Exercise Management for Young People With Type 1 Diabetes: A Structured Approach to the Exercise Consultation.

Regular physical activity during childhood is important for optimal physical and psychological development. For individuals with Type 1 Diabetes (T1D), physical activity offers many health benefits including improved glycemic control, cardiovascular function, blood lipid profiles, and psychological well-being. Despite these benefits, many young people with T1D do not meet physical activity recommendations. Barriers to engaging in a physically active lifestyle include fear of hypoglycemia, as well as insufficient knowledge in managing diabetes around exercise in both individuals and health care professionals. Diabetes and exercise management is complex, and many factors can influence an individual's glycemic response to exercise including exercise related factors (such as type, intensity and duration of the activity) and person specific factors (amount of insulin on board, person's stress/anxiety and fitness levels). International guidelines provide recommendations for clinical practice, however a gap remains in how to apply these guidelines to a pediatric exercise consultation. Consequently, it can be challenging for health care practitioners to advise young people with T1D how to approach exercise management in a busy clinic setting. This review provides a structured approach to the child/adolescent exercise consultation, based on a framework of questions, to assist the health care professional in formulating person-specific exercise management plans for young people with T1D.

Standardised mortality is increased three-fold in a population-based sample of children and adolescents with type 1 diabetes.

There are no type 1 diabetes (T1DM) mortality data on Australian children and limited contemporary data on their international counterparts. Fatalities in children and adolescents (1-17 yr) with T1DM were identified from the Western Australia Children's Diabetes Database between 1987-2011. Seventeen thousand four hundred and fifty-three patient-years of diabetes data were analysed and 13 deaths were confirmed (six male). The overall standardised mortality ratio was 3.1 [95% confidence interval (CI), 1.7-5.3] and was highest in the 10-14 yr age group, at 4.6 (95% CI, 1.5-10.8). Median age at death was 16.4 yr (range 5 to 17.8 yr), and median haemoglobin A1c at death was 10.5% (range 6.7 to >14). Cause of death was attributed to diabetes in 10 (77%) cases. Two patients were found 'dead-in-bed'. All diabetes-related deaths in subjects with known T1DM occurred outside the hospital setting.

Engagement of students with lectures in biochemistry and pharmacology.

Academic staff at universities have become concerned about the decrease in student attendance at lectures and the implication of this on student achievement and learning. Few studies have measured actual lecture attendance in a coherent or comprehensive way. The aim of this study was to measure actual lecture attendance of students over two year levels enrolled in two separate science disciplines, biochemistry and pharmacology. The study further sought to determine the factors that influence lecture attendance. Attendance at lectures in four units of study was monitored over a 12-week semester. Attendance at lectures decreased over the semester and was lower at early morning lectures (8 A.M.; 9 A.M.). A questionnaire surveying students about their preparation for lectures, their compensation for missed lectures and the factors influencing their nonattendance was administered at the end of the semester. Students reported that the major factors influencing their attendance at lectures related to timetable issues and the quality of lecturing. If students missed lectures, the majority read the lecture notes and listened to the online recordings. The availability of online recordings of lectures was not a major influence on attendance at lectures. In three of the four units studied there was no correlation between self-reported lecture attendance and exam performance. The results of the study indicate that universities should dedicate more resources to timetabling and to supporting staff to improve the quality of their lectures.

Resistance training and diastolic myocardial tissue velocities in obese children.

PURPOSE: The primary purpose of this study was to determine the effects of resistance exercise training on early diastolic myocardial velocities (E') in an obese pediatric population. METHODS: Twenty-three obese adolescents were selected to participate in either a resistance-based training program (RT; n = 13, 12.2 +/- 0.4 yr, body mass index [BMI] = 32.5 +/- 1.9 kg m(-2)) or a nonexercise control intervention (n = 10, 13.6 +/- 0.7 yr, BMI = 30.2 +/- 2.6 kg m(-2)) for 8 wk. All subjects had repeated echocardiographic assessments to determine left ventricular (LV) geometry, early transmitral flow velocity (E), and E'. RESULTS: LV mass and wall thicknesses did not significantly change with training or in controls. RT improved E' (11.9 +/- 0.5 to 13.3 +/- 0.5 cm s(-1), P< 0.01) in the presence of a decrease in E/E' (8.17 +/- 0.39 to 7.06 +/- 0.30 cm s(-1), P < 0.01), a marker of left atrial pressure. No changes were evident in the inactive control subjects. CONCLUSIONS: A supervised 8-wk RT exercise program improved early diastolic tissue velocity in obese children, independent of changes in LV morphology.

Impact of obesity on diastolic function in subjects < or = 16 years of age.

The aim of this study was to investigate the impact of obesity on diastolic function in children and adolescents. Echocardiographic measurements were compared in 28 obese subjects (14 males, 14 females) and 15 age- and gender-matched lean controls (8 males, 7 females). Two-dimensional ultrasound imaging, M-mode imaging, and pulse-wave conventional and tissue Doppler measurements were used to assess cardiac structure and function at rest. No differences were evident between lean and obese subjects in age (13.3 +/- 0.5 vs 12.4 +/- 0.4 years), height (163 +/- 4 vs 159 +/- 2 cm), or systolic blood pressure (119 +/- 3 vs 123 +/- 2 mm Hg). Body mass (54.6 +/- 4.0 vs 85.8 +/- 3.6 kg, p < 0.0001) and body mass index (20.5 +/- 0.7 vs 33.3 +/- 1.0 kg/m2, p < 0.00001) were significantly greater in the obese subjects, whereas measurements of wall thickness (interventricular septal wall 0.86 +/- 0.04 vs 0.89 +/- 0.02 cm, posterior wall 0.83 +/- 0.04 vs 0.91 +/- 0.02 cm) and fractional shortening (38.6 +/- 1.2% vs 38.8 +/- 1.2%) did not significantly differ. The E/E' ratio (6.86 +/- 0.20 vs 8.30 +/- 0.32, p < 0.01), E' (13.93 +/- 0.38 vs 12.29 +/- 0.44 cm/s, p < 0.05), the E'/A' ratio (2.49 +/- 0.17 vs 2.05 +/- 0.09, p < 0.05), and the deceleration time of early transmitral blood flow velocity (125.3 +/- 7.7 vs 154.5 +/- 6.8 ms, p < 0.01) were significantly different between the groups, suggesting reduced diastolic function in the obese subjects. In conclusion, these data suggest that indexes of diastolic function, including tissue Doppler measures, are significantly impaired in obese young subjects.

Prevalence and risk factors for microalbuminuria in a population-based sample of children and adolescents with T1DM in Western Australia.

OBJECTIVE: To define the prevalence and describe the natural history of microalbuminuria (MA) in a population-based sample of children with type 1 diabetes mellitus (T1DM). METHODS: Children with T1DM diagnosed or=20 and <200 microg/min, developed in 128 subjects (13.4%) at mean diabetes duration of 7.6 yrs. Cumulative probability for MA was 16% after 10 yrs. Determinants for MA were HbA1c [hazard ratio (HR) 1.21; 95% confidence interval (CI) 1.05-1.38; p = 0.007], onset of puberty (HR 8.01; 95% CI 3.18-20.16; p < 0.001) and age at diagnosis (HR 1.25; 95% CI 1.18-1.33; p < 0.001). Females had a higher probability for MA during puberty than males (p = 0.03). The total incidence of MA (subjects with MA/100 person-years) was 1.26, 1.85 and 2.44 for those who developed diabetes at ages <5 yrs, 5-11 yrs and >11 yrs, respectively. CONCLUSIONS: Onset of puberty, diabetes duration and metabolic control are major factors predisposing the development of MA. Children diagnosed with T1DM at younger ages have a prolonged time for developing MA.