Impact of Physical Activity on Cardiovascular Risk Factors in Children With Type 1 Diabetes A multicenter study of 23,251 patients ANTJE HERBST, MD 1 OLGA KORDONOURI, MD 2 KARL O. SCHWAB, MD 3 FRANK SCHMIDT, MD 4 REINHARD W. HOLL, PHD 5 ON BEHALF OF THE DPV INITIATIVE OF THE GERMAN WORKING GROUP FOR PEDIATRIC DIABETOLOGY GERMANY T ype 1 diabetes is associated with a high risk for early atherosclerotic complications. Patients with type 1 diabetes have a fourfold (in men) to eight- fold (in women) excess risk of coronary heart disease compared with that for the general population (1). It has been shown that type 1 diabetic patients aged 20 –39 years have a fivefold higher risk of dying from cardio- and cerebrovascular events compared with that for healthy individu- als (2). Development of atherosclerotic le- sions in healthy subjects begins upon childhood. In children with type 1 diabe- tes who had died an unnatural death, an asymptomatic increase in the intima- media thickness of the common carotid artery was found (3). Known risk factors for vascular complications are long- standing diabetes, age, poor glycemic control, smoking, hypertension, obesity, and dyslipidemia (4 – 6). In a recent study, 69% of the pediatric patients with type 1 diabetes were found to have one or more cardiovascular risk factors (7). Thus, there is an urgent need for preven- tion strategies to reduce these risk factors in childhood and adolescence. We recently showed that frequency of regular physical activity (RPA) represents an important factor influencing glycohe- moglobin and, in girls, BMI (8). The present study focuses on the impact of RPA on further cardiovascular risk factors such as plasma lipids and blood pressure in children with type 1 diabetes. RESEARCH DESIGN AND METHODS — Data were provided by the Pediatric Quality Initiative (9) and in- cluded anonymous longitudinal data of 23,251 patients (3–18 years) with type 1 diabetes from 209 centers in Germany and Austria. The data are continuously generated by the participating centers us- ing the diabetes data acquisition system for prospective surveillance [DPV] soft- ware (Diabetes Software for Prospective Documentation) and after anonymization are transmitted to the Pediatric Quality Initiative for central analysis. Plausibility of the data is reviewed twice a year, and inconsistent data are reconfirmed with the centers. In this cross-sectional study (DPV Science database, October 2006), the fol- lowing cardiovascular risk factors were evaluated: plasma lipids (cholesterol, HDL cholesterol, LDL cholesterol, and triglycerides), blood pressure, A1C, and BMI. Laboratory methods are standard- ized nationwide and follow criteria for quality management defined by the Ger- man Medical Association (10). Dyslipide- mia was defined as cholesterol 200 mg/dl (5.2 mmol/l), HDL cholesterol 35 mg/dl (0.91 mmol/l), LDL choles- terol 160 mg/dl (4.1 mmol/l), or triglyc- erides 150 mg/dl (1.7 mmol/l) (11). Normative blood pressure data developed by the Task Force on Blood Pressure Con- trol in children served as reference values (12). For comparison, the A1C values were standardized and transformed to the Diabetes Control and Complications Trial normal range (13). Baseline characteristics of the patients are shown in Table 1. Patients were grouped by the frequency of their self- reported RPA as follows: RPA0 = none (n = 10,392), RPA1 = 1–2 times/week (n = 8,607), and RPA2 = 3 times/week (n = 4,252). At every visit to the diabe- tologist, the DPV software requires infor- mation about the frequency of the patient’s RPA, which represents exercise performed at least once a week for at least 30 min. Intensity of the sports activity is not included in the protocol. School sports are also not included. The study protocol was approved by the Human Subjects Research Committee of the Uni- versity of Ulm. The data were evaluated statistically using the Kruskal-Wallis test for compar- ison among groups followed by the Holm adjustment (Bonferroni stepdown) for multiple comparisons (SAS for Windows, version 9.1; SAS Institute, Cary, NC). Multiple linear regression analysis was performed to extract possible explanatory variables affecting the levels of choles- terol, HDL cholesterol, LDL cholesterol, and triglycerides, A1C, and blood pres- sure. P  0.05 was considered statistically significant. RESULTS — Mean A1C was 7.9%. The frequency of RPA ranged between 0 and 9 times/week (average 1.29 times/ week). Of the patients, 44.7% were not physically active, 37.0% performed RPA 1–2 times/week, and 18.3% performed RPA 3 times/week. The age of the pa- tients was higher with increasing fre- ●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●● From 1 Pediatrics, Hospital of Leverkusen, Leverkusen, Germany; the 2 Diabetes Center for Children and Adolescents, Children’s Hospital auf der Bult, Hannover, Germany; 3 Pediatrics, University of Freiburg, Freiburg, Germany; 4 Pediatrics, University of Halle, Halle, Germany; and 5 Epidemiology, University of Ulm, Ulm. Germany. Address correspondence and reprint requests to Dr. Antje Herbst, MD, Pediatric Diabetology, Hospital of Leverkusen, Am Gesundheitspark 11, 51375 Leverkusen, Germany. E-mail: herbst@klinikum-lev.de. Received for publication 31 December 2006 and accepted in revised form 20 April 2007. Published ahead of print at http://care.diabetesjournals.org on 27 April 2007. DOI: 10.2337/dc06-2636. Abbreviations: DPV, diabetes data acquisition system for prospective surveillance; RPA, regular physical activity. A table elsewhere in this issue shows conventional and Syste `me International (SI) units and conversion factors for many substances. © 2007 by the American Diabetes Association. The costs of publication of this article were defrayed in part by the payment of page charges. This article must therefore be hereby marked “advertisement” in accordance with 18 U.S.C. Section 1734 solely to indicate this fact. Cardiovascular and Metabolic Risk B R I E F R E P O R T 2098 DIABETES CARE, VOLUME 30, NUMBER 8, AUGUST 2007