Fatores associados à aptidão cardiorrespiratória de crianças e adolescentes portadores de diabetes mellitus tipo 1: uma revisão de escopo

Abstract

Type 1 Diabetes Mellitus (T1DM) is an autoimmune disease that destroys the beta cells of the pancreas, resulting in insufficient insulin production. Scientific evidence shows that children and adolescents with T1DM have lower cardiorespiratory fitness (CRF) compared to their peers without the disease. However, the factors that contribute to this reduction in aerobic capacity have not yet been fully elucidated. In view of this, a scoping review was conducted with the aim of identifying the factors that influence the CRF of children and adolescents with T1DM. To this end, the guidelines and recommendations of the “JBI Manual for Evidence Synthesis” and PRISMA-ScR were adopted. The PubMed, Cochrane Library, Web of Science, Embase, LILACS, SCOPUS and SPORTDiscus databases were used for the searches. The gray literature databases were the Digital Library of Theses and Dissertations of the Coordination for the Improvement of Higher Education Personnel (CAPES), ProQuest and Clinical Trials, with no date or language restrictions. The search strategy in the databases used MeSH and DeCS terms: “Child”, ‘Adolescent’, “Diabetes Mellitus, Type 1” and “Cardiorespiratory Fitness”. The PCC (Population, Concept and Context) strategy was used: P - individuals aged 2 to 18 diagnosed with T1DM; C - any factor influencing CRF and C - CRF, and based on these definitions the guiding question was established: “What factors influence CRF in children and adolescents with T1DM”? The selection and extraction of studies was carried out by two independent reviewers, with the support of a third reviewer in the event of disagreements. The search in the databases resulted in 844 studies, of which 27 studies published between 1993 and 2024 were included, the majority from the American continent. As for the methodological design, observational studies predominated. The total sample involved 2,346 participants, 1,736 of whom had T1DM. The cardiopulmonary test was the most commonly used method for measuring CRF. The main factors associated with CRF were physiological and biochemical, particularly glycated hemoglobin (HbA1c), which was assessed in 26 (96.30%) studies, followed by body mass index (n= 18; 66.67%), level of physical activity (n= 10; 37.04%), body fat, lipid profile (n=7; 25.93%) time since diagnosis of the disease, age and gender (n= 6; 22.22%) blood pressure (n = 3; 11.11%) and vascular function (n= 2; 7.41%). HbA1c showed an inverse association in 48.1% of the studies. In addition, lipid profile and body fat showed predominantly negative associations with CRF, while physical activity levels were positively associated. No data was found on behavioral factors. Although most studies suggest an association between better glycemic control and higher CRF, the results were heterogeneous. On the other hand, regular physical activity was positively associated with better levels of CRF. We conclude that good glycemic control and physical activity are associated with better levels of CRF and that CRF can be a relevant marker of cardiometabolic health in children and adolescents with T1DM, contributing to the monitoring and prevention of metabolic and cardiovascular complications in this population.