Physiotherapy for children with type 1 diabetes mellitus (T1DM) in Malta : effects of exercise and perceptions towards exercise

Abstract

Relevance: This study explored the input of physiotherapy within the management of children suffering from T1DM in Malta offering an opportunity to consider how physiotherapy can impact on, and enhance, the population's health and well-being. Purpose: The purpose of this study was to investigate changes in blood glucose levels in children with T1DM throughout a programme that consisted of structured exercises; seeking to understand the perceptions of these children and their parents towards exercise in the management of T1DM. Methods/analysis: Data was collected in two phases. First, information leading to the perceptions and health beliefs linked to juvenile T1DM was sought via a questionnaire from the current population (n = 73) and included children and their parents. Second, a quasi-experimental design was adopted to observe 7 children (aged 6 to 10) engaging in regular exercise, at moderate intensity levels, for 30 minutes daily over a period of 6 weeks. 3 other children were followed up as a control group. Blood glucose readings were recorded 4 × daily, over a period of 12 weeks including 6 weeks prior to the exercise intervention. Results: 49% (n = 36) responded to the survey. 89% (n = 31) of children reported that they did exercise, however below the dose recommended by the WHO. 83% (n = 30) of parents reported to understand that exercise was effective in controlling the blood glucose levels in their children but did not consider exercise as being one of the main strategies for control. A reported concern was the fear of hypoglycaemia and/or injuries during exercise. Children between 5 and 8 years generally participated in individually supervised exercise whilst older children participated in team events. Children appeared to be more aware of the psychological benefits resulting from exercise than their parents and were less concerned about the possible negative effects. The parents appeared not to understand the role of physiotherapy in the management of T1DM. The blood glucose levels stabilised at 7.05 ± 0.25 mmol/l for the exercise group compared to the control group (8.63 ± 1.03 mmol/l) after lunch (p < 0.011) and before dinner (p < 0.006). This was the time when the children performed the exercise. HbA1C levels were stable in the experimental group but increased by 0.6% in the control group. Discussion and conclusions: This study has demonstrated that a structured exercise programme had a stabilising effect on the blood glucose and HbA1C levels in children with T1DM. A lack of education towards the effects of exercise on children with T1DM was noted. Practical advice on the quantity and quality of exercise and management of hypoglycaemic events could contribute to better engagement in physical activity. Impact and implications: The results serve to reinforce the notion of a positive outcome on blood glucose levels with exercise for children with T1DM however both children and parents require better education if the management of T1DM in Malta is to include exercise.