**3. Measures**

Height and body mass (mean ± SD) of the participants were measured according to standard procedures [78]. Body mass index (BMI) was calculated as weight (kg) divided by height (m) squared. All subjects were characterized by normal-weight according to international BMI cutoff values and BMI centiles [79] (Table 1).

The first group were monitored during their school classes (GrS; n=25). We assessed glycemia, diet and physical activity during the school day and leisure time. The other group comprised participants of a rehabilitation programme at a summer camp for diabetic children, organized by the Polish Society for Children and Youth with Diabetes. (GrR; n=28).

Physical activity (PA) assessment was performed using accelerometers (accelerometer ActiGraph GT3X+, USA). The first PA indicator was the number of steps per day (steps/day) while the other indicator was daily energy expenditure of physical activity (kcal/kg/day). According to recommendations, the children wore a device placed firmly on an elastic belt on the right hip. During the seven-day monitoring period, the accelerometers were taken off only at bedtime and before potential contact with water [33, 80-81]. The criteria of the 2001–2002 President's Challenge Physical Activity and Fitness Awards Program were used to assess physical activity [82]. The authors recommended that the daily number of steps, hops or position changes should be about 13,000 in boys and 11,000 in girls at least 5 days a week for a standard healthy base. Thus, the daily active energy expenditure should be at least 11 kcal/kg/day in boys and 9 kcal/kg/day in girls on most days within a week [83].

**5. Statistical analysis**

**6. Results**

Statistical significance was set at p < 0.05.

of children and adolescents with T1DM.

All results are presented as means ± standard deviation. The data were analyzed by two-way ANOVA followed by the Student-Newman-Keuls test when appropriate. Significant differ‐ ences in glucose concentrations and insulin doses and physical efficiency variables in relation to references ranges were determined using the Bonfferoni post-hock test. Pearson correlation coefficients were analyzed to determine the inter-variable relationships. All analyses were performed using the Statistica v. 9 statistical software package (StatSoft, Tulsa, OK, USA).

The Effects of Energy Intake, Insulin Therapy and Physical Activity on Glucose Homeostasis in…

http://dx.doi.org/10.5772/57590

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We studied the effects of energy intake and physical activity on glycaemic control in children and adolescents suffering from diabetes type 1. The variables associated with glucose homeo‐ stasis (e.g. daily insulin doses, energy intake, and glycated hemoglobin (HbA1c) were compared during daily activities and in response to exercise/sports participation in a sample

The assessment of nutritional status of all children and adolescents who participated in the study showed normal body mass and normal BMI percentile values (57.5 ± 20.5 and 52.7 ± 24.9, respectively). Before the study all children had similar levels of hemoglobin A1c (HbA 1c). Anthropometric features of the two study groups (GrS vs. GrR) were similar for all subjects (Table 1.) Children from the GrS accumulated an average of 8904 ± 981 steps/day while the average activity-induced energy expenditure was 248 ± 40 kcal/day and the relative energy expenditure was 6.06 ± 0.86 kcal/kg/day. The mean number of steps per day during daily PA

Analysis of variance revealed a significant effect of physical activity programme during diabetes camp on daily steps (F=44.0; p<0.001) and daily energy expenditure (F=21.0; p<0.001). The two-week adherence to a structured exercise programme increased children and adoles‐ cents physical activity. Diabetic children who participated in the camp (GrR) accumulated an average of 14378 ± 1699 steps/day, corresponding to 466 ± 48 kcal/day; the relative energy expenditure was 10.4 ± 0.85 kcal/kg/day. A comparison of the study subjects who took part in their daily PA at school according to their educational program (GrS) and participants of the camp for diabetics (GrR) revealed significant differences regarding steps per day (p<0.001) and

T1DM children participated in the camp exhibited a higher tolerance of physical exercise on each day of the investigations (Fig. 1). The average daily dose of insulin (Ins/kg) was similar for all subjects, and no significant differences were observed in GrS compared to GrR. No differences were observed in mean daily serum glucose levels between GrS vs GrR groups (p>0.05) (Table 2). However, based on the measurements of blood glucose concentrations during the day, several incidents of hypo-and hyperglycemia were observed. Two-way ANOVA revealed a significant effect of physical activity levels on hyperglycemic but not hypoglycemic incidents (GrS vs GrR; F=1014.7 p<0.001). GrR exhibited a trend to higher

at school (GrS) was low compared to recommended values (Fig.1).

daily energy expenditure (p<0.01) between these groups (Table 2).

Considering the aim of the study, PA measurements were conducted in two groups:


The first group of subjects (GrS) were asked to wear an accelerometer for 7 consecutive days, starting on the day immediately after they had received monitors at school. The second group (GrR) was monitored during the second week of a summer camp for children and adolescents with diabetes.
