Is It Really True?

Children that suffer from the chronic illness of type 1 diabetes mellitus have a diminished bone marrow density because of insulin deficiency.  Maggio et al. (2011) note that their research attempts to look at the dose and type of exercise needed for a child with type 1 diabetes mellitus (T1DM)  that will optimize bone mineral acquisition because research in this area is still not well defined. Thus, the main aim of their study determines what the effects of weight-bearing physical activity on bone mineral mass and bone turnover markers in young children with type 1 diabetes mellitus in comparison to those of healthy children.

Twenty-seven chidren who were diabetic were recruited from the Unit of Pediatric Endocrinology and Diabetology of the University Hospitals of Geneva between  the ages of 8-12. Thirty-two healthy children, also between the ages of 8-12 were recruited as peers of the diabetic children or from local schools. Both the diabetic and healthy candidates for this study were excluded for the following reasons: presence of other chronic disease, medications, hormones other than insulin or calcium preparations, presence of nephropathy, systematic disease or hospitlization for more than 2 weeks in the preceding year, and participation in competition sport (Maggio et al., 2011).

Participants with T1DM and healthy participants were randomized by gender to groups: the exercise diabetic group and the exercise healthy group (experimental groups) and the control  diabetic group and the control healthy group. Maggio et al. (2011) note that this randomization process resulted  in a similar girls/boys ratio within each group.  Children (healthy and diabetic) who were in the exercise group were instructed to go to two 90-minute exercise sessions per week for the period of 9 months. Maggio et al. (2011) demonstrate that the exercise sessions were supervised by two physical education teachers as well as, a pediatrician with experience in T1DM. Participants took part in various weight-bearing activities such as jump rope, jumping, and gymnastics. Maggio et al. (2011) also increased intensity and difficulty levels as the months progressed. The researchers (2011) also accounted for  physical leisure activity for the past 12 months via questionnaire.

All the young children that participated were tested at baseline, prior to the study, and after the 9 months had elasped during the same period (Maggio et al., 2011).  This was done to reduce some extraneous variables such as leisure time for physical activity and vitamin D concentrations. Body weight, height, body mass index (BMI), pubertal development, and lead body mass were all measured. Maggio et al. (2011) also, assessed areal bone mineral density (aBMD), lumbar spine, right femoral nech and greater trochanter.

As for the main results, researchers (2011) found that T1DM children that were in the exercise group (180 minutes of weight bearing activity/week) had improved their total body and lumbar spine bone mineral densities compared to those  diabetic patients within the control group.  What Maggio et al. (2011) find interesting is that total body and lumbar spine bone mineral densities were improved in healthy children as much as they were in participants with T1DM. Researchers (2011) also found that physical activity has different influences on different bone sites in regards to gender and pubertal stages. There are factors such as type of exercise, training duration and volume that physical activity is dependent on, as well.

What is limiting in Maggio et al. (2011) study is that their sample size was relatively small, therefore, generalizations towards the public in regards to the findings can not be made with complete assurance. Researchers (2011) further note that due to the small sample size,  a sub-analysis cannot be conducted to evaluate other factors (age and puberty) on the different variables.

This study is, however, interesting because of the quality of the researcher’s (2011) study design and the fact that there were no drop outs from the study. Also, researchers (2011) looked at something that still needed defining, which will yield an additional amount of research conducted in this area.

These findings suggest that there are positive effects of weight-bearing physical activity on total body and lumbar spine bone mineral aquistion with T1DM.Therefore, the take home message of this study conducted by Maggio et al. (2011) is that weight-bearing sports (ball games, jumping activities, gymnastics) should be encouraged and become prevalent in children with Type 1 Diabetes Mellitus in so that bone mineral acquisition is optimized during growth. Maggio et al. (2011) also make note that physical activity within these diabetic patients will prevent the development of osteoporosis later in life.

References  

Maggio, Albane B., Laetitia M. Marchand, Serge Ferrari, René Rizzoli, Maurice Beghetti, and Nathalie J. Farpour-Lambert. "Physical Activity Increases Bone Mineral Density In Children With Type 1 Diabetes: A Randomized Controlled Trial." Medicine & Science in Sports & Exercise 41.Supplement 1 (2011). PubMed. Web. 17 Mar. 2012. 

Controversies, Controversies

Thinking of Type 1 Diabetes, the word controversy is not the one that immediately comes to mind only because Type 1 Diabetes is a type of chronic disease that you either have or you don't. Simply, uou're either born with it or you're not, so there can`t be any sort of controversy, right? However, the controversy arises within the treatment/therapeutic aspect of this chronic disease. There is a heated debate over whether or not  pancreas transplants are an effective therapeutic method to treat Type 1 Diabetes. The following will further discuss the nature of the controversy and both sides of the arguments:

Essentially,  as previously noted, the main controversy here is whether or not pancreas transplants are an effective therapeutic method for Type 1 Diabetes in the IDDM (insulin dependent melitus) diabetic patients. Paul Robertson (1998) notes that there are two opposing sides to this: simple approach or circumspect approach.

The simple approach basically states that yes and only because "pancreases are being transplanted therapeutically all over the United States and Europe on a daily basis" (Robertson, 1998, p.1868). Robertson (1998) describes that the process for pancreatic transplants became feasible in 1978 and since then almost 10000 have been transplanted. Pancreas survival after transplant has a fairly high rate at 70-90% with even higher rates being reported because some groups are highly selective of their recipients (Robertson 1998). What is important to note here that Robertson (1998) discusses is that when the procedure is successful, "recipients are totally insulin-dependent, have normal levels of glycemia and...report improved qualities of life" (p. 1868). However, there is a patient mortality rate of 12%. Having said this, this rate, as pointed out by Robertson (1998), is "uninterpretable because it resembles the natural history of IDDM [for over a] 20 year duration" (p. 1868). No case-matched study regarding pancreas transplantation has been performed and most deaths occur beyond 3 months post-transplant (Robertson 1998). Is this a really reliable and valid argument then?

Thus, because there have been no controlled studies regarding pancreas transplants in diabetic patients there has to be a more circumspect explanation, as well. Robertson (1998) points out that "[s]urgical history is replete with examples of operative procedures, some good, some bad, that were developed to the
point of daily use by the trial and error approach with rarely a thought about including sham operations or controls" (p. 1868). Such is similar with pancreas transplants. Yes, doctors want to relieve human suffering but this is not a method to evaluate therapeutic efficacy. When pancreas transplantation is successful, insulin independence and normoglycemia is reestablished and improves quality of life measures, there is undoubtedly less certainty about its impact on chronic diabetic complications inclusive of retinopathy, nephropathy and neuropathy (Robertson 1998). Essentially, there are some benefits but they cannot be conclusive only because of the fact that there have been no controlled studies conducted. Therefore, "[i]n the absence of randomized trials, this makes drawing defensible conclusions difficult, if not impossible" (Robertson, 1998, p. 1868).

Personally, I believe that the simple approach lacks validity and reliability just because pancreatic transplants have not been tested under controls. Conclusions are made tentatively. I don't think that pancreatic transplants are wrong, however, it is almost similar to giving a child a herbal remedy and telling them "I do not know if this will cure your cold or not, but we can try". To a certain extent, it is risky. Therefore, I think that it is quite important to test this therapeutic method under controls to make sure conclusions are reached as specifically as possible because human lives are at stake. Robertson (1998) notes that "[p]ancreas transplantation is here to stay until something better—presumably islet transplantation—comes along and is proven to be more efficacious" (p. 1869). I believe this is true but as I've argued, I do think that it is quite crucial that it is tested to provide concrete conclusions until the point comes whereby another therapeutic method for Type 1 Diabetes is found.

References

Robertson, P.R. (1998). Has pancreatic transplantation arrives as a therapeutic option in IDDM. The Journal of Clinical Endocrinology and Metabolism, 83(6), 1868-1869.