{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,20]],"date-time":"2026-08-20T15:42:57Z","timestamp":1787240577377,"version":"build-2736575974"},"reference-count":38,"publisher":"American Diabetes Association","issue":"10","license":[{"start":{"date-parts":[[2025,8,13]],"date-time":"2025-08-13T00:00:00Z","timestamp":1755043200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/www.diabetesjournals.org\/journals\/pages\/license"}],"funder":[{"DOI":"10.13039\/501100004587","name":"Instituto de Salud Carlos III","doi-asserted-by":"publisher","award":["PI21\/01238"],"award-info":[{"award-number":["PI21\/01238"]}],"id":[{"id":"10.13039\/501100004587","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["diabetesjournals.org"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2025,10,1]]},"abstract":"<jats:sec>\n                    <jats:title>OBJECTIVE<\/jats:title>\n                    <jats:p>To evaluate the effects of resistance training supported by the mobile health application Diactive-1 on the daily insulin dose and glycemic parameters in children and adolescents with type 1 diabetes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESEARCH DESIGN AND METHODS<\/jats:title>\n                    <jats:p>In this 24-week randomized clinical trial, Diactive-1 generated progressive overload resistance training sessions tailored to real-time glycemia and provided educational support. Insulin and glycemic parameters were collected from LibreView or CareLink, whereas glycosylated hemoglobin (HbA1c) was extracted from medical records. Muscular strength was assessed using a handgrip dynamometer and e-GYM machines, targeting pushing, pulling, and lower-limb movements. The effect was analyzed using linear mixed models.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS<\/jats:title>\n                    <jats:p>Sixty-two participants (age: 8\u201318 years, girls: 48%) with type 1 diabetes (HbA1c: 7.6% [60.4 mmol\/mol]) were allocated to the usual care (n = 32) or the Diactive-1 group (n = 30). Daily insulin dose reductions were observed within the Diactive-1 group (mean difference [MD] \u22120.10 units\/kg, 95% CI \u22120.18 to \u22120.01) and when compared with usual care (MD \u22120.17 units\/kg, 95% CI \u22120.26 to \u22120.07). No adverse effects were observed on the glycemic risk index or the incidence of hypoglycemic events. Finally, handgrip strength (MD 2.90 kg, 95% CI 1.57\u20134.22), one-repetition maximum strength (MD 1.34, 95% CI 0.21\u20132.46), and muscular power (MD 0.97, 95% CI 0.01\u20131.93) increased. Four participants (6.5%) withdrew from the study.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSIONS<\/jats:title>\n                    <jats:p>Diactive-1 appears to be a safe and feasible adjunct to standard care in children and adolescents with type 1 diabetes. Its resistance training component effectively reduced insulin requirements and improved muscular strength, without increasing the risk of adverse glycemic events.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.2337\/dc25-0985","type":"journal-article","created":{"date-parts":[[2025,8,13]],"date-time":"2025-08-13T15:24:42Z","timestamp":1755098682000},"page":"1803-1811","update-policy":"https:\/\/doi.org\/10.2337\/ada-journal-policies","source":"Crossref","is-referenced-by-count":4,"title":["Effect of Diactive-1 mHealth-Supported Progressive Resistance Training on Insulin Requirements, Glycemic Stability, and Muscular Strength in Children and Adolescents With Type 1 Diabetes: A Parallel-Group Randomized Controlled Trial"],"prefix":"10.2337","volume":"48","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0210-2866","authenticated-orcid":false,"given":"Jacinto","family":"Mu\u00f1oz-Pardeza","sequence":"first","affiliation":[{"name":"Navarrabiomed, Hospital Universitario de Navarra (HUN), Universidad P\u00fablica de Navarra (UPNA), Instituto de Investigaci\u00f3n Sanitaria de Navarra 1 , Pamplona, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-7221-1731","authenticated-orcid":false,"given":"Ignacio","family":"Hormaz\u00e1bal-Aguayo","sequence":"additional","affiliation":[{"name":"Navarrabiomed, Hospital Universitario de Navarra (HUN), Universidad P\u00fablica de Navarra (UPNA), Instituto de Investigaci\u00f3n Sanitaria de Navarra 1 , Pamplona, Spain"},{"name":"Vicerrector\u00eda de Investigaci\u00f3n y Postgrado, Universidad de La Serena 2 , La Serena, Chile"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5443-5788","authenticated-orcid":false,"given":"Nidia","family":"Huerta-Uribe","sequence":"additional","affiliation":[{"name":"Navarrabiomed, Hospital Universitario de Navarra (HUN), Universidad P\u00fablica de Navarra (UPNA), Instituto de Investigaci\u00f3n Sanitaria de Navarra 1 , Pamplona, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7366-1235","authenticated-orcid":false,"given":"Mar\u00eda J.","family":"Chueca-Guindulain","sequence":"additional","affiliation":[{"name":"Pediatric Endocrinology Unit, Hospital Universitario de Navarra, Instituto de Investigaci\u00f3n Sanitaria de Navarra 3 , Pamplona, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4793-0761","authenticated-orcid":false,"given":"Sara","family":"Berrade-Zubiri","sequence":"additional","affiliation":[{"name":"Pediatric Endocrinology Unit, Hospital Universitario de Navarra, Instituto de Investigaci\u00f3n Sanitaria de Navarra 3 , Pamplona, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6121-7893","authenticated-orcid":false,"given":"Vicente","family":"Mart\u00ednez-Vizca\u00edno","sequence":"additional","affiliation":[{"name":"Health and Social Research Center, Universidad de Castilla-La Mancha 4 , Cuenca, Spain"},{"name":"Facultad de Ciencias de la Salud, Universidad Aut\u00f3noma de Chile 5 , Talca, Chile"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9691-5998","authenticated-orcid":false,"given":"Yasmin","family":"Ezzatvar","sequence":"additional","affiliation":[{"name":"Lifestyle factors with impact on Ageing and overall Health (LAH) Research Group, Department of Nursing, University of Val\u00e8ncia 6 , Valencia, Spain"},{"name":"Vicerrector\u00eda de Investigaci\u00f3n y Postgrado, Universidad de Los Lagos 7 , Osorno, Chile"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7412-7624","authenticated-orcid":false,"given":"Jos\u00e9 Francisco","family":"L\u00f3pez-Gil","sequence":"additional","affiliation":[{"name":"School of Medicine, Universidad Esp\u00edritu Santo 8 , Samborond\u00f3n, Ecuador"},{"name":"Department of Communication and Education, Universidad Loyola Andaluc\u00eda 9 , Sevilla, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1397-7182","authenticated-orcid":false,"given":"Antonio","family":"Garc\u00eda-Hermoso","sequence":"additional","affiliation":[{"name":"Navarrabiomed, Hospital Universitario de Navarra (HUN), Universidad P\u00fablica de Navarra (UPNA), Instituto de Investigaci\u00f3n Sanitaria de Navarra 1 , Pamplona, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1167","published-online":{"date-parts":[[2025,8,13]]},"reference":[{"key":"2026061714381575900_B1","doi-asserted-by":"crossref","first-page":"529","DOI":"10.1159\/000543035","article-title":"ISPAD Clinical Practice Consensus Guidelines 2024: screening, staging, and strategies to preserve beta-cell function in children and adolescents with type 1 diabetes","volume":"97","author":"Haller","year":"2024","journal-title":"Horm Res Paediatr"},{"key":"2026061714381575900_B2","doi-asserted-by":"crossref","first-page":"109083","DOI":"10.1016\/j.diabres.2021.109083","article-title":"Global estimates of incidence of type 1 diabetes in children and adolescents: results from the International Diabetes Federation Atlas, 10th edition","volume":"183","author":"Ogle","year":"2022","journal-title":"Diabetes Res Clin Pract"},{"key":"2026061714381575900_B3","doi-asserted-by":"crossref","first-page":"e3749","DOI":"10.1002\/dmrr.3749","article-title":"Incidence of type 1 diabetes mellitus in children and adolescents under 20 years of age across 55 countries from 2000 to 2022: a systematic review with meta-analysis","volume":"40","author":"Hormaz\u00e1bal-Aguayo","year":"2024","journal-title":"Diabetes Metab Res Rev"},{"key":"2026061714381575900_B4","doi-asserted-by":"crossref","first-page":"S59","DOI":"10.2337\/dc25-S004","article-title":"4. Comprehensive medical evaluation and assessment of comorbidities: Standards of Care in Diabetes\u20142025","volume":"48","author":"American Diabetes Association Professional Practice Committee","year":"2025","journal-title":"Diabetes Care"},{"key":"2026061714381575900_B5","doi-asserted-by":"crossref","first-page":"229","DOI":"10.1111\/pedi.12085","article-title":"A high mean-HbA1c value 3-15 months after diagnosis of type 1 diabetes in childhood is related to metabolic control, macroalbuminuria, and retinopathy in early adulthood\u2014a pilot study using two nation-wide population based quality registries","volume":"15","author":"Samuelsson","year":"2014","journal-title":"Pediatr Diabetes"},{"key":"2026061714381575900_B6","doi-asserted-by":"crossref","first-page":"3976","DOI":"10.2337\/db13-1093","article-title":"Diabetes Control and Complications Trial\/Epidemiology of Diabetes Interventions and Complications Study at 30 years: advances and contributions","volume":"62","author":"Nathan","year":"2013","journal-title":"Diabetes"},{"key":"2026061714381575900_B7","doi-asserted-by":"crossref","first-page":"3","DOI":"10.1007\/s00125-022-05744-z","article-title":"Automated insulin delivery: benefits, challenges, and recommendations. a consensus report of the Joint Diabetes Technology Working Group of the European Association for the Study of Diabetes and the American Diabetes Association","volume":"66","author":"Sherr","year":"2023","journal-title":"Diabetologia"},{"key":"2026061714381575900_B8","doi-asserted-by":"crossref","first-page":"1341","DOI":"10.1111\/pedi.13452","article-title":"ISPAD Clinical Practice Consensus Guidelines 2022: exercise in children and adolescents with diabetes","volume":"23","author":"Adolfsson","year":"2022","journal-title":"Pediatr Diabetes"},{"key":"2026061714381575900_B9","doi-asserted-by":"crossref","first-page":"S283","DOI":"10.2337\/dc25-S014","article-title":"14. Children and adolescents: Standards of Care in Diabetes\u20142025","volume":"48","author":"American Diabetes Association Professional Practice Committee","year":"2025","journal-title":"Diabetes Care"},{"key":"2026061714381575900_B10","doi-asserted-by":"crossref","first-page":"110697","DOI":"10.1016\/j.diabres.2023.110697","article-title":"Youth with type 1 diabetes mellitus are more inactive and sedentary than apparently healthy peers: a systematic review and meta-analysis","volume":"200","author":"Huerta-Uribe","year":"2023","journal-title":"Diabetes Res Clin Pract"},{"key":"2026061714381575900_B11","doi-asserted-by":"crossref","first-page":"111","DOI":"10.1007\/s40279-022-01741-9","article-title":"Association between physical activity, sedentary behavior and physical fitness and glycated hemoglobin in youth with type 1 diabetes: a systematic review and meta-analysis","volume":"53","author":"Huerta-Uribe","year":"2023","journal-title":"Sports Med"},{"key":"2026061714381575900_B12","doi-asserted-by":"crossref","first-page":"1056","DOI":"10.1080\/17461391.2022.2086489","article-title":"Effects of exercise training on glycaemic control in youths with type 1 diabetes: a systematic review and meta-analysis of randomised controlled trials","volume":"23","author":"Garc\u00eda-Hermoso","year":"2023","journal-title":"Eur J Sport Sci"},{"key":"2026061714381575900_B13","doi-asserted-by":"crossref","first-page":"230","DOI":"10.1186\/s12933-024-02301-3","article-title":"Nonpharmacological interventions on glycated haemoglobin in youth with type 1 diabetes: a Bayesian network meta-analysis","volume":"23","author":"Mu\u00f1oz-Pardeza","year":"2024","journal-title":"Cardiovasc Diabetol"},{"key":"2026061714381575900_B14","doi-asserted-by":"crossref","first-page":"377","DOI":"10.1016\/S2213-8587(17)30014-1","article-title":"Exercise management in type 1 diabetes: a consensus statement","volume":"5","author":"Riddell","year":"2017","journal-title":"Lancet Diabetes Endocrinol"},{"key":"2026061714381575900_B15","first-page":"dgaf328","article-title":"The role of muscular fitness on bone mineral content and areal bone mineral density in youth with type 1 diabetes","author":"Mu\u00f1oz-Pardeza","year":"2025","journal-title":"J Clin Endocrinol Metab"},{"key":"2026061714381575900_B16","doi-asserted-by":"crossref","first-page":"e70033","DOI":"10.1111\/sms.70033","article-title":"Physical fitness and activity levels as predictors of subjective well-being in youths with type 1 diabetes mellitus: a 2-year longitudinal analysis of the Diactive-1 cohort study","volume":"35","author":"Mu\u00f1oz-Pardeza","year":"2025","journal-title":"Scand J Med Sci Sports"},{"key":"2026061714381575900_B17","doi-asserted-by":"crossref","first-page":"e002177","DOI":"10.1136\/bmjsem-2024-002177","article-title":"Handgrip strength, cardiometabolic risk and body composition in youth with type 1 diabetes: the Diactive-1 Cohort Study","volume":"10","author":"Huerta-Uribe","year":"2024","journal-title":"BMJ Open Sport Exerc Med"},{"key":"2026061714381575900_B18","doi-asserted-by":"crossref","first-page":"2172","DOI":"10.1249\/MSS.0000000000002356","article-title":"Effect of strength training on glycemic control and adiponectin in diabetic children","volume":"52","author":"Petschnig","year":"2020","journal-title":"Med Sci Sports Exerc"},{"key":"2026061714381575900_B19","doi-asserted-by":"crossref","first-page":"707","DOI":"10.2337\/dc06-1982","article-title":"Insulin resistance, the metabolic syndrome, and complication risk in type 1 diabetes: \u201cdouble diabetes\u201d in the Diabetes Control and Complications Trial","volume":"30","author":"Kilpatrick","year":"2007","journal-title":"Diabetes Care"},{"key":"2026061714381575900_B20","doi-asserted-by":"crossref","first-page":"294","DOI":"10.2337\/diabetes.53.2.294","article-title":"Strength training increases insulin-mediated glucose uptake, GLUT4 content, and insulin signaling in skeletal muscle in patients with type 2 diabetes","volume":"53","author":"Holten","year":"2004","journal-title":"Diabetes"},{"key":"2026061714381575900_B21","doi-asserted-by":"crossref","first-page":"345","DOI":"10.1111\/j.1399-5448.2010.00699.x","article-title":"Effects of type 1 diabetes mellitus on skeletal muscle: clinical observations and physiological mechanisms","volume":"12","author":"Krause","year":"2011","journal-title":"Pediatr Diabetes"},{"key":"2026061714381575900_B22","doi-asserted-by":"crossref","first-page":"2042018819839298","DOI":"10.1177\/2042018819839298","article-title":"Use of apps for physical activity in type 1 diabetes: current status and requirements for future development","volume":"10","author":"Kordonouri","year":"2019","journal-title":"Ther Adv Endocrinol Metab"},{"key":"2026061714381575900_B23","doi-asserted-by":"crossref","first-page":"1354734","DOI":"10.3389\/fendo.2024.1354734","article-title":"Comprehensive management of children and adolescents with type 1 diabetes mellitus through personalized physical exercise and education using an mHealth system: the Diactive-1 study protocol","volume":"15","author":"Hormaz\u00e1bal-Aguayo","year":"2024","journal-title":"Front Endocrinol (Lausanne)"},{"key":"2026061714381575900_B24","doi-asserted-by":"crossref","first-page":"101","DOI":"10.1111\/j.1399-543X.2006.00155.x","article-title":"'The honeymoon phase' in children with type 1 diabetes mellitus: frequency, duration, and influential factors","volume":"7","author":"Abdul-Rasoul","year":"2006","journal-title":"Pediatr Diabetes"},{"key":"2026061714381575900_B25","doi-asserted-by":"crossref","first-page":"16","DOI":"10.21037\/mhealth-24-63","article-title":"Evaluating the usability of Diactive-1: mHealth for personalized exercise and education in children and adolescents with type 1 diabetes","volume":"11","author":"Hormaz\u00e1bal-Aguayo","year":"2025","journal-title":"Mhealth"},{"key":"2026061714381575900_B26","doi-asserted-by":"crossref","first-page":"299","DOI":"10.1136\/bjsports-2022-106176","article-title":"European fitness landscape for children and adolescents: updated reference values, fitness maps and country rankings based on nearly 8 million test results from 34 countries gathered by the FitBack network","volume":"57","author":"Ortega","year":"2023","journal-title":"Br J Sports Med"},{"key":"2026061714381575900_B27","doi-asserted-by":"crossref","first-page":"2501","DOI":"10.1007\/s00125-020-05263-9","article-title":"Glucose management for exercise using continuous glucose monitoring (CGM) and intermittently scanned CGM (isCGM) systems in type 1 diabetes: position statement of the European Association for the Study of Diabetes (EASD) and of the International Society for Pediatric and Adolescent Diabetes (ISPAD) endorsed by JDRF and supported by the American Diabetes Association (ADA)","volume":"63","author":"Moser","year":"2020","journal-title":"Diabetologia"},{"key":"2026061714381575900_B28","doi-asserted-by":"crossref","first-page":"1226","DOI":"10.1177\/19322968221085273","article-title":"A glycemia risk index (GRI) of hypoglycemia and hyperglycemia for continuous glucose monitoring validated by clinician ratings","volume":"17","author":"Klonoff","year":"2023","journal-title":"J Diabetes Sci Technol"},{"key":"2026061714381575900_B29","doi-asserted-by":"crossref","first-page":"1429","DOI":"10.1016\/j.socscimed.2007.11.024","article-title":"Researching health inequalities in adolescents: the development of the Health Behaviour in School-Aged Children (HBSC) Family Affluence Scale","volume":"66","author":"Currie","year":"2008","journal-title":"Soc Sci Med"},{"key":"2026061714381575900_B30","doi-asserted-by":"crossref","first-page":"1755","DOI":"10.1249\/MSS.0000000000000588","article-title":"Enhancing a somatic maturity prediction model","volume":"47","author":"Moore","year":"2015","journal-title":"Med Sci Sports Exerc"},{"key":"2026061714381575900_B31","volume-title":"Essentials of Youth Fitness.","author":"Faigenbaum","year":"2020"},{"key":"2026061714381575900_B32","doi-asserted-by":"crossref","first-page":"80","DOI":"10.1016\/j.conctc.2018.03.008","article-title":"Different ways to estimate treatment effects in randomised controlled trials","volume":"10","author":"Twisk","year":"2018","journal-title":"Contemp Clin Trials Commun"},{"key":"2026061714381575900_B33","doi-asserted-by":"crossref","DOI":"10.1017\/CBO9781139342834","volume-title":"Applied Longitudinal Data Analysis for Epidemiology: A Practical Guide.","author":"Twisk","year":"2013","edition":"2nd ed"},{"key":"2026061714381575900_B34","doi-asserted-by":"crossref","first-page":"37067","DOI":"10.1038\/srep37067","article-title":"Effectiveness of advanced carbohydrate counting in type 1 diabetes mellitus: a systematic review and meta-analysis","volume":"6","author":"Fu","year":"2016","journal-title":"Sci Rep"},{"key":"2026061714381575900_B35","doi-asserted-by":"crossref","first-page":"245","DOI":"10.1159\/000505328","article-title":"Can short bouts of exercise (\u201cexercise snacks\u201d) improve body composition in adolescents with type 1 diabetes? A feasibility study","volume":"92","author":"Hasan","year":"2019","journal-title":"Horm Res Paediatr"},{"key":"2026061714381575900_B36","doi-asserted-by":"crossref","first-page":"348","DOI":"10.1016\/j.jdiacomp.2012.04.006","article-title":"The effects of Pilates on metabolic control and physical performance in adolescents with type 1 diabetes mellitus","volume":"26","author":"Tunar","year":"2012","journal-title":"J Diabetes Complications"},{"key":"2026061714381575900_B37","doi-asserted-by":"crossref","first-page":"209","DOI":"10.1146\/annurev-physiol-060721-095517","article-title":"AMPK and the adaptation to exercise","volume":"1084","author":"Spaulding","year":"2022","journal-title":"Annu Rev Physiol"},{"key":"2026061714381575900_B38","doi-asserted-by":"crossref","first-page":"993","DOI":"10.1152\/physrev.00038.2012","article-title":"Exercise, GLUT4, and skeletal muscle glucose uptake","volume":"93","author":"Richter","year":"2013","journal-title":"Physiol Rev"}],"container-title":["Diabetes Care"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/diabetesjournals.org\/care\/article-pdf\/48\/10\/1803\/838795\/dc250985.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/diabetesjournals.org\/care\/article-pdf\/48\/10\/1803\/838795\/dc250985.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,17]],"date-time":"2026-06-17T18:38:28Z","timestamp":1781721508000},"score":1,"resource":{"primary":{"URL":"https:\/\/diabetesjournals.org\/care\/article\/48\/10\/1803\/163201\/Effect-of-Diactive-1-mHealth-Supported-Progressive"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,8,13]]},"references-count":38,"journal-issue":{"issue":"10","published-online":{"date-parts":[[2025,8,13]]},"published-print":{"date-parts":[[2025,10,1]]}},"URL":"https:\/\/doi.org\/10.2337\/dc25-0985","relation":{},"ISSN":["0149-5992","1935-5548"],"issn-type":[{"value":"0149-5992","type":"print"},{"value":"1935-5548","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,8,13]]}}}