Type 1 diabetes 'honeymoon' is almost four times longer in people who exercise

Abstract

Background:Sixty per cent of adults with newly diagnosed Type1 diabetes experience a period of partial remission, or ‘honeymoon’characterised by low insulin requirement and excellent glycaemiccontrol. Honeymoon is defined as insulin dose-adjusted A1c(IDAA1c)≤9 and has distinct clinical benefits.Aims:Honeymoon results from partial recovery of beta cellfunction and/or normalisation of insulin sensitivity. Physicalexercise improves insulin sensitivity in Type 1 diabetes andpreserves beta cell function in models of insulin-deficient diabetes.We hypothesised that exercise increases the duration of honey-moon in new-onset Type 1 diabetes.Methods:We selected 17 patients undertaking significant phys-ical exercise at the time of Type 1 diabetes diagnosis from three UKdiabetes clinics. For each case, two age-, sex- and body massindex–matched, sedentary controls were selected from the sameclinic. Data were collected on daily insulin requirement, HbA1cand weight. Honeymoon duration was calculated using IDAA1cformulae.Results:The mean duration of honeymoon was 28.1 months inphysically active cases compared with 7.5 months in sedentarycontrols. Within this series, one antibody-positive patient withType 1 diabetes had stopped all insulin therapy and was incomplete remission for two years.Conclusion:This is the first case series to examine the effect ofphysical exercise on honeymoon. Honeymoon and its contributoryfactors (improved beta cell function and insulin sensitivity) haveimportant clinical benefits. These benefits include improvedHbA1c, reduced hypoglycaemia and fewer microvascular andmacrovascular complications. Our data demonstrate a crucial rolefor exercise in people with newly diagnosed Type 1 diabetes. Thisnow needs to be tested in a formal randomised controlled trial.