Increased Physical Activity Could Slow Progression to Type 1 Diabetes in Autoantibody-Positive Children

Jeffrey Krischer, PhD
Credit: American Diabetes Association

Although more recognized for its association with decreased risk of type 2 diabetes, new research suggests increased physical activity could help stave of progression to type 1 diabetes in children with multiple autoantibodies.

Results of the study, which was an analysis of accelerometry data the TEDDY study, indicate every 10-minute increase in daily moderate to vigorous physical activity was associated with an 8% reduction in risk of progressing to type 1 diabetes, but this association was not present among those who were single islet autoantibody-positive or single islet autoantibody-negative.¹

“To date, we are not aware of any study that has examined the association between physical activity—objectively measured by accelerometry—and the progression to clinical type 1 diabetes in children positive for [islet autoantibodies,” wrote investigators.¹ “The findings are intriguing and suggest that activity could play a significant role in slowing progression to type 1 diabetes in high-risk children aged 5-15 years.”

The Environment Determinants of Diabetes in the Young (TEDDY) study was launched in 2004 with a long-term goal of identifying infectious agents, dietary factors, or other environmental agents, including psychosocial factors which trigger T1DM in genetically susceptible individuals or which protect against the disease.² A staple in healthy lifestyles and prolonging quality life years, the role of physical activity in prevention of type 2 diabetes has been well-elucidated in contemporary research, including a recent analysis published in JAMA Network Open suggesting moderate and vigorous aerobic exercise reduced risk of type 2 diabetes by 51% and 49%, respectively, relative to no exercise in at-risk individuals.³

In the current study, a team led by Jeffrey Krischer, PhD, director of the Health Informatics Institute at the USF Health Morsani College of Medicine and principal investigator for TEDDY, sought to better understand the association between physical activity and development of islet autoimmunity and type 1 diabetes in children aged 5-15 years considered to be at-risk. As part of the TEDDY study, participants underwent annual assessments of activity using accelerometry data conducted beginning at 5 years of age.¹

For the purpose of analysis, time-to-event analyses using Cox proportional hazards models were used to estimate associations between time spent in moderate to vigorous physical activity per day and with risk to progression of type 1 diabetes. Investigators pointed out patients were stratified into 3 risk categories: islet autoantibody-negative children, single islet autoantibody-positive children, and multiple islet autoantibody-positive children.¹

From the TEDDY study, investigators identified 3869 islet autoantibody-negative children and 157 of these children became single islet autoantibody-positive. A total of 302 single islet autoantibody-positive children were identified and 73 of these children became multiple islet autoantibody-positive. A total of 294 multiple islet autoantibody-positive children were identified and 148 of these children developed type 1 diabetes.¹

Upon analysis, results indicated there were no significant associations found in risk group 1 or risk group 2 between physical activity and appearance of one or several autoantibodies. In contrast, a significant association was observed in risk group 3, with every 10-minute increase in physical activity associated with an 8% relative risk reduction for progression to type 1 diabetes (Hazard ratio [HR], 0.92 [95% confidence interval [CI], 0.856-0.988]; P=.021). Further analysis indicated this apparent reduction in risk increased in magnitude to 12% per 10-minute increase among a subgroup of patients who had glutamate decarboxylase autoantibody as the first autoantibody (HR, 0.883 [95% CI, 0.783-0.996]; P=.043).¹

“Additional investigation and clinical trials to validate whether activity can reduce the risk of progression in high-risk children are warranted,” investigators concluded.¹

References:

1. Liu X, Johnson SB, Lynch KF, et al. Physical Activity and the Development of Islet Autoimmunity and Type 1 Diabetes in 5-15-Year-Old Children Followed in the TEDDY Study [published online ahead of print, 2023 May 4]. Diabetes Care. 2023;dc230036. doi:10.2337/dc23-0036
2. The Environmental Determinants of Diabetes in the Young (TEDDY) Web Site. Accessed May 11, 2023. https://teddy.epi.usf.edu/.
3. Iapoce C. Aerobic exercise programs may help prevent diabetes in individuals with obesity. HCP Live. January 30, 2023. Accessed May 11, 2023. https://www.hcplive.com/view/aerobic-exercise-programs-may-help-prevent-diabetes-individuals-obesity.