Source: Aman J, Skinner TC, de Beaufort CE, et al. Associations between physical activity, sedentary behavior, and glycemic control in a large cohort of adolescents with type 1 diabetes: the Hvidoere Study Group on Childhood Diabetes. Pediatr Diab. 2009; in press; doi:10.1111lj.1399-5448.2008.00495.xThe Hvidoere Study Group (HSG) on Childhood Diabetes, a worldwide consortium of pediatric diabetes caregivers, sought to explore whether differences in physical activity or sedentary behavior could explain the variation in metabolic outcomes in adolescents with type 1 diabetes (T1DM).Youth aged 11–18 years with T1DM for at least one year were invited to participate in the study which was conducted at 21 centers located on multiple continents. In addition to standard clinical data, diabetes-specific quality of life was assessed in study patients using an edited version of the Diabetes Quality of Life-Short Form (DQOL-SF) questionnaire.Psychological status and health perception were assessed using the World Health Organization’s Health Behavior School-aged Children Questionnaire (HBSC survey 2001). Questions on the survey included number of days during the last week being moderately physically active for more than one hour, the usual number of hours watching television during one day, the usual daily number of hours doing school homework, and the usual daily hours of computer activity. Hemoglobin A1c (HbA1c) level, assayed in one central laboratory, was the primary study outcome.Of the 2,269 patients with insulin-treated T1DM, 2,093 (92%) completed the questionnaires, and 89% had an HbA1c performed. Mean age was 14.5±2.1 years for males and 14.5±2.1 for females; insulin pump therapy was used by 15.9% of patients.Mean body mass index (BMI) was 22.8±4.2 in females and 21.7±3.7 in males and did not correlate with HbA1c or insulin regimen. The mean HbA1c in study patients was 8.2±1.4% (males 8.1±1.3%; females 8.3±1.5%) and was positively but modestly correlated to age and duration of diabetes. Adolescents whose families had language problems had significantly higher HbA1c than those from families with no language problems.Older participants and females reported less physical activity. Physical activity was not associated with metabolic outcome (HbA1c), frequency of hypoglycemia, ketoacidosis, or BMI.However, it was positively associated with all markers of psychological health including general quality of life.There were significant differences among centers for physical activity, watching television, playing on the computer, and time spent doing school homework. However, these center differences did not account for the center differences in metabolic outcomes. The authors conclude that physical activity is strongly associated with general well-being and psychological well-being but not with metabolic control.Dr. Varma has disclosed no financial relationship relevant to this commentary. This commentary does not contain a discussion of an unapproved/investigative use of a commercial product/device.Multicenter studies, particularly those with centers on multiple continents with a broad range of cultural norms, present challenges in reaching a straightforward conclusion using the same questionnaire form.Although a large group of adolescents were enrolled in the current study, the complexities of the study issues across cultures may interfere with defining a clear explanation of differences in clinical outcomes. Also, as the authors note, self-reporting on questionnaires may not be accurate. Furthermore, a single value of HbA1c may not reflect long-term control.The authors’ finding that regular physical activity was associated with better psychological health of adolescents is not surprising. Physical activity is one of the major tools for treatment of T1DM, and it has been shown to improve insulin sensitivity and increase lean body mass. The improved physical and psychological well-being also will positively affect lipid metabolism.1The authors’ conclusion, that there is no correlation between physical activity and glycemic control in adolescents, is a discouraging finding that echoes prior studies.2,3 However, recommending physical activity on a daily basis in patients with T1DM should at least benefit psychosocial health status, an important outcome for patients with chronic disease.
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Apr 1, 2018
Diane K Wherrett + 5
Open Access
