Perth Research: promoting exercise among patients with diabetes

Patients with type 1 diabetes may see significant benefits from this new program to get them moving.

Perth-based researchers, led by Dr Marian Brennan, from the School of Nursing, Midwifery and Paramedicine at Curtin University, have developed a new program, called Type 1 TACTICS for Exercise, to help improve levels pf physical activity in patients with type 1 diabetes.

The program is the first of its kind in Australia and aims to help patients overcome some common fears and barriers they face to engage in a regular exercise program. In Australia, it is estimated that about 66% of patients with type 1 diabetes do not follow recommended guidelines of physical activity, which can result in significant health problems.

About the problem
For people with diabetes, it is important to reduce events of low (hypoglycemia) or high blood sugar levels (hyperglycemia). For these patients, it is also important to reduce their risk of long-term complications, such as retinopathy, neuropathy, and cardio-vascular disease (CVD). For CVD, for example, individuals with type 1 diabetes can have a ten-times higher risk of cardiovascular events, such as myocardial infarction, stroke, angina, and the need for coronary-artery revascularisation, compared to non-diabetic populations of the same age.

For anyone with type 1 diabetes, the primary treatment to avoid complications is life-long insulin supplementation, but lifestyle changes like improved diet and exercise patterns can also help significantly. Physical activity is a particularly important aspect in the management of type 1 diabetes (T1D), as it can help improve cardiovascular health, reduce dosages of insulin and even improving levels of glycated haemoglobin.

To achieve these benefits, people with T1D need to engage in at least 150 minutes of moderate-intensity physical activity per week and resistance training 2 days per week. However, such recommendations have been hard to follow for most T1D patients. Studies show that between 65% and 83% of patients do not following the recommended PA guidelines.

Therefore, supporting this community to get active while managing this is complex, Type 1 Tactics for exercise is tailored to provide this unique support for type 1s specific needs

About the program
The novel program is defined as a theory-driven, self-management group education program, which aims to help patients with T1D overcome some common barriers to improved physical activity.

A previous study by Dr Brennan and collaborators, identified a single factor as the most common barrier preventing individuals with T1D to engage in a long-term physical activity program. “We found the most commonly reported barrier was fear of hypoglycaemia, yet there were very few (none in Australia) evidence-informed interventions to address this diabetes-specific barrier to physical activity,” Dr Brennan told Medical Forum.

To address the lack of interventional programs in Australia to address this problem, Dr Brennan designed the Type 1 TACTICS for Exercise program. The program consists of an initial 3-hour session, a 1-hour booster session four weeks later and participation in a peer-led private Facebook group, where participants can discuss any issues with their participation in the program.

In a recently published article, Dr Brennan reported that novel exercise program worked well, helping patients overcome their fear of hypoglycaemia and improve their levels of PA. “We found the program to be feasible to deliver and acceptable to people living with T1D,” Dr Brennan said.

“Preliminary efficacy found that Type 1 TACTICS for Exercise decreased barriers to physical activity (including fear of hypoglycaemia), improved confidence to manage blood glucose levels before, during, and after physical activity, reduced diabetes distress, and improved well-being,” she added.

With these promising results in the table Diabetes WA is planning to implement the Type 1 TACTICS for Exercise program in Western Australia, later in 2021. The program may benefit thousands of people currently living with T1D in WA.

General Manager of Growth and Innovation Sophie McGough said Diabetes WA plans to start running Type 1 Tactics for Exercise for free for people living with diabetes in the next 12 months

“With additional funding we can run more programs in rural and remote areas where there is a huge need, and to train other credentialled diabetes educators to deliver the program across Western Australia,” she added.