Supervisors info:
Κυριακή Καραβανάκη, Αναπληρώτρια Καθηγήτρια, Ιατρική Σχολή, ΕΚΠΑ
Γεώργιος Χρούσος, Καθηγητής, Ιατρική Σχολή, ΕΚΠΑ
Ευαγγελία Χαρμανδάρη, Καθηγήτρια, Ιατρική Σχολή, ΕΚΠΑ
Summary:
Introduction:
Physical exercise and healthy eating, along with regular self-control of blood sugar are the main pillars for the achievement of optimal diabetic control in patients with type 1 diabetes (type 1 DM).
Aims:
The main purpose of this study was to investigate the frequency, the degree and type of physical activity in children and adolescents with type 1 DM. Additionally, secondary goals, such as the assessment of the effect of exercise on body composition, diabetic control, lipidemic profile, cardiovascular system and on the occurrence of diabetes complications, were set. Additional factors influencing the patients’ body composition and lipidemic profile, such as dietary habits and extracurricular activities (hobbies), were also investigated. Finally, the frequency and severity of the acute complications of exercise, i.e. hypoglycemic episodes, were studied.
Materials and methods:
This study included 79 children and adolescents with type 1 DM, aged (mean ± SD) 14.1±3.98 years (range: 6-20 years) with a diabetes duration of 5.76±4.1 years (range: 0.5-16 years), who were followed at the Diabetic Clinic of the 2nd Department of Pediatrics, University of Athens, "P.&A.Kyriakou" Children’s Hospital, Athens. Initially, measurements of body weight, height and blood pressure were performed for each patient, the BMI-z-scores and blood pressure percentiles were estimated, and fat/muscle mass (%) were calculated using the bioelectric impedance scale. Patients then answered specific anonymous questionnaires, which constituted the data collection tools of the study. In particular, the questionnaire consisted of four modules: 1. Demographic characteristics, 2. Physical Activity, 3. Eating habits, 4. Participation in hobbies.
Results:
Among the study population, 29/79 (36.7%) patients participated systematically in sports clubs, while the remaining 50 patients (63.29%), did not do any systematic exercise, and the latter two patients’ groups were used for statistical analysis. Investigating the effect of exercise on the body composition of systematically exercising and non-exercising patients of our study, we found that the two groups did not differ significantly in terms of somatometric data, with the exception of the group of systematically exercising adolescents, who showed significantly lower body weight, lower BMI (but similar BMI-z-score) and lower muscle mass (%) than nonexercising teenagers. The most statistically significant differences were found in the group of teenage girls, since the systematically exercising ones had significantly lower body weight (p<0.014), lower BMI (p <0.009), with similar BMI-z-score and lower fat percentage compared to non-exercising ones (22.9% vs 28.6%, p<0.009). Regarding the parameters of diabetic control, no significant difference in terms of the mean-12 month-HbA1c nor the daily insulin dosage was observed between systematically exercising and non-exercising patients as a whole. Only in the group of systematically exercising adolescent boys, insulin sensitivity was higher compared to the non-exercising ones (63.5vs 44.5 mg of blood glucose/IU, p=0.035). Regarding the occurrence of hypoglycaemic episodes in relation to exercise, it was found that the systematically exercising patients had mostly mild and moderate but not severe hypoglycaemic episodes compared to the non-exercising ones. Moreover patients with excellent glycaemic control experienced episodes of mild hypoglycaemia three times more frequently than those with moderate control (p=0.035), while there were no episodes of severe hypoglycaemia. Regarding the effect of exercise on blood pressure, lower systolic pressure was observed only in systematically exercising pubertal girls in comparison with the non-exercising ones (32.25% vs 55.81%, p=0.026). Moreover in the total patients’ group, systematic exercise was associated with the absence of dyslipidemia (x2=3.68, p=0.049).
From our study results it was also found that about half of our patients (58.6%) had healthy eating habits, whileunhealthy diet was followed by 1/5 (16.5%). Moreover the majority (92.4%) of patients had beneficial hobbies, and about half (62%) of them non-beneficial hobbies. Systematic exercise was not necessarily related to the presence of healthy diet and beneficial hobbies, but the presence of non-beneficial hobbies was less common among exercising patients. Unhealthy eating habits and video gaming have been found to contribute to the development of obesity and poor diabetic control in children and adolescents with type 1 DM. It is noteworthy that none of the exercising patients smoked, while alcohol use was observed only in a very small percentage of patients (6%). The parental educational level significantly contributed to the treatment approach of their children's diabetes, by adopting systematic exercise, healthy eating habits and beneficial hobbies.
Conclusions:
Among the children and adolescents with type 1 DM of our study a significant proportion (36.7%) followed systematic exercise, which in combination with healthy eating habits and the avoidance of non-beneficial hobbies seem to play an important role in the best disease management. Systematic exercise contributed to the improvement of the patients’ body composition, blood pressure and lipid profile, while the fear of hypoglycaemia was not an obstacle to their daily activities. Finally, the role of parents' educational level is crucial to the correct approach of the disease in terms of adopting exercise, healthy eating and avoiding harmful habits, leading to obesity and metabolic disregulation.
