Energy Expenditure and Metabolic Control among T1D Youth

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DESCRIPTION (provided by applicant): Type 1 diabetes is a lifelong illness that demands constant attention and management, requiring adhering to a complex, medically prescribed self-care regimen. Behavioral interventions to promote adherence in diabetes management in youth have largely focused on consistent blood glucose monitoring, and the role of physical activity has been inconsistently examined in relationship to metabolic outcomes. This is true despite regular physical activity being medically advised as part of comprehensive care planning, as supported by data from large, national studies of children's metabolic control. However, little is known about the specific nature and timing of the impact of levels on children's blood glucose regulation. Some indications of benefit include short- term changes in metabolic control and enhanced quality of life, balanced against the risks of low blood glucose levels that can accompany high energy expenditure. Though there are new and advanced measures and methods in exercise science that could be brought to bear in addressing these complex biobehavioral questions, this knowledge and expertise tends to reside outside of the clinical and behavioral research literature in childhood diabetes. By combining these tools for the assessment of physical activity and energy expenditure (i.e., the amount of energy used to perform a physical activity) with those that measure glycemic variability (i.e., excursions of blood glucose from low to high and back again), I plan to incorporate more informed physical activity recommendations into my behavioral interventions for youth with diabetes. I propose to do this by seeking mentored training experiences with Dr. Loretta DiPietro (an expert in exercise science) at The George Washington University, as well as by taking additional coursework at the University in exercise science methods and data analysis, biostatistics, and physiology. These are cornerstones of basic behavioral research in health, and hold promise in enriching my clinical research program and strengthening my capacity to meet the public health challenges associated with pediatric diabetes prevention and control. PUBLIC HEALTH RELEVANCE: The management of type 1 diabetes in children demands constant attention and careful adherence to a complex medical regimen, including monitoring of physical activity. However, behavioral interventions aimed to promote adherence in children with type 1 diabetes rarely include physical activity. By examining the relationship among energy expenditure and glycemic variability, we will gain a better understanding of the role of physical activity in diabetes management. Findings can lead to the inclusion of physical activity into future behaviorally based adherence promotion programs.