Features of glycemic management in children and adolescents with type 1 diabetes mellitus during systematic physical activity

Introduction. Achieving and maintaining stable glycemic levels in children with type 1 diabetes (T1D) who are regularly engaged in physical activity (PA) represents a complex clinical challenge that requires a multidisciplinary team approach.

Aim. To study the characteristics of blood glucose fluctuations in children with T1DM during regular physical activity, and to develop, on this basis, practical personalized recommendations for the prevention of complications and improving the effectiveness of long-term disease management.

Materials and methods. This retrospective study included 60 children and adolescents aged 6 to 17 years with T1D. The following parameters were assessed: glycated hemoglobin (HbA1c), time in range (TIR), time above range (TAR), and time below range (TBR). Statistical analysis was performed using StatTech software v. 4.5.0.

Results. No statistically significant differences in HbA1c, TIR, TAR, and TBR were found between patients using insulin pump therapy and those on multiple daily injections. Regular glycemic monitoring during exercise sessions was associated with significantly higher TIR (77.21% vs. 64.33%) and lower TAR. Each additional minute of exercise duration was associated with a 0.111% increase in TIR and a 0.135% decrease in TAR. Impaired hypoglycemia awareness was more common in children under 10 years of age and was associated with HbA1c levels > 6.8%.

Conclusions. Both insulin delivery methods (pump therapy and multiple daily injections) provide comparable glycemic control in physically active patients with T1DM. The key success factor is regular glucose monitoring. Longer exercise sessions are associated with improved glycemic outcomes. Impaired hypoglycemia awareness requires special attention in younger children. These findings emphasize the importance of a multidisciplinary approach to ensuring safe and effective physical activity in patients with T1D.

1. Fitzpatrick R, Davison G, Wilson JJ, McMahon G, McClean C. Exercise, type 1 diabetes mellitus and blood glucose: The implications of exercise timing. Front Endocrinol. 2022;13:1021800. https://doi.org/10.3389/fendo.2022.1021800.

2. Curran M, Drayson MT, Andrews RC, Zoppi C, Barlow JP, Solomon TPJ, Narendran P. The benefits of physical exercise for the health of the pancreatic β-cell: a review of the evidence. Exp Physiol. 2020;105(4):579–589. https://doi.org/10.1113/EP088220.

3. Valli G, Minnock D, Tarantino G, Neville RD. Delayed effect of different exercise modalities on glycaemic control in type 1 diabetes mellitus: A systematic review and meta-analysis. Nutr Metab Cardiovasc Dis. 2021;31(3):705–716. https://doi.org/10.1016/j.numecd.2020.12.006.

4. Cunha VN, de Paula Lima M, Motta-Santos D, Pesquero JL, de Andrade RV, de Almeida JA et al. Role of exercise intensity on GLUT4 content, aerobic fitness and fasting plasma glucose in type 2 diabetic mice. Cell Biochem Funct. 2015;33(7):435–442. https://doi.org/10.1002/cbf.3128.

5. Cigrovski Berkovic M, Bilic-Curcic I, La Grasta Sabolic L, Mrzljak A, Cigrovski V. Fear of hypoglycemia, a game changer during physical activity in type 1 diabetes mellitus patients. World J Diabetes. 2021;12(5):569–577. https://doi.org/10.4239/wjd.v12.i5.569.

6. Montt-Blanchard D, Sánchez R, Dubois-Camacho K, Leppe J, Onetto MT. Hypoglycemia and glycemic variability of people with type 1 diabetes with lower and higher physical activity loads in free-living conditions using continuous subcutaneous insulin infusion with predictive lowglucose suspend system. BMJ Open Diabetes Res Care. 2023;11(2):e003082. https://doi.org/10.1136/bmjdrc-2022-003082.

7. Lee AS, Way KL, Johnson NA, Twigg SM. High-intensity interval exercise and hypoglycaemia minimisation in adults with type 1 diabetes: A randomised cross-over trial. J Diabetes Complications. 2020;34(3):107514. https://doi.org/10.1016/j.jdiacomp.2019.107514.

8. de Assis RC, Celedonio RF, Valentim AB, Monteiro GR, da Silva AMH, Dantas ACP, Maia CSC. Influence of Anaerobic Exercise in Type 1 Diabetes Mellitus Biomarkers: ASystematic Review. Curr Diabetes Rev. 2024;20(9):e230124226018. https://doi.org/10.2174/0115733998274125231126111321.

9. García-Hermoso A, Ezzatvar Y, Huerta-Uribe N, Alonso-Martínez AM, Chueca-Guindulain MJ, Berrade-Zubiri S et al. Effects of exercise training on glycaemic control in youths with type 1 diabetes: A systematic review and meta-analysis of randomised controlled trials. Eur J Sport Sci. 2023;23(6):1056–1067. https://doi.org/10.1080/17461391.2022.2086489.

10. Keyu G, Jiaqi L, Liyin Z, Jianan Y, Li F, Zhiyi D et al. Comparing the effectiveness of continuous subcutaneous insulin infusion with multiple daily insulin injection for patients with type 1 diabetes mellitus evaluated by retrospective continuous glucose monitoring: A real-world data analysis. Front Public Health. 2022;10:990281. https://doi.org/10.3389/fpubh.2022.990281.

11. de Bock M, Codner E, Craig ME, Huynh T, Maahs DM, Mahmud FH et al. ISPAD Clinical Practice Consensus Guidelines 2022: Glycemic targets and glucose monitoring for children, adolescents, and young people with diabetes. Pediatr Diabetes. 2022;23(8):1270–1276. https://doi.org/10.1111/pedi.13455.

12. Yeh HC, Brown TT, Maruthur N, Ranasinghe P, Berger Z, Suh YD et al. Comparative effectiveness and safety of methods of insulin delivery and glucose monitoring for diabetes mellitus: a systematic review and meta-analysis. Ann Intern Med. 2012;157(5):336–347. https://doi.org/10.7326/0003-4819-157-5-201209040-00508.

13. Tauschmann M, Hovorka R. Technology in the management of type 1 diabetes mellitus – current status and future prospects. Nat Rev Endocrinol. 2018;14(8):464–475. https://doi.org/10.1038/s41574-018-0044-y.

14. Battelino T, Danne T, Bergenstal RM, Amiel SA, Beck R, Biester T et al. Clinical Targets for Continuous Glucose Monitoring Data Interpretation: Recommendations From the International Consensus on Time in Range. Diabetes Care. 2019;42(8):1593–1603. https://doi.org/10.2337/dci19-0028.

15. Beato-Víbora PI, Quirós-López C, Lázaro-Martín L, Martín-Frías M, Barrio-Castellanos R, Gil-Poch E et al. Impact of Sensor-Augmented Pump Therapy with Predictive Low-Glucose Suspend Function on Glycemic Control and Patient Satisfaction in Adults and Children with Type 1 Diabetes. Diabetes Technol Ther. 2018;20(11):738–743. https://doi.org/10.1089/dia.2018.0199.

16. Adolfsson P, Taplin CE, Zaharieva DP, Pemberton J, Davis EA, Riddell MC et al. ISPAD Clinical Practice Consensus Guidelines 2022: Exercise in children and adolescents with diabetes. Pediatr Diabetes. 2022;23(8):1341–1372. https://doi.org/10.1111/pedi.13452.

17. Riddell MC, Scott SN, Fournier PA, Colberg SR, Gallen IW, Moser O et al. The competitive athlete with type 1 diabetes. Diabetologia. 2020;63(8):1475–1490. https://doi.org/10.1007/s00125-020-05183-8.

18. Tagougui S, Taleb N, Legault L, Suppère C, Messier V, Boukabous I et al. A single-blind, randomised, crossover study to reduce hypoglycaemia risk during postprandial exercise with closed-loop insulin delivery in adults with type 1 diabetes: announced (with or without bolus reduction) vs unannounced exercise strategies. Diabetologia. 2020;63(11):2282–2291. https://doi.org/10.1007/s00125-020-05244-y.

19. Heinemann L, Freckmann G, Ehrmann D, Faber-Heinemann G, Guerra S, Waldenmaier D, Hermanns N. Real-time continuous glucose monitoring in adults with type 1 diabetes and impaired hypoglycaemia awareness or severe hypoglycaemia treated with multiple daily insulin injections (HypoDE): a multicentre, randomised controlled trial. Lancet. 2018;391(10128):1367–1377. https://doi.org/10.1016/S0140-6736(18)30297-6.

20. Amiel SA, Potts L, Goldsmith K, Jacob P, Smith EL, Gonder-Frederick L, Heller S et al. A parallel randomised controlled trial of the Hypoglycaemia Awareness Restoration Programme for adults with type 1 diabetes and problematic hypoglycaemia despite optimised self-care (HARPdoc). Nat Commun. 2022;13(1):2229. https://doi.org/10.1038/s41467022-29488-x.