TYPE 1 DIABETES, MUSCULOSKELETAL HEALTH, AND PHYSICAL ACTIVITY IN CHILDREN
Date
2024-01-23
Authors
Journal Title
Journal ISSN
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Publisher
ORCID
Type
Thesis
Degree Level
Doctoral
Abstract
Objectives: (1) To synthesize and update evidence related to imaged musculoskeletal
characteristics and physical activity (PA) in children with type 1 diabetes (T1D) compared to
typically developing children (TDC); (2) test hypothesis that higher muscle and PA measures
would mediate bone differences between children with T1D and TDC; and (3) characterize
precision errors and monitoring time intervals (MTI) of muscle measures, including imaged
muscle properties and neuromuscular performance measures, in children.
Methods: We performed two meta-analyses to compare bone and accelerometer-measured PA
between children with T1D and TDC (Objective 1). We measured bone and muscle properties
using high-resolution and standard peripheral quantitative tomography, neuromuscular
performance, as well as PA (accelerometers and questionnaire) in 56 children with T1D and 56
sex- and maturity-matched TDC (Obj. 2). We compared bone, muscle, and neuromuscular
performance measures with MANCOVA and PA with an independent t-tests, and performed
mediation analysis to explore if the muscle or PA would mediate bone differences between
children with T1D and TDC (Obj. 2). We assessed precision errors in 35 TDC and annual
changes in 40 TDC participants to estimate MTIs for muscle properties and neuromuscular
performance measures (Obj. 3).
Results: Bone and PA meta-analyses demonstrated children with T1D had lower bone content,
density, trabecular micro-architecture (0.1-0.4 standardized mean difference) at various
locations, and 3 times the odds of not achieving recommended 60 min moderate-to-vigorous PA
(MVPA) per day. Children with T1D had 6-9% deficits in trabecular micro-architecture
measures, while 3-17% higher cortical measures. Muscle density was 3% higher and PA score
14% lower in children with T1D. The PA score mediated difference in distal radius trabecular
number (indirect effect -0.04) between children with T1D and TDC. Precision errors range from
1.3-13.6% among muscle measures, and MTI ranged from 0.9-2.6yrs, except muscle density
(≥36yrs) in children.
Conclusion: Meta-analyses indicated that children with T1D had bone deficits primarily in
trabecular bone and were less likely to meet MVPA guidelines. Matched cohort comparison
suggested that more PA can potentially help to minimize trabecular bone deficits in children with
T1D. Based on 1-2 year monitoring time intervals of imaged muscle area and neuromuscular
performance, these measures benefit designs of prospective studies and PA interventions aiming
to optimize bone development in children with T1D.
Description
Keywords
Type 1 diabetes, pediatrics, musculoskeletal health, physical activity
Citation
Degree
Doctor of Philosophy (Ph.D.)
Department
Kinesiology
Program
Kinesiology