Sulfonylurea Use Associated With Reduction in Blood Glucose Levels During Exercise Stress Testing

Risk of hypoglycaemia associated with professional, recreational, and traffic-related activities in patients with type 2 diabetes: a cross-sectional study by questionnaire

AIMS

We aimed to quantify the exposure to physical exercise associated with professional, recreational, or traffic-related activities in patients with type 2 diabetes, which may provoke or aggravate hypoglycaemic episodes, and to assess whether such risks determine the choice of medications minimizing the risk of hypoglycaemia.

METHODS

In total, 203 patients with type 2 diabetes (98 women, 105 men, age 65 [56;72; median, inter-quartile range] years, diabetes duration 10 [5;15] years) were recruited from a German diabetes practice. A questionnaire assessed their engagement in professional, recreational, or traffic-related activities. The prescription insulin or sulphonylureas was quantified in relation to the number of such activities.

RESULTS

63.5% of the patients were treated with insulin, 7.4% with sulphonylureas, and 70.9% with either. Sixty-six patients (22.7%) were professionally active: 36 (54.4%) of those were professionally exposed to risky behaviour (14 [31.8%] patients with exposure to multiple risks and 20 (30.3%) who experienced hypoglycaemic episodes in the past year). In total, 194 (95.6%) patients were exposed to risky behaviour during recreational activities, 129 (63.6%) to multiple ones. All patients were exposed to traffic-related activities, 144 (70.9%) were exposed to more than being pedestrian, and 24 (11.8%) experienced hypoglycaemic episodes while in traffic.

CONCLUSIONS

Patients with type 2 diabetes are exposed to risks associated with professional, recreational, and traffic-related activities. We recommend a careful assessment of such risks before glucose-lowering medications with a potential for provoking hypoglycaemic episodes are prescribed.

Acute exercise-induced glucose change during an exercise program in type 2 diabetes

PURPOSE

Supervised exercise programs have been demonstrated to improve overall glycemic control but less well characterized is the evolution of glucose response to exercise during an exercise program. We addressed this issue, using an observational cohort design, among overweight adults with type 2 diabetes. We hypothesized that during the course of the program, glucose levels during exercise would become more stable, as insulin sensitivity improved. Among adults with type 2 diabetes, glucose levels often decline acutely during exercise.

METHODS

Thirty-five adults with type 2 diabetes underwent capillary blood glucose (CBG) testing before and after supervised exercise during a 24-week program (48 sessions). After-exercise CBG values were subtracted from before-exercise values (CBG difference). Through repeated measures analysis, we examined CBG difference, before-exercise values, and after-exercise values during the program. Assuming that some initial period of exercise training is necessary to impact CBG difference, in exploratory analyses, we varied the time period analyzed (eg. Weeks 2-24, Weeks 3-24, etc).

RESULTS

CBG difference appeared stable throughout the program when all available data were considered. In models that examined periods following Week 11, however, the magnitude of CBG difference declined progressively, as did before-exercise values. After-exercise values remained stable for all time periods examined.

CONCLUSIONS

Our exploratory analyses suggest that following 11 weeks of exercise supervision, before-exercise CBG values decline progressively but after-exercise values remain stable, resulting in a progressive decline in CBG difference.