Regular physical exercise is one of the most important factors predicting glycemic control in children with type 1 diabetes mellitus (T1DM), according to the results of a cross-sectional analysis. "Regular physical activity (RPA) can improve the lipoprotein profile, lower blood pressure, and improve cardiovascular fitness and quality of life in patients with T1DM," write Antje Herbst, MD, from the University of Bonn in Germany, and colleagues from the DPV (Diabetessoftware zur Prospektiven Verlaufsdokumentation/Diabetes Software for Prospective Documentation) Science Initiative. "The effect of physical activity training on the control of glycemia remains controversial, as some studies have shown, and some studies have failed to show, an independent effect of physical activity training on the control of glycemia as measured by the glycosylated [glycated] hemoglobin (HbA1c) level in patients with T1DM."
The investigators performed a cross-sectional analysis of data for 19,143 patients aged 3 to 20 years with T1DM at 179 pediatric diabetes clinics in Germany and Austria comparing control of glycemia and rate of hypoglycemia by frequency of RPA per week as follows: RPA0, none; RPA1, 1 or 2 times per week; and RPA2, 3 or more times per week. Primary endpoints were HbA1c level, body mass index z score (BMI; weight in kilograms divided by the square of height in meters), and frequency of severe hypoglycemia.
In both sexes and in all age groups, HbA1c level was higher in those with less frequent RPA (8.4% in group RPA0 vs 8.1% in group RPA2; P < .001). In female patients but not in male patients, BMI z score decreased from 0.60 in group RPA0 to 0.51 in group RPA2 (P < .001). RPA was one of the most important factors influencing the HbA1c level based on multiple regression analysis. There was no apparent association between frequency of RPA and frequency of severe hypoglycemia or hypoglycemia with loss of consciousness or seizure.
"In pediatric patients with type 1 diabetes mellitus, frequency of RPA is a major factor influencing the control of glycemia without increasing the risk for severe hypoglycemia," the authors write. "Regular physical activity should be recommended in pediatric patients with type 1 diabetes mellitus."
"Regular physical activity results in better control of glycemia, including a lower HbA1c level and, in female patients, lower BMI," the authors conclude. "The risk for severe hypoglycemia or hypoglycemia with loss of consciousness or seizure is not elevated in pediatric patients with a high frequency of RPA."
· The German Federal Ministry of Health, Novo Nordisk Germany, the Dr Bürger-Büsing Foundation, and the Children with T1DM who engage in RPA have lower HbA1c level.
· Children with T1DM who engage in RPA are not at higher risk for severe hypoglycemia or hypoglycemia with seizure or loss of consciousness.
Arch Pediatr Adolesc Med. 2006;160:573-577
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