JDRF Effort Creates Exercise Guidelines for Type 1 Diabetes

Too often, experts say, fear of hypoglycemia causes those with T1D to forgo exercise, despite the benefits.

For those with type 1 diabetes (T1D), exercise can be a double-edged sword—its long-term health benefits are clear, but its short-term effect on blood glucose levels can be tough to navigate.

To help those with T1D to exercise safely, a team of experts, funded by JDRF (formerly the Juvenile Diabetes Research Foundation), has created the first-ever guidelines for this population, which appeared Tuesday in The Lancet Diabetes & Endocrinology.

“Exercise has tremendous benefits for people with T1D, but it can be hard to predict how it will affect their blood glucose and how they feel during and following physical activity,” Aaron Kowalski, PhD, chief mission officer for JDRF, said in an announcement from the group. “The lack of reliable information on how to exercise safely has created obstacles for people with T1D who want to maintain a healthy lifestyle.”

Guideline development was a 2-year process, in which leading diabetes researchers, physicians, and other experts reviewed observational studies and clinical trials to create a consensus report on how different types of exercise affect blood glucose levels. Kowalski said the guidelines, along with JDRF’s new PEAK program (Performance in Exercise and Knowledge), are removing barriers for those living with T1D.

Too often, said Michael Riddell, PhD, a professor in the School of Kinesiology and Health Science at Toronto’s York University, fear outweighs better health. “Regular exercise can help individuals with diabetes to achieve their blood lipid, body composition, fitness, and blood sugar goals, but for people with type 1 diabetes, the fear of hypoglycemia, loss of glycemic control, and inadequate knowledge around exercise management are major barriers,” Riddell said.

CDC recommends at least 150 minutes per week of moderate-to-vigorous physical activity, but a large share of those with T1D don’t achieve this, the authors note. As a result, the majority of those with the condition are overweight or obese, when in prior generations, they were comparatively slim.

Generally, aerobic activities like walking or cycling are associated with reductions in glycemia, while anaerobic activities that include short bursts of exertion—like sprinting, weight lifting, or hockey—can temporarily increase blood sugar levels. Both forms can trigger hypoglycemia after the activity ends, when patients are sleeping. Thus, knowing what to expect from each sport or activity is crucial. The guidelines feature specific glucose targets, and nutrition and insulin dosing information to protect against glucose peaks or valleys.

“The guidelines fulfil a major unmet need to help patients with T1D, and their healthcare professionals, to overcome the various barriers for exercise, and this, in turn, should help them achieve the multitude of health benefits that exercise affords,” said Remi Rabasa-Lhoret, of the Montreal Clinical Research Institute.

Reference

Riddell MC, Gallen IW, Smart CE, et al. Exercise management in type 1 diabetes: a consensus statement [published January 23, 2017]. Lancet Diab Endocrinol. 2017; doi: http://dx.doi.org/10.1016/S2213-8587(17)30014-1.