title: Do youth with type 1 diabetes exercise safely? A focus on patient practices and glycemic outcomes.
abstract: Insulin adjustments have been shown to reduce glycemic excursions during and after exercise, but little is known about their use in youth with type 1 diabetes (T1D). We aimed to assess practices in youth with T1D around exercise, assess factors that influence practices, and examine associations between key behaviors and glycemic outcomes.
  
  
  
  We developed the 'Type 1 Diabetes Report of Exercise Practices Survey (T1D-REPS)' and piloted this tool in 100 youth with T1D on an insulin pump. Participants completed a 3-day physical activity recall and 30 days of pump/glucose data were collected. Chart review was conducted for key clinical measures.
  
  
  
  Eighty-four percent of participants modified their insulin regimen around exercise; only 40% reported adjusting prandial insulin immediately before exercise while 68% reported some modification (suspension or decrease) of basal insulin during exercise. Following exercise, only 10% reported reducing overnight basal insulin. Those who performed ≥ 5 glucose checks/day adjusted basal insulin during exercise more frequently than those with fewer daily glucose checks (33% vs. 13%, p = 0.05, chi-squared = 3.7), and were more likely to report decreasing insulin dose for the bedtime snack following exercise (50% vs. 17%, p = 0.004, chi-squared = 8.2).
  
  
  
  Despite several studies showing the frequency of hypoglycemia during and after exercise, many youth are not adjusting insulin for exercise. A tool designed to capture patient practices and provide clinicians with a framework for patient education may lead to improved safety around exercise in youth with T1D.
authors.affiliation: Seattle Children's Hospital Division of Endocrinology and Diabetes, Seattle, WA, USA.|University of Washington, Seattle, WA, USA.
authors.forename: Alissa J
authors.initials: AJ
authors.lastname: Roberts
authors.affiliation: Seattle Children's Research Institute, Seattle, WA, USA.
authors.forename: Joyce P
authors.initials: JP
authors.lastname: Yi-Frazier
authors.affiliation: Seattle Children's Hospital Division of Endocrinology and Diabetes, Seattle, WA, USA.
authors.forename: Karen E
authors.initials: KE
authors.lastname: Aitken
authors.affiliation: Seattle Children's Research Institute, Seattle, WA, USA.
authors.forename: Connor A
authors.initials: CA
authors.lastname: Mitrovich
authors.affiliation: Seattle Children's Research Institute, Seattle, WA, USA.
authors.forename: Michael F
authors.initials: MF
authors.lastname: Pascual
authors.affiliation: Seattle Children's Hospital Division of Endocrinology and Diabetes, Seattle, WA, USA.|University of Washington, Seattle, WA, USA.
authors.forename: Craig E
authors.initials: CE
authors.lastname: Taplin
mesh_terms: D000293:Adolescent; D000294:Adolescent Behavior; D001786:Blood Glucose / Q000032:analysis; D002648:Child; D002652:Child Behavior; D015331:Cohort Studies; D003131:Combined Modality Therapy / Q000009:adverse effects; D003922:Diabetes Mellitus, Type 1 / Q000097:blood / Q000628:therapy*; D015444:Exercise; D005260:Female; D006801:Humans; D006943:Hyperglycemia / Q000453:epidemiology / Q000517:prevention & control; D007003:Hypoglycemia / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control*; D007004:Hypoglycemic Agents / Q000008:administration & dosage* / Q000009:adverse effects / Q000627:therapeutic use; D007328:Insulin / Q000008:administration & dosage* / Q000009:adverse effects / Q000627:therapeutic use; D007332:Insulin Infusion Systems / Q000009:adverse effects; D008297:Male; D055118:Medication Adherence; D010865:Pilot Projects; D015995:Prevalence; D012306:Risk; D057566:Self Report; D014861:Washington / Q000453:epidemiology
chemical_list: D001786:Blood Glucose; D007004:Hypoglycemic Agents; D007328:Insulin
keywords: exercise; insulin pump; type 1 diabetes mellitus