Researchers studied 124 young people with type 1 diabetes to understand what helps keep their bones strong and healthy. They found that kids with diabetes tend to have slightly weaker bones than other kids their age. The good news? Four things seem to help: keeping blood sugar levels in a healthy range, getting enough vitamin D, maintaining a healthy weight, and doing high-impact exercise like jumping or running. This research suggests that paying attention to these four areas could help young people with diabetes build stronger bones and prevent problems later in life.

The Quick Take

  • What they studied: Whether blood sugar control, vitamin D levels, weight, and exercise affect bone strength in kids and teens with type 1 diabetes
  • Who participated: 124 young people aged 8-17 years old who have had type 1 diabetes for at least one year. The average age was about 13 years old, and they had been managing diabetes for about 6 years on average.
  • Key finding: Kids with type 1 diabetes have bones that are slightly weaker than expected for their age. However, those who exercised regularly, had good vitamin D levels, controlled their blood sugar well, and maintained a healthy weight had noticeably stronger bones.
  • What it means for you: If you or your child has type 1 diabetes, focusing on these four areas—exercise, vitamin D, blood sugar control, and healthy weight—may help build stronger bones now and reduce bone problems in the future. Talk to your doctor before making any major changes.

The Research Details

This was a cross-sectional study, which means researchers looked at a group of young people with type 1 diabetes at one point in time and measured their bone strength using a special X-ray machine called a DEXA scan. This machine is painless and takes pictures to show how dense (thick and strong) bones are. The researchers also collected information about each person’s blood sugar control, vitamin D levels, weight, exercise habits, and insulin use. They then looked for patterns to see which factors seemed connected to stronger or weaker bones.

This type of study helps researchers understand what factors are connected to bone health in young people with diabetes. While it can’t prove that one thing causes another, it can point researchers toward areas worth studying more carefully. Understanding these connections is important because bone health in childhood affects bone strength for the rest of a person’s life.

This study included a reasonable number of participants (124 young people) and used a reliable method to measure bone strength. The researchers collected detailed information about blood sugar control and vitamin D levels, which strengthens the findings. However, because this is a cross-sectional study, it shows connections between factors but cannot prove that one thing causes another. The study was published in a respected medical journal, which means it went through expert review before publication.

What the Results Show

The main finding was that young people with type 1 diabetes have bones that are about 0.2 units weaker than expected for their age group (this difference was statistically significant, meaning it’s unlikely to be due to chance). The researchers found four factors connected to stronger bones: First, kids with better blood sugar control—measured by how much time their blood sugar stayed in the healthy range—had stronger bones. Second, those with adequate vitamin D levels had stronger bones, and the 9% of kids who were vitamin D-deficient had noticeably weaker bones (about 0.7 units weaker). Third, kids with a healthier weight had stronger bones. Fourth, those who did high-impact weight-bearing activities like jumping, running, or sports had stronger bones than those who didn’t exercise this way.

The study found that several factors were NOT connected to bone strength, including how long someone had had diabetes, how much insulin they used, whether they used an insulin pump, or how much their blood sugar bounced around day-to-day. Interestingly, 73% of the young people in the study used insulin pumps, which is a common way to deliver insulin. About half of the participants (51%) regularly did high-impact weight-bearing activities.

Previous research has shown that people with type 1 diabetes often have weaker bones than people without diabetes. This study confirms that finding and adds important new information about what might help. The connection between vitamin D and bone strength matches what researchers have found in other groups of young people. The finding that exercise helps bone strength is also consistent with previous research showing that weight-bearing activities are important for building strong bones during childhood and teenage years.

This study only looked at young people at one point in time, so we can’t know if the factors that seem connected to bone strength actually cause stronger bones or if something else is responsible. The study included mostly young people from one area, so the results might not apply to all kids with type 1 diabetes. The researchers didn’t measure all possible factors that might affect bone health, such as diet quality or family history. Finally, because this is observational research, we can’t be certain about cause-and-effect relationships.

The Bottom Line

Young people with type 1 diabetes should aim to: (1) Keep blood sugar in the target range as much as possible—work with your diabetes care team to set realistic goals; (2) Maintain adequate vitamin D levels through sun exposure, food, or supplements if recommended by your doctor; (3) Maintain a healthy weight through balanced nutrition and regular activity; (4) Do weight-bearing exercise like running, jumping, dancing, or sports at least 3-4 times per week. These recommendations are supported by moderate evidence from this study combined with previous research. Confidence level: Moderate—these factors show promise, but more research is needed to confirm they directly improve bone health.

This research is most relevant for young people aged 8-17 with type 1 diabetes and their families. It’s also useful for doctors and diabetes educators who work with this age group. The findings may also apply to young adults with type 1 diabetes, though this study didn’t include people over 17. People without diabetes or with type 2 diabetes should know that while exercise and vitamin D are important for everyone, the specific findings here apply to type 1 diabetes.

Building stronger bones takes time. You won’t see dramatic changes in a few weeks, but consistent attention to these four areas over months and years can make a real difference. The teenage years are a critical time for bone building, so starting these habits now can have benefits that last a lifetime. Most experts suggest giving lifestyle changes at least 3-6 months to see measurable improvements.

Want to Apply This Research?

  • Track weekly high-impact exercise minutes (running, jumping, dancing, sports) and vitamin D intake or sun exposure. Set a goal of 150+ minutes per week of weight-bearing activity and monitor vitamin D levels through regular blood tests with your doctor.
  • Use the app to set reminders for: (1) Daily vitamin D intake or weekly sun exposure goals; (2) Weekly exercise targets with specific weight-bearing activities; (3) Blood sugar time-in-range goals; (4) Weight tracking if appropriate. Create a weekly exercise schedule that includes at least 3-4 sessions of high-impact activities.
  • Check in monthly on exercise consistency and vitamin D status. Review blood sugar time-in-range trends monthly. Get vitamin D levels checked twice yearly (spring and fall) with your doctor. Track bone health through DEXA scans every 1-2 years as recommended by your healthcare provider.

This research describes associations between certain factors and bone strength in young people with type 1 diabetes, but does not prove cause-and-effect relationships. These findings should not replace medical advice from your doctor or diabetes care team. Before making significant changes to exercise, vitamin D intake, or diabetes management, consult with your healthcare provider. This study was conducted on a specific population and may not apply to all individuals with type 1 diabetes. Always work with your medical team to develop a personalized plan for managing your diabetes and bone health.