Hasan Saima, Shaw Sian M, Gelling Leslie H, Kerr Catherine J, Meads Catherine A
Faculty of Health, Social Care and Education (FHSCE), Anglia Ruskin University, Cambridge, UK.
Freelance Research Consultant, Cambridge, UK.
BMJ Open Diabetes Res Care. 2018 Oct 8;6(1):e000578. doi: 10.1136/bmjdrc-2018-000578. eCollection 2018.
Type 1 diabetes mellitus rates are rising worldwide. The health benefits of physical exercise in this condition are many, but more than 60% do not participate, mainly from fear of hypoglycemia. This systematic review explores the effects of physical exercise modes on blood glucose levels in adults for hypoglycemia prevention.
Predefined inclusion criteria were randomized or non-randomized cross-over trials of healthy non-obese adults with type 1 diabetes mellitus. Exercise interventions used standardized protocols of intensity and timing. Outcomes included hypoglycemia during or after exercise, and acute glycemic control. Medline, Cumulative Index to Nursing and Allied Health Literature, Allied and Complementary Medicine Database, SPORTDiscus, CochraneCENTRAL (1990 to 11 January 2018), and Embase (1988 to 9 April 2018) were searched using keywords and Medical Subject Heading (MeSH) terms. Inclusions, data extraction and quality assessment using the Critical Appraisal Skills Programme checklists were done by one researcher and checked by a second. Review Manager (V.5.3) was used for meta-analysis where four or more outcomes were reported.
From 5459 citations, we included 15 small cross-over studies (3 non-randomized), 13 assessing aerobic (intermittent high-intensity exercise (IHE) vs continuous, or continuous vs rest) and 2 assessing resistance exercise versus rest. Study quality was good, and all outcome measures were reported. Thirteen gave hypoglycemia results, of which five had no episodes. Meta-analysis of hypoglycemia during or after IHE compared with continuous exercise showed no significant differences (n=5, OR=0.68 (95% CI 0.16 to 2.86), I=56%). For blood glucose there was little difference between groups at any time point.
IHE may be safer than continuous exercise because of lesser decline in blood glucose, but more research needs to demonstrate if this would be reflected in hypoglycemic episode rates.
CRD42018068358.
1型糖尿病发病率在全球范围内呈上升趋势。体育锻炼对这种疾病有诸多健康益处，但超过60%的患者不参与锻炼，主要是出于对低血糖的恐惧。本系统评价探讨了体育锻炼方式对成年1型糖尿病患者血糖水平的影响，以预防低血糖。
预定义的纳入标准为针对健康非肥胖成年1型糖尿病患者的随机或非随机交叉试验。运动干预采用标准化的强度和时间方案。结局指标包括运动期间或运动后的低血糖以及急性血糖控制情况。使用关键词和医学主题词（MeSH）检索了Medline、护理及相关健康文献累积索引、补充与替代医学数据库、体育科学数据库、Cochrane CENTRAL（1990年至2018年1月11日）以及Embase（1988年至2018年4月9日）。由一名研究人员根据关键评估技能计划清单进行纳入、数据提取和质量评估，并由另一名研究人员进行核对。当报告的结局指标有四项或更多时，使用Review Manager（V.5.3）进行荟萃分析。
从5459条文献中，我们纳入了15项小型交叉研究（3项非随机研究），其中13项评估有氧运动（间歇性高强度运动（IHE）与持续运动对比，或持续运动与休息对比），2项评估抗阻运动与休息对比。研究质量良好，所有结局指标均有报告。13项研究给出了低血糖结果，其中5项未出现低血糖发作。与持续运动相比，IHE期间或之后低血糖的荟萃分析显示无显著差异（n = 5，OR = 0.68（95%CI 0.16至2.86），I = 56%）。各时间点组间血糖水平差异不大。
由于血糖下降幅度较小，IHE可能比持续运动更安全，但需要更多研究来证明这是否会反映在低血糖发作率上。
CRD42018068358。
