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Archives de pédiatrie
Volume 26, n° 3
pages 161-167 (avril 2019)
Doi : 10.1016/j.arcped.2018.12.006
Received : 20 Mars 2018 ;  accepted : 11 December 2018
Research Papers

Impact of a sports project centered on scuba diving for adolescents with type 1 diabetes mellitus: New guidelines for adolescent recreational diving, a modification of the French regulations
 

B. Lormeau a, S. Pichat b, c, , L. Dufaitre d, A. Chamouine e, M. Gataa f, J. Rastami g, C. Coll-Lormeau h, G. Goury c, A.-L. François c, V. Etien c, J.-L. Blanchard i, D. Hervé j, A. Sola-Gazagnes k
a Diabetologist, 5, rue du marché, 93160 Noisy le Grand, France 
b Université de Lyon, ENS de Lyon, 46, allée d’Italie, 69364 Lyon cedex 7, France 
c Association diabète et plongée, MDA1, 5, rue du Louvre, 75001 Paris, France 
d Service diabétologie – endocrinologie, hôpital Saint-Joseph, 26, boulevard de Louvain, 13008 Marseille, France 
e Pôle pédiatrie, centre hospitalier de Mayotte, rue de l’Hôpital, BP 04, 97600 MaMoudzou, Mayotte 
f Réseau diabète (Rédiab Ylang 976), rue de Cavani, 97600 MaMoudzou, Mayotte 
g Association AJD 976, 19, rue Cavani, 97615 Pamandzi, Mayotte 
h Nurse, 53, avenue Aristide-Briand, 93160 Noisy le Grand, France 
i FFESSM (French underwater federation), 24, Quai de Rive-Neuve, 13284 Marseille cedex 07, France 
j Direction de la jeunesse, des sports et de la cohésion sociale (DJSCS) de Mayotte, Bat. A et B, rue de l’Archipel, BP104 Kaweni, 97600 MaMoudzou, Mayotte 
k Unité fonctionnelle diabétologie, immunologie clinique, hôpital Cochin AP–HP, 27, rue du Faubourg Saint-Jacques, 75014 Paris, France 

Corresponding author at: université de Lyon, ENS de Lyon, 46, allée d’Italie, 69364 Lyon cedex 7, France.université de Lyon, ENS de Lyon46, allée d’ItalieLyon cedex 769364France
Abstract
Background

Recreational scuba diving has been authorized for type 1 diabetics over 18 years old – the age of majority in France – since 2004, but it remained forbidden for younger diabetics by the French underwater federation (FFESSM). Here, we present a study to evaluate:

– the conditions under which diving could be authorized for 14- to 18 year olds with type 1 diabetes;

– the value of continuous glucose monitoring (CGM) while diving. A secondary objective was to monitor the impact of diving on the teenagers’ quality of life.

Subject and methods

Sixteen adolescents (14–17.5 years old) were included. Diabetes was known for 6 years (range, 1–14) and Hb1Ac was 9.0% (range, 7.7–11.9). The study was conducted in Mayotte with both capillary glycemia (CG) and CGM measurements taken during five dives.

Results

The average CG prior to diving was 283mg/dL and decreased by 75±76mg/dL during the dive. No hypoglycemia occurred during the dives and four episodes occurred after. Glycemia variations during dives and for the overall duration of the study were greater than for adults, most likely due to the general adolescent behavior, notably regarding diet and diabetes management. CGM was greatly appreciated by the adolescents. They had an overall satisfactory quality of life. No significant variations were observed during the entire course of the study.

Conclusions

Although in need of further studies, these preliminary results show that CGM can be used while diving. CGM records show a continuous decrease of glycemia during dives. Based on these results, the French underwater federation has now authorized diving for adolescent type 1 diabetics following a specific diving protocol that includes HbA1c<8.5%, autonomous management of diabetes by the adolescent, reduction of insulin doses, and target glycemia prior to the dive>250mg/dL.

The full text of this article is available in PDF format.

Keywords : Teenager, Continuous glucose monitoring (CGM), Scuba diving protocol, Physical activity, Diabetes, French regulations, Sports project




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