Managing the blood glucose levels around physical activity remains one of the most challenging aspects of living with type 1 diabetes (T1D). There is a need to develop an easily accessible exercise intervention to help young people with T1D take appropriate action to optimise glucose levels during and after exercise.
Type 1 diabetes (T1D) is a chronic autoimmune condition caused by a loss of the ability to produce insulin. It affects around 1200 children in Western Australia, with approximately 160 new diagnoses every year.
Exercise is a vital part of managing T1D in childhood, as well as into adulthood, resulting not only in a stronger heart but also improved strength, fitness and mental wellbeing, reduced insulin requirements – and importantly, fewer life-limiting complications in adulthood.
Despite the many physical and psychological health benefits of regular exercise, many do not meet physical activity recommendations of at least 60 minutes/day of moderate to vigorous activity, with only 40-50% of individuals with T1D achieving a physically active lifestyle. Cardiovascular disease is the most common cause of shortened life expectancy in T1D and is clearly linked to key modifiable factors, including exercise.
Physical activity, however, presents unique challenges for young people with T1D, especially the risk of hypoglycaemia, which is frequently reported to be a barrier to an active lifestyle. Inadequate patient and health care provider knowledge about exercise-related diabetes management is another significant barrier.
Exercise management for young people with T1D is complex and one approach does not fit all. Many factors influence an individual’s glycaemic response to exercise including the exercise type, intensity and duration, fitness levels, insulinaemic state, environmental conditions, and anxiety and stress levels.
Despite the technological advances in diabetes management, such as insulin pumps and continuous glucose monitoring (CGM) systems, which have aided in the management of T1D, managing blood glucose levels around physical activity remains one of the biggest challenges to overcome due to the often-unpredictable nature of exercise and its effect on blood glucose levels.
Key professional societies and organisations have published recommendations for the prevention of exercise-related hypoglycaemia based on previous clinical studies and expert opinion. However, these recommendations can be challenging to follow and are often located in medical journals, not readily accessible to the general T1D community.
Therefore, adolescents and young adults with T1D may benefit from having access to decision-support aids to effectively contextualise a blood glucose result and take appropriate action to optimise glucose levels during and after exercise.
The Children’s Diabetes Centre at Telethon Kids Institute and Perth Children’s Hospital aims to address the exercise-related challenges faced by adolescents and young adults with T1D by developing a digital educational exercise intervention in order to support them to exercise safely and more frequently.
The development included multiple components. Firstly, we conducted focus groups with adolescents and young adults with T1D to identify barriers and facilitators in managing blood glucose levels around exercise. Next, we engaged them in co-designing an exercise intervention mobile health application (app) and finally testing the functionality, efficacy and safety of the app before translation and implementation to clinical practice in Western Australia, nationally and internationally.
- Personalised insulin dose and carbohydrate advice for exercise lasting up to 60 minutes based on the user’s input on the type, intensity and duration of physical activity they are about to complete, duration since the last insulin bolus and their current blood glucose levels
- Information on hypoglycaemia treatment, pre- and post-exercise insulin, and carbohydrate advice
- Educational food guide that highlights the importance of low and high glycaemic index (GI) foods in the context of exercise management.
In an early pilot trial, acT1ve was found to be informative, functional, acceptable and to attract high user satisfaction, making it a promising intervention for exercise management. The app was amended based on the feedback from the pilot trial.
The current phase of this program involves testing the efficacy and safety of acT1ve to obtain regulatory approvals before translation and implementation of this app into routine clinical practice, as a valuable supplement to diabetes management around exercise for adolescents and young adults with T1D.
ED: Dr Shetty is a Clinical Researcher at the Children’s Diabetes Centre, Telethon Kids Institute.
Author competing interests – the author was involved in the app development