Open Access
Effects of exercise training on glycaemic control in youths with type 1 diabetes: a systematic review and meta-analysis of randomised controlled trials
(Taylor & Francis, 2022) García Hermoso, Antonio; Ezzatvar, Yasmin; Huerta Uribe, Nidia; Alonso Martínez, Alicia; Chueca-Guindulain, María J.; Berrade-Zubiri, Sara; Izquierdo Redín, Mikel; Ramírez Vélez, Robinson; Ciencias de la Salud; Osasun Zientziak
The aim of the study is to evaluate whether exercise interventions are associated with improved glycaemic control in children and adolescents with type 1 diabetes mellitus (T1DM), and to examine its relationship with the characteristics of the intervention (i.e. type, intensity, length, and duration of the sessions). Eligible criteria were randomised controlled trials of youth aged 6– 18 years with T1DM, participating in an exercise-based intervention where glycaemic control is measured (i.e. glycated haemoglobin [HbA1c]). Pooled effect sizes (Hedges’g) were calculated using random-effects inverse-variance analyses. Fourteen studies enrolling 509 patients were analysed. Effect size was expressed as Hedges’ g to correct for possible small sample bias. Overall, HbA1c levels in the exercise group (g = –0.38 95% confidence interval [CI], –0.66 to –0.11; mean difference [MD] = –0.62%) were reduced compared with the control group. Concurrent training (g = –0.63 95%CI, –1.05 to –0.21), high-intensity exercise (g = –0.43 95%CI, –0.83 to –0.03), interventions ≥24 weeks (g = –0.92 95%CI, –1.44 to –0.40), and sessions ≥60 minutes (g = –0.71 95%CI, –1.05 to –0.08) showed larger changes (MD = –0.66% to 1.30%). In conclusion, our study suggests that programmes longer than 24 weeks with at least 60 min/session of high-intensity concurrent exercise may serve as a supportive therapy to metabolic control in youth with T1DM.
Open Access
Incidence of type 1 diabetes mellitus in children and adolescents under 20 years of age across 55 countries from 2000 to 2022: a systematic review with meta-analysis
(Wiley, 2023) Hormazábal Aguayo, Ignacio; Ezzatvar, Yasmin; Huerta Uribe, Nidia; Ramírez Vélez, Robinson; Izquierdo Redín, Mikel; García Hermoso, Antonio; Ciencias de la Salud; Osasun Zientziak
Aims: the aim of this study was to determine the global incidence of type 1 diabetes mellitus (T1DM) in children and adolescents under 20 years of age from 2000 to 2022. Materials and methods: two reviewers searched three electronic databases (PubMed, Web of Science, and CINAHL) for studies published between January 2000 and November 2022. Pooled estimates of T1DM incidence with a 95% confidence interval (CI) per 100,000 person-years were calculated by country/region, sex, age, and COVID-19 pandemic period (pre-COVID-19 and pandemic). Results: the study included 126 studies from 55 countries and 18 regions. The incidence rate (IR) of T1DM from 2000 to 2022 was 14.07 (95%CI, 12.15-16.29) per 100,000 person-years. Finland and high-income North America had the highest IR, with 56.81 (95%CI, 55.91-57.73) and 28.77 (95%CI, 26.59-31.13) per 100,000 person-years, respectively. The IR was 13.37 (95%CI, 10.60-16.88) per 100,000 person-years in boys and 13.87 (95%CI, 11.51-16.70) per 100,000 person-years in girls. There were statistically significant differences among different age ranges: 0-4 versus 5-9 and 10-14 years old (p < 0.001); 5-9 versus 15-19 (p < 0.001) and 10- 14 versus 15-19 years old (p = 0.003). Finally, during the pandemic period (2020-2022), the IR was 24.84 (95%CI, 17.16-35.96) per 100,000 person-years, which was higher but not significant compared with the prepandemic period (2017-2019) of 13.56 (95%CI, 7.49-24.56) per 100,000 person-years (p = 0.090). Conclusions: the IR of T1DM in children and adolescents under 20 years of age is substantial, especially during the pandemic period, although it varies across regions. More reliable data from additional countries are needed to determine the worldwide incidence of T1DM.
Embargo
Physical fitness and activity levels as predictors of subjective well-being in youths with type 1 diabetes mellitus: a 2-year longitudinal analysis of the diactive-1 cohort study
(Wiley, 2025-03-05) Muñoz Pardeza, Jacinto; López Gil, José Francisco; Huerta Uribe, Nidia; Hormazábal Aguayo, Ignacio; Yáñez-Sepúlveda, Rodrigo; Ezzatvar, Yasmin; Izquierdo Redín, Mikel; García Hermoso, Antonio; Ciencias de la Salud; Osasun Zientziak
Subjective well-being (SWB), including cognitive and affective components, may be influenced by the management of type 1diabetes mellitus (T1DM). Physical fitness and adherence to physical activity (PA) are associated with better glycaemic stabilityand diabetes management. However, the relationship with SWB is not yet understood. The aim of the study was to determinethe relationship between physical fitness, PA, and SWB over two years in youths with T1DM. This longitudinal study involved83 participants (aged 6–18 years; 44.6% girls) from the Diactive-1 Cohort. Physical fitness was assessed by spirometry (peak ox-ygen consumption) and dynamometry (handgrip strength). PA domains were measured using triaxial accelerometers, whereasthe number of days participating in muscle-strengthening activities was assessed using a question. The Cuestionario Único deBienestar Escolar was used to determine SWB. Glycaemic stability was determined when glycosylated hemoglobin < 7%, coef-ficient of variability ≤ 36%, and time-in-range target > 70% were met. The linear mixed models used considered three assess-ments and subject variability, showing significant associations between overall physical fitness (unstandardized beta coefficient[B] = 1.778, 95% confidence interval [CI] 0.413–3.158; p = 0.012) and total PA (B = 0.034, 95% CI 0.005–0.063; p = 0.020) withSWB. Although time did not moderate the association with physical fitness (p = 0.116), this was true for PA only in the secondyear (p = 0.020). In contrast, glycaemic stability did not moderate the associations (p > 0.05). In conclusion, physical fitness andPA are associated with greater SWB in young people with T1DM, which may play a role in the psychological aspects of diseasemanagement.
Open Access
Youth with type 1 diabetes mellitus are more inactive and sedentary than apparently healthy peers: a systematic review and meta-analysis
(Elsevier, 2023) Huerta Uribe, Nidia; Hormazábal Aguayo, Ignacio; Izquierdo Redín, Mikel; García Hermoso, Antonio; Ciencias de la Salud; Osasun Zientziak; Universidad Pública de Navarra / Nafarroako Unibertsitate Publikoa
Aims: To conduct a meta-analysis of differences in physical activity, sedentary behaviour, and physical fitness between children and adolescents with type 1 diabetes and their healthy peers. Methods: The databases EMBASE, PubMed and SportsDiscus were searched for studies. Pooled effects were calculated using random effects inverse-variance models with the Hartung–Knapp–Sidik–Jonkman adjustment. Results: Thirty-five studies were included, comprising a total of 4,751 youths (53% girls, 2,452 with type 1 diabetes). Youth with type 1 diabetes were less physically active (Cohen’s d = − 0.23, 95%CI − 0.42 to − 0.04), more sedentary (Cohen’s d = 0.33, 95%CI 0.06 to 0.61), and had lower cardiorespiratory fitness (Cohen’s d = − 0.52, 95%CI − 0.73 to − 0.31) than their healthy peers. This corresponds to –12.72 min/day of moderate-tovigorous physical activity, 63.3 min/day of sedentary time (accelerometry) and –4.07 ml/kg/min of maximum/peak oxygen consumption. In addition, young people with type 1 diabetes were less likely to meet the international physical activity recommendations than their healthy peers (odds ratio = 0.44, 95%CI 0.31 to 0.62). Conclusions: Keeping in mind the heterogeneity between studies in the design, population and assessment, our findings show that children and adolescents with type 1 diabetes seem to be less active, more sedentary, and have lower cardiorespiratory fitness levels than their healthy peers.
Open Access
Nonpharmacological interventions on glycated haemoglobin in youth with type 1 diabetes: a Bayesian network meta-analysis
(BMC, 2024-07-01) Muñoz Pardeza, Jacinto; López Gil, José Francisco; Huerta Uribe, Nidia; Hormazábal Aguayo, Ignacio; Izquierdo Redín, Mikel; García Hermoso, Antonio; Ciencias de la Salud; Osasun Zientziak
The available evidence on the impact of specific non-pharmacological interventions on glycaemic control is currently limited. Consequently, there is a need to determine which interventions could provide the most significant benefits for the metabolic health of young individuals with type 1 diabetes mellitus. The aim of this study was to identify optimal nonpharmacological interventions on glycaemic control, measured by glycated haemoglobin (HbA1c), in children and adolescents with type 1 diabetes. Systematic searches were conducted in PubMed, Web of Science, Scopus, and SPORTDiscus from inception to July 1, 2023. Randomised clinical trials (RCT) investigating nonpharmacological interventions (e.g., physical activity, nutrition, and behavioural therapies) were included. Primary outcome was change in HbA1c levels. Secondary outcome was change in daily insulin dose requirement. Seventy-four RCT with 6,815 participants (49.43% girls) involving 20 interventions were analysed using a network meta-analysis. Most interventions showed greater efficacy than standard care. However, multicomponent exercise, which includes aerobic and strength training (n = 214, standardised mean difference [SMD] =– 0.63, 95% credible interval [95% CrI] – 1.09 to – 0.16) and nutritional supplements (n = 146, SMD =– 0.49, – 0 .92 to – 0.07) demonstrated the greatest HbA1c reductions. These interventions also led to the larger decreases in daily insulin needs (n = 119, SMD =– 0.79, 95% CrI – 1.19 to – 0.34) and (n = 57, SMD =– 0.62, 95% CrI – 1.18 to – 0.12, respectively). The current study underscores non-pharmacological options such as multicomponent exercise and nutritional supplements, showcasing their potential to significantly improve HbA1c in youth with type 1 diabetes. Although additional research to confirm their efficacy is required, these approaches could be considered as potential adjuvant therapeutic options in the management of type 1 diabetes among children and adolescents.
Open Access
Is fear of hypoglycemia a major barrier to an active lifestyle in children and adolescents with type 1 diabetes? The Diactive-1 study
(Wiley, 2023) Huerta Uribe, Nidia; Chueca-Guindulain, María J.; Berrade-Zubiri, Sara; Burillo Sánchez, Elisabeth; Izquierdo Redín, Mikel; García Hermoso, Antonio; Ciencias de la Salud; Osasun Zientziak; Universidad Pública de Navarra / Nafarroako Unibertsitate Publikoa
Studies on fear of hypoglycemia as a barrier to physical activity among youth with type 1 diabetes (T1D) have been limited and controversial, most of which used self-reported assessment. The aim of the study was to evaluate the relationship between fear of hypoglycemia and physical activity and glycemic metrics in children and adolescents with T1D. Seventy-four participants (6–18 years of age; 44.6% females) with T1D were included in the study. Physical activity was assessed through accelerometry on nine consecutive days, and blood glucose metrics were simultaneously tracked using continuous glucose monitoring (time-in-range and hypoglycemic events). A closed question was used to evaluate the avoidance of physical activity due to fear of hypoglycemia. Fifteen participants (20%) reported avoiding physical activity due to fear of hypoglycemia. The group reporting no fear of hypoglycemia showed lower total physical activity (−35.33min/day, 95% confidence interval [CI] (−77.57 to −1.47)) and light physical activity (−29.81min/day, 95% CI −64.01 to −2.75) and higher sedentary time (77.95min/day, 95% CI 26.46–136.87) per day compared with those with fear of hypoglycemia. No difference was found between those patients with fear of hypoglycemia in terms of meeting the recommendations of glycated hemoglobin, glucose coefficient of variation, and time-in-range when compared to those with no fear of hypoglycemia. In conclusion, children and adolescents with fear of hypoglycemia were more active, less sedentary, and had similar glycemic metrics to those without fear. Our results therefore suggest that fear of hypoglycemia may be less of a barrier to an active lifestyle than previously believed.
Embargo
Is physical fitness associated with leucocyte telomere length in youth with type 1 diabetes?
(Springer, 2024-11-14) Muñoz Pardeza, Jacinto; López Gil, José Francisco; Huerta Uribe, Nidia; Hormazábal Aguayo, Ignacio; Ojeda-Rodríguez, Ana; Martí del Moral, Amelia; Izquierdo Redín, Mikel; García Hermoso, Antonio; Ciencias de la Salud; Osasun Zientziak
Background: in type 1 diabetes, telomere length (TL) may predict complications and could be influenced by glycaemic control and physical activity, but its relationship with physical fitness in youths remains unexplored. The aim of the study was to assess the association between physical fitness and TL in youth with type 1 diabetes, both at baseline and one year later. Methods: eighty-three children and adolescents (aged 6-18 years; 44.6% girls) with type 1 diabetes from the Diactive-1 Cohort Study were involved in this study. Physical fitness was assessed using spirometry on a cycloergometer (i.e., peak oxygen consumption), dynamometry, and maximal isometric strength (one-repetition maximum [1RM]), and muscle power. Leucocyte TL was assessed using multiplex monochrome real-time quantitative polymerase chain reaction. Results: positive cross-sectional associations were identified between 1RM (unstandardized beta coefficient [B] = 0.042, 95% bias corrected and accelerated [BCa] confidence interval [CI] 0.012-0.069), muscle power (B = 0.056, 95% BCa CI 0.02-0.250), and overall physical fitness (B = 0.043, 95% BCa CI 0.015¿0.071) with TL independent of maturation, glycated haemoglobin, and diabetes duration. However, no associations were observed one year later. Conclusion: higher levels of fitness, particularly muscle strength, may play a role in telomere dynamics in youth with type 1 diabetes, suggesting that strength training exercise could be beneficial. Impact: this is the first study to examine cross-sectional and longitudinal perspectives on the correlation among muscle strength, peak oxygen consumption [VO2peak] and telomere length in youths with type 1 diabetes. Higher physical fitness levels, as assessed by measures such as one-repetition maximum, muscle power, and overall physical fitness, are positively associated with telomere length in youths with type 1 diabetes. Understanding this link could improve management strategies, prioritizing muscle strength training for better long-term health in type 1 diabetes.
Open Access
Handgrip strength, cardiometabolic risk and body composition in youth with type 1 diabetes: the Diactive-1 Cohort Study
(BMJ Publishing, 2024-12-04) Huerta Uribe, Nidia; Hormazábal Aguayo, Ignacio; Muñoz Pardeza, Jacinto; Chueca-Guindulain, María J.; Berrade-Zubiri, Sara; Andrés Sesma, Carlos; Burillo Sánchez, Elisabeth; Ezzatvar, Yasmin; Yáñez-Sepúlveda, Rodrigo; Izquierdo Redín, Mikel; García Hermoso, Antonio; Ciencias de la Salud; Osasun Zientziak
Objective: this study aimed to explore the association between handgrip strength, cardiometabolic risk (CMR) and body composition in youth with type 1 diabetes. Methods: for this prospective cohort study, muscular fitness was assessed via handgrip test and relativised by weight, and body composition, evaluated through dual-energy X-ray absorptiometry in type 1 diabetes patients aged 6-18 years. CMR score included z-scores for total body fat, blood pressure, glycated haemoglobin (HbA1c), low-density lipoprotein cholesterol, high-density lipoprotein cholesterol and triglyceride-glucose index. Results: eighty-three patients were analysed at baseline and 1-year follow-up (44.6% females, mean age 12.77 years). Individuals with high handgrip strength tended to have lower CMR and body fat compared with those with low handgrip strength. Over a year, individuals with high handgrip strength showed reduced HbA1c, CMR and subcutaneous fat. Consistently meeting high handgrip strength criteria resulted in reductions in HbA1c levels, CMR score and subcutaneous adipose tissue compared with those who never complied or lost compliance during follow-up. Additionally, subjects classified with high handgrip strength both at baseline and follow-up had a lower likelihood of being classified with high CMR (OR=0.241, 95% CI 0.121 to 0.947, p=0.044). Conclusions: high handgrip strength was associated with significant cardiometabolic and body composition benefits in youth with type 1 diabetes. This tool could be considered of potential clinical value for incorporating assessments like handgrip tests to monitor and address cardiometabolic health.
Open Access
Association of physical activity patterns with nocturnal hypoglycemia events in youth with type 1 diabetes
(Oxford University Press, 2024-07-02) Hormazábal Aguayo, Ignacio; Huerta Uribe, Nidia; Muñoz Pardeza, Jacinto; Ezzatvar, Yasmin; Izquierdo Redín, Mikel; García Hermoso, Antonio; Ciencias de la Salud; Osasun Zientziak
Aims This study sought to elucidate the interactions among physical activity (PA) patterns, mean glucose concentrations, and the incidence of nocturnal hypoglycemia events in children and adolescents with type 1 diabetes, examining the moderating influence of daily dosage on these associations.Methods Eighty-two participants aged 6 to 18 years (43.9% girls) from the Diactive-1 Cohort Study, diagnosed with type 1 diabetes, were included. Data collection involved continuous glucose monitoring, accelerometry to assess real-world PA, as well as documentation of daily insulin doses and carbohydrate counting over the same 7 days.Results A total of 19 participants experienced at least 1 nocturnal hypoglycemia event over a span of 574 measurement days (106 days with and 451 days without nocturnal hypoglycemia). Higher levels of vigorous PA (VPA) were associated with lower same-day mean glucose levels (P = .014). Additionally, higher levels of moderate PA (P = .023), VPA (P = .011), and moderate-to-vigorous PA (P = .010) were associated with a greater number of nocturnal hypoglycemia events. Specifically, a significant association was identified between VPA and nocturnal hypoglycemia events when the daily insulin dose was at or above 1.04 units per kilogram of body weight per day (P = .016).Conclusion Daily VPA is associated with glucose reductions, potentially leading to more hypoglycemic episodes, particularly when there is an excess of daily insulin. This highlights the need for careful insulin management in children and adolescents with type 1 diabetes engaging in VPA.
Open Access
Comprehensive management of children and adolescents with type 1 diabetes mellitus through personalized physical exercise and education using an mHealth system: the Diactive-1 study protocol
(Frontiers Media, 2024) Hormazábal Aguayo, Ignacio; Muñoz Pardeza, Jacinto; López Gil, José Francisco; Huerta Uribe, Nidia; Chueca-Guindulain, María J.; Berrade-Zubiri, Sara; Burillo Sánchez, Elisabeth; Izquierdo Redín, Mikel; Ezzatvar, Yasmin; García Hermoso, Antonio; Ciencias de la Salud; Osasun Zientziak
Introduction: The use of new technologies presents an opportunity to promote physical activity, especially among young people with type 1 diabetes (T1DM), who tend to be less active compared to their healthy counterparts. The aim of this study is to investigate the impact of a personalized resistance exercise program, facilitated by the Diactive-1 App, on insulin requirements among children and adolescents diagnosed with T1DM. Methods and analysis: A minimum of 52 children and adolescents aged 8-18 years, who were diagnosed with T1DM at least 6 months ago, will be randomly assigned to either a group engaging in an individualized resistance exercise program at least 3 times per week over a 24-week period or a waiting-list control group. The primary outcome will be the daily insulin dose requirement. The secondary outcomes will include glycemic control, cardiometabolic profile, body composition, vascular function, physical fitness, 24-hour movement behaviors, diet, and psychological parameters. The usability of the app will also be assessed. Ethics and dissemination: Ethical approval to conduct this study has been granted by the University Hospital of Navarra Research Board (PI_2020/140). Parents or legal guardians of minors participating in the study will provide written consent, while children and adolescents will sign an assent form to indicate their voluntary agreement. The trial's main findings will be shared through conference presentations, peer-reviewed publications, and communication directly with participating families. This study aims to offer valuable insights into the holistic management of children and adolescents with T1DM by utilizing personalized exercise interventions through an mHealth system.