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Schubert-Olesen O, Kröger J, Siegmund T, Thurm U, Halle M. Continuous Glucose Monitoring and Physical Activity. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:12296. [PMID: 36231598 PMCID: PMC9564842 DOI: 10.3390/ijerph191912296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Revised: 09/02/2022] [Accepted: 09/03/2022] [Indexed: 06/16/2023]
Abstract
Continuous glucose monitoring (CGM) use has several potential positive effects on diabetes management. These benefits are, e.g., increased time in range (TIR), optimized therapy, and developed documentation. Physical activity is a recommended intervention tool in diabetes management, especially for people with type 2 diabetes (T2D). The benefits of physical activity for people with diabetes can be seen as an improvement of glycemic control, glycemic variability, and the reduction of insulin resistance. In relation to the physical activity of people with T2D, the benefits of CGM use can even be increased, and CGM can be a helpful tool to prevent adverse events due to physical activity of people with diabetes, such as hypoglycemic events and nocturnal hypoglycemia after sports. This narrative review aims to provide solid recommendations for the use of CGM in everyday life physical activities based on the noted benefits and to give a general overview of the guidelines on physical activity and CGM use for people with diabetes.
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Affiliation(s)
| | - Jens Kröger
- Center of Digital Diabetology Hamburg, 21029 Hamburg, Germany
| | - Thorsten Siegmund
- Diabetes, Hormones and Metabolism Center, Private Practice at the Isar Clinic, 80331 Munich, Germany
| | - Ulrike Thurm
- IDAA, Diabetic Athletes Association, 12621 Berlin, Germany
| | - Martin Halle
- Department of Preventive Sports Medicine and Sports Cardiology, University Hospital Klinikum Rechts der Isar, Technical University of Munich, 80992 Munich, Germany
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Matejko B, Tota Ł, Mrozińska S, Morawska M, Pałka T, Kieć-Wilk B, Klupa T, Malecki MT. Predictors of the maximal oxygen consumption in adult patients with type 1 diabetes treated with personal insulin pumps. J Diabetes Investig 2021; 12:1377-1385. [PMID: 33378577 PMCID: PMC8354502 DOI: 10.1111/jdi.13490] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 11/24/2020] [Accepted: 12/27/2020] [Indexed: 12/31/2022] Open
Abstract
Aims/Introduction Regular physical activity for adults with type 1 diabetes mellitus improves cardiorespiratory fitness (CF) and quality of life. The aim of our study was to evaluate clinical and biochemical features that might be associated with CF in a homogenous group of adults with type 1 diabetes mellitus who are all treated with a personal insulin pump (continuous subcutaneous insulin infusion). Materials and Methods We assessed CF in 62 patients (74.2% of whom were men) who fulfilled the eligibility criteria. To determine maximal oxygen consumption, the march‐running test on the treadmill was carried out. Two hours before the test, the patients consumed a defined meal covered by a dose of rapid acting insulin analog that was reduced by 25% from their regular dose. Basal insulin infusion was reduced by 50% for an hour. Additionally, the Perceived Stress Scale‐10 questionnaire was used to measure the perception of stress. Results There was no episode of severe hypoglycemia during or after the test. In the final model, independent predictors of maximal oxygen consumption were sex, body fat percentage, lactate at 20 min after CF test and Perceived Stress Scale‐10 score. Of interest, neither short‐term (continuous glucose monitoring) nor long‐term (glycosylated hemoglobin) metabolic control parameters were predictors of CF. Conclusions In our selected homogenous group of patients with type 1 diabetes mellitus treated with personal insulin pumps, higher CF was associated with a lower percentage of body fat, male sex, higher lactate level after the CF test and the Perceived Stress Scale‐10 score. The proposed protocol in our cohort proved to be safe with regard to glycemic control.
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Affiliation(s)
- Bartłomiej Matejko
- Department of Metabolic Diseases, Jagiellonian University Medical College, Krakow, Poland.,University Hospital, Krakow, Poland
| | - Łukasz Tota
- Department of Physiology and Biochemistry, Faculty of Physical Education and Sport, University of Physical Education in Krakow, Krakow, Poland
| | | | - Małgorzata Morawska
- Department of Sports Medicine and Human Nutrition, Faculty of Physical Education and Sport, University of Physical Education in Krakow, Krakow, Poland
| | - Tomasz Pałka
- Department of Physiology and Biochemistry, Faculty of Physical Education and Sport, University of Physical Education in Krakow, Krakow, Poland
| | - Beata Kieć-Wilk
- Department of Metabolic Diseases, Jagiellonian University Medical College, Krakow, Poland.,University Hospital, Krakow, Poland
| | - Tomasz Klupa
- Department of Metabolic Diseases, Jagiellonian University Medical College, Krakow, Poland.,University Hospital, Krakow, Poland
| | - Maciej T Malecki
- Department of Metabolic Diseases, Jagiellonian University Medical College, Krakow, Poland.,University Hospital, Krakow, Poland
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Matejko B, Gawrecki A, Wróbel M, Hohendorff J, Benbenek-Klupa T, Zozulińska-Ziółkiewicz D, Malecki MT, Klupa T. Physiological Characteristics of Type 1 Diabetes Patients during High Mountain Trekking. J Diabetes Res 2020; 2020:8068710. [PMID: 33015195 PMCID: PMC7519997 DOI: 10.1155/2020/8068710] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 08/17/2020] [Accepted: 08/25/2020] [Indexed: 12/24/2022] Open
Abstract
In this study, the aim was to provide observational data from an ascent to the summit of Mount Damavand (5670 meters above sea level (m.a.s.l), Iran) by a group of people with type 1 diabetes (T1DM), with a focus on their physiological characteristics. After a 3-day expedition, 18 T1DM patients, all treated with personal insulin pumps, successfully climbed Mount Damavand. Information was collected on their physiological and dietary behaviors, as well as medical parameters, such as carbohydrate consumption, glucose patterns, insulin dosing, and the number of hypo- and hyperglycemic episodes during this time frame. The participants consumed significantly less carbohydrates on day 3 compared to day 1 (16.4 vs. 23.1 carbohydrate units; p = 0.037). Despite this, a gradual rise in the mean daily glucose concentration as measured with a glucometer was observed. Interestingly, the patients did not fully respond to higher insulin delivery as there was no significant difference in mean daily insulin dose during the expedition. There were more hyperglycemic episodes (≥180 mg/dL) per patient on day 3 vs. day 1 (p < 0.05) and more severe hyperglycemic episodes (>250 mg/dL) per patient on days 2 (p < 0.05) and 3 (p < 0.05) vs. day 1. In summary, high mountain trekking is feasible for T1DM patients with good glycemic control and no chronic complications. However, some changes in dietary preferences and an observable rise in glucose levels may occur. This requires an adequate therapeutic response.
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Affiliation(s)
- Bartłomiej Matejko
- Department of Metabolic Diseases, Jagiellonian University Medical College, Krakow, Poland
- University Hospital, Krakow, Poland
| | - Andrzej Gawrecki
- Department of Internal Medicine and Diabetology, Poznan University of Medical Sciences, Poznan, Poland
| | - Marta Wróbel
- Department of Internal Medicine, Diabetology and Cardiometabolic Diseases, Silesian Center of Heart Diseases, Zabrze, Poland
| | - Jerzy Hohendorff
- Department of Metabolic Diseases, Jagiellonian University Medical College, Krakow, Poland
- University Hospital, Krakow, Poland
| | | | | | - Maciej T. Malecki
- Department of Metabolic Diseases, Jagiellonian University Medical College, Krakow, Poland
- University Hospital, Krakow, Poland
| | - Tomasz Klupa
- Department of Metabolic Diseases, Jagiellonian University Medical College, Krakow, Poland
- University Hospital, Krakow, Poland
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VanBaak KD, Nally LM, Finigan RT, Jurkiewicz CL, Burnier AM, Conrad BP, Khodaee M, Lipman GS. Wilderness Medical Society Clinical Practice Guidelines for Diabetes Management. Wilderness Environ Med 2019; 30:S121-S140. [PMID: 31753543 DOI: 10.1016/j.wem.2019.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Revised: 10/11/2019] [Accepted: 10/11/2019] [Indexed: 11/18/2022]
Abstract
The Wilderness Medical Society convened an expert panel in 2018 to develop a set of evidence-based guidelines for the treatment of type 1 and 2 diabetes, as well as the recognition, prevention, and treatment of complications of diabetes in wilderness athletes. We present a review of the classifications, pathophysiology, and evidence-based guidelines for planning and preventive measures, as well as best practice recommendations for both routine and urgent therapeutic management of diabetes and glycemic complications. These recommendations are graded based on the quality of supporting evidence and balance between the benefits and risks or burdens for each recommendation.
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Affiliation(s)
- Karin D VanBaak
- Department of Family Medicine and Department of Orthopedics, University of Colorado School of Medicine, Aurora, CO.
| | - Laura M Nally
- Department of Pediatric Endocrinology, Yale University School of Medicine, New Haven, CT
| | | | - Carrie L Jurkiewicz
- Department of Emergency Medicine, Stanford University School of Medicine, Stanford, CA
| | | | - Barry P Conrad
- Division of Endocrinology, Stanford Children's Hospital, Stanford, CA
| | - Morteza Khodaee
- Department of Family Medicine and Department of Orthopedics, University of Colorado School of Medicine, Aurora, CO
| | - Grant S Lipman
- Department of Emergency Medicine, Stanford University School of Medicine, Stanford, CA
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Koufakis T, Karras SN, Mustafa OG, Zebekakis P, Kotsa K. The Effects of High Altitude on Glucose Homeostasis, Metabolic Control, and Other Diabetes-Related Parameters: From Animal Studies to Real Life. High Alt Med Biol 2018; 20:1-11. [PMID: 30362832 DOI: 10.1089/ham.2018.0076] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Exposure to high altitude activates several complex and adaptive mechanisms aiming to protect human homeostasis from extreme environmental conditions, such as hypoxia and low temperatures. Short-term exposure is followed by transient hyperglycemia, mainly triggered by the activation of the sympathetic system, whereas long-term exposure results in lower plasma glucose concentrations, mediated by improved insulin sensitivity and augmented peripheral glucose disposal. An inverse relationship between altitude, diabetes, and obesity has been well documented. This is the result of genetic and physiological adaptations principally to hypoxia that favorably affect glucose metabolism; however, the contribution of financial, dietary, and other life-style parameters may also be important. According to existing evidence, people with diabetes are capable of undertaking demanding physical challenges even at extreme altitudes. Still, a number of issues should be taken into account, including the increased physical activity leading to changes in insulin demands and resistance, the performance of measurement systems under extreme weather conditions and the potential deterioration of metabolic control during climbing expeditions. The aim of this review is to present available evidence in the field in a comprehensive way, beginning from the physiology of glucose homeostasis adaptation mechanisms to high altitudes and ending to what real life experience has taught us.
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Affiliation(s)
- Theocharis Koufakis
- 1 Division of Endocrinology and Metabolism and Diabetes Center, First Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, AHEPA University Hospital , Thessaloniki, Greece
| | - Spyridon N Karras
- 1 Division of Endocrinology and Metabolism and Diabetes Center, First Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, AHEPA University Hospital , Thessaloniki, Greece
| | - Omar G Mustafa
- 2 Department of Diabetes, King's College Hospital , London, United Kingdom
| | - Pantelis Zebekakis
- 1 Division of Endocrinology and Metabolism and Diabetes Center, First Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, AHEPA University Hospital , Thessaloniki, Greece
| | - Kalliopi Kotsa
- 1 Division of Endocrinology and Metabolism and Diabetes Center, First Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, AHEPA University Hospital , Thessaloniki, Greece
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Thomakos P, Vazeou A, Sakkas D, Panagopoulos G, Anifantakis K, Smyrnaki P, Arvanitaki T, Kyrlaki E, Kefalogiannis N, Mamoulakis D, Pappas A, Mitrakou A. Avoiding hypoglycemia: the use of insulin pump combined with continuous glucose monitor in type 1 diabetes crossing a Rocky Gorge. QJM 2018; 111:629-633. [PMID: 29939323 DOI: 10.1093/qjmed/hcy136] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2018] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND Continuous subcutaneous insulin infusion (CSII) and continuous glucose monitoring systems (CGMS) have been proven very effective in diabetes management. AIM This study evaluated the usefulness of these devices during prolonged, intense physical activity in an uncontrolled natural environment away from the clinical research center. DESIGN Non-randomized, prospective and observational study. METHODS During the summer, 38 participants with type 1 diabetes crossed the Samaria gorge, the second largest gorge in Europe (17 km). Twenty subjects on CSII combined with real-time CGMS and 18 on multiple daily injections (MDI) combined with professional (retrospective) CGMS participated in the program. All participants were unsupervised during the event. RESULTS All 38 participants managed to reach the destination point safely. There were no episodes of severe hypoglycemia. The duration of the exercise (mean ±SD) was 6.4 ± 1.3 h. The CSII group exhibited significantly lower hypoglycemic episodes during exercise (0.1 ± 0.3 vs. 0.4 ± 0.6; P = 0.047) as well as lower AUC below 70 mg/dl compared with the MDI, during the 24 h (0.61 ± 0.78 vs. 1.84 ± 1.55; P = 0.007). Individuals on CSII were significantly less likely to develop a hypoglycemic episode during exercise (P = 0.038). Exercise induced nocturnal hypoglycemia was not prevented effectively in neither group. CONCLUSIONS CSII combined with CGMS is effective in controlling blood glucose levels in type 1 diabetics who perform prolonged strenuous exercise. The use of insulin pump technology in regions with hot Mediterranean climates is safe and can provide protection against exercise-induced hypoglycemia. Development of precise instructions for T1DM who occasionally get involved in exercise activities, requires further studies.
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Affiliation(s)
- P Thomakos
- From the Department of Clinical Therapeutics Medical School of National and Kapodistrian University of Athens, Alexandra Hospital, Lourou Street, 115 28 Athens, Greece
- Hygeia General Hospital, Diabetes Center, 4, Erythrou Stavrou, 151 23 Marousi, Athens, Greece
| | - A Vazeou
- Pediatric Unit, P&A Kyriakou Children's Hospital, Diabetes Unit, Livadias Street, 115 27 Athens, Greece
| | - D Sakkas
- From the Department of Clinical Therapeutics Medical School of National and Kapodistrian University of Athens, Alexandra Hospital, Lourou Street, 115 28 Athens, Greece
| | - G Panagopoulos
- From the Department of Clinical Therapeutics Medical School of National and Kapodistrian University of Athens, Alexandra Hospital, Lourou Street, 115 28 Athens, Greece
| | - K Anifantakis
- Venizeleio Hospital-PAGN, Diabetes Unit, Knosou Avenue, 714 09 Heraclion, Greece
| | - P Smyrnaki
- Venizeleio Hospital-PAGN, Diabetes Unit, Knosou Avenue, 714 09 Heraclion, Greece
| | - T Arvanitaki
- Chania General Hospital, Pediatric Unit, Diabetes Unit, Agiou Eleftheriou Street, 733 00 Chania, Greece
| | - E Kyrlaki
- Venizeleio Hospital-PAGN, Diabetes Unit, Knosou Avenue, 714 09 Heraclion, Greece
| | - N Kefalogiannis
- Asklipios Center, Diabetes Unit, 10, Mahis Critis Street, 713 03 Heraclion, Greece
| | - D Mamoulakis
- Venizeleio Hospital-PAGN, Diabetes Unit, Knosou Avenue, 714 09 Heraclion, Greece
| | - A Pappas
- Venizeleio Hospital-PAGN, Diabetes Unit, Knosou Avenue, 714 09 Heraclion, Greece
| | - A Mitrakou
- From the Department of Clinical Therapeutics Medical School of National and Kapodistrian University of Athens, Alexandra Hospital, Lourou Street, 115 28 Athens, Greece
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Nabrdalik K, Kwiendacz H, Gubała M, Tyrała K, Seweryn M, Tomasik A, Sawczyn T, Kukla M, Grzeszczak W, Gumprecht J. Diabetes-Related Knowledge of Polish National Mountain Leaders. High Alt Med Biol 2018; 19:237-243. [PMID: 29924643 DOI: 10.1089/ham.2017.0168] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
Nabrdalik, Katarzyna, Hanna Kwiendacz, Monika Gubała, Kinga Tyrała, Mariusz Seweryn, Andrzej Tomasik, Tomasz Sawczyn, Michał Kukla, Władysław Grzeszczak, and Janusz Gumprecht. Diabetes-related knowledge of Polish national mountain leaders. High Alt Med Biol. 19:237-243, 2018.-Mountain trekking is a popular activity for patients with diabetes. In Poland, mountain leaders often accompany organized groups to ensure their safety during treks; we aimed to evaluate their competency in caring for diabetic clients by assessing their diabetes-related knowledge. This was a cross-sectional study among Polish, certified, active mountain leaders carried out by means of an anonymous, standardized 41-item questionnaire adapted from a study by Wee et al. It was distributed through e-mail to 500 leaders. A total of 106 (21.2%) mountain leaders completed the questionnaire (males 60.4%) with a mean (standard deviation [SD]) age of 38.6 (13.5) years. Their mean (SD) length of experience acting as a mountain leader was 11.9 (10.2) years. The average score was 72.4% of the maximum possible (29.7 of 41 points). Results varied significantly depending on gender (p = 0.006). The percentage of correct answers among questions in each section varied between 23.6% and 100%. The main sources of diabetes-related knowledge identified by respondents were members of their family and their friends who suffer from diabetes (33%). First aid courses were indicated as sources of information by only 12.6% of the informants. Results of the questionnaire revealed that respondents did have a reasonable level of diabetes-related knowledge. There were topics in which the respondents achieved lower than an average score, demonstrating a need for further education.
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Affiliation(s)
- Katarzyna Nabrdalik
- 1 Department of Internal Medicine, Diabetology and Nephrology in Zabrze, School of Medicine with the Division of Dentistry in Zabrze, Medical University of Silesia , Katowice, Poland
| | - Hanna Kwiendacz
- 1 Department of Internal Medicine, Diabetology and Nephrology in Zabrze, School of Medicine with the Division of Dentistry in Zabrze, Medical University of Silesia , Katowice, Poland
| | - Monika Gubała
- 2 Student's Scientific Association by the Department of Internal Medicine, Diabetology and Nephrology in Zabrze, School of Medicine with the Division of Dentistry in Zabrze, Medical University of Silesia , Katowice, Poland
| | - Kinga Tyrała
- 2 Student's Scientific Association by the Department of Internal Medicine, Diabetology and Nephrology in Zabrze, School of Medicine with the Division of Dentistry in Zabrze, Medical University of Silesia , Katowice, Poland
| | - Mariusz Seweryn
- 3 Department of Epidemiology, Medical University of Silesia , Katowice, Poland
| | - Andrzej Tomasik
- 4 Second Department of Cardiology, School of Medicine with the Division of Dentistry in Zabrze, Medical University of Silesia , Katowice, Poland
| | - Tomasz Sawczyn
- 5 Department of Physiology in Zabrze, School of Medicine with the Division of Dentistry in Zabrze, Medical University of Silesia , Katowice, Poland
| | - Michał Kukla
- 6 Department of Gastroenterology and Hepatology in Katowice, Medical University of Silesia , Katowice, Poland
| | - Władysław Grzeszczak
- 1 Department of Internal Medicine, Diabetology and Nephrology in Zabrze, School of Medicine with the Division of Dentistry in Zabrze, Medical University of Silesia , Katowice, Poland
| | - Janusz Gumprecht
- 1 Department of Internal Medicine, Diabetology and Nephrology in Zabrze, School of Medicine with the Division of Dentistry in Zabrze, Medical University of Silesia , Katowice, Poland
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