Potential Barriers To The Implementation Of Physical Activity Recommendations In Patients With Type 1 Diabetes Mellitus

Abstract

Introduction: Type 1 diabetes mellitus (type 1 DM) results from autoimmune destruction of insulin-producing beta cells in the pancreas in genetically predisposed individuals, leading to insulin deficiency and hyperglycemia. It usually manifests itself in childhood and adolescence, and its prevalence reaches epidemic proportions. It is a complex disease that affects not only the physical health of the individual, but also his social integration and quality of life. For their current treatment, patients with type 1 DM require exogenous insulin replacement therapy.  Along with drug treatment, physical activity (PA) has a significant impact on the health status of those diagnosed with type 1 DM.

PA, along with insulin treatment, is considered a tool of disease management and good control. The benefits of PA for people with type 1 DM can be seen as improving glycemic control, blood pressure, cardiac activity, lipid profile, weight reduction, physical and mental well-being, and delayed complications.

Aim: The aim of the current review is placed on potential barriers to the implementation of physical activity recommendations in patients with type 1 DM.

Materials and methods: A review and systematic search of databases of - Google Scholar, Pub Med, Medscape and Science Direct for the last 10 years has been made, with key words: diabetes type 1, barriers, physical activity, recommendations, from which an overview of recommended physical activity in type 1 DM and difficulties in its implementation is written. From 493 overview articles which were reviewed, 68 met the criteria for full-text inclusion. From these, only overview articles on the subject have been analysed and included. Inclusion criteria included patients diagnosed with type 1 DM for more than 1 year; on insulin therapy with pump therapy and multiple daily applications of fast-acting and long-acting insulin; aged ≥ 18 years. Exclusion criteria included pregnant or patients with severe diabetic complications, with chronic conditions unable to move (eg, severe peripheral or autonomic neuropathy), patients over 65 years of age in whom (IPAQ) was invalidated.

Results: The analysis of the data shows that the patients included in the study with an average age of 40 years and a diagnosis of type 1 DM with a long duration of insulin treatment. To evaluate interventions, an international physical activity questionnaire (IPAQ), an axelometer, and continuous blood glucose (CGM) monitoring systems are often used. Overweight and obesity were found in a large part of the patients. PA recommendations are implemented by only a third of patients enrolled in the studies.

Conclusion: PA improves physical fitness and strength, reduces cardiovascular risk factors, and improves well-being in type 1 DM. It also significantly reduces insulin requirements and has been shown to improve glycemic control as measured by HbA1c.