The Effects of Aerobic Exercise on Glucose and Counterregulatory Hormone Concentrations in Children With Type 1 Diabetes

Tansey, Michael; Tsalikian, Eva; Beck, Roy W.; Mauras, Nelly; Buckingham, Bruce A.; Weinzimer, Stuart A.; Janz, Kathleen F.; Kollman, Craig; Xing, Dongyuan; Ruedy, Katrina J.; Steffes, Michael W.; Borland, Timothy M.; Singh, Ravinder J.; Tamborlane, William V.

doi:10.2337/diacare.29.1.20

Cited by 51 publications

(14 citation statements)

References 9 publications

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“…We observed a higher incidence of hypoglycemia during exercise and during the night following exercise versus after a sedentary day in adolescents with type 1 diabetes (1,2). Although hypoglycemia decreased by discontinuing the insulin pump during exercise, significant rebound hyperglycemia was observed (3).…”

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confidence: 70%

Effects of Glutamine on Glycemic Control During and After Exercise in Adolescents With Type 1 Diabetes

et al. 2010

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OBJECTIVETo investigate if oral glutamine ameliorates exercise and postexercise nighttime hypoglycemia in type 1 diabetic adolescents.RESEARCH DESIGN AND METHODSTen adolescents (15.2 ± 1.4 years [SD], A1C 6.9 ± 0.9%) on insulin pumps were studied. The subjects were randomized to receive a glutamine or placebo drink pre-exercise and at bedtime (0.25 g/kg/dose). A 3:00 p.m. exercise session consisted of four 15-min treadmill/5-min rest cycles. Pre-exercise blood glucose was 140–150 mg/dl and was monitored throughout the night. Studies were randomized crossover over 3 weeks.RESULTSBlood glucose levels dropped comparably (52%) during exercise on both days. However, the overnight number of hypoglycemic events was higher on glutamine than placebo (≤70 mg/dl, P = 0.03 and ≤60, P = 0.05). The cumulative probability of nighttime hypoglycemia was increased on glutamine days (80%) versus placebo days (50%) (P = 0.02).CONCLUSIONSGlutamine increased the cumulative probability of postexercise overnight hypoglycemia compared with placebo in adolescents with type 1 diabetes. Whether glutamine may enhance insulin sensitivity postexercise requires further study in type 1 diabetes.

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confidence: 70%

Effects of Glutamine on Glycemic Control During and After Exercise in Adolescents With Type 1 Diabetes

et al. 2010

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“…31 Physical activity is another key determinant of glucose excursions and must be considered in optimal insulin dosing. 32 …”

Section: Discussionmentioning

confidence: 99%

Glycemic Control in Youth with Diabetes: The SEARCH for Diabetes in Youth Study

Petitti

Klingensmith

Bell

et al. 2009

The Journal of Pediatrics

365

301

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Objective To assess correlates of glycemic control in a diverse population of children and youth with diabetes. Study design This was a cross-sectional analysis of data from a 6-center US study of diabetes in youth, including 3947 individuals with type 1 diabetes (T1D) and 552 with type 2 diabetes (T2D), using hemoglobin A1c (HbA1c) levels to assess glycemic control. Results HbA1c levels reflecting poor glycemic control (HbA1c ≥ 9.5%) were found in 17% of youth with T1D and in 27% of those with T2D. African-American, American Indian, Hispanic, and Asian/Pacific Islander youth with T1D were significantly more likely to have higher HbA1c levels compared with non-Hispanic white youth (with respective rates for poor glycemic control of 36%, 52%, 27%, and 26% vs 12%). Similarly poor control in these 4 racial/ethnic groups was found in youth with T2D. Longer duration of diabetes was significantly asso*ciated with poorer glycemic control in youth with T1D and T2D. Conclusions The high percentage of US youth with HbA1c levels above the target value and with poor glycemic control indicates an urgent need for effective treatment strategies to improve metabolic status in youth with diabetes.

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“…Many factors collectively make patients with type 1 diabetes vulnerable to severe hypoglycemic events, including early loss of the plasma glucagon responses to hypoglycemia, blunted epinephrine responses during sleep, impaired glucose counter regulation resulting from recurrent episodes of mild hypoglycemia especially during the night, progressive loss of the modulating effects of residual endogenous insulin secretion (4-6), and the immediate and delayed glucose-lowering effects of aerobic exercise (7). Since publication of the results of the landmark Diabetes Control and Complications Trial (DCCT), the aim of treatment of T1D has been to achieve target glycemic control to minimize vascular complications while attempting to avoid hypoglycemia (1, 8).…”

Section: Introductionmentioning

confidence: 99%

Severe hypoglycemia and diabetic ketoacidosis among youth with type 1 diabetes in the T1D Exchange clinic registry

et al. 2013

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Objective Severe hypoglycemia (SH) and diabetic ketoacidosis (DKA) are common serious acute complications of type 1 diabetes (T1D). The aim of this study was to determine the frequency of SH and DKA and identify factors related to their occurrence in the T1D Exchange pediatric and young adult cohort. Research Design and Methods The analysis included 13,487 participants in the T1D Exchange clinic registry aged 2-<26 years with T1D ≥2 years. Separate logistic regression models were used to evaluate the association of baseline demographic and clinical factors with the occurrence of SH or DKA in the prior 12 months. Results Non-White race, no private health insurance and lower household income were associated with higher frequencies of both SH and DKA (p<0.001). SH frequency was highest in children <6 years old (p=0.005), but across the age range, SH was not associated with HbA1c levels after controlling for other factors (p=0.72). DKA frequency was highest in adolescents (p<0.001) and associated with higher HbA1c (p<0.001). Conclusions Our data show that poor glycemic control increases the risk of DKA but does not protect against severe hypoglycemia in youth and young adults with type 1 diabetes. The high frequencies of SH and DKA observed in disadvantaged minorities with T1D highlight the need for targeted interventions and new treatment paradigms for patients in these high risk groups.

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The Effects of Aerobic Exercise on Glucose and Counterregulatory Hormone Concentrations in Children With Type 1 Diabetes

Cited by 51 publications

References 9 publications

Effects of Glutamine on Glycemic Control During and After Exercise in Adolescents With Type 1 Diabetes

Effects of Glutamine on Glycemic Control During and After Exercise in Adolescents With Type 1 Diabetes

Glycemic Control in Youth with Diabetes: The SEARCH for Diabetes in Youth Study

Severe hypoglycemia and diabetic ketoacidosis among youth with type 1 diabetes in the T1D Exchange clinic registry

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