Who are our exercise researchers and what do they do?
A new Q&A series focusing on the different research themes within the Children’s Diabetes Centre. Working with our colleagues in the Diabetes Department at Perth Children's Hospital, we are looking at:
Research focus: Exercise is an important part of staying both physically and mentally healthy, and for improving day-to-day diabetes management. The aim of our research is to assist people with type 1 diabetes (T1D) to exercise with confidence and safely.
Team members (pictured left-right):
Professor Liz Davis, chief investigator (Telethon Kids Institute/Perth Children's Hospital): Professor Davis is the chief investigator for the exercise theme. Her work has focussed on translation to improve outcomes and has impacted on changes to policy and practice. She contributed to the International Society of Paediatric & Adolescent Diabetes (ISPAD) clinical exercise guidelines and is an invited member of an international collaboration working to translate evidence about exercise and T1D into educational resources for patients and healthcare professionals.
Dr Vinutha Shetty, theme lead (Telethon Kids Institute/PCH): Dr Shetty is a paediatric endocrinologist who has recently been awarded her PhD for her work related to carbohydrate requirements to maintain stable glucose levels during exercise in individuals with T1D. Her current work is aimed at developing an exercise app to help individuals with T1D manage their blood glucose during and after exercise.
Professor Paul Fournier, chief investigator (University of Western Australia): Professor Fournier is an integrative biochemist/physiologist with a strong research and teaching interest in the field of bioenergetics in health and diabetes. His research, over the past 15 years, has focused on understanding how blood glucose levels respond to exercise in T1D and how best to manage blood glucose levels for both the prevention of exercise-mediated hypoglycaemia and optimisation of glycaemic control.
Dr Craig Taplin, paediatric endocrinologist (PCH/Telethon Kids Institute): Dr Taplin began working in the area of exercise and T1D in 2006 at The Barbara Davis Center for Childhood Diabetes in Colorado, USA, where he worked on the prevention of nocturnal hypoglycaemia after exercise. During a 10-year period working at Seattle Children’s Hospital, he and his team investigated and published methods to improve the quality of exercise education in diabetes clinics, how levels of fear of hypoglycaemia may impact exercise, and published data related to how often youth with T1D follow safety guidelines around exercise. Since joining PCH and Telethon Kids, he has been working on methods to systematically evaluate physical activity levels in youth with T1D, with the goal to incorporate this metric into routine clinical care and to identify youth who might benefit from activity interventions.
Wayne Soon, research assistant (Telethon Kids Institute): Wayne is a PhD candidate who has recently had his thesis passed. His area of research interest is exercise management for people with T1D.
Heather Roby, project manager (Telethon Kids Institute): As project manager, Heather is responsible for the administration and management of projects to achieve milestones and research outputs. Heather supports the exercise team to plan and conduct high quality research on the interaction between exercise and T1D.
Niru Paramalingam, research coordinator/research nurse (Telethon Kids Institute/PCH): Niru is the diabetes research coordinator, with a special interest in exercise and diabetes management. She is currently looking at the benefits of protein intake in managing post-exercise hypoglycaemia.
Jo O’Dea, research assistant (Telethon Kids Institute): In her role as research assistant, Jo is involved in most of the exercise group's studies. You might have met her if you have come in to do a VO2 testing session for a study. Right now, she is working on a project looking to develop resources for sports coaches and on the LOPEH study.
How will our current and future research make a difference to people living with type 1 diabetes?
Exercise app trial: It’s important for people with T1D to exercise, but it can be challenging to keep blood glucose levels under control during and after exercise. T1D exercise guidelines from leading research teams around the world have been published, but they are not written for young people with T1D and they are also difficult to access. Our research team has developed a smartphone app called ‘acT1ve’, which gives users personalised carbohydrate and insulin advice for any exercise they are about to participate in, and is based on international guidelines. We have had 10 young people with T1D test the app so far. The feedback has been positive, so we will be looking to test it in many more people soon.
Dishabituation study: About one quarter of people with T1D have impaired awareness of hypoglycaemia. This means that these people are not able to feel when their blood glucose levels are going low. This can be dangerous, because if they do not treat themselves when they are low, they may be at risk of severe hypoglycaemia. There is some evidence that participating in high-intensity exercise may be able bring back this awareness of hypoglycaemia, but these studies have been done in adults with T1D in a laboratory setting. We will be looking to see if a high-intensity exercise program carried out at home, can bring back hypoglycaemia awareness in young people with T1D.
Protein supplementation to prevent overnight hypoglycaemia following afternoon exercise: Those living with T1D may experience low blood glucose levels overnight after exercising at moderate intensity in the late afternoon (e.g cycling, swimming, jogging). The aim of this study is to find how much protein is required at bedtime to prevent these overnight lows. This information will allow young people with diabetes to exercise confidently, knowing that they will be able to prevent overnight lows. We will recruit 12 young people with T1D, aged 12-25yrs, to take part in this study involving 45 minutes of cycling on a stationary bicycle, on three different evenings. After exercise and dinner in the research unit, participants will go home and rest. They will have the protein drink (a different amount of protein each night) before bedtime, but not eat anything else unless they have a low. They will wear a continuous glucose monitoring (CGM) system to pick up any lows, and will be monitored overnight using the Dexcom G5 system. The overnight monitoring ends when the participant wakes for breakfast.
Exercise intervention study: Physical activity is associated with improved psychological wellbeing, ﬁtness and quality of life and may mitigate the risk of poor glycaemic control but maintaining stable blood glucose levels is a challenge and can present a barrier to engagement in exercise. Consequently, participation and ﬁtness levels in adolescents with T1D are lower than recommended. Our researchers are developing and piloting an exercise intervention aimed at improving mental health outcomes in this population. The intervention is designed to increase physical activity engagement to improve psychological and physiological outcomes.
Sports coach resources: Through consultation with our diabetes community, we have learned that there is a significant knowledge gap related to diabetes and its management in the community sport setting. Working together with sports coaches and T1D players, and in collaboration with local government and diabetes community groups, we will seek to develop a suite of resources for sports coaches to help them better understand diabetes and how they can support their players.