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Da Prato G, Csermely A, Pilati M, Carletti L, Rinaldi E, Donà S, Santi L, Negri C, Bonora E, Moghetti P, Trombetta M. A Randomized Crossover Trial Comparing Glucose Control During Postprandial Moderate Aerobic Activity and High-Intensity Interval Training in Adults With Type 1 Diabetes Using an Advanced Hybrid Closed-Loop System. J Diabetes Sci Technol 2024; 18:1256-1257. [PMID: 39081024 PMCID: PMC11418531 DOI: 10.1177/19322968241258444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/02/2024]
Affiliation(s)
- Guliana Da Prato
- Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, University Hospital of Verona, Verona, Italy
| | - Alessandro Csermely
- Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, University Hospital of Verona, Verona, Italy
| | - Martina Pilati
- Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, University Hospital of Verona, Verona, Italy
| | - Lorenza Carletti
- Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, University Hospital of Verona, Verona, Italy
| | - Elisabetta Rinaldi
- Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, University Hospital of Verona, Verona, Italy
| | - Silvia Donà
- Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, University Hospital of Verona, Verona, Italy
| | - Lorenza Santi
- Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, University Hospital of Verona, Verona, Italy
| | - Carlo Negri
- Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, University Hospital of Verona, Verona, Italy
| | - Enzo Bonora
- Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, University Hospital of Verona, Verona, Italy
| | - Paolo Moghetti
- Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, University Hospital of Verona, Verona, Italy
| | - Maddalena Trombetta
- Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, University Hospital of Verona, Verona, Italy
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Molveau J, Myette-Côté É, Tagougui S, Taleb N, St-Amand R, Suppère C, Bourdeau V, Heyman E, Rabasa-Lhoret R. Assessing the influence of insulin type (ultra-rapid vs rapid insulin) and exercise timing on postprandial exercise-induced hypoglycaemia risk in individuals with type 1 diabetes: a randomised controlled trial. Diabetologia 2024:10.1007/s00125-024-06234-0. [PMID: 39069599 DOI: 10.1007/s00125-024-06234-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2024] [Accepted: 06/10/2024] [Indexed: 07/30/2024]
Abstract
AIMS/HYPOTHESIS The relationship between pre-meal insulin type, exercise timing and the risk of postprandial exercise-induced hypoglycaemia in people living with type 1 diabetes is unknown. We aimed to evaluate the effects of exercise timing (60 vs 120 min post meal) and different insulin types (aspart vs ultra-rapid aspart) on hypoglycaemic risk. METHODS This was a four-way crossover randomised trial including 40 individuals with type 1 diabetes using multiple daily injections (mean HbA1c 56 mmol/mol [7.4%]). Participants, who were recruited from the Montreal Clinical Research Institute, undertook 60 min cycling sessions (60% ofV ˙ O 2 peak ) after breakfast (60 min [EX60min] or 120 min [EX120min] post meal) with 50% of their usual insulin dose (aspart or ultra-rapid aspart). Eligibility criteria included age ≥18 years old, clinical diagnosis of type 1 diabetes for at least 1 year and HbA1c ≤80 mmol/mol (9.5%). Participants were allocated using sequentially numbered, opaque sealed envelopes. Participants were masked to their group assignment, and each participant was allocated a unique identification number to ensure anonymisation. The primary outcome was change in blood glucose levels between exercise onset and nadir. RESULTS Prior to exercise onset, time spent in hyperglycaemia was lower for EX60min vs EX120min (time >10.0 mmol/l: 56.6% [1.2-100%] vs 78.0% [52.7-97.9%]; p<0.001). The glucose reduction between exercise onset and nadir was less pronounced with EX60min vs EX120min (-3.8±2.7 vs -4.7±2.5 mmol/l; p<0.001). A similar number of hypoglycaemic events occurred during both exercise timings. Blood glucose between exercise onset and nadir decreased less with ultra-rapid aspart compared with aspart (-4.1±2.3 vs -4.4±2.8 mmol/l; p=0.037). While a similar number of hypoglycaemic events during exercise were observed, less post-exercise hypoglycaemia occurred with ultra-rapid aspart (n=0, 0%, vs n=15, 38%; p=0.003). No interactions between insulin types and exercise timings were found. CONCLUSIONS/INTERPRETATION EX60min blunted the pre-exercise glucose increase following breakfast and was associated with a smaller glucose reduction during exercise. Ultra-rapid aspart led to a smaller blood glucose reduction during exercise and might be associated with diminished post-exercise hypoglycaemia. TRIAL REGISTRATION ClinicalTrials.gov NCT03659799 FUNDING: This study was funded by Novo Nordisk Canada.
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Affiliation(s)
- Joséphine Molveau
- Institut de recherches cliniques de Montréal, Montréal, QC, Canada
- Département de Nutrition, Faculté de Médecine, Université de Montréal, Montréal, QC, Canada
- ULR 7369 - URePSSS - Unité de Recherche Pluridisciplinaire Sport Santé Société, Université de Lille, Université d'Artois, Université du Littoral Côte d'Opale, Lille, France
| | - Étienne Myette-Côté
- Institut de recherches cliniques de Montréal, Montréal, QC, Canada
- Department of Applied Human Sciences, Faculty of Science, University of Prince Edward Island, Charlottetown, PE, Canada
| | - Sémah Tagougui
- ULR 7369 - URePSSS - Unité de Recherche Pluridisciplinaire Sport Santé Société, Université de Lille, Université d'Artois, Université du Littoral Côte d'Opale, Lille, France
| | - Nadine Taleb
- Institut de recherches cliniques de Montréal, Montréal, QC, Canada
- Division of Endocrinology, Centre Hospitalier de l'Université de Montréal (CHUM), Montréal, QC, Canada
| | - Roxane St-Amand
- Institut de recherches cliniques de Montréal, Montréal, QC, Canada
| | - Corinne Suppère
- Institut de recherches cliniques de Montréal, Montréal, QC, Canada
| | - Valérie Bourdeau
- Institut de recherches cliniques de Montréal, Montréal, QC, Canada
| | - Elsa Heyman
- ULR 7369 - URePSSS - Unité de Recherche Pluridisciplinaire Sport Santé Société, Université de Lille, Université d'Artois, Université du Littoral Côte d'Opale, Lille, France
- Institut Universitaire de France (IUF), Paris, France
| | - Rémi Rabasa-Lhoret
- Institut de recherches cliniques de Montréal, Montréal, QC, Canada.
- Département de Nutrition, Faculté de Médecine, Université de Montréal, Montréal, QC, Canada.
- ULR 7369 - URePSSS - Unité de Recherche Pluridisciplinaire Sport Santé Société, Université de Lille, Université d'Artois, Université du Littoral Côte d'Opale, Lille, France.
- Division of Endocrinology, Centre Hospitalier de l'Université de Montréal (CHUM), Montréal, QC, Canada.
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Helleputte S, Stautemas J, Jansseune L, De Backer T, Marlier J, Lapauw B, Calders P. Glycemic Management Around Postprandial Exercise in People With Type 1 Diabetes: Challenge Accepted. J Clin Endocrinol Metab 2024; 109:2039-2052. [PMID: 38330239 DOI: 10.1210/clinem/dgae079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Revised: 02/01/2024] [Accepted: 02/06/2024] [Indexed: 02/10/2024]
Abstract
CONTEXT The precise glycemic impact and clinical relevance of postprandial exercise in type 1 diabetes (T1D) has not been clarified yet. OBJECTIVE This work aimed to examine acute, subacute, and late effects of postprandial exercise on blood glucose (BG). METHODS A randomized, controlled trial comprised 4 laboratory visits, with 24-hour follow-up at home. Participants included adults with T1D (n = 8), aged 44 ± 13 years, with body mass index of 24 ± 2.1. Intervention included 30 minutes of rest (CONTROL), walking (WALK), moderate-intensity (MOD), or intermittent high-intensity (IHE) exercise performed 60 minutes after a standardized meal. Main outcome measures included BG change during exercise/control (acute), and secondary outcomes included the subacute (≤2 h after) and late glycemic effects (≤24 h after). RESULTS Exercise reduced postprandial glucose (PPG) excursion compared to CONTROL, with a consistent BG decline in all patients for all modalities (mean declines -45 ± 24, -71 ± 39, and -35 ± 21 mg/dL, during WALK, MOD, and IHE, respectively (P < .001). For this decline, clinical superiority was demonstrated separately for each exercise modality vs CONTROL. Noninferiority of WALK vs MOD was not demonstrated, noninferiority of WALK vs IHE was demonstrated, and equivalence of IHE vs MOD was not demonstrated. Hypoglycemia did not occur during exercise. BG increased in the hour after exercise (more than after CONTROL; P < .001). More than half of participants showed hyperglycemia after exercise necessitating insulin correction. There were more nocturnal hypoglycemic events after exercise vs CONTROL (P < .05). CONCLUSION Postprandial exercise of all modalities is effective, safe, and feasible if necessary precautions are taken (ie, prandial insulin reductions), as exercise lowered maximal PPG excursion and caused a consistent and clinically relevant BG decline during exercise while there was no hypoglycemia during or shortly after exercise. However, there seem to be 2 remaining challenges: subacute postexercise hyperglycemia and nocturnal hypoglycemia.
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Affiliation(s)
- Simon Helleputte
- Faculty of Medicine and Health Sciences, Ghent University, Ghent 9000, Belgium
- Fonds Wetenschappelijk Onderzoek (FWO) Flanders, Brussel 1000, Belgium
| | - Jan Stautemas
- Faculty of Medicine and Health Sciences, Ghent University, Ghent 9000, Belgium
| | - Laura Jansseune
- Faculty of Medicine and Health Sciences, Ghent University, Ghent 9000, Belgium
| | - Tine De Backer
- Faculty of Medicine and Health Sciences, Ghent University, Ghent 9000, Belgium
- Department of Cardiology, Ghent University Hospital, Ghent 9000, Belgium
- Department of Internal Medicine & Paediatrics, Ghent University, Ghent 9000, Belgium
| | - Joke Marlier
- Department of Endocrinology, Ghent University Hospital, Ghent 9000, Belgium
| | - Bruno Lapauw
- Faculty of Medicine and Health Sciences, Ghent University, Ghent 9000, Belgium
- Department of Internal Medicine & Paediatrics, Ghent University, Ghent 9000, Belgium
- Department of Endocrinology, Ghent University Hospital, Ghent 9000, Belgium
| | - Patrick Calders
- Faculty of Medicine and Health Sciences, Ghent University, Ghent 9000, Belgium
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Jafar A, Pasqua MR. Postprandial glucose-management strategies in type 1 diabetes: Current approaches and prospects with precision medicine and artificial intelligence. Diabetes Obes Metab 2024; 26:1555-1566. [PMID: 38263540 DOI: 10.1111/dom.15463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Revised: 01/01/2024] [Accepted: 01/05/2024] [Indexed: 01/25/2024]
Abstract
Postprandial glucose control can be challenging for individuals with type 1 diabetes, and this can be attributed to many factors, including suboptimal therapy parameters (carbohydrate ratios, correction factors, basal doses) because of physiological changes, meal macronutrients and engagement in postprandial physical activity. This narrative review aims to examine the current postprandial glucose-management strategies tested in clinical trials, including adjusting therapy settings, bolusing for meal macronutrients, adjusting pre-exercise and postexercise meal boluses for postprandial physical activity, and other therapeutic options, for individuals on open-loop and closed-loop therapies. Then we discuss their challenges and future avenues. Despite advancements in insulin delivery devices such as closed-loop systems and decision-support systems, many individuals with type 1 diabetes still struggle to manage their glucose levels. The main challenge is the lack of personalized recommendations, causing suboptimal postprandial glucose control. We suggest that postprandial glucose control can be improved by (i) providing personalized recommendations for meal macronutrients and postprandial activity; (ii) including behavioural recommendations; (iii) using other personalized therapeutic approaches (e.g. glucagon-like peptide-1 receptor agonists, sodium-glucose co-transporter inhibitors, amylin analogues, inhaled insulin) in addition to insulin therapy; and (iv) integrating an interpretability report to explain to individuals about changes in treatment therapy and behavioural recommendations. In addition, we suggest a future avenue to implement precision recommendations for individuals with type 1 diabetes utilizing the potential of deep reinforcement learning and foundation models (such as GPT and BERT), employing different modalities of data including diabetes-related and external background factors (i.e. behavioural, environmental, biological and abnormal events).
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Affiliation(s)
- Adnan Jafar
- Department of Biomedical Engineering, McGill University, Montreal, Quebec, Canada
| | - Melissa-Rosina Pasqua
- Division of Endocrinology, Department of Medicine, McGill University, Montreal, Quebec, Canada
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McClure RD, Talbo MK, Bonhoure A, Molveau J, South CA, Lebbar M, Wu Z. Exploring Technology's Influence on Health Behaviours and Well-being in Type 1 Diabetes: a Review. Curr Diab Rep 2024; 24:61-73. [PMID: 38294726 DOI: 10.1007/s11892-024-01534-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/17/2024] [Indexed: 02/01/2024]
Abstract
PURPOSE OF REVIEW Maintaining positive health behaviours promotes better health outcomes for people with type 1 diabetes (T1D). However, implementing these behaviours may also lead to additional management burdens and challenges. Diabetes technologies, including continuous glucose monitoring systems, automated insulin delivery systems, and digital platforms, are being rapidly developed and widely used to reduce these burdens. Our aim was to review recent evidence to explore the influence of these technologies on health behaviours and well-being among adults with T1D and discuss future directions. RECENT FINDINGS Current evidence, albeit limited, suggests that technologies applied in diabetes self-management education and support (DSME/S), nutrition, physical activity (PA), and psychosocial care areas improved glucose outcomes. They may also increase flexibility in insulin adjustment and eating behaviours, reduce carb counting burden, increase confidence in PA, and reduce mental burden. Technologies have the potential to promote health behaviours changes and well-being for people with T1D. More confirmative studies on their effectiveness and safety are needed to ensure optimal integration in standard care practices.
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Affiliation(s)
- Reid D McClure
- Faculty of Kinesiology, Sport and Recreation, University of Alberta, 3-100 University Hall, Edmonton, AB, T6G 2H9, Canada
- Alberta Diabetes Institute, Li Ka Shing Centre, University of Alberta, Edmonton, AB, T6G 2T9, Canada
| | - Meryem K Talbo
- School of Human Nutrition, McGill University, 21111 Lakeshore Dr, Sainte-Anne-de-Bellevue, Quebec, H9X 3V9, Canada
| | - Anne Bonhoure
- Montreal Clinical Research Institute, 110 Pine Ave W, Montreal, QC, H2W 1R7, Canada
- Department of Nutrition, Faculty of Medicine, Universite de Montréal, 2405, Chemin de La Côte-Sainte-Catherine, Montreal, QC, H3T 1A8, Canada
| | - Joséphine Molveau
- Montreal Clinical Research Institute, 110 Pine Ave W, Montreal, QC, H2W 1R7, Canada
- Department of Nutrition, Faculty of Medicine, Universite de Montréal, 2405, Chemin de La Côte-Sainte-Catherine, Montreal, QC, H3T 1A8, Canada
- Univ. Lille, Univ. Artois, Univ. Littoral Côte d'Opale, ULR 7369 - URePSSS - Unité de Recherche Pluridisciplinaire Sport Santé Société, Lille, France
| | - Courtney A South
- School of Human Nutrition, McGill University, 21111 Lakeshore Dr, Sainte-Anne-de-Bellevue, Quebec, H9X 3V9, Canada
| | - Maha Lebbar
- Montreal Clinical Research Institute, 110 Pine Ave W, Montreal, QC, H2W 1R7, Canada
- Department of Nutrition, Faculty of Medicine, Universite de Montréal, 2405, Chemin de La Côte-Sainte-Catherine, Montreal, QC, H3T 1A8, Canada
| | - Zekai Wu
- Montreal Clinical Research Institute, 110 Pine Ave W, Montreal, QC, H2W 1R7, Canada.
- Department of Medicine, Division of Experimental Medicine, McGill University, 1001 Décarie Boulevard, Montreal, QC, H4A 3J1, Canada.
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Moser O, Pemberton JS. Rethinking the safety and efficacy assessment of (Hybrid) Closed Loop systems: Should we promote the need for a minimum of exercise data within the regulatory approval? Diabet Med 2024; 41:e15305. [PMID: 38332559 DOI: 10.1111/dme.15305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/10/2024]
Affiliation(s)
- Othmar Moser
- Department of Exercise Physiology and Metabolism, University of Bayreuth, Bayreuth, Germany
- Division of Endocrinology and Diabetology, Medical University of Graz, Graz, Austria
| | - John S Pemberton
- Department of Endocrinology and Diabetes, Birmingham Children's Hospital, Birmingham Women's, and Children's NHS Foundation Trust, Birmingham, UK
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Zimmer RT, Auth A, Schierbauer J, Haupt S, Wachsmuth N, Zimmermann P, Voit T, Battelino T, Sourij H, Moser O. (Hybrid) Closed-Loop Systems: From Announced to Unannounced Exercise. Diabetes Technol Ther 2023. [PMID: 38133645 DOI: 10.1089/dia.2023.0293] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2023]
Abstract
Physical activity and exercise have many beneficial effects on general and type 1 diabetes (T1D) specific health and are recommended for individuals with T1D. Despite these health benefits, many people with T1D still avoid exercise since glycemic management during physical activity poses substantial glycemic and psychological challenges - which hold particularly true for unannounced exercise when using an AID system. Automated insulin delivery (AID) systems have demonstrated their efficacy in improving overall glycemia and in managing announced exercise in numerous studies. They are proven to increase time in range (70-180 mg/dL) and can especially counteract nocturnal hypoglycemia, even when evening exercise was performed. AID-systems consist of a pump administering insulin as well as a CGM sensor (plus transmitter), both communicating with a control algorithm integrated into a device (insulin pump, mobile phone/smart watch). Nevertheless, without manual pre-exercise adaptions, these systems still face a significant challenge around physical activity. Automatically adapting to the rapidly changing insulin requirements during unannounced exercise and physical activity is still the Achilles' heel of current AID systems. There is an urgent need for improving current AID-systems to safely and automatically maintain glucose management without causing derailments - so that going forward, exercise announcements will not be necessary in the future. Therefore, this narrative literature review aimed to discuss technological strategies to how current AID-systems can be improved in the future and become more proficient in overcoming the hurdle of unannounced exercise. For this purpose, the current state-of-the-art therapy recommendations for AID and exercise as well as novel research approaches are presented along with potential future solutions - in order to rectify their deficiencies in the endeavor to achieve fully automated AID-systems even around unannounced exercise.
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Affiliation(s)
- Rebecca Tanja Zimmer
- University of Bayreuth, 26523, Division Exercise Physiology and Metabolism Institute of Sport Science, Bayreuth, Bavaria, Germany;
| | - Alexander Auth
- University of Bayreuth, 26523, Division Exercise Physiology and Metabolism Institute of Sport Science, Bayreuth, Bavaria, Germany;
| | - Janis Schierbauer
- University of Bayreuth, 26523, Division Exercise Physiology and Metabolism Institute of Sport Science, Bayreuth, Bavaria, Germany;
| | - Sandra Haupt
- University of Bayreuth, 26523, Division Exercise Physiology and Metabolism Institute of Sport Science, Bayreuth, Bavaria, Germany;
| | - Nadine Wachsmuth
- University of Bayreuth, 26523, Division Exercise Physiology and Metabolism Institute of Sport Science, Bayreuth, Bavaria, Germany;
| | - Paul Zimmermann
- University of Bayreuth, 26523, Division Exercise Physiology and Metabolism Institute of Sport Science, Bayreuth, Bavaria, Germany;
| | - Thomas Voit
- University of Bayreuth, 26523, Division Exercise Physiology and Metabolism Institute of Sport Science, Bayreuth, Bavaria, Germany;
| | - Tadej Battelino
- University Children's Hospital, Ljubljana, Slovenia, Department of Endocrinology, Diabetes and Metabolism, Bohoriceva 20, Ljubljana, Slovenia, 1000
- Slovenia;
| | - Harald Sourij
- Medical University of Graz, 31475, Auenbruggerplatz 15, 8036 Graz, Graz, Austria, 8036;
| | - Othmar Moser
- University of Bayreuth, 26523, Division Exercise Physiology and Metabolism Institute of Sport Science, Universitätsstraße 30, Bayreuth, Bayern, Germany, 95440;
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Gitsi E, Livadas S, Angelopoulos N, Paparodis RD, Raftopoulou M, Argyrakopoulou G. A Nutritional Approach to Optimizing Pump Therapy in Type 1 Diabetes Mellitus. Nutrients 2023; 15:4897. [PMID: 38068755 PMCID: PMC10707799 DOI: 10.3390/nu15234897] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2023] [Revised: 11/14/2023] [Accepted: 11/20/2023] [Indexed: 12/18/2023] Open
Abstract
Achieving optimal glucose control in individuals with type 1 diabetes (T1DM) continues to pose a significant challenge. While continuous insulin infusion systems have shown promise as an alternative to conventional insulin therapy, there remains a crucial need for greater awareness regarding the necessary adaptations for various special circumstances. Nutritional choices play an essential role in the efficacy of diabetes management and overall health status for patients with T1DM. Factors such as effective carbohydrate counting, assessment of the macronutrient composition of meals, and comprehending the concept of the glycemic index of foods are paramount in making informed pre-meal adjustments when utilizing insulin pumps. Furthermore, the ability to handle such situations as physical exercise, illness, pregnancy, and lactation by making appropriate adjustments in nutrition and pump settings should be cultivated within the patient-practitioner relationship. This review aims to provide healthcare practitioners with practical guidance on optimizing care for individuals living with T1DM. It includes recommendations on carbohydrate counting, managing mixed meals and the glycemic index, addressing exercise-related challenges, coping with illness, and managing nutritional needs during pregnancy and lactation. Additionally, considerations relating to closed-loop systems with regard to nutrition are addressed. By implementing these strategies, healthcare providers can better equip themselves to support individuals with T1DM in achieving improved diabetes management and enhanced quality of life.
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Affiliation(s)
- Evdoxia Gitsi
- Diabetes and Obesity Unit, Athens Medical Center, 15125 Athens, Greece; (E.G.); (M.R.)
| | | | | | - Rodis D. Paparodis
- Center for Diabetes and Endocrine Research, College of Medicine and Life Sciences, University of Toledo, Toledo, OH 43614, USA;
| | - Marina Raftopoulou
- Diabetes and Obesity Unit, Athens Medical Center, 15125 Athens, Greece; (E.G.); (M.R.)
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Lega IC, Yale JF, Chadha A, Paty B, Roscoe R, Snider M, Steier J, Bajaj HS, Barnes T, Gilbert J, Honshorst K, Kim J, Lewis J, MacDonald B, MacKay D, Mansell K, Senior P, Rabi D, Sherifali D. Hypoglycemia in Adults. Can J Diabetes 2023; 47:548-559. [PMID: 37821214 DOI: 10.1016/j.jcjd.2023.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/13/2023]
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Helleputte S, Yardley JE, Scott SN, Stautemas J, Jansseune L, Marlier J, De Backer T, Lapauw B, Calders P. Effects of postprandial exercise on blood glucose levels in adults with type 1 diabetes: a review. Diabetologia 2023; 66:1179-1191. [PMID: 37014379 DOI: 10.1007/s00125-023-05910-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Accepted: 03/03/2023] [Indexed: 04/05/2023]
Abstract
People with type 1 diabetes experience challenges in managing blood glucose around exercise. Previous studies have examined glycaemic responses to different exercise modalities but paid little attention to participants' prandial state, although this is an important consideration and will enhance our understanding of the effects of exercise in order to improve blood glucose management around activity. This review summarises available data on the glycaemic effects of postprandial exercise (i.e. exercise within 2 h after a meal) in people with type 1 diabetes. Using a search strategy on electronic databases, literature was screened until November 2022 to identify clinical trials evaluating acute (during exercise), subacute (≤2 h after exercise) and late (>2 h to ≤24 h after exercise) effects of postprandial exercise in adults with type 1 diabetes. Studies were systematically organised and assessed by exercise modality: (1) walking exercise (WALK); (2) continuous exercise of moderate intensity (CONT MOD); (3) continuous exercise of high intensity (CONT HIGH); and (4) interval training (intermittent high-intensity exercise [IHE] or high-intensity interval training [HIIT]). Primary outcomes were blood glucose change and hypoglycaemia occurrence during and after exercise. All study details and results per outcome were listed in an evidence table. Twenty eligible articles were included: two included WALK sessions, eight included CONT MOD, seven included CONT HIGH, three included IHE and two included HIIT. All exercise modalities caused consistent acute glycaemic declines, with the largest effect size for CONT HIGH and the smallest for HIIT, depending on the duration and intensity of the exercise bout. Pre-exercise mealtime insulin reductions created higher starting blood glucose levels, thereby protecting against hypoglycaemia, in spite of similar declines in blood glucose during activity between the different insulin reduction strategies. Nocturnal hypoglycaemia occurred after higher intensity postprandial exercise, a risk that could be diminished by a post-exercise snack with concomitant bolus insulin reduction. Research on the optimal timing of postprandial exercise is inconclusive. In summary, individuals with type 1 diabetes exercising postprandially should substantially reduce insulin with the pre-exercise meal to avoid exercise-induced hypoglycaemia, with the magnitude of the reduction depending on the exercise duration and intensity. Importantly, pre-exercise blood glucose and timing of exercise should be considered to avoid hyperglycaemia around exercise. To protect against late-onset hypoglycaemia, a post-exercise meal with insulin adjustments might be advisable, especially for exercise in the evening or with a high-intensity component.
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Affiliation(s)
- Simon Helleputte
- Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium.
- Fonds Wetenschappelijk Onderzoek (FWO) Vlaanderen, Flanders, Belgium.
| | - Jane E Yardley
- Augustana Faculty, University of Alberta, Edmonton, Alberta, Canada
- Alberta Diabetes Institute, Edmonton, Alberta, Canada
- Faculty of Kinesiology, Sport and Recreation, University of Alberta, Edmonton, Alberta, Canada
- Women and Children's Health Research Institute, Edmonton, Alberta, Canada
| | - Sam N Scott
- Team Novo Nordisk Professional Cycling Team, Atlanta, GA, USA
| | - Jan Stautemas
- Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Laura Jansseune
- Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Joke Marlier
- Department of Endocrinology, Ghent University Hospital, Ghent, Belgium
| | - Tine De Backer
- Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
- Department of Cardiology, Ghent University Hospital, Ghent, Belgium
| | - Bruno Lapauw
- Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
- Department of Endocrinology, Ghent University Hospital, Ghent, Belgium
| | - Patrick Calders
- Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
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Zaharieva DP, Morrison D, Paldus B, Lal RA, Buckingham BA, O'Neal DN. Practical Aspects and Exercise Safety Benefits of Automated Insulin Delivery Systems in Type 1 Diabetes. Diabetes Spectr 2023; 36:127-136. [PMID: 37193203 PMCID: PMC10182962 DOI: 10.2337/dsi22-0018] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/18/2023]
Abstract
Regular exercise is essential to overall cardiovascular health and well-being in people with type 1 diabetes, but exercise can also lead to increased glycemic disturbances. Automated insulin delivery (AID) technology has been shown to modestly improve glycemic time in range (TIR) in adults with type 1 diabetes and significantly improve TIR in youth with type 1 diabetes. Available AID systems still require some user-initiated changes to the settings and, in some cases, significant pre-planning for exercise. Many exercise recommendations for type 1 diabetes were developed initially for people using multiple daily insulin injections or insulin pump therapy. This article highlights recommendations and practical strategies for using AID around exercise in type 1 diabetes.
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Affiliation(s)
- Dessi P Zaharieva
- Division of Endocrinology, Department of Pediatrics, Stanford University School of Medicine, Stanford, CA
| | - Dale Morrison
- Department of Medicine, The University of Melbourne, Melbourne, Australia
| | - Barbora Paldus
- Department of Medicine, The University of Melbourne, Melbourne, Australia
- Department of Endocrinology & Diabetes, St Vincent's Hospital Melbourne, Melbourne, Australia
| | - Rayhan A Lal
- Division of Endocrinology, Department of Pediatrics, Stanford University School of Medicine, Stanford, CA
- Stanford Diabetes Research Center, Stanford, CA
- Division of Endocrinology, Department of Medicine, Stanford University School of Medicine, Stanford, CA
| | - Bruce A Buckingham
- Division of Endocrinology, Department of Pediatrics, Stanford University School of Medicine, Stanford, CA
- Stanford Diabetes Research Center, Stanford, CA
| | - David N O'Neal
- Department of Medicine, The University of Melbourne, Melbourne, Australia
- Department of Endocrinology & Diabetes, St Vincent's Hospital Melbourne, Melbourne, Australia
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12
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Abstract
Regular physical activity improves cardiometabolic and musculoskeletal health, helps with weight management, improves cognitive and psychosocial functioning, and is associated with reduced mortality related to cancer and diabetes mellitus. However, turnover rates of glucose in the blood increase dramatically during exercise, which often results in either hypoglycaemia or hyperglycaemia as well as increased glycaemic variability in individuals with type 1 diabetes mellitus (T1DM). A complex neuroendocrine response to an acute exercise session helps to maintain circulating levels of glucose in a fairly tight range in healthy individuals, while several abnormal physiological processes and limitations of insulin therapy limit the capacity of people with T1DM to exercise in a normoglycaemic state. Knowledge of the acute and chronic effects of exercise and regular physical activity is critical for the formulation of clinical strategies for the management of insulin and nutrition for active patients with T1DM. Emerging diabetes-related technologies, such as continuous glucose monitors, automated insulin delivery systems and the administration of solubilized glucagon, are demonstrating efficacy for preserving glucose homeostasis during and after exercise in this population of patients. This Review highlights the beneficial effects of regular exercise and details the complex endocrine and metabolic responses to different types of exercise for adults with T1DM. An overview of basic clinical strategies for the preservation of glucose homeostasis using emerging technologies is also provided.
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Affiliation(s)
- Michael C Riddell
- Muscle Health Research Centre, School of Kinesiology and Health Science, York University, Toronto, Ontario, Canada.
- LMC Diabetes and Endocrinology, Toronto, Ontario, Canada.
| | - Anne L Peters
- Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
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13
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Adolfsson P, Taplin CE, Zaharieva DP, Pemberton J, Davis EA, Riddell MC, McGavock J, Moser O, Szadkowska A, Lopez P, Santiprabhob J, Frattolin E, Griffiths G, DiMeglio LA. ISPAD Clinical Practice Consensus Guidelines 2022: Exercise in children and adolescents with diabetes. Pediatr Diabetes 2022; 23:1341-1372. [PMID: 36537529 PMCID: PMC10107219 DOI: 10.1111/pedi.13452] [Citation(s) in RCA: 32] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/07/2022] [Indexed: 12/24/2022] Open
Affiliation(s)
- Peter Adolfsson
- Department of PediatricsKungsbacka HospitalKungsbackaSweden
- Institute of Clinical Sciences, Sahlgrenska AcademyUniversity of GothenburgGothenburgSweden
| | - Craig E. Taplin
- Department of Endocrinology and DiabetesPerth Children's HospitalNedlandsWestern AustraliaAustralia
- Telethon Kids InstituteUniversity of Western AustraliaPerthWestern AustraliaAustralia
- Centre for Child Health ResearchUniversity of Western AustraliaPerthWestern AustraliaAustralia
| | - Dessi P. Zaharieva
- Division of Endocrinology, Department of PediatricsSchool of Medicine, Stanford UniversityStanfordCaliforniaUSA
| | - John Pemberton
- Department of Endocrinology and DiabetesBirmingham Women's and Children's HospitalBirminghamUK
| | - Elizabeth A. Davis
- Department of Endocrinology and DiabetesPerth Children's HospitalNedlandsWestern AustraliaAustralia
- Telethon Kids InstituteUniversity of Western AustraliaPerthWestern AustraliaAustralia
- Centre for Child Health ResearchUniversity of Western AustraliaPerthWestern AustraliaAustralia
| | | | - Jonathan McGavock
- Faculty of Kinesiology and Recreation ManagementUniversity of ManitobaWinnipegManitobaCanada
- Diabetes Research Envisioned and Accomplished in Manitoba (DREAM) ThemeChildren's Hospital Research Institute of ManitobaWinnipegManitobaCanada
- Department of Pediatrics and Child HealthUniversity of ManitobaWinnipegManitobaCanada
- Diabetes Action Canada SPOR NetworkTorontoOntarioCanada
| | - Othmar Moser
- Division Exercise Physiology and Metabolism, Department of Sport ScienceUniversity of BayreuthBayreuthGermany
- Interdisciplinary Metabolic Medicine Trials Unit, Division of Endocrinology and Diabetology, Department of Internal MedicineMedical University of GrazGrazAustria
| | - Agnieszka Szadkowska
- Department of Pediatrics, Diabetology, Endocrinology & NephrologyMedical University of LodzLodzPoland
| | - Prudence Lopez
- Department of PaediatricsJohn Hunter Children's HospitalNewcastleNew South WalesAustralia
- University of NewcastleNewcastleNew South WalesAustralia
| | - Jeerunda Santiprabhob
- Siriraj Diabetes CenterFaculty of Medicine Siriraj Hospital, Mahidol UniversityBangkokThailand
- Division of Endocrinology and Metabolism, Department of PediatricsFaculty of Medicine Siriraj Hospital, Mahidol UniversityBangkokThailand
| | | | | | - Linda A. DiMeglio
- Department of Pediatrics, Division of Pediatric Endocrinology and DiabetologyIndiana University School of Medicine, Riley Hospital for ChildrenIndianapolisIndianaUSA
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14
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Pemberton JS, Barrett TG, Dias RP, Kershaw M, Krone R, Uday S. An effective and cost-saving structured education program teaching dynamic glucose management strategies to a socio-economically deprived cohort with type 1 diabetes in a VIRTUAL setting. Pediatr Diabetes 2022; 23:1045-1056. [PMID: 35689452 DOI: 10.1111/pedi.13381] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2021] [Revised: 05/16/2022] [Accepted: 06/07/2022] [Indexed: 12/01/2022] Open
Abstract
OBJECTIVES Compare the clinical and cost-effectiveness of an established face to face (F2F) structured education program to a new remote (VIRTUAL) program teaching dynamic glucose management (DynamicGM) to children and young people with type 1 diabetes (CYPD) using continuous glucose monitoring (CGM). To ascertain the most effective DynamicGM strategies predicting time in range (TIR) (3.9-10.0 mmol/L) and incorporating these into a user-friendly teaching aid. DESIGN AND METHODS Effectiveness of the F2F and VIRTUAL programs were ascertained by comparing the mean change (Δ) from baseline to 6 months in HbA1c, TIR and severe hypoglycemia. Delivery cost for the two programs were evaluated. Factors predicting TIR in the combined cohort were determined and incorporated into a user-friendly infographic. RESULTS First 50 graduates per group were evaluated. The mean difference in Δ HbA1c, Δ TIR and Δ episodes of severe hypoglycemia between VIRTUAL and F2F groups were 1.16 (p = 0.47), 0.76 (p = 0.78) and -0.06 (p = 0.61) respectively. Delivery cost per 50 CYPD for VIRTUAL and F2F were $5752 and $7020, respectively. The strongest predictors of TIR (n = 100) were short bursts of exercise (10-40 min) to lower hyperglycemia (p < 0.001), using trend arrow adjustment tools (p < 0.001) and adjusting pre-meal bolus timing based on trend arrows (p < 0.01). These strategies were translated into a GAME (Stop highs), SET (Stay in target), MATCH (Prevent lows) mnemonic. CONCLUSION Teaching DynamicGM VIRTUALLY is just as effective as F2F delivery and cost saving. Short bursts of exercise and using CGM trend arrows to adjust insulin dose and timing improves TIR.
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Affiliation(s)
- John S Pemberton
- Department of Endocrinology and Diabetes, Birmingham Children's Hospital, Birmingham Women's, and Children's NHS Foundation Trust, Birmingham, UK
| | - Timothy G Barrett
- Department of Endocrinology and Diabetes, Birmingham Children's Hospital, Birmingham Women's, and Children's NHS Foundation Trust, Birmingham, UK.,College of Medical and Dental Sciences, Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
| | - Renuka P Dias
- Department of Endocrinology and Diabetes, Birmingham Children's Hospital, Birmingham Women's, and Children's NHS Foundation Trust, Birmingham, UK.,College of Medical and Dental Sciences, Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK
| | - Melanie Kershaw
- Department of Endocrinology and Diabetes, Birmingham Children's Hospital, Birmingham Women's, and Children's NHS Foundation Trust, Birmingham, UK
| | - Ruth Krone
- Department of Endocrinology and Diabetes, Birmingham Children's Hospital, Birmingham Women's, and Children's NHS Foundation Trust, Birmingham, UK
| | - Suma Uday
- Department of Endocrinology and Diabetes, Birmingham Children's Hospital, Birmingham Women's, and Children's NHS Foundation Trust, Birmingham, UK.,College of Medical and Dental Sciences, Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK
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15
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McCarthy M, Ilkowitz J, Zheng Y, Vaughan Dickson V. Exercise and Self-Management in Adults with Type 1 Diabetes. Curr Cardiol Rep 2022; 24:861-868. [PMID: 35524882 DOI: 10.1007/s11886-022-01707-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/20/2022] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW The purpose of this review paper is to examine the most recent evidence of exercise-related self-management in adults with type 1 diabetes (T1D). RECENT FINDINGS This paper reviews the benefits and barriers to exercise, diabetes self-management education, the role of the healthcare provider in assessment and counseling, the use of technology, and concerns for special populations with T1D. Adults with T1D may not exercise at sufficient levels. Assessing current levels of exercise, counseling during a clinical visit, and the use of technology may improve exercise in this population.
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Affiliation(s)
- Margaret McCarthy
- Rory Meyers College of Nursing, New York University, New York, NY, USA.
| | - Jeniece Ilkowitz
- Pediatric Diabetes Center, NYU Langone Health, New York, NY, USA
| | - Yaguang Zheng
- Rory Meyers College of Nursing, New York University, New York, NY, USA
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16
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Tagougui S, Legault L, Heyman E, Messier V, Suppere C, Potter KJ, Pigny P, Berthoin S, Taleb N, Rabasa-Lhoret R. Anticipated Basal Insulin Reduction to Prevent Exercise-Induced Hypoglycemia in Adults and Adolescents Living with Type 1 Diabetes. Diabetes Technol Ther 2022; 24:307-315. [PMID: 35099281 DOI: 10.1089/dia.2021.0375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Objective: We investigated the effect of two key timings for basal insulin rate reduction on exercise-induced glucose changes and explored the association between circulating insulin concentrations and muscle vasoreactivity. Research Design and Methods: Twenty adults and adolescents performed 60-min exercise sessions (ergocycle) at 60% VO2peak, 240 min after a standardized lunch. In a randomized order, we compared an 80% basal insulin reduction applied 40 min (T-40) or 90 min (T-90) before exercise onset. Near-infrared spectroscopy was used to investigate muscle hemodynamics at vastus lateralis. Glucose and insulin plasma concentrations were measured. Results: Reduction in plasma glucose (PG) level during exercise was attenuated during T-90 versus T-40 strategy (-0.89 ± 1.89 mmol/L vs. -2.17 ± 2.49 mmol/L, respectively; P = 0.09). Linear mixed model analysis showed that PG dropped by an additional 0.01 mM per minute in T-40 versus T-90 (time × strategy interaction, P < 0.05). The absolute number of hypoglycemic events was not different between the two strategies, but they occurred later with T-90. Free insulin tends to decrease more during the pre-exercise period in the T-90 strategy (P = 0.08). Although local muscle vasodilatation (ΔTHb) was comparable between the two strategies, we found that PG dropped more in cases of higher exercise-induced skeletal muscle vasodilatation (ΔTHb × time interaction P < 0.005, e: -0.0086 mM/min and additional mM of ΔTHb). Conclusion: T-90 timing reduced exercise-induced drop in PG and delayed the occurrence of hypoglycemic episodes compared with T-40 timing without a significant reduction in the number of events requiring treatment. Trial registration: ClinicalTrials.gov identifier: NCT03349489.
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Affiliation(s)
- Sémah Tagougui
- Montreal Clinical Research Institute (IRCM), Montreal, Canada
- Département de nutrition, Université de Montréal, Montreal, Canada
- Univ. Lille, Univ. Artois, Univ. Littoral Côte d'Opale, ULR 7369 - URePSSS - Unité de Recherche Pluridisciplinaire Sport Santé Société, Lille, France
| | - Laurent Legault
- Montreal Clinical Research Institute (IRCM), Montreal, Canada
- McGill University Health Center (MUHC), Montreal Children's Hospital, Montreal, Canada
| | - Elsa Heyman
- Univ. Lille, Univ. Artois, Univ. Littoral Côte d'Opale, ULR 7369 - URePSSS - Unité de Recherche Pluridisciplinaire Sport Santé Société, Lille, France
| | | | - Corinne Suppere
- Montreal Clinical Research Institute (IRCM), Montreal, Canada
| | | | - Pascal Pigny
- Laboratoire de Biochimie-Hormonologie, CHU Lille, Centre de Biologie-Pathologie, Lille, France
| | - Serge Berthoin
- Univ. Lille, Univ. Artois, Univ. Littoral Côte d'Opale, ULR 7369 - URePSSS - Unité de Recherche Pluridisciplinaire Sport Santé Société, Lille, France
| | - Nadine Taleb
- Montreal Clinical Research Institute (IRCM), Montreal, Canada
- Division of Biomedical Sciences, Faculty of Medicine, Université de Montréal, Montréal, Canada
- Endocrinology Division, Montreal Diabetes Research Center (MDRC), Montreal University Hospital (CHUM), Montreal, Canada
| | - Rémi Rabasa-Lhoret
- Montreal Clinical Research Institute (IRCM), Montreal, Canada
- Département de nutrition, Université de Montréal, Montreal, Canada
- Endocrinology Division, Montreal Diabetes Research Center (MDRC), Montreal University Hospital (CHUM), Montreal, Canada
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17
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Paiement K, Frenette V, Wu Z, Suppère C, Messier V, Lasalle-Vaillancourt A, Mathieu ME, Rabasa-Lhoret R. Is a better understanding of management strategies for type 1 diabetes associated with a lower risk of developing hypoglycemia during and after physical activity? Can J Diabetes 2022; 46:526-534. [DOI: 10.1016/j.jcjd.2022.02.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Revised: 02/08/2022] [Accepted: 02/20/2022] [Indexed: 11/29/2022]
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18
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Biester T, Tauschmann M, Chobot A, Kordonouri O, Danne T, Kapellen T, Dovc K. The automated pancreas: A review of technologies and clinical practice. Diabetes Obes Metab 2022; 24 Suppl 1:43-57. [PMID: 34658126 DOI: 10.1111/dom.14576] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2021] [Revised: 10/07/2021] [Accepted: 10/07/2021] [Indexed: 12/12/2022]
Abstract
Insulin pumps and glucose sensors are effective in improving diabetes therapy and reducing acute complications. The combination of both devices using an algorithm-driven interoperable controller makes automated insulin delivery (AID) systems possible. Many AID systems have been tested in clinical trials and have proven safety and effectiveness. However, currently, none of these systems are available for routine use in children younger than 6 years in Europe. For continued use, both users and prescribers must have sound knowledge of the features of the individual AID systems. Presently, all systems require various user interactions (e.g. meal announcements) because fully automated systems are not yet developed. Open-source systems are non-regulated variants to circumvent existing regulatory conditions. There are risks here for both users and prescribers. To evaluate AID therapy, the metric data of the glucose sensors, 'time in target range' and 'glucose management index', are novel recognized and suitable parameters allowing a consultation based on real glucose and insulin pump download data from the daily life of people with diabetes. Read out via cloud-based software or automatic download of such individual treatment data provides the ideal technical basis for shared decision-making through telemedicine, which must be further evaluated for general use.
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Affiliation(s)
- Torben Biester
- AUF DER BULT, Diabetes Center for Children and Adolescents, Hannover, Germany
| | - Martin Tauschmann
- Department of Pediatric and Adolescent Medicine, Medical University of Vienna, Vienna, Austria
| | - Agata Chobot
- Department of Pediatrics, Institute of Medical Sciences, University of Opole, Opole, Poland
| | - Olga Kordonouri
- AUF DER BULT, Diabetes Center for Children and Adolescents, Hannover, Germany
| | - Thomas Danne
- AUF DER BULT, Diabetes Center for Children and Adolescents, Hannover, Germany
| | - Thomas Kapellen
- Department of Pediatrics, MEDIAN Clinic for Children 'Am Nicolausholz' Bad Kösen, Naumburg, Germany
| | - Klemen Dovc
- Department of Pediatric Endocrinology, Diabetes and Metabolic Diseases, UMC - University Children's Hospital, Ljubljana, Slovenia and Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
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19
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Abstract
Advances in diabetes technologies have enabled the development of automated closed-loop insulin delivery systems. Several hybrid closed-loop systems have been commercialised, reflecting rapid transition of this evolving technology from research into clinical practice, where it is gradually transforming the management of type 1 diabetes in children and adults. In this review we consider the supporting evidence in terms of glucose control and quality of life for presently available closed-loop systems and those in development, including dual-hormone closed-loop systems. We also comment on alternative 'do-it-yourself' closed-loop systems. We remark on issues associated with clinical adoption of these approaches, including training provision, and consider limitations of presently available closed-loop systems and areas for future enhancements to further improve outcomes and reduce the burden of diabetes management.
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Affiliation(s)
- Charlotte K Boughton
- Wellcome Trust-Medical Research Council Institute of Metabolic Science, University of Cambridge, Cambridge, UK
| | - Roman Hovorka
- Wellcome Trust-Medical Research Council Institute of Metabolic Science, University of Cambridge, Cambridge, UK.
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20
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Molveau J, Rabasa-Lhoret R, Taleb N, Heyman E, Myette-Côté É, Suppère C, Berthoin S, Tagougui S. Minimizing the Risk of Exercise-Induced Glucose Fluctuations in People Living With Type 1 Diabetes Using Continuous Subcutaneous Insulin Infusion: An Overview of Strategies. Can J Diabetes 2021; 45:666-676. [PMID: 33744123 DOI: 10.1016/j.jcjd.2021.01.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Revised: 01/11/2021] [Accepted: 01/11/2021] [Indexed: 12/16/2022]
Abstract
Physical activity (PA) is important for individuals living with type 1 diabetes (T1D) due to its various health benefits. Nonetheless, maintaining adequate glycemic control around PA remains a challenge for many individuals living with T1D because of the difficulty in properly managing circulating insulin levels around PA. Although the most common problem is increased incidence of hypoglycemia during and after most types of PA, hyperglycemia can also occur. Accordingly, a large proportion of people living with T1D are sedentary partly due to the fear of PA-associated hypoglycemia. Continuous subcutaneous insulin infusion (CSII) offers a higher precision and flexibility to adjust insulin basal rates and boluses according to the individual's specific needs around PA practice. Indeed, for physically active patients with T1D, CSII can be a preferred option to facilitate glucose regulation. To our knowledge, there are no guidelines to manage exercise-induced hypoglycemia during PA, specifically for individuals living with T1D and using CSII. In this review, we highlight the current state of knowledge on exercise-related glucose variations, especially hypoglycemic risk and its underlying physiology. We also detail the current recommendations for insulin modulations according to the different PA modalities (type, intensity, duration, frequency) in individuals living with T1D using CSII.
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Affiliation(s)
- Joséphine Molveau
- Institut de recherches cliniques de Montréal, Montréal, Québec, Canada; Département de Nutrition, Faculté de Médicine, Université de Montréal, Montreal, Québec, Canada
| | - Rémi Rabasa-Lhoret
- Institut de recherches cliniques de Montréal, Montréal, Québec, Canada; Département de Nutrition, Faculté de Médicine, Université de Montréal, Montreal, Québec, Canada; Département des Sciences Biomédicales, Faculté de Médicine, Université de Montréal, Montreal, Québec, Canada; Division of Endocrinology, McGill University, Montreal, Québec, Canada; Endocrinology Division, Montreal Diabetes Research Center, Montreal, Québec, Canada
| | - Nadine Taleb
- Institut de recherches cliniques de Montréal, Montréal, Québec, Canada; Département des Sciences Biomédicales, Faculté de Médicine, Université de Montréal, Montreal, Québec, Canada
| | - Elsa Heyman
- Université Lille, Unité de Recherche Pluridisciplinaire Sport Santé Société, Lille, France; Université Artois, Artois, France; Université Littoral Côte d'Opale, Dunkerque, France
| | - Étienne Myette-Côté
- Institut de recherches cliniques de Montréal, Montréal, Québec, Canada; Department of Medicine, McGill University, Montreal, Québec, Canada
| | - Corinne Suppère
- Institut de recherches cliniques de Montréal, Montréal, Québec, Canada
| | - Serge Berthoin
- Université Lille, Unité de Recherche Pluridisciplinaire Sport Santé Société, Lille, France; Université Artois, Artois, France; Université Littoral Côte d'Opale, Dunkerque, France
| | - Sémah Tagougui
- Institut de recherches cliniques de Montréal, Montréal, Québec, Canada; Département de Nutrition, Faculté de Médicine, Université de Montréal, Montreal, Québec, Canada; Université Lille, Unité de Recherche Pluridisciplinaire Sport Santé Société, Lille, France; Université Artois, Artois, France; Université Littoral Côte d'Opale, Dunkerque, France.
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