Clinicians managing a child or adolescent with Type 1 diabetes often have very little accurate information about the patient’s physical activity, but a new study shows activity monitors like wearable fitness trackers provide a clear picture to help balance activity with nutrition or insulin needs.

“Patients often overestimate their amount of physical activity. This study demonstrated that activity monitors provide patients with a firm grip as to what they actually do,” said Bradly J. Thrasher, D.O., MBA, co-author of the study and a pediatric endocrinologist with Norton Children’s Endocrinology, affiliated with the UofL School of Medicine.

Dr. Thrasher sees patients at the Wendy Novak Diabetes Institute, a part of Norton Children’s Endocrinology, and is lead physician at the Christensen Family Sports & Activity Program. He is an assistant professor of pediatrics in the Division of Endocrinology at the University of Louisville School of Medicine.

Physical activity makes the body more sensitive to insulin, making detailed activity information and monitoring important for diabetes patients. Adjustments to either nutrition or insulin need to be made around activity to keep the patient safe and to allow for optimal performance.

“Once patients see their actual data, they can establish better routines and identify better diabetes management strategies,” Dr. Thrasher said.

Already, many children with Type 1 diabetes wear continuous glucose monitoring devices, continuous subcutaneous insulin pumps, and hybrid, closed-loop systems. Accurate information about physical activity has been a missing — and vital — data point.

“Integration of Consumer-Based Activity Monitors into Clinical Practice for Children with Type 1 Diabetes: A Feasibility Study” was published in the International Journal of Environmental Research and Public Health, an interdisciplinary, peer-reviewed, open-access journal.

Wearable fitness/activity monitors could lead to clinically relevant health improvements

In the study, 57 children and teenagers ages 7 to 19 receiving care at the Wendy Novak Diabetes Institute agreed to wear a Fitbit device and keep a diet log for a minimum of three days. More than half were compliant for both activity monitoring and diet logs.

Even though the study had a small sample size, it proved the feasibility of monitoring daily physical activity and diet using consumer-based devices rather than relying on patients’ self-reporting during clinical visits.

The study also provided short-term benefits to the participants themselves, especially those with new onsets, as they received additional diabetes education from certified diabetes educators, according to Dr. Thrasher.

All children are encouraged to accumulate at least 60 minutes of moderate to vigorous physical activity per day, but some children with Type 1 diabetes and their families shy away from physical activity out of fear of diabetes-related complications.

Glucose response to exercise is highly variable and dependent on both the intensity and duration of the physical activity. To make matters more complicated, children have sometimes rapidly changing carbohydrate needs and insulin requirements as they grow.

Also, during moderate-to-vigorous physical activity, there are significant changes in blood glucose concentration in children with Type 1 diabetes. Poor glycemic control can result in altered aerobic muscle capacity in the short term and impaired physical growth and a delay in pubertal development in the long term.

The study found gathering diet and physical activity data using wearable technology potentially could have clinically relevant effects on improving health outcomes among children and adolescents with Type 1 diabetes.

Future studies need to work on incorporating this technology into diabetes care management for people of all ages, the authors concluded.

Additional co-authors of the study

• Jason R. Jaggers, Ph.D., FACSM, associate professor of exercise physiology, University of Louisville Department of Health and Sport Sciences
• Timothy McKay, M.S., CEP, clinical research exercise coordinator, Norton Children’s Research Institute, affiliated with the UofL School of Medicine
• Kristi M. King, Ph.D., CHES, associate professor, University of Louisville Department of Health and Sport Sciences
• Kupper A. Wintergerst, M.D., FAAP, chief, pediatric endocrinology; director, Wendy Novak Diabetes Institute, Norton Children’s Endocrinology