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TOPLINE:

Adolescents with type 1 diabetes (T1D) experience a similar incidence of nighttime hypoglycemia after exercise as after sedentary days, reports a study exploring factors that influence postexercise glycemia.

METHODOLOGY:

• The recommendation on physical activity for adolescents with T1D mirrors that for those without T1D (60 min of daily moderate to vigorous activity), but barriers such as fear of hypoglycemia may hinder the child or their parent from participating in such an activity.
• Researchers analyzed data from the T1DEXIP study to determine the influencing factors and the risk for postexercise hypoglycemia and glycemia in adolescents with T1D.
• They included 251 adolescents aged 12-17 years (42% girls) with T1D for at least 3 months prior, who used various insulin delivery methods, and were at least moderately active.
• Participants were trained to use a wrist-worn activity tracker and self-reported any activity lasting ≥ 10 minutes and meal intakes through the Bant Diabetes smartphone app for 3 days, while the data on insulin were entered manually or downloaded using a continuous glucose monitoring device.
• The outcomes evaluated were mean glucose in 4-hour intervals postexercise, lowest glucose levels postexercise, percentage of time in range (70-180 mg/dL), and hypoglycemic events during the overnight period postexercise.

TAKEAWAY:

• The incidence of nocturnal hypoglycemia was similar during nights following exercise compared with that during nights after sedentary days (14% vs 12% of nights), and it was higher among participants with an average total activity duration > 60 min/d than those with a lower daily activity duration (17% vs 8%; P = .01), and on days with longer individual exercise sessions.
• A larger decline in the mean glucose level during exercise was associated with lower postexercise mean glucose levels immediately after activity (P < .001) and after 12 to < 16 hours (P = .02).
• Individuals with a shorter diabetes duration (< 1 year) exhibited lower postexercise mean glucose levels in the 24-hour recovery period.
• The incidence of overnight hypoglycemia was higher among individuals with longer disease duration or lower A1c, those using traditional pumps, or if time below range was ≥ 4% in the previous 24 hours.

IN PRACTICE:

"Given the relatively lower incidence in this cohort compared with historic studies, it is feasible that achievement of physical activity targets can be attained through education and development of individualized plans, as recommended by the International Society for Pediatric and Adolescent Diabetes (ISPAD) clinical practice guidelines," the authors wrote.

SOURCE:

This study, led by Jennifer L. Sherr, Yale School of Medicine, New Haven, Connecticut, was published online in Diabetes Care.

LIMITATIONS:

The generalizability of this study is limited, as participants who were less than moderately physically active were excluded and most were non-Hispanic White. Because of a low overall hypoglycemia rate, the analysis was limited to hypoglycemic events rather than assessing the percentage of time below the target glucose range. The findings may not accurately represent adolescents with T1D who have higher rates of hypoglycemia associated with exercise.

DISCLOSURES:

The study was funded by the Leona M. and Harry B. Helmsley Charitable Trust. Some of the authors declared serving on advisory panels, working as consultants, and receiving research support, grants, or contracts from pharmaceutical, biotechnology, and medical device companies, as well as from foundations and advocacy organizations.