Interpretation of ISPAD Clinical Practice Consensus Guidelines 2022: Exercise in Children and Adolescents with Diabetes

doi:10.12114/j.issn.1007-9572.2023.0327

Chinese General Practice ›› 2023, Vol. 26 ›› Issue (30): 3719-3724.DOI: 10.12114/j.issn.1007-9572.2023.0327

Special Issue: 内分泌代谢性疾病最新文章合辑；儿科最新文章合辑；运动相关研究最新文章合辑；指南/共识最新文章合辑

• Guidelines Interpretation • Next Articles

Interpretation of ISPAD Clinical Practice Consensus Guidelines 2022: Exercise in Children and Adolescents with Diabetes

1. School of Physical Education, Henan University, Kaifeng 475000, China
2. School of Sports Science, Kyonggi University, Suwon 16227, South Korea
3. Graduate School, KyungHee University, Suwon 16227, South Korea
4. Department of Endocrinology, Henan Province Hospital of TCM/the Second Affiliated Hospital of Henan University of Chinese Medicine, Zhengzhou 450003, China
5. Department of Endocrinology, Henan Provincial People's Hospital/Zhengzhou University People's Hospital, Zhengzhou 450003, China

Received:2023-05-04 Revised:2023-06-10 Published:2023-10-20 Online:2023-06-19
Contact: QIAO Junjun, WANG Yanfang

《2022 ISPAD临床实践共识指南：儿童和青少年糖尿病患儿运动》解读

1．475000　河南省开封市，河南大学体育学院
2．16227京畿道水原市，韩国京畿大学体育科学学院
3．16227京畿道水原市，韩国庆熙大学研究生院
4．450003　河南省郑州市，河南省中医院　河南中医药大学第二附属医院内分泌科
5．450003　河南省郑州市，河南省人民医院　郑州大学人民医院内分泌科

通讯作者: 乔军军, 汪艳芳
作者简介:
作者贡献：程经纬、尹振、王庆贺负责文章构思与设计、研究资料收集与整理、论文撰写、图表制作；胡俊鹏、柳杨青负责论文修订、格式编辑、整理；乔军军、汪艳芳负责文章质量控制及审校、监督管理，对文章整体负责。
基金资助:
河南省医学科技攻关计划省部共建项目(SBGJ2018069)

Abstract

Abstract:

Regular physical activity is a cornerstone of diabetes management, and more precise guidance on exercise prescriptions is needed in children and adolescents with diabetes due to the complexity of glycemic changes, however, there are relatively few guidelines for this population. As the continuous exploration of experts and scholars in this field, after five years, the International Society for Pediatric and Adolescent Diabetes (ISPAD) updated its guidelines on exercise for children and adolescents with diabetes in 2022. The guidelines target the service population more precisely to the children and adolescents with type 1 diabetes and provide comprehensive guidance from the perspectives of exercise types, exercise timing, blood glucose fluctuations during exercise, insulin adjustment and nutritional supplementation. This article interprets the main contents and key updates of the 2022 ISPAD guidelines, aiming to provide more scientific exercise prescriptions for children and adolescents with diabetes in China.

Key words: Diabetes mellitus, type 1, Child, Adolescent, Physical activity, Exercise, International Society for Pediatric and Adolescent Diabetes, Guide interpretation

摘要：

身体活动是糖尿病管理的基石，儿童和青少年糖尿病患儿因其血糖变化的复杂性需要更精准的运动处方指导，但此类人群的运动指南相对较少。随着专家学者对该领域的不断研究探索，2022年国际儿童青少年糖尿病协会（ISPAD）更新了关于儿童和青少年糖尿病患儿运动的指南。本指南将服务人群更精准地面向1型糖尿病儿童和青少年患儿，从运动类型、运动时机、运动时血糖波动、胰岛素调整及营养补充等角度全面提出了指导意见。本文对《2022 ISPAD临床实践共识指南：儿童和青少年糖尿病患儿运动》指南的主要内容及重点更新内容进行解读，旨在为国内儿童和青少年糖尿病患儿提供更科学的运动指导。

关键词: 糖尿病, 1型, 儿童, 青少年, 身体活动, 运动, 国际儿童青少年糖尿病协会, 指南解读

CHENG Jingwei,QIAO Junjun,YIN Zhen, et al. Interpretation of ISPAD Clinical Practice Consensus Guidelines 2022: Exercise in Children and Adolescents with Diabetes[J]. Chinese General Practice, 2023, 26(30): 3719-3724. DOI: 10.12114/j.issn.1007-9572.2023.0327.
程经纬,乔军军,尹振等. 《2022 ISPAD临床实践共识指南：儿童和青少年糖尿病患儿运动》解读[J]. 中国全科医学, 2023, 26(30): 3719-3724. DOI: 10.12114/j.issn.1007-9572.2023.0327.

Figures/Tables 5

References 23

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运动类型	生理特征	对T1DM患儿血糖的影响^a	项目举例
有氧运动	主要为低于乳酸阈值的持续中等强度运动，肌肉对葡萄糖的摄取大于肝脏葡萄糖输出	轻度降低或明显降低	慢跑、散步、远足、骑自行车、划船、游泳、健身操
无氧运动	肝脏葡萄糖输出大于肌肉摄取量，以高于乳酸阈值的强度进行最大强度的疲劳运动（5 s~10 min）	轻度升高或明显升高	100 m冲刺跑、50~1 500 m赛跑、举重、1~2 km循环计时赛
有氧与短时间无氧混合运动	中等至高强度有氧运动，期间穿插较短时间（5~30 s）的无氧爆发	轻度降低或无明显变化	篮球、足球、板球、手球、武术
有氧与长时间无氧混合运动	低至中等强度有氧运动，期间穿插较长时间（10~180 s）的无氧爆发	轻度升高或无明显变化	阻力训练、循环训练、体操、冲刺训练（跑步、游泳、骑自行车等）
体育比赛	与日常训练相比，比赛中肝脏葡萄糖输出量明显增加，导致明显高血糖	明显升高	团体或个人游戏/比赛

运动类型	生理特征	对T1DM患儿血糖的影响^a	项目举例
有氧运动	主要为低于乳酸阈值的持续中等强度运动，肌肉对葡萄糖的摄取大于肝脏葡萄糖输出	轻度降低或明显降低	慢跑、散步、远足、骑自行车、划船、游泳、健身操
无氧运动	肝脏葡萄糖输出大于肌肉摄取量，以高于乳酸阈值的强度进行最大强度的疲劳运动（5 s~10 min）	轻度升高或明显升高	100 m冲刺跑、50~1 500 m赛跑、举重、1~2 km循环计时赛
有氧与短时间无氧混合运动	中等至高强度有氧运动，期间穿插较短时间（5~30 s）的无氧爆发	轻度降低或无明显变化	篮球、足球、板球、手球、武术
有氧与长时间无氧混合运动	低至中等强度有氧运动，期间穿插较长时间（10~180 s）的无氧爆发	轻度升高或无明显变化	阻力训练、循环训练、体操、冲刺训练（跑步、游泳、骑自行车等）
体育比赛	与日常训练相比，比赛中肝脏葡萄糖输出量明显增加，导致明显高血糖	明显升高	团体或个人游戏/比赛

运动类型	运动时血糖	运动前	运动后
		餐时胰岛素（如果在运动前2 h以上进食，应按常规餐时剂量注射，以预防高血糖。如果在运动前2 h内进食，请根据以下建议调整餐时剂量）	餐时胰岛素	若16：00后运动且持续时间>30 min，选择以下1个或2个选项
			餐时胰岛素	夜间基础胰岛素	如血糖<10.0 mmol/L，建议根据以下剂量增加摄入低升糖指数碳水化合物，且睡前无需追加胰岛素；如血糖<7.0 mmol/L，则在碳水化合物基础上额外增加15 g蛋白质
有氧运动	>15.0 mmol/L	-25%	-25%	不变	碳水化合物0.2 g/kg
	5.0~15.0 mmol/L	-50%	-50%	-20%	碳水化合物0.4 g/kg
	<5.0 mmol/L	-75%	-75%	-40%	碳水化合物0.6 g/kg
混合运动	>15.0 mmol/L	-25%	不变	不变	碳水化合物0.2 g/kg
	5.0~15.0 mmol/L	-50%	-25%	-20%	碳水化合物0.4 g/kg
	<5.0 mmol/L	-75%	-50%	-40%	碳水化合物0.6 g/kg
无氧运动	>15.0 mmol/L	不变	不变	不变	碳水化合物0.2 g/kg
	5.0~15.0 mmol/L	-25%	-25%	-20%	碳水化合物0.4 g/kg
	<5.0 mmol/L	-50%	-50%	-40%	碳水化合物0.6 g/kg

运动类型	运动时血糖	运动前	运动后
		餐时胰岛素（如果在运动前2 h以上进食，应按常规餐时剂量注射，以预防高血糖。如果在运动前2 h内进食，请根据以下建议调整餐时剂量）	餐时胰岛素	若16：00后运动且持续时间>30 min，选择以下1个或2个选项
			餐时胰岛素	夜间基础胰岛素	如血糖<10.0 mmol/L，建议根据以下剂量增加摄入低升糖指数碳水化合物，且睡前无需追加胰岛素；如血糖<7.0 mmol/L，则在碳水化合物基础上额外增加15 g蛋白质
有氧运动	>15.0 mmol/L	-25%	-25%	不变	碳水化合物0.2 g/kg
	5.0~15.0 mmol/L	-50%	-50%	-20%	碳水化合物0.4 g/kg
	<5.0 mmol/L	-75%	-75%	-40%	碳水化合物0.6 g/kg
混合运动	>15.0 mmol/L	-25%	不变	不变	碳水化合物0.2 g/kg
	5.0~15.0 mmol/L	-50%	-25%	-20%	碳水化合物0.4 g/kg
	<5.0 mmol/L	-75%	-50%	-40%	碳水化合物0.6 g/kg
无氧运动	>15.0 mmol/L	不变	不变	不变	碳水化合物0.2 g/kg
	5.0~15.0 mmol/L	-25%	-25%	-20%	碳水化合物0.4 g/kg
	<5.0 mmol/L	-50%	-50%	-40%	碳水化合物0.6 g/kg

项目	运动前	运动中	运动后	睡前
营养补充建议	·为减少循环胰岛素并最大限度储存糖原，降低运动时低血糖风险，应尽量在运动前至少180 min进餐（膳食内容同运动后） ·如果未在运动前180 min内进餐，应尽可能在运动前60~90 min进餐，以降低运动前高血糖风险	·运动期间频繁测血糖时选择高升糖指数碳水化合物 ·运动期间不常或从不测血糖时选择中等升糖指数碳水化合物	运动后90 min内进食，优先摄入蛋白质	16：00后运动且持续时间≥30 min：血糖<10 mmol/L时补充碳水化合物；血糖<7 mmol/L时补充碳水化合物+蛋白质
膳食内容	运动前60~90 min膳食内容：碳水化合物1.0~1.5 g/kg，低蛋白质，低脂肪	碳水化合物摄入量根据运动前设定的血糖目标、运动前和运动中指尖血糖、体质量计算，详见原指南附表	膳食内容：碳水化合物1~4 g/kg，蛋白质≥15 g，中等脂肪	零食内容：中低升糖指数碳水化合物0.4 g/kg，蛋白质15 g

Interpretation of ISPAD Clinical Practice Consensus Guidelines 2022: Exercise in Children and Adolescents with Diabetes

《2022 ISPAD临床实践共识指南：儿童和青少年糖尿病患儿运动》解读

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项目	使用策略
运动前餐时胰岛素减量	运动前餐时胰岛素剂量减少25%（否则运动前血糖将升高，胰岛素自动输送增加，IOB升高）
运动前血糖阈值	·运动前1~2 h设定 ·运动结束时恢复 ·如果低血糖风险增加，运动恢复过程中保持较高的血糖阈值1~2 h
运动开始前降低IOB	运动前至少3 h摄入主餐
胰岛素泵暂停或断开	胰岛素泵避免长时间（>120 min）暂停（否则增加高血糖或酮症风险）

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