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)

Abstract

Aims

To evaluate the associations between physical activity (PA) and metabolic control, measured by glycated hemoglobin (HbA1c), in a large group of children and adolescents with type 1 diabetes.

Methods

Cross-sectional analysis of data from 4655 patients, comparing HbA1c values with levels of physical activity. The data for the children and adolescents were obtained from the Swedish pediatric diabetes quality registry, SWEDIABKIDS. The patients were 7–18 years of age, had type 1 diabetes and were not in remission. Patients were grouped into five groups by frequency of PA.

Results

Mean HbA1c level was higher in the least physically active groups (PA0: 8.8% ± 1.5 (72 ± 16 mmol/mol)) than in the most physically active groups (PA4: 7.7% ± 1.0 (60 ± 11 mmol/mol)) (p < 0.001). An inverse dose–response association was found between PA and HbA1c (β: −0.30, 95% CI: −0.34 to −0.26, p < 0.001). This association was found in both sexes and all age groups, apart from girls aged 7–10 years. Multiple regression analysis revealed that the relationship remained significant (β: −0.21, 95% CI: −0.25 to −0.18, p < 0.001) when adjusted for possible confounding factors.

Conclusions

Physical activity seems to influence HbA1c levels in children and adolescents with type 1 diabetes. In clinical practice these patients should be recommended daily physical activity as a part of their treatment.

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.