The effects of physical exercise on blood glucose kinetics concentrations in teenagers with type 1 diabetes mellitus in Brazzaville (Congo)

Objective. -To appreciate the influence of the physical exercise, age and nutritional status on blood glucose concentrations in teenagers with type 1 diabetes mellitus (T1DM). Material and methods. -Cross-sectional and case-control study, including 29 children and ado lescents with T1DM and 29 non-diabetic aged from 10 to 19 years. All patients were subjected to a physical exercise on cycloergometer, until exhaustion. Blood glucose was measured before, at the end of exercise, and during the recovery phase. In patients with T1DM, no insulin adjustments were made prior to exercise. Results. -Before exercise, the mean blood glucose concentrations were statistically identical in males and females with T1DM: 1.51 g/L vs 1.41 g/L, independently to the age group. During the exercise session, an increase of blood glucose in both groups was noted, more significantly in patients with T1DM: 32% vs 60% (P < 0.001). After the effort phase, blood glucose dropped more quickly up to 2 minutes' post-exercise among patients with diabetes compared to the controls. This decrease of blood glucose was noted between the 2nd and the 8th minutes in both groups, the decrease being more evident in TIDM patients. On the other hand in the control group the increase of blood glucose remained up to 2 minutes, reaching the threshold of 1.4 g/L. However, during and after exercise in both groups blood glucose kinetics was identical independently to age group. Nevertheless, it was observed that blood glucose concentrations were higher in subjects aged 15-19 years compared to those aged 10-14 years during exercise and at 6 minutes in the period of recovery. Lastly, baseline blood glucose was lower (P < 0.05) in children with normal nutritional status than in undernourished, the same notice was made at the end of exercise (1.44 +/- 0.24 g/L vs 1.55 +/- 0.15 g/L) and even in post-exercise (1.41 +/- 0.16 g/L vs 1.61 +/- 0.15 g/L). Conclusion. -In the absence of any prior adjustment of insulin therapy in patients with T1DM, the glucose lowering effect of physical exercise appears to be related to nutritional status, which should favor in the case of undernutrition a greater action of the hyperglycemic counter regulation hormones. Therefore, the glycemic control is not significantly impaired, and this effect of physical exercise on blood glucose should not justify a ban of physical activity in these young patients, given also the benefits that physical exercise provides for their health. However, consideration should be given to child's perfect balance of blood glucose, age, dietary balance and nutritional status when choosing the type of physical exercise and especially its intensity. This requires a multidisciplinary team in the management of teenagers with diabetes. (C) 2017 Elsevier Masson SAS. All rights reserved.