Increase in physical activity is associated with lower HbA1c levels in children and adolescents with type 1 diabetes: Results from a cross-sectional study based on the Swedish pediatric diabetes quality registry (SWEDIABKIDS)
Introduction
Physical activity has an important part to play in the prevention of diabetes complications and in the management of type 1 and type 2 diabetes mellitus [1], [2]. To attain desired health outcomes, school-age youth are recommended to engage in moderate to vigorous physical activity 60 min or more per day [3]. Swedish guidelines for diabetes care recommend regular physical activity for patients with type 1 diabetes [4]. Physical activity benefits the lipid profile and blood pressure [1], and improves endothelial function [2] all of which are of great value in reducing diabetes-related complications such as cardiovascular disease. Furthermore, physical activity increases insulin sensitivity, improves physical fitness and increases psychological well-being in patients with type 1 diabetes [2].
Another possible health benefit of physical activity is better metabolic control, with reduced glycated hemoglobin (HbA1c). Several studies have focused on the correlation between physical activity and HbA1c. Some have succeeded in showing a significant HbA1c-lowering effect of physical activity [5], [6], [7], [8], [9], [10], [11], [12], [13], [14], [15], whereas others have failed do so [16], [17], [18], [19], [20], [21], [22]. HbA1c is a main variable in pediatric diabetes care. Prospective randomized trials suggest a strong, exponential association between high long-standing HbA1c levels and increased risk of diabetic microangiopathy [23].
The aim of the present study is to evaluate associations between physical activity and metabolic control, measured by HbA1c values, in children and adolescents with type 1 diabetes in Sweden.
Section snippets
The Swedish pediatric diabetes quality registry
Outpatient attendance data from all Swedish pediatric diabetes centers (n = 43) are registered in the Swedish pediatric diabetes quality registry, SWEDIABKIDS [24], which was set up in 2000. In Sweden, pediatric clinics treat all children and adolescents aged 0–18 years with diabetes from defined geographic areas. Thus the registry includes data on almost all (around 99%) of the children and adolescents with diabetes in Sweden. In 2010, the registry included data from more than 235,000 outpatient
Clinical characteristics
Data from 4655 visits were included in the analysis. The mean age of the patients was 14.3 ± 3.1 years with a median diabetes duration of 5.7 years (1.0–17.7.years) and a mean HbA1c of 8.1 ± 1.2 (65 ± 13 mmol/mol). When the data were stratified by gender and age, we found that the HbA1c level increased with increasing age. Furthermore, girls in age group 15–18 years had 0.30% (3.3 mmol/mol) higher HbA1c than boys in the same age group (p < 0.001). In the other age groups, there was no statistically
Discussion
Our population-based study of data from 4655 children and adolescents with type 1 diabetes in the Swedish quality registry demonstrates a statistically significant inverse dose–response association between the amount of physical activity and HbA1c. Our results indicate significant associations between physical activity and HbA1c levels in patients with type 1 diabetes. This association could be explained by increased insulin sensitivity and improved glucose uptake in muscles, reflected by a
Conflict of interest
None declared.
Acknowledgements
The Swedish board of Health and Welfare, the Swedish Association of Local Authorities and Regions.
We thank the pediatric diabetes centers who have contributed to the study by registering data on the children and adolescents with type 1 diabetes attending their diabetes center.
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2022, Endocrinologia, Diabetes y NutricionCitation Excerpt :Similarly, the physical activity score significantly decreased in the patients with optimal metabolic control whose mean HbA1c level showed an increase after the lockdown period. In patients with T1D, regular physical activity is associated with several positive health effects which was supported by Beraki et al.31 in a cross-sectional analysis of data from 4655 children and adolescents with T1D, concluding that physical activity seemed to influence HbA1c levels in children and adolescents with T1D. During the COVID-19 pandemic, glycemic control of 13 patients with a median age of 14.2 years was retrospectively analyzed and compared between patients who exercised regularly (n = 8) and those who did not (n = 5).23
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