Investigation of The Effect of Combined Exercises on Glycemic Control in Individuals with Type 1 Diabetes

Yıl 2023, , 1008 - 1019, 28.09.2023

Tamer Civil , Nevin Gündüz , Mitat Koz , Hüseyin Demirbilek

https://doi.org/10.38021/asbid.1271649

Öz

The aim of the present study was to investigate the effect of the combined physical exercise protocols on the blood glucose (BG) of children with T1D. The study was conducted over four weeks using self-controlled clinical trials. The first two weeks were control period and the last two weeks were the experimental period. A total of 6 exercise sessions were performed 3 days a week during the experimental period. The exercise program consisted of aerobic, stretching, and resistance exercises. Each exercise session was performed for 40 minutes. A total of 15 children with T1D, whose mean age was 13.3±SD, were included in the study. The blood glucose and insulin dose data of the participants were recorded in both periods through the continuous glucose measurement system and the registry. It was determined that aerobic exercises provided a significant decrease in blood glucose (p < .05). There was no statistically significant difference between the mean BG values in the control (211.7±37.3) and experimental (208.7±40.4) periods (p >0.05). On the other hand, a statistically significant decrease was found in the total daily insulin doses used by participants during the experimental (31.6±20.8 Unit) period (p < 0.001). Physical exercises had an acute positive effect on blood glucose in children with T1D. However, the effect of exercise alone is not sufficient for chronic glycemic control in T1D. For chronic glycemic control, first of all, the injected insulin doses should be carefully regulated according to carbohydrates and exercise.

Anahtar Kelimeler

Type 1 Diabetes, Exercise, Glycemic control

Tip 1 Diyabetli Bireylerde Kombine Egzersizlerin Glisemik Kontrol Üzerine Etkisinin İncelenmesi

Öz

Bu çalışmada kombine egzersizlerden oluşan fiziksel aktivite protokolünün tip 1 diyabetli (T1D) bireylerin kan glukozu (KG) üzerine etkisinin incelenmesi amaçlanmaktadır. Çalışma, dört hafta boyunca kendinden kontrollü klinik araştırmalar yöntemiyle gerçekleştirildi. Çalışmanın ilk iki haftası kontrol dönemi son iki hafta deney dönemi olarak planlandı. Deney döneminde haftada 3 gün toplam 6 egzersiz programı tasarlandı. Egzersiz programı aerobik (yürüyüş, koşu) egzersizler, germe egzersizleri ve direnç egzersizlerinden oluşturuldu. Her egzersiz programı 40 dakika süresince uygulandı. Çalışmaya yaş ortalaması 13.3±SD 15 T1D'li birey dâhil edildi. Katılımcıların kan glukoz ve insulin dozu verileri her iki dönemde de sürekli glukoz ölçüm sistemi ve kayıt defteri aracılığı ile kaydedildi. Aerobik egzersizlerin kan glukozunda anlamlı düzeyde azalma sağladığı saptandı (p < ,05). Kontrol (KG: 211.7±37.3) ve deneysel (KG: 208.7±40.4) dönemlerdeki ortalama KG değerleri arasında istatistiksel olarak anlamlı bir fark yoktu (p >0.05). Fakat deney (31.6±20.8 Ünite) döneminde katılımcılar tarafından kullanılan toplam günlük insülin dozlarında istatistiksel olarak anlamlı bir düşüş bulundu (p < 0.001). Fiziksel egzersizlerin T1D'li çocuklarda kan şekeri üzerinde akut pozitif etkisi olduğu sonucuna ulaşılmıştır. Ancak T1D'de kronik glisemik kontrol için egzersizin etkisi tek başına yeterli değildir. Kronik glisemik kontrol için öncelikle enjekte edilen insülin dozları tüketilen karbonhidratlara ve yapılan egzersize göre dikkatli bir şekilde ayarlanmalıdır.

Anahtar Kelimeler

Tip 1 Diyabet, Egzersiz, Glisemik kontrol

Kaynakça

• Beraki, A., Magnuson, A., Sarnblad, S., Aman, J., & Samuelsson, U.L.F. (2014). 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. Diabetes Research and Clinical Practice, 105(2), 119–125.
• Boulinguiez, A., Staels, B., Duez, H., & Lancel, S. (2017). Mitochondria and endoplasmicreticulum: Targets for a better insulin sensitivity in skeletal muscle?.Biochimica et Biophysica Acta (BBA) - Molecular and Cell Biology of Lipids, 1862(9), 901-916.
• Carral, F., Gutierrez, J. V., Ayala, M., García, G., & Aguilar, M. (2013). Intense physical activity is associated with better metabolic control in patients with type 1diabetes. Diabetes Research and Clinical Practice, 101(1), 45–49.
• Chimen, M., Kennedy, A., Nirantharakumar, K., Pang, T. T., Andrews, R., & Narendran, P. (2012). What are the health benefits of physical activity in type 1 diabetes mellitus? A literature review. Diabetologia, 55(3), 542-51.
• D’hooge, R., Hellinckx, T., VanLaethem, C., Stegen, S., De Schepper, J., Van Aken, S., Dewolf, D., & Calders, P. (2011). Influence of combined aerobic and resistance training on metabolic control, cardiovascular fitness and quality of life in adolescents with type 1 diabetes: a randomized controlled trial. Clinical Rehabilitation, 25(4), 349-359.
• Tsalikian, E., Mauras, N., Beck, R. W., Tamborlane, W. V., Janz, K.F., Chase, H. P., Wysocki. T., Weinzimer, S. A., Bruce, A., Buckingham, B. A., Kollman, C., Xing, D., & Ruedy, D. (2005). Impact of exercise on overnight glycemic control in children with type 1 diabetes mellitus. The Journal of Pediatrics, 147(4), 528-534.
• Garcia, F., Kumareswaran, K., Hovorka, R., & Hernando, M. E. (2015). Quantifying the acute changes in glucose with exercise in type 1 diabetes: A Systematic review and meta-analysis. Sports Medicine, 45(4), 587–599.
• Guelfi, K. J., Jones, T. W., & Fournier, P. A. (2005). The decline in blood glucose levels is less with intermittent high-intensity compared with moderate exercise in individuals with type 1 diabetes. Diabetes Care, 28(6), 1289-9.
• Guelfi, K. J., Jones, T. W., & Fournier, P. A. (2007). New insights into managing the risk of hypoglycaemia associated with intermittent high-intensity exercise in individuals with type 1 diabetes mellitus. Sports Medicine, 37(11), 937-946.
• Herbst, A., Bachran, R., Kapellen, T., & Holl, R. W. (2006). Effects of regular physical activity on control of glycemia in pediatric patients with type 1 diabetes mellitus. Archives Pediatrics and Adolescent Medicine, 160(6), 573-577.
• Iscoe, K. E., & Riddell, M. C. (2011). Continuous moderate-intensity exercise with or without intermittent highintensity work: effects on acute and late glycaemia in athletes with type 1 diabetes mellitus. Diabetic Medicine, 28(7), 824-32.
• Kennedy, A., Nirantharakumar, K., Chimen, M., Pang, T. T., Hemming, K., Andrews, R. C., & Narendran, P. (2013). Does Exercise Improve Glycaemic Control in Type 1 Diabetes? A Systematic Review and Meta-Analysis. Plos One, 8(3), e58861.
• Leclair, E., DeKerdanet, M., Riddell, M., & Heyman, E. (2013). Type 1 Diabetes and Physical Activity in Children and Adolescents. Journal of Diabetes & Metabolism, 10(4), 2-10.
• Marliss, E. B., & Vranic, M. (2002). Intense exercise has unique effects on both insulin release and its roles in glucoregulation: implications for diabetes. Diabetes, 51(1), 271-283.
• Mendoza, J. A., Haaland, W., D'agostino, R. B., Martini, L., Pihoker, C., Frongillo, E. A., Mayerdavis, E. J., Liu, L. L., Dabelea, D., Lawrence, J. M., & Liese A. D. (2018). Food insecurity is associated with high risk glycemic control and higher health care utilization among youth and young adults with type 1 diabetes. Diabetes Research and Clinical Practice, 138(4), 128-137.
• Mosher, P. E., Nash, M. S., Perry, A. C., Laperriere, A. R., & Goldberg, R. B. (1998). Aerobic circuit exercise training: effect on adolescents with well-controlled insulin-dependent diabetes mellitus. Archives of Physical Medicine and Rehabilitation, 79(6), 652-657.
• Ramalho, A. C., DeLourdes, L. M., Nunes, F., Cambui, Z., & Barbosa, C. (2006). The effect of resistance versus aerobic training on metabolic control in patients with type-1 diabetes mellitus. Diabetes Research Clinical Practice, 72(3), 271-6.
• Riddell, M. C., & Iscoe, K. E. (2006). Physical activity, sport, and pediatric diabetes. Pediatr Diabetes, 7(1), 60-70. Robertson, K., Adolfsson, P., Riddell, M., Scheiner, G., & Hanas, R. (2009). Exercise in children and adolescents with diabetes. Pediatric Diabetes, 10(12), 154–168.
• Ruzic, L., Sporis, G., & Matkovic, B. R. (2008). High volume-low intensity exercise camp and glycemic control in diabetic children. Journal of Paediatrics Child Health, 44(3), 122-8.
• Ryninks, K., Sutton, E., Thomas, E., Jago, R., Shield, J. P. H., & Burren, C. P. (2015). Attitudes to exercise and diabetes in young people with type 1 diabetes mellitus: A qualitative analysis. Plos One, 10(10), e0137562
• Shulman, R. M., & Daneman, D. (2010). Type 1 diabetes mellitus in childhood. Medicine, 38(12), 679-685.
• Tansey, M. J., Tsalikian, E., Beck, R. W., Mauras, N., Buckingham, B. A., Weinzimer, S. A., Janz, K. F., Kollman, C., Xing, D., Ruedy, K. J., Steffes, M. W., Borland, T. M., Singh, R. J., & Tamborlane, W. V. (2006). The effects of aerobic exercise on glucose and counterregulatory hormone concentrations in children with type 1 diabetes. Diabetes Care, 29(1), 20-25.
• Tonoli, C., Heyman, E., Roelands, B., Buyse, L., Cheung, S. S., Berthoin, S., & Meeusen, R. (2012). Effects of different types of acute and chronic (training) exercise on glycaemic control in type 1 diabetes mellitus a meta-analysis. Sport Medicine, 42(12), 1059-80.
• Tunar, M., Ozen, S., Goksen, D., Asar, G., Bediz, C. S., & Darcan, S. (2012). The effects of Pilates on metabolic control and physical performance in adolescents with type 1 diabetes mellitus. Journal Diabetes Complications, 26(4), 348-351.
• Wong, C. H., Chiang, Y. C., Wai, J. P. M., Lo, F. S., Yeh, C. H., Chung, S. C., & Chang, C. W. (2011). Effects of a home‐based aerobic exercise programme in children with type 1 diabetes mellitus. Journal of Clinical Nursing, 20(5-6), 681-691.
• Yamanouchi, K., Abe, R., Takeda, A., Atsumi, Y., Shichiri, M., & Sato, Y. (2002). The effect of walking before and after breakfast on blood glucose levels in patients with type 1 diabetes treated with intensive insulin therapy. Diabetes Res Clin Pract, 58(1), 11-18.
• Yardley, J. E., Kenny, G. P., Perkins, B. A., Riddell, M. C., Malcolm, J., Boulay, P., Khandwala, F., & Sigal, R. J. (2012). Effects of Performing Resistance Exercise Before Versus After Aerobic Exercise on Glycemia in Type 1 Diabetes. Diabetes Care, 35(4), 669–675.
• Yates, T., & Davies, M. J. (2017). Physical activity and Type 1 diabetes: an underused therapy. Diabetic Medicine, 34(11), 1498-99.
• Zinman, B., Zuniga-Guajardo, S., & Kelly, D. (1984). Comparison of the acute and long-term effects of exercise on glucose control in type I diabetes. Diabetes Care, 7(6), 515-9.