Does Exercise Improve Glycaemic Control in Type 1 Diabetes? A Systematic Review and Meta-Analysis

<div><p>Objective</p><p>Whilst regular exercise is advocated for people with type 1 diabetes, the benefits of this therapy are poorly delineated. Our objective was to review the evidence for a glycaemic benefit of exercise in type 1 diabetes.</p> <p>Research Design and Methods</p><p>Electronic database searches were carried out in MEDLINE, Embase, Cochrane’s Controlled Trials Register and SPORTDiscus. In addition, we searched for as yet unpublished but completed trials. Glycaemic benefit was defined as an improvement in glycosylated haemoglobin (HbA1c). Both randomised and non-randomised controlled trials were included.</p> <p>Results</p><p>Thirteen studies were identified in the systematic review. Meta-analysis of twelve of these (including 452 patients) demonstrated an HbA1c reduction but this was not statistically significant (standardised mean difference (SMD) −0.25; 95% CI, −0.59 to 0.09).</p> <p>Conclusions</p><p>This meta-analysis does not reveal evidence for a glycaemic benefit of exercise as measured by HbA1c. Reasons for this finding could include increased calorie intake, insulin dose reductions around the time of exercise or lack of power. We also suggest that HbA1c may not be a sensitive indicator of glycaemic control, and that improvement in glycaemic variability may not be reflected in this measure. Exercise does however have other proven benefits in type 1 diabetes, and remains an important part of its management.</p> </div

Results of studies of physical activity and glycaemic control (HbA1c) in type 1 diabetes patients according to age groups of participants.

<p>Results of studies of physical activity and glycaemic control (HbA1c) in type 1 diabetes patients according to age groups of participants.</p

Metaregression by duration of study (A) and age of participants (B).

<p>Metaregression by duration of study (A) and age of participants (B).</p

Flow diagram of articles identified.

<p>Flow diagram of articles identified.</p

Quality Assessment.

b<p>Although reported as a RCT, groups were randomly assigned by a diabetologist to either exercise programme. It is not clear if the controls were selected randomly or those who didn’t attend the exercise session were designated as controls.</p>c<p>randomisation occurred before consent was sought.</p

Study Characteristics and Results.

a<p>Participants performed one 2 hour supervised exercise session and an additional one 1 hour unsupervised session per week. Attendance for the unsupervised session was 52–89%.</p>b<p>Although reported as a RCT, groups were randomly assigned by a diabetologist to either exercise programme. It is not clear if the controls were selected randomly or those who didn’t attend the exercise session were designated as controls.</p>c<p>Control participants are the same for both interventions. These participants therefore appear twice in this table, explaining a total of 452 participants across all studies in this table.</p>d<p>Weighted mean (for two control groups).</p>e<p>Randomisation occurred before consent was sought.</p>f<p>Participants could undertake an additional unsupervised exercise session at home.</p>g<p>Median.</p