ISPAD Clinical Practice Consensus Guidelines 2022: Exercise in children and adolescents with diabetes

Peter Adolfsson^{1

2}, Craig E Taplin^{3

4

5}, Dessi P Zaharieva⁶, John Pemberton⁷, Elizabeth A Davis^{3

4

5}, Michael C Riddell⁸, Jonathan McGavock^{9

10

11

12}, Othmar Moser^{13

14}, Agnieszka Szadkowska¹⁵, Prudence Lopez^{16

17}, Jeerunda Santiprabhob^{18

19}, Elena Frattolin²⁰, Gavin Griffiths²¹, Linda A DiMeglio²²

Affiliations

¹ Department of Pediatrics, Kungsbacka Hospital, Kungsbacka, Sweden.
² Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
³ Department of Endocrinology and Diabetes, Perth Children's Hospital, Nedlands, Western Australia, Australia.
⁴ Telethon Kids Institute, University of Western Australia, Perth, Western Australia, Australia.
⁵ Centre for Child Health Research, University of Western Australia, Perth, Western Australia, Australia.
⁶ Division of Endocrinology, Department of Pediatrics, School of Medicine, Stanford University, Stanford, California, USA.
⁷ Department of Endocrinology and Diabetes, Birmingham Women's and Children's Hospital, Birmingham, UK.
⁸ Muscle Health Research Centre, York University, Toronto, Ontario, Canada.
⁹ Faculty of Kinesiology and Recreation Management, University of Manitoba, Winnipeg, Manitoba, Canada.
¹⁰ Diabetes Research Envisioned and Accomplished in Manitoba (DREAM) Theme, Children's Hospital Research Institute of Manitoba, Winnipeg, Manitoba, Canada.
¹¹ Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, Manitoba, Canada.
¹² Diabetes Action Canada SPOR Network, Toronto, Ontario, Canada.
¹³ Division Exercise Physiology and Metabolism, Department of Sport Science, University of Bayreuth, Bayreuth, Germany.
¹⁴ Interdisciplinary Metabolic Medicine Trials Unit, Division of Endocrinology and Diabetology, Department of Internal Medicine, Medical University of Graz, Graz, Austria.
¹⁵ Department of Pediatrics, Diabetology, Endocrinology & Nephrology, Medical University of Lodz, Lodz, Poland.
¹⁶ Department of Paediatrics, John Hunter Children's Hospital, Newcastle, New South Wales, Australia.
¹⁷ University of Newcastle, Newcastle, New South Wales, Australia.
¹⁸ Siriraj Diabetes Center, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
¹⁹ Division of Endocrinology and Metabolism, Department of Pediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
²⁰ Board of Diabete Italia, Diabete Forum, Italy.
²¹ DiAthlete & League of DiAthlete Global Programme, UK.
²² Department of Pediatrics, Division of Pediatric Endocrinology and Diabetology, Indiana University School of Medicine, Riley Hospital for Children, Indianapolis, Indiana, USA.

PMID: 36537529
PMCID: PMC10107219
DOI: 10.1111/pedi.13452

ISPAD Clinical Practice Consensus Guidelines 2022: Exercise in children and adolescents with diabetes

Peter Adolfsson et al. Pediatr Diabetes. 2022 Dec.

. 2022 Dec;23(8):1341-1372.

doi: 10.1111/pedi.13452.

Authors

Affiliations

¹ Department of Pediatrics, Kungsbacka Hospital, Kungsbacka, Sweden.
² Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
³ Department of Endocrinology and Diabetes, Perth Children's Hospital, Nedlands, Western Australia, Australia.
⁴ Telethon Kids Institute, University of Western Australia, Perth, Western Australia, Australia.
⁵ Centre for Child Health Research, University of Western Australia, Perth, Western Australia, Australia.
⁶ Division of Endocrinology, Department of Pediatrics, School of Medicine, Stanford University, Stanford, California, USA.
⁷ Department of Endocrinology and Diabetes, Birmingham Women's and Children's Hospital, Birmingham, UK.
⁸ Muscle Health Research Centre, York University, Toronto, Ontario, Canada.
⁹ Faculty of Kinesiology and Recreation Management, University of Manitoba, Winnipeg, Manitoba, Canada.
¹⁰ Diabetes Research Envisioned and Accomplished in Manitoba (DREAM) Theme, Children's Hospital Research Institute of Manitoba, Winnipeg, Manitoba, Canada.
¹¹ Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, Manitoba, Canada.
¹² Diabetes Action Canada SPOR Network, Toronto, Ontario, Canada.
¹³ Division Exercise Physiology and Metabolism, Department of Sport Science, University of Bayreuth, Bayreuth, Germany.
¹⁴ Interdisciplinary Metabolic Medicine Trials Unit, Division of Endocrinology and Diabetology, Department of Internal Medicine, Medical University of Graz, Graz, Austria.
¹⁵ Department of Pediatrics, Diabetology, Endocrinology & Nephrology, Medical University of Lodz, Lodz, Poland.
¹⁶ Department of Paediatrics, John Hunter Children's Hospital, Newcastle, New South Wales, Australia.
¹⁷ University of Newcastle, Newcastle, New South Wales, Australia.
¹⁸ Siriraj Diabetes Center, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
¹⁹ Division of Endocrinology and Metabolism, Department of Pediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
²⁰ Board of Diabete Italia, Diabete Forum, Italy.
²¹ DiAthlete & League of DiAthlete Global Programme, UK.
²² Department of Pediatrics, Division of Pediatric Endocrinology and Diabetology, Indiana University School of Medicine, Riley Hospital for Children, Indianapolis, Indiana, USA.

PMID: 36537529
PMCID: PMC10107219
DOI: 10.1111/pedi.13452

No abstract available

PubMed Disclaimer

Conflict of interest statement

Peter Adolfsson has received speaker's honoraria from Dexcom, Eli Lilly, Insulet, Novo Nordisk, Sanofi, and Tandem in the last 24 months. He has had consulting fees and/or advisory positions with Dexcom, Eli Lilly, Medtronic, Novo Nordisk, and Roche. Craig E. Taplin has received honoraria from Medtronic Diabetes Australia, Insulet Australia and Eli Lilly Australia. Dessi P. Zaharieva has received speaker's honoraria from Medtronic Diabetes, Ascensia Diabetes, and Insulet Canada; and research support from the Helmsley Charitable Trust and ISPAD‐JDRF Research Fellowship. She is also on the Dexcom Advisory board. John Pemberton has worked for Medtronic from 2011 to 2016 and has attended two SIGMA CGM educational events sponsored by Dexcom in 2017 and 2019. Elizabeth A. Davis has received honoraria from Eli Lilly Australia in the last 24 months. Michael C. Riddell has received speaker's honoraria from Novo Nordisk, Eli Lilly, Dexcom and Roche in the last 24 months. He has had consulting fees and/or advisory positions with Zealand Pharm, Zucara Therapeutics, Eli Lilly, and Indigo Diabetes. Jonathan McGavock: none. Othmar Moser has received speaker's honoraria from Medtronic, Sanofi, Novo Nordisk and TAD Pharma. Research funding/support: Novo Nordisk, Sanofi, Abbott, Medtronic, Dexcom, Maisels, Horizon 2020, EFSD. Agnieszka Szadkowska has received speaker's honoraria from Medtronic Diabetes, Ascensia Diabetes, Abbott, Dexcom, Roche Diabetes, NovoNordisk, Eli Lilly, Sanofi, has been a member of advisory board for Medtronic Diabetes, Ascensia Diabetes, Abbott, Dexcom, Roche Diabetes, NovoNordisk, Eli Lilly, and has received a research funding from Roche Diabetes. Prudence Lopez: none. Jeerunda Santiprabhob has received speaker's honoraria from Sanofi, Novo Nordisk, and Ferring and has been a member of Thailand advisory board of Liraglutide and Norditropin (Novo Nordisk). Elena Frattolin: none. Gavin Griffiths: none.

Figures

**FIGURE 1**
Structured approach to exercise consultations (original work by Chetty et al). Copyright © 2019 Chetty, Shetty, Fournier, Adolfsson, Jones and Davis. This is an open‐access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

**FIGURE 2**
In general, aerobic exercise is associated with a drop in glycemia, while anaerobic and mixed forms of exercise can be associated with less of a drop or even a rise in glycemia. Individual responses are dependent on various additional factors, including the duration and intensity of the activity; initial blood glucose concentrations; individual fitness; time of day of exercise, concentrations of insulin, glucagon, and other counter‐regulatory hormones in the circulation; and the nutritional status of the individual. Reproduced with permission from: Riddell MC. Management of exercise for children and adolescents with type 1 diabetes mellitus. In: UpToDate, Post‐TW (Ed), UpToDate, Waltham, MA. (Accessed on August 2, 2022) Copyright © 2018 UpToDate, Inc.

See this image and copyright information in PMC

References

1. Adolfsson P, Riddell MC, Taplin CE, et al. ISPAD clinical practice consensus guidelines 2018: exercise in children and adolescents with diabetes. Pediatr Diabetes. 2018;19(27):205‐226. - PubMed
1. Jendle JH, Riddell MC, Jones TW. Physical Activity and Type 1 Diabetes. Frontiers Media SA; 2020. - PMC - PubMed
1. Klaprat N, MacIntosh A, McGavock JM. Gaps in knowledge and the need for patient‐partners in research related to physical activity and type 1 diabetes: a narrative review. Front Endocrino. 2019;10:42. - PMC - PubMed
1. Yardley JE, Brockman NK, Bracken RM. Could age, sex and physical fitness affect blood glucose responses to exercise in type 1 diabetes? Front Endocrinol. 2018;9:674. - PMC - PubMed
1. Chetty T, Shetty V, Fournier PA, Adolfsson P, Jones TW, Davis EA. Exercise management for young people with type 1 diabetes: a structured approach to the exercise consultation. Front Endocrinol. 2019;10:326. - PMC - PubMed

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ISPAD Clinical Practice Consensus Guidelines 2022: Exercise in children and adolescents with diabetes

Affiliations

ISPAD Clinical Practice Consensus Guidelines 2022: Exercise in children and adolescents with diabetes

Authors

Affiliations

Conflict of interest statement

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References

MeSH terms

Substances

Grants and funding

LinkOut - more resources

Full Text Sources

Medical