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Delaying the Progression of Type 1 Diabetes

Oct 13, 2018
 
Editor: Steve Freed, R.PH., CDE

Author: Angela Reyes, Pharm.D. Candidate, LECOM College of Pharmacy

Exercise can lengthen remission — delaying the progression of type 1 diabetes — after being diagnosed.

After being diagnosed with type 1 diabetes, about 60% of patients experience a honeymoon phase in which the pancreas continues to make insulin but in limited amounts before all the insulin- producing beta cells are destroyed. This phase could last a few days, weeks, or months. A new study showed patients who exercised during the first months of being diagnosed with type 1 diabetes had a longer honeymoon phase than patients who did not exercise.

The study was conducted using 17 people in the UK who were all recently diagnosed with type 1 diabetes and maintained a high level of exercise. These patients were matched with others of the the same age, sex, and weight who were recently diagnosed with type 1 diabetes but had low to no daily exercise. Type and duration of exercise was analyzed along with daily insulin requirement, weight, and HbA1c. Honeymoon period was defined as insulin dose adjusted HbA1c at 9 or less. The insulin dose-adjusted HbA1c was calculated as HbA1c + [4 x insulin dose]. The Kruskal-Wallis test compared age, BMI, and follow-up length.

Findings showed that among the group that had daily exercise, the honeymoon period on average lasted 33 months (95% CI, 24.9-41.1). The non-exercising group had remission for an average of 6 months (95% CI, 2.3-9.7). The physically active patients had a 5-times longer remission compared to the group that did no exercise.

This study had a small sample size, but it was the first to research the effect of physical activity on the honeymoon period in a person newly diagnosed with type 1 diabetes. Larger, randomized trials are needed to test if this is a typical effect of exercise in this population and to discover the mechanism behind this delay in progression.

People who have type 1 diabetes are at risk of dangerously low blood glucose levels. During the honeymoon period, the body responds better to insulin and blood glucose regulation is easier. To extend this period is only beneficial to the patient. Dr. Parth Narendran of the University of Birmingham and lead study author stated, “We propose that exercise prolongs honeymoon through a combination of improving how the body responds to insulin and preserving the function of insulin-producing cells in the pancreas. This could have important benefits for people with type 1 diabetes, including improved blood glucose control, [fewer] episodes of [hypoglycemia] and a reduced risk of diabetes-related complications.”

Practice Pearls:

  • Physical activity after being diagnosed with type 1 diabetes can increase time in the honeymoon period.
  • The average honeymoon period in this trial was 33 months for people newly diagnosed type 1 diabetes who exercise.
  • Exercise is a beneficial way to regulate blood glucose and delay the progression of type 1 diabetes during disease onset.

References:

R. Chetan et al. The Type 1 diabetes ‘honeymoon’ period is five times longer in men who exercise: a case-control study. Diabetic Medicine (2018). DOI: 10.1111/dme.13802