Type 1 Diabetes Weight Management Diets Do Not Influence Physical Activity

A comparison of 3 standard dietary strategies for weight and glycemia control showed no difference in exercise metrics.

A pilot feasibility trial has found that diet and weight loss designed for young adults with type 1 diabetes may often be delivered with below-average physical activity intervention.

The findings, presented at the American Diabetes Association (ADA) 2021 Scientific Sessions this week, highlight the need for greater comprehensive weight loss and management strategies in clinician-referred programs that may also influence patients’ glycemic control.

Investigators from the Advancing Care for Type 1 Diabetes and Obesity Network (ACT1ON), led by Dessi P. Zaharieva, a PhD candidate with Stanford University, sought to identify the dietary strategies that optimize glycemic control and weight management among overweight or obese young adults with type 1 diabetes.

Their assessment included a sequential multiple-assignment randomization of 27 patients to 3 diet plans: hypocaloric low-carbohydrate (20-25% carbohydrate); hypocaloric moderately low fat (30% energy fat), or Mediterranean (no calorie restriction).

Participants were additionally advised to maintain usual physical activity, which was collected via convenience sample from June 2020 to February 2021. Wearable physical activity trackers were provided to participants, who used them to track “daily steps” for 2-week periods during their diet assignments.

Mean participant age was 25 years old, with more than three-fourths (78%) being female, and mean A1c levels of 7.3%. Mean participant body mass index (BMI) was 30.7.

Median daily steps were 4931 (IQR, 3443 – 7363) among participants during the hypocaloric low-carbohydrate diet. During the hypocaloric moderately low fat diet, median steps were 5562 (IQR, 4191 – 9931). And during the Mediterranean diet, median steps were 6457 (IQR, 4394 – 9655).

Minutes of daily moderate-to-vigorous physical activity were 16 (IQR, 4 – 31), 18 (IQR, 5 – 31), and 22 (6 – 32) during each respective diet. Zaharieva and colleagues confirmed that daily steps, active time, or moderate-to-vigorous physical activity counts did not differ by dietary intake (P <.05).

“We demonstrate that in a pilot study emphasizing diet and weight loss in young adults with type 1 diabetes, physical activity was often below the recommended target of 30 mins MVPA/day (or 150 mins/week),” they concluded. “Thus, a larger, adaptive weight management intervention will need to incorporate diet as well as safe and effective physical activity strategies for overweight and obese young adults with type 1 diabetes."

The study, “Limited Physical Activity among Overweight and Obese Young Adults with Type 1 Diabetes: Results from Advancing Care for Type 1 Diabetes and Obesity Network (ACT1ON),” was presented at ADA 2021.