Neuromuscular Physiology Laboratory, Department of Biomedical Sciences, University of Padova, Italy.
School of Public Health, Physiotherapy and Sports Science, University College Dublin, Ireland.
Nutr Metab Cardiovasc Dis. 2021 Mar 10;31(3):705-716. doi: 10.1016/j.numecd.2020.12.006. Epub 2020 Dec 13.
Despite the crucial role of exercise in the prevention of comorbidities and complications in type 1 diabetes mellitus (T1DM), people living with the disease are often insufficiently physically active, mainly due to the fear of hypoglycaemia. Research using continuous glucose monitoring (CGM) devices has shown that exercise affects glycaemic control in T1DM for over 24 h. The aim of this systematic review and meta-analysis is, therefore, to investigate the delayed effects of different exercise modalities on glycaemic control in adults with T1DM.
The literature search of experimental studies was conducted on PubMed, SPORTDiscus and EMBASE from January 2000 to September 2019. Twelve studies using CGM devices were included. Compared to endurance, intermittent exercise increased the time spent in hypoglycaemia (0.62, 0.07 to 1.18; standardised effect size, 95% CI) and reduced the mean interstitial glucose concentration (-0.88, -1.45 to -0.33). No differences emerged in the time spent in hyperglycaemia (-0.07, -0.58 to 0.45) or in the proportion of exercisers experiencing hypoglycaemic events (0.82, 0.45 to 1.49; proportion ratio, 95% CI) between conditions. The systematic review also found a reduced risk of hypoglycaemia if exercise is performed in the morning rather than in the afternoon, and with a 50% rapid-acting insulin reduction. It was not possible to determine the benefits of resistance exercise.
For the first time, we systematically investigated the delayed effect of exercise in adults with T1DM, highlighted undetected effects, shortcomings in the existing literature, and provided suggestions to design future comparable studies.
尽管运动对于预防 1 型糖尿病（T1DM）的合并症和并发症至关重要，但患者通常运动不足，主要是因为担心低血糖。使用连续血糖监测（CGM）设备的研究表明，运动对 T1DM 的血糖控制影响超过 24 小时。因此，本系统评价和荟萃分析的目的是研究不同运动方式对 T1DM 成人血糖控制的延迟影响。
从 2000 年 1 月至 2019 年 9 月，在 PubMed、SPORTDiscus 和 EMBASE 上对实验研究进行了文献检索。纳入了 12 项使用 CGM 设备的研究。与耐力运动相比，间歇运动增加了低血糖时间（0.62，0.07 至 1.18；标准化效应量，95%置信区间），降低了平均间质葡萄糖浓度（-0.88，-1.45 至 -0.33）。在高血糖时间（-0.07，-0.58 至 0.45）或经历低血糖事件的锻炼者比例（0.82，0.45 至 1.49；比例比，95%置信区间）方面，不同条件之间没有差异。系统评价还发现，如果在上午而不是下午进行运动，或者将速效胰岛素减少 50%，则发生低血糖的风险降低。无法确定抗阻运动的益处。
我们首次系统地研究了 T1DM 成人运动的延迟效应，突出了未被发现的效应、现有文献的不足，并为设计未来的可比研究提供了建议。
