Glycemic control during consecutive days with prolonged walking exercise in individuals with type 1 diabetes mellitus

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