운동 강도에 따른 제1형 당뇨 환자의 혈당 반응
Blood Glucose Response to Various Exercise Intensities in Children and Adolescence with Type 1 Diabetes
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초록
본 연구에서는 제1형 당뇨환자를 대상으로 다양한 유산소 운동 강도에 따른 혈당 반응의 차이를 알아보고, 운동으로 유발되는 저혈당 발생을 예측하고 이를 대비할 수 있는 기초자료를 제공하는 데 목적이 있었다. 본 연구의 참여자는 제1형 당뇨병 환자 51명으로(남=19, 여=32, 12.1±2.4세, 20.1±3.5 kg/m2, 47.7±12.4 kg), 4가지의 운동처치(GXT, graded exercise test; 20 m PSRT, 20 m progressive shuttle run test; 80 %HRmax, 55 %HRmax)를 실시하여 운동전과 운동직후의 혈당변화를 관찰하였다. 고강도 운동처치 간 비교(GXT vs. 20 m PSRT)에서는 운동소요시간(GXT=10.6±3.0분 vs. 20 m PSRT=4.7±1.4분, p=.035)은 차이가 있었으나 두 집단(GXT와 20 m PSRT) 모두 운동전에 비해 운동직후 혈당이 유의하게 감소(p=.05, p=.017)하였다. 저, 중, 고강도 비교(15분간 55 %HRmax, 15분간 80 %HRmax, 10.6±3분간 GXT)에서는 고강도 대 저강도 운동(p=.018), 중강도 대 저강도 운동(p=.003)에서 각각 유의한 상호작용효과가 나타났다. 즉, 고강도와 중강도에서는 운동직후 혈당이 운동전에 비해 유의하게 감소한 반면 저강도에서는 운동전 수준을 유지하는 패턴의 차이를 보였다. 또한 80 %HRmax와 100 %HRmax 강도에서의 운동 시 각각 분당 3.3 mg/dL, 2.83 mg/dL의 혈당이 소모되었다. 결론적으로, 고강도 운동(GXT와 20 m PSRT)의 경우 운동직후의 혈당 반응은 운동소요시간보다는 운동강도에 더욱 민감하게 반응하는 것으로 나타났다. 둘째, 단시간(10-15분)의 운동 시 중강도 이상(≥ 80 %HRmax)의 운동이 혈당을 감소시키는데 효과적인 것으로 나타났다. 이상의 결과를 바탕으로, 47.7±12.4 kg의 체중을 지닌 제1형 당뇨환자의 경우, 운동 시 분당 혈당 사용량이 약 3 mg/dL라는 점을 고려하여 운동소요시간에 따른 글루코스 소모량을 예측하고, 이를 토대로 운동 중과 후의 글루코스 투여량을 산출할 수 있을 것으로 기대된다.
Abstract
The purpose of this study was to examine differences in blood glucose response to various intensities of aerobic exercise to predict and prevent an occurrence of hypoglycemia-induced exercise in type 1 diabetes. Fifty one patients with type 1 diabetes (19 boys, 32 girls, 12.1±2.4 ys, 20.1±3.5 kg/m2, 47.7±12.4 kg) participated in this study. Subjects performed two types of exercise tests (GXT: Graded exercise test, 20 m PSRT: 20 m progressive shuttle run test) at two different intensities (80 %HRmax, 55 %HRmax). Blood was sampled before and after each exercise trial for checking a blood glucose level. As the results, in comparison of high-intensity exercise trials (GXT vs. 20 m PSRT), there was a difference in exercise time (GXT = 10.6±3.0 mins vs. 20 m PSRT = 4.7±1.4 mins, p=.035). However, both exercise tests decreased blood glucose levels immediately after exercise (p=.050, p=.017) compared to ones before exercise. The second, in comparison of glucose by various exercise intensities (15 minutes 55 %HRmax = L, 15 minutes 80 %HRmax = M, 10.6±3 minutes GXT = 100 %HRmax = H), H to L (p=.018) and M to L (p=.003) were found to show significant interaction effect. This result indicated that a glucose level was significantly lowered after M and H unlike L exercises. On the other hand, the blood glucose level of L group did not change after exercise, which resulted in the difference in the pattern to maintain the pre-exercise level. Therefore, we concluded that first, in case of H exercise (GXT and 20 m PSRT), blood glucose responses after exercise might be more sensitive to intensity of exercise than time spent in these types of exercise. Secondly, in short-time exercise at a moderate intensity (over 80 %HRmax) might be more effective in lowering a blood glucose level(3 mg/dL/min) with type 1 diabetes.
참고문헌 (28)
- 김덕희, "청소년 건강 2 : 논단 ; 만성질환을 가진 청소년기 아동의 건강관리", 간호학탐구, 6(2), pp.9~24 (1997)
- 신충호, "소아 청소년기의 당뇨병 관리", 대한당뇨병학회 19차 춘계학술대회논문집 (2006)
- 홍창의, "소아과학" (2001), 대한교과서
- ACSM, "ACSM's Guidelines for Exercise Testing and Prescription" (2010), Lippincott Williams & Wilkins
- American Diabetes Association, "Standards of medical care in diabetes-2008", Diabetes Care, 31(Suppl. 1), pp.S12~S54 (2008)
- Aschner, P., "The team approach to diabetes management: Partnering with patients", International Journal of Clinical Practice, 61(Suppl. 157), pp.22~30 (2007)
- Brugnara, L., "Metabolomics approach for analyzing the effects of exercise in subjects with type 1diabetes mellitus", PLoS One, 7(7), pp.e40600~ (2012)
- Camacho, R. C., "Glucoregulation during and after exercise in health and insulin-dependent diabetes", Exercise and Sport Sciences Reviews, 33(1), pp.17~23 (2005)
- Daugaard, J. R., "Relationship between muscle fibre composition, glucose transporter protein 4and exercise training: possible consequences in non-insulin-dependent diabetes mellitus", Acta Physiol. Scand, 171(3), pp.267~276 (2001)
- Davey, R. J., "The effect of midday moderate-intensity exercise on postexercise hypoglycemia risk in individuals with type 1 diabetes", The Journal of Clinical Endocrinology and Metabolism, 98(7), pp.2908~2914 (2013)
- Davis, E. A., "Hypoglycemia: Incidence and clinical predictors in a large population-based sample of children and adolescents with IDDM", Diabetes Care, 20(1), pp.22~25 (1997)
- Garcia, M., "How does physical activity and fitness influence glycaemic control in young people with type 1 diabetes", Diabet. Med, 29(10), pp.e369~e376 (2012)
- Gellish, R. L., "Longitudinal modeling of the relationship between age and maximal heart rate", Medicine and Science in Sports Exercise, 39(5), pp.822~829 (2007)
- Guelfi, K. J., "The decline in blood glucose levels is less with intermittent high-intensity compared with moderate exercise in individuals with type 1 diabetes", Diabetes Care, 28(6), pp.1289~1294 (2005)
- Guelfi, K. J., "Intermittent high-intensity exercise does not increase the risk of early postexercise hypoglycemia in individuals with type 1 diabetes", Diabetes Care, 28(2), pp.416~418 (2005)
- Guelfi, K. J., "Effect of intermittent highintensity compared with continuous moderate exercise on glucose production and utilization in individuals with type 1 diabetes", American Journal of Physiology-Endocrinology and Metabolism, 292(3), pp.E865~E870 (2007)
- Iscoe, K. E., "Continuous moderate-intensity exercise with or without intermittent high-intensity work: effects on acute and late glycaemia in athletes with Type 1 diabetes mellitus", Diabetic Medicine, 28(7), pp.824~832 (2011)
- Kilpatrick, E. S., "International Expert Committee report on the role of the A1C assay in the diagnosis of diabetes: response to the International Expert Committee", Diabetes Care, 32(12), pp.e159~ (2009)
- Laville, M., "Acute regulation by insulin of phosphatidylinositol-3-kinase, Rad, Glut 4, and lipoprotein lipase mRNA levels in human muscle", J. Clin. Invest, 98(1), pp.43~49 (1996)
- Mann, C. J., "Skeletal muscle metabolism in the pathology and treatment of type 1 diabetes", Current Pharmaceutical Design, 16(8), pp.1002~1020 (2010)
- McArdle, W. D., "Exercise Physiology: Energy, Nutrition and Human Performance" (1986), Lea and Febiger
- Patton, S. R., "Parental fear of hypoglycemia: young children treated with continuous subcutaneous insulin infusion", Pediatr. Diabetes, 8(6), pp.362~368 (2007)
- Petersen, K. F., "Regulation of net hepatic glycogenolysis and gluconeogenesis during exercise: Impact of type 1 diabetes", The Journal of Clinical Endocrinology and Metabolism, 89(9), pp.4656~4664 (2004)
- Tsalikian, E., "Impact of exercise on overnight glycemic control in children with type 1 diabetes mellitus", J. pediatr, 147(4), pp.528~534 (2005)
- Weltman, N. Y., "The use of exercise in the management of type 1 and type 2 diabetes", Clinics in Sports Medicine, 28(3), pp.423~439 (2009)
- Yardley, J. E., "Effects of performing resistance exercise before versus after aerobic exercise on glycemia in type 1 diabetes", Diabetes Care, 35(4), pp.669~675 (2012)
- Yki-Jarvinen, H., "Regulation of glycogen synthase and phosphorylase activities by glucose and insulin in human skeletal muscle", The Journal of Clinical Investigation, 80(1), pp.95~100 (1987)
- Zorzano, A., "Mechanisms regulating GLUT4 glucose transporter expression and glucose transport in skeletal muscle", Acta Physiol. Scand, 183(1), pp.43~58 (2005)