Type 1 diabetes is one of the most common chronic diseases among children and adolescents and is a condition where lifestyle choices make a major impact on the short- and long-term effects of the illness. In the September issue of Pediatrics, early releasing online in August, Shorey and co-authors examined this issue by performing a systematic review and meta-analysis of studies on physical activity and nutrition interventions in children and adolescents with type 1 diabetes (10.1542/peds.2022-056540).
The authors included randomized controlled trials looking at the effects of interventions related to physical activity and nutrition on hemoglobin A1c (HgbA1c) and health-related quality of life. It would seem that there would be an abundance of high-quality literature looking at the effects of lifestyle interventions on this common condition, yet only 18 articles met their criteria for inclusion.
Take home point #1: Although calls for further study are ubiquitous in medicine, this is truly an area where additional studies may be of particular importance for the long-term health of large numbers of children and adolescents.
When you look at the figures in this article, notice how most of the studies favor the interventions, even though the meta-analysis does not support statistical significance. Many of these studies were quite small, and the protocols were highly variable, so the meta-analysis adds power, but the heterogeneity of the study protocols makes broad conclusions problematic. As you interpret these findings, it is important to recognize several key features:
- Most of the physical activity studies included 2-3 sessions of low-moderate intensity exercise per week. This is far lower than the current recommendations for 60 minutes of moderate-vigorous activity per day for children and adolescents.
- This systematic review and meta-analysis are NOT looking at the effects of physical activity and nutrition per se, but the effects of interventions designed to increase physical activity and improve nutritional choices. Two of the physical activity studies included in the review did not result in significant change in activity levels.
Take home point #2: If “exercise is medicine” then it is highly likely that the dosage of activity in most of the included studies is too low to be effective.
Take home point #3: It is not just the intent of an intervention, but the actual uptake of that intervention that drives results.
In the discussion, the authors describe the features of interventions that demonstrated greater impact on measured outcomes. For physical activity, studies with higher frequency and duration of exercise sessions were more effective at reducing HgbA1c. Take a look at their discussion and conclusions to learn more about which interventions might be of greatest benefit to your patients with type 1 diabetes.
