Type 1 Diabetes: First-Ever Exercise Guidelines

A new set of guidelines compiled by JDRF will help people with type 1 diabetes mellitus (T1DM) exercise safely to avoid fluctuations in blood sugar, according to a team of international researchers and clinicians.

“Regular exercise can help individuals with diabetes to achieve their blood lipid, body composition, fitness and blood sugar goals, but for people living with type 1 diabetes, the fear of hypoglycemia, loss of glycemic control, and inadequate knowledge around exercise management are major barriers,” said lead author Michael C Riddell, PhD, of the Muscle Health Research Centre, York University, Toronto, Ontario. “This is a big struggle for both type 1 diabetes patients and their healthcare providers. This first-ever set of consensus guidelines from leading experts will help them.”

The new guidelines were published online in Lancet Diabetes & Endocrinology.

The review of observational studies and clinical trials on exercise management conducted by 21 international experts provides an up-to-date consensus on exercise management for individuals with T1DM who exercise regularly, including glucose targets for safe and effective exercise, and nutritional and insulin dose adjustments to protect against exercise-related glucose excursions.

The experts note that about 60% of people with T1DM are overweight or obese, about 40% have hypertension, about 60% have dyslipidemia, and most do not engage in enough regular physical activity.

They recommend that adults with T1DM garner at least 150 minutes of accumulated physical activity per week, with no more than two consecutive days without activity. Resistance exercise is also recommended two to three times a week. For children and young people with diabetes, the guidelines call for at least 60 minutes of physical exercise a day.

“Regular exercise helps patients achieve a number of goals. In pediatric patients in particular, it reduces the cardiovascular disease risk profile, improves the sense of well-being and brings down average blood glucose levels (glycated hemoglobin),” said Riddell.

In adults, both diabetic eye disease and kidney disease are less common in those who are more physically active. They also have a better chance of achieving target levels of glycated hemoglobin levels, blood pressure levels, and a healthier body mass index when compared to inactive patients, the experts state.

In general, aerobic exercise reduces glycemia while anaerobic exercise temporarily increases glucose levels. Both forms of exercise can produce hypoglycemia in late recovery.

Clinicians need a clear understanding of the physiology of different forms of exercise and the changes that can influence glycemia during exercise to ensure safe and effective glycemic management strategies.

“More studies are needed to determine how to best prevent exercise-associated hypoglycemia with basal rate insulin dose adjustments and how to manage glycemia in the recovery period after exercise,” they stated.

The guidelines provide detailed recommendations on physiology of physical activity and exercise; exercise goals and glycemic targets, including insulin adjustments and glucose monitoring before and after exercise; contraindications and cautions for exercise, including recent hypoglycemia, ketones, and diabetes complications; nutritional management; recommendations for management of glycemia; and emerging tools for exercise management.

Reference: Riddell MC, et al. Exercise management in type 1 diabetes: a consensus statement. Lancet Diabetes Endocrinol. 2017 Jan 23.