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Do youth with type 1 diabetes exercise safely? A focus on patient practices and glycemic outcomes
Author(s) -
Roberts Alissa J.,
YiFrazier Joyce P.,
Aitken Karen E.,
Mitrovich Connor A.,
Pascual Michael F.,
Taplin Craig E.
Publication year - 2017
Publication title -
pediatric diabetes
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.678
H-Index - 75
eISSN - 1399-5448
pISSN - 1399-543X
DOI - 10.1111/pedi.12402
Subject(s) - medicine , bedtime , glycemic , type 1 diabetes , hypoglycemia , insulin , insulin pump , basal (medicine) , regimen , diabetes mellitus , physical therapy , type 2 diabetes , basal insulin , endocrinology
Objective Insulin adjustments have been shown to reduce glycemic excursions during and after exercise, but little is known about their use in youth with type 1 diabetes (T1D). We aimed to assess practices in youth with T1D around exercise, assess factors that influence practices, and examine associations between key behaviors and glycemic outcomes. Research design and methods We developed the ‘Type 1 Diabetes Report of Exercise Practices Survey (T1D‐REPS)’ and piloted this tool in 100 youth with T1D on an insulin pump. Participants completed a 3‐day physical activity recall and 30 days of pump/glucose data were collected. Chart review was conducted for key clinical measures. Results Eighty‐four percent of participants modified their insulin regimen around exercise; only 40% reported adjusting prandial insulin immediately before exercise while 68% reported some modification (suspension or decrease) of basal insulin during exercise. Following exercise, only 10% reported reducing overnight basal insulin. Those who performed ≥ 5 glucose checks/day adjusted basal insulin during exercise more frequently than those with fewer daily glucose checks (33% vs. 13%, p = 0.05, chi‐squared = 3.7), and were more likely to report decreasing insulin dose for the bedtime snack following exercise (50% vs. 17%, p = 0.004, chi‐squared = 8.2). Conclusions Despite several studies showing the frequency of hypoglycemia during and after exercise, many youth are not adjusting insulin for exercise. A tool designed to capture patient practices and provide clinicians with a framework for patient education may lead to improved safety around exercise in youth with T1D.