Effect of physical exercise on glycaemic control in children and adolescents with type-1 diabetes mellitus

Abstract

Children and adolescents with Type 1 diabetes need to lead a healthy life as possible to avoid further health complications, however they still have a life ahead which they need to enjoy as much as possible. Unfortunately, there is a tendency that their parents are overprotective and although they control their kids’ diet, some tend to reduce physical exertion to avoid possible hypoglycaemic episodes. The main aim of this research was to critically appraise studies that evaluated the relationship between exercise (aerobic, resistance or combination) and glycaemic control in children and adolescents with Type 1 diabetes especially the possible adverse effects. Therefore, a PICO question was developed: In children and adolescents with Type 1 diabetes mellitus, does physical exercise improve glycaemic control? Initially, an inclusion and exclusion criteria were established which served as a guideline through the literature search process and facilitated the selection of studies pertaining to the PICO question. Keywords were identified using the Medical Subject Headings (MeSH) and combined together so as to retrieve relevant articles. A systematic search was conducted in several databases followed by manual hand search through the reference lists of the excluded articles. The search yielded eight studies; three systematic reviews with meta-analyses and five randomised controlled trials. The studies were assessed for their methodological rigour with the help of Critical Appraisal Skills Programme (CASP) and Quality of Reporting of Metaanalyses (QUORUM) depending on study design. Results differed between studies with the majority indicating that exercise improved glycaemic control in the population under study. Whilst some studies found a significant reduction in HbA1c values, other studies found a significant reduction in insulin dosages or in both outcome measures following the intervention. However, in other studies either no significance difference was found or there was even an increase in HbA1c values. Possible confounding factors such as diet, insulin fluctuations and adverse reactions may have influenced HbA1c values obtained. Several recommendations have been discussed to enhance future research as well as local practice, education and public health policy. Multicentre trials may aid in conducting larger scale studies and participants need to report in detail confounding factors. Studies need to be of longer duration, mixed intervention (aerobic and resistance) and at least 60 minutes three times per week so as to establish an outcome effect. Malta would also benefit from local research and local guidelines can be built upon study findings.