Top

Current Cardiology Reports

Published in:

07-05-2022 | Insulins | Diabetes and Cardiovascular Disease (D Bruemmer, Section Editor)

Exercise and Self-Management in Adults with Type 1 Diabetes

Authors: Margaret McCarthy, Jeniece Ilkowitz, Yaguang Zheng, Victoria Vaughan Dickson

Published in: Current Cardiology Reports | Issue 7/2022

Abstract

Purpose of Review

The purpose of this review paper is to examine the most recent evidence of exercise-related self-management in adults with type 1 diabetes (T1D).

Recent Findings

This paper reviews the benefits and barriers to exercise, diabetes self-management education, the role of the healthcare provider in assessment and counseling, the use of technology, and concerns for special populations with T1D.

Summary

Adults with T1D may not exercise at sufficient levels. Assessing current levels of exercise, counseling during a clinical visit, and the use of technology may improve exercise in this population.

National Diabetes Statistics Report | Data & Statistics | Diabetes | CDC. 2020. https://www.cdc.gov/diabetes/data/statistics/statistics-report.html. Accessed 11 Mar 2020.

Xia Y, Xie Z, Huang G, Zhou Z. Incidence and trend of type 1 diabetes and the underlying environmental determinants. Diabetes Metab Res Rev. 2019;35(1): e3075. https://doi.org/10.1002/dmrr.3075.CrossRefPubMed

DiMeglio LA, Evans-Molina C, Oram RA. Type 1 diabetes. Lancet. 2018;391(10138):2449–62. https://doi.org/10.1016/S0140-6736(18)31320-5.CrossRefPubMedPubMedCentral

Benjamin EJ, et al. Heart disease and stroke statistics-2019 update: a report from the American Heart Association. Circulation. 2019;139(10):e56–66. https://doi.org/10.1161/CIR.0000000000000659.CrossRefPubMed

American Diabetes Association Professional Practice Committee, et al. 10 Cardiovascular disease and risk management: standards of medical care in diabetes-2022. Diabetes Care. 2022;45(Suppl 1):S144–S174. https://doi.org/10.2337/dc22-S010.

Snell-Bergeon JK, Nadeau K. Cardiovascular disease risk in young people with type 1 diabetes. J Cardiovasc Transl Res. 2012;5(4):446–62. https://doi.org/10.1007/s12265-012-9363-x.CrossRefPubMed

Secrest AM, Becker DJ, Kelsey SF, Laporte RE, Orchard TJ. Cause-specific mortality trends in a large population-based cohort with long-standing childhood-onset type 1 diabetes. Diabetes. 2010;59(12):3216–22. https://doi.org/10.2337/db10-0862.CrossRefPubMedPubMedCentral

Rawshani A, et al. Excess mortality and cardiovascular disease in young adults with type 1 diabetes in relation to age at onset: a nationwide, register-based cohort study. The Lancet. 2018;392(10146):477–86. https://doi.org/10.1016/S0140-6736(18)31506-X.CrossRef

American Diabetes Association. 6 Glycemic targets: standards of medical care in diabetes-2021. Diabetes Care. 2021;44(Suppl 1):S73–S84. https://doi.org/10.2337/dc21-S006.

10.

Association AD. 5 Lifestyle management: standards of medical care in diabetes—2019. Diabetes Care. 2019;42(Supplement 1):S46–S60. https://doi.org/10.2337/dc19-S005.

11.

Katz M, Giani E, Laffel L. Challenges and opportunities in the management of cardiovascular risk factors in youth with type 1 diabetes: lifestyle and beyond. Curr Diab Rep. 2015;15(12):119–015–0692–4. https://doi.org/10.1007/s11892-015-0692-4.

12.

• 2018 Physical Activity Guidelines Advisory Committee. Physical Activity Guidelines Advisory Committee Scientific Report. Washington, DC: U.S. Department of Health and Human Services. 2018. [Online]. Accessed Date 2 May 2022 Available: https://health.gov/paguidelines/second-edition/report/pdf/PAG_Advisory_Committee_Report.pdf. This report is an essential resource for healthcare professionals and policymakers as they design physical activity programs to help Americans be physically active.

13.

American Diabetes Association Professional Practice Committee. 5 Facilitating behavior change and well-being to improve health outcomes: standards of medical care in diabetes—2022. Diabetes Care. 2021;45(Supplement_1):S60–S82. https://doi.org/10.2337/dc22-S005.

14.

Tikkanen-Dolenc H, et al. Physical activity reduces risk of premature mortality in patients with type 1 diabetes with and without kidney disease. Diabetes Care. 2017;40(12):1727–32. https://doi.org/10.2337/dc17-0615.CrossRefPubMed

15.

McCarthy MM, Funk M, Grey M. Cardiovascular health in adults with type 1 diabetes. Prev Med. 2016;91:138–143.

16.

Lauer EE, Jackson AW, Martin SB, Morrow JR Jr. Meeting USDHHS physical activity guidelines and health outcomes. Int J Exerc Sci. 2017;10(1):121–7.PubMedPubMedCentral

17.

Rohling M, Herder C, Roden M, Stemper T, Mussig K. Effects of long-term exercise interventions on glycaemic control in type 1 and type 2 diabetes: a systematic review. Exp Clin Endocrinol Diabetes. 2016;124(8):487–94. https://doi.org/10.1055/s-0042-106293.CrossRefPubMed

18.

Moser O, Yardley JE, Bracken RM. Interstitial glucose and physical exercise in type 1 diabetes: integrative physiology, technology, and the gap in-between. Nutrients. 2018;10(1):E93. https://doi.org/10.3390/nu10010093.CrossRefPubMed

19.

Moser O, Eckstein ML, West DJ, Goswami N, Sourij H, Hofmann P. Type 1 diabetes and physical exercise: moving (forward) as an adjuvant therapy. Curr Pharm Des. 2020;26(9):946–57. https://doi.org/10.2174/1381612826666200108113002.CrossRefPubMed

20.

McCarthy O, et al. Extent and prevalence of post-exercise and nocturnal hypoglycemia following peri-exercise bolus insulin adjustments in individuals with type 1 diabetes. Nutr Metab Cardiovasc Dis. 2021;31(1):227–36. https://doi.org/10.1016/j.numecd.2020.07.043.CrossRefPubMed

21.

Ostman C, Jewiss D, King N, Smart NA. Clinical outcomes to exercise training in type 1 diabetes: a systematic review and meta-analysis. Diabetes Res Clin Pract. 2018;139:380–91. https://doi.org/10.1016/j.diabres.2017.11.036.CrossRefPubMed

22.

Wild D, von Maltzahn R, Brohan E, Christensen T, Clauson P, Gonder-Frederick L. A critical review of the literature on fear of hypoglycemia in diabetes: implications for diabetes management and patient education. Patient Educ Couns. 2007;68(1):10–5. https://doi.org/10.1016/j.pec.2007.05.003.CrossRefPubMed

23.

Roberts AJ, et al. Association between fear of hypoglycemia and physical activity in youth with type 1 diabetes: the SEARCH for diabetes in youth study. Pediatr Diabetes. 2020;21(7):1277–84. https://doi.org/10.1111/pedi.13092.CrossRefPubMedPubMedCentral

24.

Kennedy A, Narendran P, Andrews RC, Daley A, Greenfield SM. Attitudes and barriers to exercise in adults with a recent diagnosis of type 1 diabetes: a qualitative study of participants in the Exercise for Type 1 Diabetes (EXTOD) study. BMJ Open 2018;8(1). https://doi.org/10.1136/bmjopen-2017-017813.

25.

Brazeau AS, Rabasa-Lhoret R, Strychar I, Mircescu H. Barriers to physical activity among patients with type 1 diabetes. Diabetes Care. 2008;31(11):2108–9. https://doi.org/10.2337/dc08-0720.CrossRefPubMedPubMedCentral

26.

Pivovarov JA, Taplin CE, Riddell MC. Current perspectives on physical activity and exercise for youth with diabetes: perspectives on exercise. Pediatr Diabetes. 2015;16(4):242–55. https://doi.org/10.1111/pedi.12272.CrossRefPubMed

27.

Ilkowitz JR, Wu F, Chen Y, Gallagher MP. Perspectives on the role of exercise in the treatment of pediatric type 1 diabetes. Pediatr Diabetes. 2020;21(3):466–72. https://doi.org/10.1111/pedi.12965.CrossRefPubMed

28.

Zhang Y, et al. Fear of hypoglycemia in patients with type 1 and 2 diabetes: a systematic review. J Clin Nurs. 2020. https://doi.org/10.1111/jocn.15538.CrossRefPubMedPubMedCentral

29.

Cigrovski Berkovic M, Bilic-Curcic I, La Grasta Sabolic L, Mrzljak A, Cigrovski V. Fear of hypoglycemia, a game changer during physical activity in type 1 diabetes mellitus patients. WJD 2021;12(5):569–577. https://doi.org/10.4239/wjd.v12.i5.569.

30.

Martyn-Nemeth P, Duffecy J, Quinn L, Park C, Mihailescu D, Penckofer S. A cognitive behavioral therapy intervention to reduce fear of hypoglycemia in young adults with type 1 diabetes (FREE): study protocol for a randomized controlled trial. Trials. 2019;20(1):796. https://doi.org/10.1186/s13063-019-3876-4.CrossRefPubMedPubMedCentral

31.

Tagougui S, Taleb N, Rabasa-Lhoret R. The benefits and limits of technological advances in glucose management around physical activity in patients type 1 diabetes. Front Endocrinol. 2019;9:818. https://doi.org/10.3389/fendo.2018.00818.CrossRef

32.

Finn M, Sherlock M, Feehan S, Guinan EM, Moore KB. Adherence to physical activity recommendations and barriers to physical activity participation among adults with type 1 diabetes. Ir J Med Sci. 2021. https://doi.org/10.1007/s11845-021-02741-w.CrossRefPubMed

33.

Aronson R, Brown RE, Li A, Riddell MC. Optimal insulin correction factor in post-high-intensity exercise hyperglycemia in adults with type 1 diabetes: the FIT study. Diabetes Care. 2019;42(1):10–6. https://doi.org/10.2337/dc18-1475.CrossRefPubMed

34.

American Diabetes Association Professional Practice Committee. 5 Facilitating behavior change and well-being to improve health outcomes: standards of medical care in diabetes—2022. Diabetes Care 2022;45(Supplement_1):S60–S82. https://doi.org/10.2337/dc22-S005.

35.

Diabetic‑induced alterations in hepatic glucose and lipid metabolism: the role of type 1 and type 2 diabetes mellitus (Review) - PubMed. https://pubmed-ncbi-nlm-nih-gov.proxy.library.nyu.edu/32468027/. Accessed 10 Mar 2022.

36.

Exercise & pump therapy : diabetes education online. https://dtc.ucsf.edu/types-of-diabetes/type1/treatment-of-type-1-diabetes/medications-and-therapies/type-1-insulin-pump-therapy/how-to-use-your-pump/exercise-pump-therapy/. Accessed 04 Feb 2022.

37.

Molveau J, et al. Minimizing the risk of exercise-induced glucose fluctuations in people living with type 1 diabetes using continuous subcutaneous insulin infusion: an overview of strategies. Can J Diabetes. 2021;45(7):666–76. https://doi.org/10.1016/j.jcjd.2021.01.003.CrossRefPubMed

38.

Zaharieva DP, Riddell MC. Insulin management strategies for exercise in diabetes. Can J Diabetes. 2017;41(5):507–16. https://doi.org/10.1016/j.jcjd.2017.07.004.CrossRefPubMed

39.

Moser O, et al. Glucose management for exercise using continuous glucose monitoring (CGM) and intermittently scanned CGM (isCGM) systems in type 1 diabetes: position statement of the European Association for the Study of Diabetes (EASD) and of the International Society for Pediatric and Adolescent Diabetes (ISPAD) endorsed by JDRF and supported by the American Diabetes Association (ADA). Pediatr Diabetes. 2020;21(8):1375–93. https://doi.org/10.1111/pedi.13105.CrossRefPubMedPubMedCentral

40.

Colberg SR, et al. Physical activity/exercise and diabetes: a position statement of the American Diabetes Association. Diabetes Care. 2016;39(11):2065–2079. https://doi.org/10.2337/dc16-1728.

41.

Eckel RH, et al. 2013 AHA/ACC guideline on lifestyle management to reduce cardiovascular risk: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Circulation. 2014;129(25 Suppl 2):S76-99. https://doi.org/10.1161/01.cir.0000437740.48606.d1.CrossRefPubMed

42.

American Diabetes Association. 10 Cardiovascular disease and risk management: standards of medical care in diabetes-2021. Diabetes Care. 2021;44(Suppl 1):S125–S150. https://doi.org/10.2337/dc21-S010.

43.

Tully C, Aronow L, Mackey E, Streisand R. Physical activity in youth with type 1 diabetes: a review. Curr Diab Rep. 2016;16(9):85. https://doi.org/10.1007/s11892-016-0779-6.CrossRefPubMed

44.

Ilkowitz J, Gallagher MP. Provider perspectives on exercise in children with type 1 diabetes. Diabetes. 2018;67(Supplement):1. https://doi.org/10.2337/db18-737-P.CrossRef

45.

• Sallis R. Exercise is medicine: a call to action for physicians to assess and prescribe exercise. Phys Sportsmed. 2015;43(1):22–26. https://doi.org/10.1080/00913847.2015.1001938. The goal of the Exercise is Medicine (EIM) initiative is to make physical activity assessment and exercise prescription a standard component of patient care. The EIM website contains an action guide for healthcare providers.

46.

Colberg SR, Laan R, Dassau E, Kerr D. Physical activity and type 1 diabetes: time for a rewire? J Diabetes Sci Technol. 2015;9(3):609–18. https://doi.org/10.1177/1932296814566231.CrossRefPubMedPubMedCentral

47.

Welsh JB, et al. Accuracy, utilization, and effectiveness comparisons of different continuous glucose monitoring systems. Diabetes Technol Ther. 2019;21(3):128–32. https://doi.org/10.1089/dia.2018.0374.CrossRefPubMedPubMedCentral

48.

Ajjan RA, Cummings MH, Jennings P, Leelarathna L, Rayman G, Wilmot EG. Accuracy of flash glucose monitoring and continuous glucose monitoring technologies: implications for clinical practice. Diab Vasc Dis Res. 2018;15(3):175–84. https://doi.org/10.1177/1479164118756240.CrossRefPubMed

49.

American Diabetes Association. 7 Diabetes technology: standards of medical care in diabetes-2021. Diabetes Care. 2021;44(Suppl 1):S85-s99. https://doi.org/10.2337/dc21-S007.

50.

Hirsch IB, Nardacci E, Verderese CA. Flash continuous glucose monitoring: implications for use of continuous data in daily diabetes management. Diabetes Spectr. 2019;32(4):355–67. https://doi.org/10.2337/ds18-0059.CrossRefPubMedPubMedCentral

51.

• Dicembrini I, Cosentino C, Monami M, Mannucci E, Pala L. Effects of real-time continuous glucose monitoring in type 1 diabetes: a meta-analysis of randomized controlled trials. Acta Diabetologica. 2021;58(4):401–410. https://doi.org/10.1007/s00592-020-01589-3. Findings from this systematic review indicated that patients with type 1 diabetes who use continuous glucose monitoring had a reduction in glucose control and severe hypoglycemia compared to those who use self-monitoring of blood glucose monitoring.

52.

Pickup J, Keen H. Continuous subcutaneous insulin infusion at 25 years: evidence base for the expanding use of insulin pump therapy in type 1 diabetes. Diabetes Care. 2002;25(3):593–8. https://doi.org/10.2337/diacare.25.3.593.CrossRefPubMed

53.

Tagougui S, Taleb N, Rabasa-Lhoret R. The benefits and limits of technological advances in glucose management around physical activity in patients type 1 diabetes. Front Endocrinol (Lausanne). 2018;9:818. https://doi.org/10.3389/fendo.2018.00818.

54.

Taleb N, et al. Efficacy of single-hormone and dual-hormone artificial pancreas during continuous and interval exercise in adult patients with type 1 diabetes: randomised controlled crossover trial. Diabetologia. 2016;59(12):2561–71. https://doi.org/10.1007/s00125-016-4107-0.CrossRefPubMed

55.

Zaharieva DP, Messer LH, Paldus B, O’Neal DN, Maahs DM, Riddell MC. Glucose control during physical activity and exercise using closed loop technology in adults and adolescents with type 1 diabetes. Can J Diabetes. 2020;44(8):740–9. https://doi.org/10.1016/j.jcjd.2020.06.003.CrossRefPubMed

56.

Vettoretti M, Facchinetti A. Combining continuous glucose monitoring and insulin pumps to automatically tune the basal insulin infusion in diabetes therapy: a review. Biomed Eng Online. 2019;18(1):37. https://doi.org/10.1186/s12938-019-0658-x.CrossRefPubMedPubMedCentral

57.

Jayawardene DC, et al. Closed-loop insulin delivery for adults with type 1 diabetes undertaking high-intensity interval exercise versus moderate-intensity exercise: a randomized, crossover study. Diabetes Technol Ther. 2017;19(6):340–8. https://doi.org/10.1089/dia.2016.0461.CrossRefPubMed

58.

Paldus B, et al. A Randomized crossover trial comparing glucose control during moderate-intensity, high-intensity, and resistance exercise with hybrid closed-loop insulin delivery while profiling potential additional signals in adults with type 1 diabetes. Diabetes Care. 2022;45(1):194–203. https://doi.org/10.2337/dc21-1593.CrossRefPubMed

59.

Vinals C, et al. Artificial pancreas with carbohydrate suggestion performance for unannounced and announced exercise in type 1 diabetes. J Clin Endocrinol Metab. 2021;106(1):55–63. https://doi.org/10.1210/clinem/dgaa562.CrossRefPubMed

60.

Tagougui S, et al. A single-blind, randomised, crossover study to reduce hypoglycaemia risk during postprandial exercise with closed-loop insulin delivery in adults with type 1 diabetes: announced (with or without bolus reduction) vs unannounced exercise strategies. Diabetologia. 2020;63(11):2282–91. https://doi.org/10.1007/s00125-020-05244-y.CrossRefPubMed

61.

Eckstein ML, et al. Time in range for closed-loop systems versus standard of care during physical exercise in people with type 1 diabetes: a systematic review and meta-analysis. J Clin Med 2021;10(11). https://doi.org/10.3390/jcm10112445.

62.

Matson RIB, Leary SD, Cooper AR, Thompson C, Narendran P, Andrews RC. Objective measurement of physical activity in adults with newly diagnosed type 1 diabetes and healthy individuals. Front Public Health. 2018;6:360. https://doi.org/10.3389/fpubh.2018.00360.CrossRefPubMedPubMedCentral

63.

Cescon M, et al. Activity detection and classification from wristband accelerometer data collected on people with type 1 diabetes in free-living conditions. Comput Biol Med. 2021;135: 104633. https://doi.org/10.1016/j.compbiomed.2021.104633.CrossRefPubMed

64.

Stenerson M, et al. The impact of accelerometer use in exercise-associated hypoglycemia prevention in type 1 diabetes. J Diabetes Sci Technol. 2015;9(1):80–5. https://doi.org/10.1177/1932296814551045.CrossRefPubMed

65.

Schwartz FL, Marling CR, Bunescu RC. The promise and perils of wearable physiological sensors for diabetes management. J Diabetes Sci Technol. 2018;12(3):587–91. https://doi.org/10.1177/1932296818763228.CrossRefPubMedPubMedCentral

66.

Weinstock RS, et al. Severe hypoglycemia and diabetic ketoacidosis in adults with type 1 diabetes: results from the T1D Exchange clinic registry. J Clin Endocrinol Metab. 2013;98(8):3411–9. https://doi.org/10.1210/jc.2013-1589.CrossRefPubMed

67.

Gandhi GY, Mooradian AD. Clinical considerations for insulin therapy in older adults with type 1 diabetes. Drugs Aging. 2022;39(1):23–37. https://doi.org/10.1007/s40266-021-00900-3.CrossRefPubMed

68.

Riddell MC, et al. Exercise management in type 1 diabetes: a consensus statement. Lancet Diabetes Endocrinol. 2017;5(5):377–90.CrossRef

69.

Peters TM, Brazeau A-S. Exercise in pregnant women with diabetes. Curr Diab Rep. 2019;19(9):80. https://doi.org/10.1007/s11892-019-1204-8.CrossRefPubMed

70.

American Diabetes Association. 14 Management of diabetes in pregnancy: standards of medical care in diabetes-2021. Diabetes Care. 2021;44(Suppl 1):S200–S210. https://doi.org/10.2337/dc21-S014.

71.

Kumareswaran K, et al. Physical activity energy expenditure and glucose control in pregnant women with type 1 diabetes: is 30 minutes of daily exercise enough? Diabetes Care. 2013;36(5):1095–101. https://doi.org/10.2337/dc12-1567.CrossRefPubMedPubMedCentral

72.

A systematic review and meta-analysis of exercise interventions in adults with type 1 diabetes - PubMed. https://pubmed-ncbi-nlm-nih-gov.proxy.library.nyu.edu/25451913/. Accessed 08 Mar 2022.

73.

Heart rate variability and plasma biomarkers in patients with type 1 diabetes mellitus: effect of a bout of aerobic exercise - PubMed. https://pubmed-ncbi-nlm-nih-gov.proxy.library.nyu.edu/26678666/. Accessed 08 Mar 2022.

74.

Bohn B, et al. Impact of physical activity on glycemic control and prevalence of cardiovascular risk factors in adults with type 1 diabetes: a cross-sectional multicenter study of 18,028 patients. Diabetes Care. 2015;38(8):1536–43. https://doi.org/10.2337/dc15-0030.CrossRefPubMed

75.

Tikkanen-Dolenc H, et al. Frequent and intensive physical activity reduces risk of cardiovascular events in type 1 diabetes. Diabetologia. 2016. https://doi.org/10.1007/s00125-016-4189-8.

76.

Houlder SK, Yardley JE. Continuous glucose monitoring and exercise in type 1 diabetes: past, present and future. Biosensors (Basel). 2018;8(3):73. https://doi.org/10.3390/bios8030073.CrossRef

77.

American Diabetes Association Professional Practice Committee, et al. 15 Management of diabetes in pregnancy: standards of medical care in diabetes-2022. Diabetes Care. 2022;45(Suppl 1):S232–S243. https://doi.org/10.2337/dc22-S015.

Title: Exercise and Self-Management in Adults with Type 1 Diabetes
Authors: Margaret McCarthy
Jeniece Ilkowitz
Yaguang Zheng
Victoria Vaughan Dickson
Publication date: 07-05-2022
Publisher: Springer US
Keywords: Insulins
Hypoglycemia
Insulins
Type 1 Diabetes
Published in: Current Cardiology Reports / Issue 7/2022
Print ISSN: 1523-3782
Electronic ISSN: 1534-3170
DOI: https://doi.org/10.1007/s11886-022-01707-3

ACC 2024 Congress Coverage

Heart Failure Video

At a glance: The STEP trials

Springer Medicine

Exercise and Self-Management in Adults with Type 1 Diabetes

Abstract

Purpose of Review

Recent Findings

Summary

ACC 2024 Congress Coverage

Year in Review: Heart failure and cardiomyopathies

Semaglutide benefits people with type 2 diabetes and obesity-related heart failure

Incentivised to exercise

New intervention for STEMI-related cardiogenic shock

» View more highlights on the ACC 2024 congress hub page

At a glance: The STEP trials

Springer Medicine

Abstract

Purpose of Review

Recent Findings

Summary

Please log in to get access to this content

Other articles of this Issue 7/2022

Safety and Efficacy of Robotic-Assisted PCI

Treatment of Hypertension Among Non-Cardiac Hospitalized Patients

How Much Lowering of Blood Pressure Is Required to Prevent Cardiovascular Disease in Patients With and Without Previous Cardiovascular Disease?

Assessment of Cardiac Risk in Women with Autoimmune Disease

COVID’s Impact on Non-communicable Diseases: What We Do Not Know May Hurt Us

Atherectomy vs Other Modalities for Treatment During Peripheral Vascular Intervention

ACC 2024 Congress Coverage

Year in Review: Heart failure and cardiomyopathies

Semaglutide benefits people with type 2 diabetes and obesity-related heart failure

Incentivised to exercise

New intervention for STEMI-related cardiogenic shock

» View more highlights on the ACC 2024 congress hub page