Image: PD
1. In a meta-analysis including studies of exercise and insulin levels among child 6 to 19 years of age, exercise was found to be associated with decreased fasting insulin and insulin resistance (IR) among children and adolescents with type 2 diabetes mellitus.
2. The relationship between exercise and decreased fasting insulin and IR was stronger among children who had larger body mass index (BMI).
Evidence Rating Level: 1 (Excellent)
Study Rundown: Exercise, in the setting of diabetes, has been linked to decreased insulin resistance (IR) in prior meta-analyses of adults and children with type 1 diabetes mellitus. This study is the first meta-analysis to examine the role of exercise in IR for children with type 2 diabetes mellitus (T2DM). The analysis included randomized controlled trials (RCTs) that examined the impact of exercise in children 6 to 19 years on IR and fasting insulin. Results indicated that exercise was associated with improved fasting insulin and IR. In addition, researchers found that children with higher body mass indices (BMIs) had a greater decrease in IR and fasting insulin when compared to those with lower BMIs. The analysis is limited by the variability in exercise interventions among the included studies. These findings support the use of exercise as an intervention for children with T2DM, and also highlight key areas for further study, such as the need to identify the type of exercise best-suited for combating insulin resistance in children.
Click to read the study in Pediatrics
Relevant Reading: Exercise for the management of Type 2 Diabetes: a review of the evidence
In-Depth [meta-analysis]: RCTs investigating IR and fasting insulin among participants ages 9 to 16 with diabetes were included from a search of PubMed, SPORTDiscus, Physical Education Index, and Web of Science. A total of 24 studies completed from 1999 to 2013, which included 1599 children subjects (mean age = 11.4 years old, 54.3% female, mean BMI 27.2 kg/m2). Effect size (ES) of exercise training on fasting insulin and IR was calculated. A positive ES indicated a decrease in fasting insulin or IR. Results showed that exercise intervention was associated with reduced fasting insulin (mean ES = 0.48, 95% CI: 0.22-0.74). Improvement in IR was also related to exercise (mean ES = 0.31, 95% CI: 0.06-0.56). A regression model of baseline BMI showed a significant association between the change in fasting insulin and insulin resistance (R2 = 0.15, β= 0.38, z= 2.25, P < .05). These findings equated exercise with a 11.4-U/mL (95% CI: 5.2-17.5) improvement in fasting insulin and a 2.0 (95% CI: 0.4-3.6) improvement in IR among obese children.
By Laurel Wickberg and Leah H. Carr
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