Original Article
Impact of Exercise on Overnight Glycemic Control in Children with Type 1 Diabetes Mellitus

https://doi.org/10.1016/j.jpeds.2005.04.065Get rights and content

Objective

To examine the effect of exercise on overnight hypoglycemia in children with type 1 diabetes mellitus (T1DM).

Study design

At 5 clinical sites, 50 subjects with T1DM (age 11 to 17 years) were studied in a clinical research center on 2 separate days. One day included an afternoon exercise session on a treadmill. On both days, frequently sampled blood glucose levels were measured at the DirecNet central laboratory. Insulin doses were similar on both days.

Results

During exercise, plasma glucose levels fell in almost all subjects; 11 (22%) developed hypoglycemia. Mean glucose level from 10 pm to 6 am was lower on the exercise day than on the sedentary day (131 vs 154 mg/dL; P = .003). Hypoglycemia developed overnight more often on the exercise nights than on the sedentary nights (P = .009), occurring on the exercise night only in 13 (26%), on the sedentary night only in 3 (6%), on both nights in 11 (22%), and on neither night in 23 (46%). Hypoglycemia was unusual on the sedentary night if the pre-bedtime snack glucose level was > 130 mg/dL.

Conclusions

These findings indicate that overnight hypoglycemia after exercise is common in children with T1DM and support the importance of modifying diabetes management after afternoon exercise to reduce the risk of hypoglycemia.

Section snippets

Consent procedures

The DirecNet Data and Safety Monitoring Board and the institutional review boards at each of the DirecNet centers approved the study protocol, consent form, and assent form. A parent or guardian and each subject gave written consent and assent, respectively.

Eligibility criteria and assessment

To be eligible for the study, subjects had to meet the following criteria: (1) age 10 to 18 years; (2) a clinical diagnosis of T1DM of ≥18 months duration; (3) on a stable insulin regimen for at least 1 month, involving either use of an

Results

Fifty subjects participated in the study between June 2004 and November 2004. Their average age was 14.8 ± 1.7 years; 44% were female; and the racial/ethnic distribution was 90% Caucasian, 4% African-American, 2% Hispanic, and 4% Asian. The mean duration of T1DM was 7.0 ± 3.7 years. An insulin pump was used by 54%; multiple daily injections by the other 46%. Mean HbA1c was 7.8 ± 0.8%. Three subjects (6%) reported a severe episode of hypoglycemia (resulting in seizure or loss of consciousness)

Discussion

We designed the present study to more carefully define the effect of afternoon exercise on the relative risk of hypoglycemia during the following night in a cohort of 50 children with T1DM who were using an intensive diabetes management regimen involving either insulin pumps or multiple daily insulin injections. A carefully controlled cross-over design that involved a supervised and standardized exercise protocol was used to compare the frequency of overnight hypoglycemia after afternoon

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    Supported by NIH/NICHD grants HD041919-01, HD041915-01, HD041890, HD041918-01, HD041908-01, and HD041906-01 and by the Nemours Research Programs. Clinical centers also received funding through GCRC grants M01 RR00069, RR00059, RR06022, and RR00070-41. LifeScan, Milpitas, CA, provided the One-Touch Ultra blood glucose monitoring systems and test strips.

    Reprint requests: Eva Tsalikian, MD, c/o DirecNet Coordinating Center, Jaeb Center for Health Research, 15310 Amberly Drive, Suite 350, Tampa, FL 33647. E-mail: [email protected].

    The members of the DirecNet Study Group are listed in the Appendix.

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