Abstract

Objective: We evaluated substrate utilization during submaximal exercise, together with glycemic responses and hormonal counter-regulation to exercise, in children with type 1 diabetes mellitus (T1DM).Methods: Twelve pre-pubescent children with T1DM and 12 healthy children were matched by sex and age. Participants completed a submaximal incremental exercise test to determine their fat and carbohydrate oxidation rates by indirect calorimetry. Levels of glycemia, glucagon, cortisol, growth hormone, noradrenaline, adrenaline, and insulin were monitored until 120 min post-exercise.Results: Absolute peak oxygen uptake (VO2 peak) was significantly lower in the children with T1DM than in the healthy controls (1131.4 ± 102.5 vs. 1383.0 ± 316.6 ml.min−1, p = 0.03). Overall carbohydrate and lipid oxidation rates were the same in the two groups, but for exercise intensities, higher than 50% of VO2 peak, fat oxidation rate was significantly lower in the children with T1DM. The absolute maximal lipid oxidation rate was significantly lower in the T1DM children (158.1 ± 31.6 vs. 205.4 ± 42.1 mg.min−1, p = 0.005), and they reached a significantly lower exercise power than the healthy controls (26.4 ± 1.2 vs. 35.4 ± 3.3 W, p = 0.03). Blood glucose responses to exercise were negatively correlated with pre-exercise blood glucose concentrations (r = −0.67; p = 0.03).Conclusion: Metabolic and hormonal responses during sub-maximal exercise are impaired in young children with T1DM.

Highlights

  • Type 1 diabetes mellitus (T1DM) is an autoimmune metabolic diseases associated with deficient insulin secretion and resulting in impaired carbohydrate metabolism

  • There was no significant difference between the children with T1DM and the healthy children in resting metabolism, relative VO2 peak, BMI-for-age percentile, rest heart rate, maximal heart rate, or physical activity level score (Table 1)

  • The present study showed an impairment in physical fitness and in metabolic fitness in pre-pubescent children with T1DM

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Summary

Introduction

Type 1 diabetes mellitus (T1DM) is an autoimmune metabolic diseases associated with deficient insulin secretion and resulting in impaired carbohydrate metabolism (dysglycemia; Galassetti and Riddell, 2013). Regular exercise increases cardiorespiratory fitness, improves insulin function, and reduces risk of diabetes-related complications, children with T1DM tend to be less physically active than their healthy peers (Valerio et al, 2007) and so can be less physically fit (e.g., lower VO2max and muscle strength; Lukács et al, 2012; Galassetti and Riddell, 2013). This lower physical activity in children with T1DM may be explained by difficulties in managing insulin administration during exercise to avoid unexpected hypo- and/or hyperglycemic episodes during and after physical activity. Improved treatment regimens (pumps, or long-lasting background insulins) and glycemic management (continuous glucose monitoring and intermittently scanned continuous glucose monitoring systems), to measure glucose and manage adaptations around exercise, are a major advance for a more active lifestyle (Moser et al, 2020)

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