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Advice to help people with type 1 diabetes exercise safely

By Nicole Mackee
Exercise management guidelines for people with type 1 diabetes aim to encourage regular participation in physical activity and improve glycaemic control, say experts in a recently published consensus statement.

Writing in The Lancet, the statement authors said a fear of hypoglycaemia, loss of glycaemic control and a lack of knowledge on exercise management often deterred people with type 1 diabetes from participating in physical activity. They pointed to research that showed that about 60% of people with type 1 diabetes did no structured exercise, despite a recommendation that patients engage in 150 minutes of physical activity each week.

‘Regular exercise should be encouraged and supported by healthcare professionals for many reasons, but primarily because the overall cardiometabolic benefits outweigh the immediate risks if certain precautions are taken,’ the authors wrote.

The statement covers metabolic and neuroendocrine responses to various exercise types, glycaemic targets and management, nutritional considerations and contraindications.

Statement coauthor, Professor Tim Jones of the Princess Margaret Hospital for Children and the University of Western Australia, said past guidelines had advised a ‘trial-and-error’ approach to exercise, but the new statement sought to provide a more detailed framework.

‘Exercise is critically important for people with type 1 diabetes; physical activity has cardiovascular benefits, glucose benefits and psychological benefits,’ Professor Jones said. ‘But it’s been too hard for them to do it in the past due to the risk of hypoglycaemia and, in some instances, hyperglycaemia as exercise can also push glucose concentrations up. So, this is an attempt to put some guidelines in place to help people to exercise safely.’

Talking to Endocrinology Today, Professor Jones said the varying glycaemic impact of different forms of exercise had not been well understood in the past, but research was building in this area.

‘If you go on a long jog, your blood glucose tends to drop, but if you play a sport like soccer, where you have sprints involved, it will push it up for a while,’ Professor Jones said.

The authors said patient goals for exercise – e.g. metabolic control, weight loss or competition – needed to be considered before diabetes management decisions were made.

Professor Jones said technological advances such as continuous glucose monitoring, better insulins and pump therapy are also helping to break down the barriers to exercise for people with type 1 diabetes as glucose levels and trends can be monitored much more easily now.

The authors cautioned that additional vigilance around glucose monitoring was required before, during and after exercise.
Lancet Diabetes Endocrinol 2017; doi: 10.1016/S2213-8587(17)30014-1.