Energy Expenditure and Metabolic Control among T1D Youth

描述(申请人提供)：1型糖尿病是一种终生疾病，需要持续的关注和治疗，需要坚持复杂的、医学上规定的自我护理方案。在年轻人中，促进糖尿病治疗坚持的行为干预主要集中在持续的血糖监测上，而体力活动的作用与代谢结果的关系也没有得到一致的检验。这是真的，尽管作为综合护理计划的一部分，医学上建议进行定期的体力活动，这一点得到了来自大型国家儿童代谢控制研究的数据的支持。然而，关于这些水平对儿童血糖调节的具体性质和时间的影响，人们知之甚少。一些有益的迹象包括代谢控制的短期变化和生活质量的提高，与可能伴随高能量消耗的低血糖水平的风险相平衡。尽管运动科学中有一些新的、先进的措施和方法可以用来解决这些复杂的生物行为问题，但这些知识和专业知识往往存在于儿童糖尿病的临床和行为研究文献之外。通过将这些用于评估体力活动和能量消耗(即进行体力活动所用的能量)的工具与那些测量血糖变异性(即血糖从低到高再回来)的工具相结合，我计划将更多知情的体力活动建议纳入我对青少年糖尿病患者的行为干预中。为了做到这一点，我建议在乔治华盛顿大学寻求洛蕾塔·迪皮特罗博士(运动科学专家)的指导培训经验，并在该大学参加运动科学方法和数据分析、生物统计学和生理学的额外课程。这些都是基本的健康行为研究的基石，并有望丰富我的临床研究计划，增强我应对与儿科糖尿病预防和控制相关的公共卫生挑战的能力。 公共卫生相关性：儿童1型糖尿病的管理需要持续关注和谨慎遵守复杂的医疗方案，包括监测体力活动。然而，旨在促进1型糖尿病儿童坚持治疗的行为干预措施很少包括体力活动。通过研究能量消耗和血糖变异性之间的关系，我们将更好地理解体力活动在糖尿病管理中的作用。研究结果可能导致将体育活动纳入未来基于行为的遵从性促进计划。

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.