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Gómez AM, Henao DC, Muñoz OM, Romero DM, León JDS, Jaramillo PE, Moscoso E, Parra Prieto DA, Robledo S, Jaramillo MG, Rondón Sepúlveda M. Temporary Target Versus Suspended Insulin Infusion in Patients with Type 1 Diabetes Using the MiniMed 780G Advanced Closed-Loop Hybrid System During Aerobic Exercise: A Randomized Crossover Clinical Trial. Diabetes Technol Ther 2024. [PMID: 39284173 DOI: 10.1089/dia.2023.0589] [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] [Indexed: 10/01/2024]
Abstract
Aim: To compare the safety in terms of hypoglycemic events and continuous glucose monitoring (CGM) metrics during aerobic exercise (AE) of using temporary target (TT) versus suspension of insulin infusion (SII) in adults with type 1 diabetes (T1D) using advanced hybrid closed-loop systems. Methods: This was a randomized crossover clinical trial. Two moderate-intensity AE sessions were performed, one with TT and one with SII. Hypoglycemic events and CGM metrics were analyzed during the immediate (baseline to 59 min), early (60 min to 6 h), and late (6 to 36 h) post-exercise phases. Results: In total, 33 patients were analyzed (44.6 ± 13.8 years), basal time in range (%TIR 70-180 mg/dL) was 79.4 ± 12%, and time below range (%TBR) <70 mg/dL was 1.8 ± 1.7% and %TBR <54 mg/dL was 0.5 ± 0.9%. No difference was found in the number of hypoglycemic events, %TBR <70 mg/dL and %TBR <54 mg/dL between TT and SII. Differences were found in the early phase, with better values when using TT for %TIR 70-180 mg/dL (83.0 vs. 65.3, P = 0.005), time in tight range (%TITR 70-140 mg/dL) (56.3 vs. 41.5, P = 0.04), and time above range (%TAR >180 mg/dL) (15.3 vs. 31.8, P = 0.01). In the diurnal period, again %TIR was better for TT use (82.1 vs. 73.1, P = 0.02) and %TAR (15.0 vs. 22.96, P = 0.04). No significant differences were found in the CGM metrics during the different phases of AE. Conclusion: Our data appear to show that the use of TT compared with SII is equally safe in all phases of AE. However, the use of TT allows for a better glycemic profile in the early phase of exercise.
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Affiliation(s)
- Ana María Gómez
- Endocrinology Unit, Hospital Universitario San Ignacio, Pontificia Universidad Javeriana, Bogotá, Colombia
| | - Diana Cristina Henao
- Endocrinology Unit, Hospital Universitario San Ignacio, Pontificia Universidad Javeriana, Bogotá, Colombia
| | - Oscar Mauricio Muñoz
- Internal Medicine Department, Hospital Universitario San Ignacio, Pontificia Universidad Javeriana, Bogotá, Colombia
| | - Diana Marcela Romero
- Endocrinology Unit, Hospital Universitario San Ignacio, Pontificia Universidad Javeriana, Bogotá, Colombia
| | - Julio David Silva León
- Endocrinology Unit, Hospital Universitario San Ignacio, Pontificia Universidad Javeriana, Bogotá, Colombia
| | - Pablo Esteban Jaramillo
- Endocrinology Unit, Hospital Universitario San Ignacio, Pontificia Universidad Javeriana, Bogotá, Colombia
| | - Evelyn Moscoso
- Endocrinology Unit, Hospital Universitario San Ignacio, Pontificia Universidad Javeriana, Bogotá, Colombia
| | - Darío A Parra Prieto
- Endocrinology Unit, Hospital Universitario San Ignacio, Pontificia Universidad Javeriana, Bogotá, Colombia
| | - Sofía Robledo
- Faculty of Medicine, Pontificia Universidad Javeriana, Bogotá, Colombia
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2
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Sterner Isaksson S, Ólafsdóttir AF, Ivarsson S, Imberg H, Toft E, Hallström S, Rosenqvist U, Ekström M, Lind M. The effect of carbohydrate intake on glycaemic control in individuals with type 1 diabetes: a randomised, open-label, crossover trial. THE LANCET REGIONAL HEALTH. EUROPE 2024; 37:100799. [PMID: 38362553 PMCID: PMC10866914 DOI: 10.1016/j.lanepe.2023.100799] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Revised: 11/14/2023] [Accepted: 11/15/2023] [Indexed: 02/17/2024]
Abstract
Background Few studies have examined the effects of lower carbohydrate diets on glucose control in persons with type 1 diabetes (T1D). The objective of the study was to investigate whether a moderate carbohydrate diet improves glucose control in persons with T1D. Methods A randomised, multicentre, open-label, crossover trial over 12 weeks. There were 69 individuals assessed for eligibility, 54 adults with T1D and HbA1c ≥ 58 mmol/mol (7.5%) were randomised. Interventions were moderate carbohydrate diet versus traditional diet (30 vs 50% of total energy from carbohydrates) over four weeks, with a four-week wash-out period between treatments. Masked continuous glucose monitoring was used to evaluate effects on glucose control. The primary endpoint was the difference in mean glucose levels between the last 14 days of each diet phase. Findings 50 individuals were included in the full analysis set with a mean baseline HbA1c of 69 mmol/mol (8.4%), BMI 29 kg/m2, age of 48 years, and 50% were female. The difference in mean glucose levels between moderate carbohydrate and traditional diet was -0.6 mmol/L, 95% CI -0.9 to -0.3, p < 0.001. Time in range increased during moderate carbohydrate diet by 4.7% (68 min/24 h) (95% CI 1.3 to 8.0), p = 0.008. Time above range (>10 mmol/L) decreased by 5.9% (85 min/24 h), 95% CI -9.6 to -2.2, p = 0.003. There were no significant differences in the standard deviation of glucose levels (95% CI -0.3 to 0.0 mmol/L, p = 0.15) or hypoglycaemia in the range <3.9 mmol/L (95% CI -0.4 to 2.9%, p = 0.13) and <3.0 mmol/L (95% CI -0.4 to 1.6%, p = 0.26). Four participants withdrew, none because of adverse events. There were no serious adverse events including severe hypoglycaemia and ketoacidosis. Mean ketone levels were 0.17 (SD 0.14) mmol/L during traditional and 0.18 (SD 0.13) mmol/L during moderate carbohydrate diet (p = 0.02). Interpretation A moderate carbohydrate diet is associated with decreases in mean glucose levels and time above range and increases in time in range without increased risk of hypoglycaemia or ketoacidosis compared with a traditional diet in individuals with T1D. Funding The Healthcare Board, Region Västra Götaland, The Dr P Håkansson Foundation and the Swedish state under the agreement between the Swedish government and the county councils, the ALF-agreement [ALFGBG-966173].
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Affiliation(s)
- Sofia Sterner Isaksson
- Department of Molecular and Clinical Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Medicine, NU Hospital Group, Uddevalla, Sweden
| | - Arndís F. Ólafsdóttir
- Department of Molecular and Clinical Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Medicine, NU Hospital Group, Uddevalla, Sweden
- Department of Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Simon Ivarsson
- Department of Medicine, NU Hospital Group, Uddevalla, Sweden
| | - Henrik Imberg
- Statistiska Konsultgruppen, Gothenburg, Sweden
- Department of Mathematical Sciences, Chalmers University of Technology and University of Gothenburg, Gothenburg, Sweden
| | - Eva Toft
- Department of Medicine, Ersta Hospital, Stockholm, Sweden
- Department of Clinical Education and Science, Södersjukhuset, Karolinska Institute, Stockholm, Sweden
| | - Sara Hallström
- Department of Molecular and Clinical Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Ulf Rosenqvist
- Department of Internal Medicine, Motala Hospital, Motala, Sweden
| | - Marie Ekström
- Department of Medicine, NU Hospital Group, Uddevalla, Sweden
| | - Marcus Lind
- Department of Molecular and Clinical Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Medicine, NU Hospital Group, Uddevalla, Sweden
- Department of Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden
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3
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de Assis RC, Celedonio RF, Valentim AB, Monteiro GR, da Silva AMH, Dantas ACP, Maia CSC. Influence of Anaerobic Exercise in Type 1 Diabetes Mellitus Biomarkers: ASystematic Review. Curr Diabetes Rev 2024; 20:e230124226018. [PMID: 38275039 DOI: 10.2174/0115733998274125231126111321] [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: 08/28/2023] [Revised: 10/23/2023] [Accepted: 10/24/2023] [Indexed: 01/27/2024]
Abstract
AIM Physical exercise is part of the type 1 diabetes mellitus (T1DM) treatment. However, this practice is still neglected due to the wide variety of glycemic responses under the influence of anaerobic exercise. Therefore, this study aimed to investigate the influence of anaerobic exercise on biomarkers of T1DM. METHODS The systematic review was conducted on PubMed, Lilacs, and Embase, according to PRISMA. For this purpose, three groups of descriptors were used: Adults with T1DM, anaerobic physical exercise, and glycemic control. The search filter was set to human beings older than 18 years of age, longitudinal and cross-sectional studies, with studies published from 2000 to 2023 in English, Spanish, or Portuguese. Titles and abstracts were read independently by two reviewers, and then the articles were selected for this review. The Kappa coefficient was measured to evaluate the selection. RESULTS A total of 738 articles were identified, and five were selected to be part of the review after applying the steps of the procedure. Some benefits were observed in fatigue reduction, absence of diabetic ketoacidosis requiring hospitalization, and enhancement of glucose monitoring during exercise. In the anaerobic workouts of the groups with T1DM, glycemic mean values ranged from 124.5-185.0 mg/dl, and glycated hemoglobin records ranged from 6.7-8.1%. CONCLUSION Anaerobic exercise improved the biomarkers of T1DM, especially glycemic control, and the reduction of symptomatic hypoglycemic episodes. Anaerobic exercise can be performed by individuals with T1DM, suggesting an individualized training prescription and encouraging its practice associated with aerobic exercise.
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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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5
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Sterner Isaksson S, Ólafsdóttir AF, Lind M. Design of a randomized cross-over study evaluating effects of carbohydrate intake on glycemic control in persons with type 1 diabetes. Front Nutr 2023; 10:1114317. [PMID: 36992911 PMCID: PMC10041710 DOI: 10.3389/fnut.2023.1114317] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Accepted: 02/22/2023] [Indexed: 03/18/2023] Open
Abstract
IntroductionDiet is an important factor in managing glycemic control in type 1 diabetes (T1D). Reducing carbohydrate intake may be important for stabilizing blood glucose levels in certain groups of patients with T1D. There are few studies examining the effects of a low carbohydrate diet in patients with T1D. The aim of this study is to investigate the effects of carbohydrate intake on glucose control in adults with T1D.Materials and methodsAdults with T1D (N = 54) and inadequate glycemic control (HbA1c ≥ 7.5%; 58 mmol/mol) were randomized in a cross-over design to a moderate carbohydrate diet (30 percent of total energy from carbohydrates) versus a traditional diabetes diet (50 percent of total energy from carbohydrates) for 4 weeks with a between wash-out period of 4 weeks. Masked continuous glucose monitoring was used throughout the study to evaluate effects on mean blood glucose levels, time-in-range, hypoglycemia, hyperglycemia, and glycemic variability. Diabetes treatment satisfaction, hypoglycemic confidence, and physical activity were measured using questionnaires during different phases of the trial. HbA1c, blood lipids, blood pressure, and ketone levels were also measured. The primary endpoint is the difference in mean blood glucose level between the diet periods. Study completion is anticipated during winter 2022.DiscussionThe study seeks to increase knowledge about the effects of dietary carbohydrate intake on glycemic control and other health parameters in patients with T1D. If beneficial effects on mean blood glucose level without elevated risk of hypoglycemia or ketoacidosis are shown, a moderate carbohydrate diet may be a treatment option for people with T1D that have unsatisfactory blood glucose levels.Clinical Trials Registration:www.clinicaltrials.gov, ID: NCT03400618.
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Affiliation(s)
- Sofia Sterner Isaksson
- Department of Molecular and Clinical Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Medicine, NU Hospital Group, Uddevalla, Sweden
- *Correspondence: Sofia Sterner Isaksson,
| | - Arndís F. Ólafsdóttir
- Department of Molecular and Clinical Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Medicine, NU Hospital Group, Uddevalla, Sweden
| | - Marcus Lind
- Department of Molecular and Clinical Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Medicine, NU Hospital Group, Uddevalla, Sweden
- Department of Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden
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6
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Esefeld K, Kress S, Behrens M, Zimmer P, Stumvoll M, Thurm U, Gehr B, Halle M, Brinkmann C. Diabetes, Sports and Exercise. Exp Clin Endocrinol Diabetes 2023; 131:51-60. [PMID: 36638806 DOI: 10.1055/a-1946-3768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Affiliation(s)
- Katrin Esefeld
- Department of Preventive Sports Medicine, Klinikum rechts der Isar, Technical University Munich, Munich, Germany.,German Center for Cardiovascular Research (Deutsches Zentrum für Herzkreislaufforschung - DZHK), partner site Munich Heart Alliance (MHA), Munich, Germany
| | - Stephan Kress
- Diabetes, Sport and Physical Activity Working Group of the DDG.,Department of Internal Medicine I, Vinzentius Hospital Landau, Landau, Germany
| | - Meinolf Behrens
- Diabetes, Sport and Physical Activity Working Group of the DDG.,Diabetes Center Minden, Minden, Germany
| | - Peter Zimmer
- Diabetes, Sport and Physical Activity Working Group of the DDG
| | - Michael Stumvoll
- Department of Internal Medicine III, University Hospital Leipzig, Leipzig, Germany
| | - Ulrike Thurm
- Diabetes, Sport and Physical Activity Working Group of the DDG
| | - Bernhard Gehr
- Diabetes, Sport and Physical Activity Working Group of the DDG.,m&i specialized clinic Bad Heilbrunn, Bad Heilbrunn, Germany
| | - Martin Halle
- Department of Preventive Sports Medicine, Klinikum rechts der Isar, Technical University Munich, Munich, Germany.,German Center for Cardiovascular Research (Deutsches Zentrum für Herzkreislaufforschung - DZHK), partner site Munich Heart Alliance (MHA), Munich, Germany.,Diabetes, Sport and Physical Activity Working Group of the DDG
| | - Christian Brinkmann
- Diabetes, Sport and Physical Activity Working Group of the DDG.,Institute of Cardiovascular Research and Sport Medicine, German Sport University Cologne, Cologne, Germany.,IST University of Applied Sciences Düsseldorf, Düsseldorf, Germany
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7
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Paldus B, Morrison D, Lee M, Zaharieva DP, Riddell MC, O'Neal DN. Strengths and Challenges of Closed-Loop Insulin Delivery During Exercise in People With Type 1 Diabetes: Potential Future Directions. J Diabetes Sci Technol 2022:19322968221088327. [PMID: 35466723 DOI: 10.1177/19322968221088327] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Exercise has many physical and psychological benefits and is recommended for people with type 1 diabetes; however, there are many barriers to exercise, including glycemic instability and fear of hypoglycemia. Closed-loop (CL) systems have shown benefit in the overall glycemic management of type 1 diabetes, including improving HbA1c levels and reducing the incidence of nocturnal hypoglycemia; however, these systems are challenged by the rapidly changing insulin needs with exercise. This commentary focuses on the principles, strengths, and challenges of CL in the management of exercise, and discusses potential approaches, including the use of additional physiological signals, to address their shortcomings in the pursuit of fully automated CL systems.
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Affiliation(s)
- Barbora Paldus
- Department of Medicine, The University of Melbourne, Victoria, Australia
- Department of Endocrinology & Diabetes, St. Vincent's Hospital Melbourne, Victoria, Australia
| | - Dale Morrison
- Department of Medicine, The University of Melbourne, Victoria, Australia
| | - Melissa Lee
- Department of Medicine, The University of Melbourne, Victoria, Australia
- Department of Endocrinology & Diabetes, St. Vincent's Hospital Melbourne, Victoria, Australia
| | - Dessi P Zaharieva
- Division of Endocrinology, Department of Pediatrics, School of Medicine, Stanford University, CA, USA
| | - Michael C Riddell
- School of Kinesiology and Health Science, Muscle Health Research Centre, York University, Toronto, ON, Canada
| | - David N O'Neal
- Department of Medicine, The University of Melbourne, Victoria, Australia
- Department of Endocrinology & Diabetes, St. Vincent's Hospital Melbourne, Victoria, Australia
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8
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Glucose and unstructured physical activity coupling during sleep and wake in young adults with type 1 diabetes. Sci Rep 2022; 12:5790. [PMID: 35388088 PMCID: PMC8986774 DOI: 10.1038/s41598-022-09728-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Accepted: 03/28/2022] [Indexed: 11/30/2022] Open
Abstract
Glucose variations have a bidirectional relationship with the sleep/wake and circadian systems in type 1 diabetes (T1D); however, the mechanisms remain unclear. The aim of this study was to describe the coupling between glucose and unstructured physical activity over 168 h in young adults with T1D. We hypothesized that there would be differences in sleep and wake characteristics and circadian variations. Glucose was measured with a continuous glucose monitoring device every 5 min and activity with a non-dominant wrist-worn actigraph in 30-s epochs over 6–14 days. There was substantial glucose and unstructured physical activity coupling during sleep and wake, along with circadian variation based on the wavelet coherence analysis. The extent to which glucose fluctuations result in disrupted sleep over longer than one week should be examined considering the harmful effects on achieving glycemic targets. Further studies are needed to delineate the respective roles of glucose production and utilization and the potential for improved meal and insulin timing to optimize glucose and sleep in this population reliant on exogenous insulin.
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9
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Pujalte G, Alhumaidi HM, Ligaray KPL, Vomer RP, Israni K, Abadin AA, Meek SE. Considerations in the Care of Athletes With Type 1 Diabetes Mellitus. Cureus 2022; 14:e22447. [PMID: 35345701 PMCID: PMC8942069 DOI: 10.7759/cureus.22447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/21/2022] [Indexed: 11/12/2022] Open
Abstract
Type 1 diabetes mellitus is an autoimmune disease caused by affected individuals’ autoimmune response to their own pancreatic beta-cell. It affects millions of people worldwide. Exercise has numerous health and social benefits for patients with type 1 diabetes mellitus; however, careful management of blood glucose is crucial to minimize the risk of hypoglycemia and hyperglycemia. Anaerobic and aerobic exercises cause different glycemic responses during and after exercise, each of which will affect athletes’ ability to reach their target blood glucose ranges. The optimization of the patient’s macronutrient consumption, especially carbohydrates, the dosage of basal and short-acting insulin, and the frequent monitoring of blood glucose, will enable athletes to perform at peak levels while reducing their risk of dysglycemia. Despite best efforts, hypoglycemia can occur. Recognition of symptoms and rapid treatment with either fast-acting carbohydrates or glucagon is important. Continuous glucose monitoring devices have become more widely used in preventing hypoglycemia.
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10
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Valder S, Brinkmann C. Is intake of fruit juice useful in exercise-induced hypoglycemia prevention in individuals with type 1 diabetes mellitus? Front Endocrinol (Lausanne) 2022; 13:1045639. [PMID: 36339413 PMCID: PMC9633660 DOI: 10.3389/fendo.2022.1045639] [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] [Received: 09/15/2022] [Accepted: 10/03/2022] [Indexed: 11/13/2022] Open
Affiliation(s)
- Sarah Valder
- Institute of Cardiovascular Research and Sport Medicine, Department of Molecular and Cellular Sport Medicine, German Sport University Cologne, Cologne, Germany
| | - Christian Brinkmann
- Institute of Cardiovascular Research and Sport Medicine, Department of Preventive and Rehabilitative Sport Medicine, German Sport University Cologne, Cologne, Germany
- IST University of Applied Sciences, Düsseldorf, Germany
- *Correspondence: Christian Brinkmann,
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11
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Aldibbiat A, Alqashami A, Hussain S. Use of automated insulin delivery systems in people with type 1 diabetes fasting during Ramadan: An observational study. J Diabetes Investig 2021; 13:647-651. [PMID: 34826214 PMCID: PMC9017633 DOI: 10.1111/jdi.13720] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2021] [Revised: 10/18/2021] [Accepted: 11/07/2021] [Indexed: 12/11/2022] Open
Abstract
Fasting among people with type 1 diabetes imposes the risk of metabolic decompensation. Automated insulin dosing systems can allow better glycemic control without safety concerns. The utility in prolonged and repetitive fasting has not been studied. In this observational study, validated glycemic data were reviewed and analyzed from people with type 1 diabetes who observed fasting during Ramadan in 2019 and 2020 using automated insulin dosing systems. Six profiles met the inclusion criteria. The average age was 33.7 ± 4.8 years, diabetes duration was 23.5 ± 7.9 years, body mass index 23.6 ± 1.9 kg/m2 and glycated hemoglobin was 6.3 ± 0.2% (45 ± 5 mmol/mol). The average glucose during Ramadan was 7.0 ± 0.5 mmol/L (126 ± 9 mg/dL), coefficient of variation 28.5%, percentage of time in range 3.9–10 mmol/L (70–180 mg/dL) 88.8 ± 7.3% and percentage time <3.9 mmol/L (<70.0 mg/dL) 2.5 ± 1.3%. The number of fasting days was 27.3 ± 3.3, and the number of days where fasting was broken due diabetes was 1 ± 1.5/participant. No significant differences in glycemic outcomes were noted between Ramadan and non‐Ramadan periods. In this first clinically validated study, automated insulin dosing systems showed a safe and effective management strategy to support prolonged and consecutive fasting in people with type 1 diabetes.
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Affiliation(s)
- Ali Aldibbiat
- Dasman Diabetes Institute, Kuwait City, Kuwait.,Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, UK.,Department of Endocrinology, Prime Hospital, Dubai, United Arab Emirates
| | | | - Sufyan Hussain
- Department of Diabetes & Endocrinology, Guy's and St Thomas' Hospital NHS Trust, London, UK.,Department of Diabetes, School of Life Course Sciences, King's College London, London, UK.,Institute of Diabetes, Endocrinology and Obesity, King's Health Partners, London, UK
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12
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Esefeld K, Kress S, Behrens M, Zimmer P, Stumvoll M, Thurm U, Gehr B, Brinkmann C, Halle M. Diabetes, Sport und Bewegung. DIABETOL STOFFWECHS 2021. [DOI: 10.1055/a-1515-8792] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Affiliation(s)
- Katrin Esefeld
- Präventive und Rehabilitative Sportmedizin, Klinikum rechts der Isar, Technische Universität München, München
- Deutsches Zentrum für Herzkreislaufforschung (DZHK), partner site Munich Heart Alliance (MHA), München
| | - Stephan Kress
- AG Diabetes, Sport und Bewegung der DDG
- Medizinische Klinik Vinzentius-Krankenhaus Landau
| | - Meinolf Behrens
- AG Diabetes, Sport und Bewegung der DDG
- Diabeteszentrum Minden, Minden
| | | | - Michael Stumvoll
- Medizinische Klinik und Poliklinik III, Universitätsklinik Leipzig, Leipzig
| | | | - Bernhard Gehr
- AG Diabetes, Sport und Bewegung der DDG
- m&i Fachklinik Bad Heilbrunn
| | - Christian Brinkmann
- AG Diabetes, Sport und Bewegung der DDG
- Institut für Kreislaufforschung und Sportmedizin, Deutsche Sporthochschule Köln, Köln
- IST Hochschule Düsseldorf, Düsseldorf
| | - Martin Halle
- Präventive und Rehabilitative Sportmedizin, Klinikum rechts der Isar, Technische Universität München, München
- AG Diabetes, Sport und Bewegung der DDG
- Deutsches Zentrum für Herzkreislaufforschung (DZHK), partner site Munich Heart Alliance (MHA), München
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13
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De Paoli B, D’Antoni F, Merone M, Pieralice S, Piemonte V, Pozzilli P. Blood Glucose Level Forecasting on Type-1-Diabetes Subjects during Physical Activity: A Comparative Analysis of Different Learning Techniques. Bioengineering (Basel) 2021; 8:bioengineering8060072. [PMID: 34073433 PMCID: PMC8229703 DOI: 10.3390/bioengineering8060072] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Revised: 05/17/2021] [Accepted: 05/22/2021] [Indexed: 01/26/2023] Open
Abstract
Background: Type 1 Diabetes Mellitus (T1DM) is a widespread chronic disease in industrialized countries. Preventing blood glucose levels from exceeding the euglycaemic range would reduce the incidence of diabetes-related complications and improve the quality of life of subjects with T1DM. As a consequence, in the last decade, many Machine Learning algorithms aiming to forecast future blood glucose levels have been proposed. Despite the excellent performance they obtained, the prediction of abrupt changes in blood glucose values produced during physical activity (PA) is still one of the main challenges. Methods: A Jump Neural Network was developed in order to overcome the issue of predicting blood glucose values during PA. Three learning configurations were developed and tested: offline training, online training, and online training with reinforcement. All configurations were tested on six subjects suffering from T1DM that held regular PA (three aerobic and three anaerobic) and exploited Continuous Glucose Monitoring (CGM). Results: The forecasting performance was evaluated in terms of the Root-Mean-Squared-Error (RMSE), according to a paradigm of Precision Medicine. Conclusions: The online learning configurations performed better than the offline configuration in total days but not on the only CGM associated with the PA; thus, the results do not justify the increased computational burden because the improvement was not significant.
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Affiliation(s)
- Benedetta De Paoli
- Unit of Computer Systems and Bioinformatics, Department of Engineering, Università Campus Bio-Medico di Roma, 00128 Rome, Italy; (B.D.P.); (F.D.)
| | - Federico D’Antoni
- Unit of Computer Systems and Bioinformatics, Department of Engineering, Università Campus Bio-Medico di Roma, 00128 Rome, Italy; (B.D.P.); (F.D.)
| | - Mario Merone
- Unit of Computer Systems and Bioinformatics, Department of Engineering, Università Campus Bio-Medico di Roma, 00128 Rome, Italy; (B.D.P.); (F.D.)
- Correspondence: ; Tel.: +39-06-225-419-622
| | - Silvia Pieralice
- Unit of Diabetology and Endocrinology, Department of Medicine, Università Campus Bio-Medico di Roma, 00128 Rome, Italy; (S.P.); (P.P.)
| | - Vincenzo Piemonte
- Unit of Chemical Engineering, Department of Engineering, Università Campus Bio-Medico di Roma, 00128 Rome, Italy;
| | - Paolo Pozzilli
- Unit of Diabetology and Endocrinology, Department of Medicine, Università Campus Bio-Medico di Roma, 00128 Rome, Italy; (S.P.); (P.P.)
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14
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Diabetes, Sport und Bewegung. DIABETOLOGE 2021. [DOI: 10.1007/s11428-021-00745-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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15
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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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16
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Esefeld K, Kress S, Behrens M, Zimmer P, Stumvoll M, Thurm U, Gehr B, Brinkmann C, Halle M. Diabetes, Sports and Exercise. Exp Clin Endocrinol Diabetes 2020; 129:S52-S59. [PMID: 33348380 DOI: 10.1055/a-1284-6097] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
- Katrin Esefeld
- Department of Preventive Sports Medicine and Sports Cardiology, Technical University Munich, Munich, Germany.,German Center for Cardiovascular Research (Deutsches Zentrum für Herzkreislaufforschung - DZHK), partner site Munich Heart Alliance (MHA), Munich, Germany
| | - Stephan Kress
- Diabetes, Sport and Physical Activity Working Group of the DDG, Germany.,Department of Internal Medicine I, Vinzentius Hospital Landau, Germany
| | - Meinolf Behrens
- Diabetes, Sport and Physical Activity Working Group of the DDG, Germany.,Diabetes Center Minden, Minden, Germany
| | - Peter Zimmer
- Diabetes, Sport and Physical Activity Working Group of the DDG, Germany
| | - Michael Stumvoll
- Medical Department III - Endocrinology, Nephrology, Rheumatology, University Hospital Leipzig, Leipzig, Germany
| | - Ulrike Thurm
- Diabetes, Sport and Physical Activity Working Group of the DDG, Germany
| | - Bernhard Gehr
- Diabetes, Sport and Physical Activity Working Group of the DDG, Germany.,m&i specialized clinic Bad Heilbrunn, Germany
| | - Christian Brinkmann
- Diabetes, Sport and Physical Activity Working Group of the DDG, Germany.,Institute of Cardiovascular Research and Sport Medicine, German Sport University Cologne, Cologne, Germany.,IST University of Applied Sciences Düsseldorf, Düsseldorf, Germany
| | - Martin Halle
- Department of Preventive Sports Medicine and Sports Cardiology, Technical University Munich, Munich, Germany.,Diabetes, Sport and Physical Activity Working Group of the DDG, Germany.,German Center for Cardiovascular Research (Deutsches Zentrum für Herzkreislaufforschung - DZHK), partner site Munich Heart Alliance (MHA), Munich, Germany
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17
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Esefeld K, Kress S, Behrens M, Zimmer P, Stumvoll M, Thurm U, Gehr B, Brinkmann C, Halle M. Diabetes, Sport und Bewegung. DIABETOL STOFFWECHS 2020. [DOI: 10.1055/a-1193-3901] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Affiliation(s)
- Katrin Esefeld
- Präventive und Rehabilitative Sportmedizin, Klinikum rechts der Isar, Technische Universität München, München
- Deutsches Zentrum für Herzkreislaufforschung (DZHK), partner site Munich Heart Alliance (MHA), München
| | - Stephan Kress
- AG Diabetes und Sport der DDG
- Medizinische Klinik Vinzentius-Krankenhaus Landau
| | | | | | - Michael Stumvoll
- Medizinische Klinik und Poliklinik III, Universitätsklinik Leipzig, Leipzig
| | | | - Bernhard Gehr
- AG Diabetes und Sport der DDG
- m&i Fachklinik Bad Heilbrunn
| | - Christian Brinkmann
- AG Diabetes und Sport der DDG
- Institut für Kreislaufforschung und Sportmedizin, Deutsche Sporthochschule Köln, Köln
- IST Hochschule Düsseldorf, Düsseldorf
| | - Martin Halle
- Präventive und Rehabilitative Sportmedizin, Klinikum rechts der Isar, Technische Universität München, München
- AG Diabetes und Sport der DDG
- Deutsches Zentrum für Herzkreislaufforschung (DZHK), partner site Munich Heart Alliance (MHA), München
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18
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Nutrition and Exercise Performance in Adults With Type 1 Diabetes. Can J Diabetes 2020; 44:750-758. [PMID: 32847769 DOI: 10.1016/j.jcjd.2020.05.014] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Revised: 05/22/2020] [Accepted: 05/26/2020] [Indexed: 11/21/2022]
Abstract
The best nutritional practices for exercise and sports performance are largely activity specific. The presence of type 1 diabetes undeniably bestows additional factors to consider to manage exercise and ensure adequate nutrients and fuels are available for optimal performance. Whether participating in sports or physical activity on a recreational basis or striving to achieve a high level of athletic performance, individuals with type 1 diabetes must pay attention to their nutritional and dietary patterns, including intake of macronutrients, micronutrients, fluids and supplements, such as caffeine to maintain metabolic and glycemic balance. Performance aside, nutritional recommendations may also differ on an individual basis relative to exercise, glycemic management and body weight goals. Balancing all these dietary factors can be challenging for individuals with type 1 diabetes, and many related aspects have yet to be fully researched in this population.
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19
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Eckstein ML, McCarthy O, Tripolt NJ, Müller A, Birnbaumer P, Pferschy PN, Hofmann P, Bracken RM, Sourij H, Moser O. Efficacy of Carbohydrate Supplementation Compared With Bolus Insulin Dose Reduction Around Exercise in Adults With Type 1 Diabetes: A Retrospective, Controlled Analysis. Can J Diabetes 2020; 44:697-700. [PMID: 32565070 DOI: 10.1016/j.jcjd.2020.03.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2019] [Revised: 03/10/2020] [Accepted: 03/10/2020] [Indexed: 12/27/2022]
Abstract
OBJECTIVES Individuals with type 1 diabetes try to manage the risk of exercise-induced hypoglycemia by either pre-exercise/pre-meal bolus insulin dose reductions and/or consuming additional carbohydrates during exercise. Both strategies have proven to be effective in offsetting hypoglycemia, but it remains unclear which one is more beneficial. The aim of this study was to assess the efficacy of carbohydrate supplementation vs bolus insulin dose reduction in prevention of hypoglycemia during moderate-intensity exercise in those with type 1 diabetes. METHODS This investigation was a retrospective, controlled analysis of 2 independent clinical trials. All participants performed continuous, moderate-intensity cycle ergometer exercise for ∼45 minutes. Two therapy management groups and a control group were compared. Group A was supplemented with 15 to 30 g carbohydrates at a glycemic threshold of 7.0 mmol/L during exercise, group B reduced their individual bolus insulin dose by 50% with their last meal before exercise and group C served as a control. RESULTS No hypoglycemic events occurred in group A, whereas 4 events were recorded in groups B (p=0.02) and C (p=0.02). CONCLUSIONS Carbohydrate supplementation was superior to bolus insulin reduction for prevention of hypoglycemia during exercise in people with type 1 diabetes.
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Affiliation(s)
- Max L Eckstein
- Cardiovascular Diabetology Research Group, Division of Endocrinology and Diabetology, Medical University of Graz, Graz, Austria
| | - Olivia McCarthy
- Applied Sport, Technology, Exercise and Medicine Research Centre, Swansea University, Swansea, United Kingdom
| | - Norbert J Tripolt
- Cardiovascular Diabetology Research Group, Division of Endocrinology and Diabetology, Medical University of Graz, Graz, Austria
| | - Alexander Müller
- Exercise Physiology, Training and Training Therapy Research Group, Institute of Sports Science, University of Graz, Graz, Austria
| | - Philipp Birnbaumer
- Exercise Physiology, Training and Training Therapy Research Group, Institute of Sports Science, University of Graz, Graz, Austria
| | - Peter N Pferschy
- Cardiovascular Diabetology Research Group, Division of Endocrinology and Diabetology, Medical University of Graz, Graz, Austria
| | - Peter Hofmann
- Exercise Physiology, Training and Training Therapy Research Group, Institute of Sports Science, University of Graz, Graz, Austria
| | - Richard M Bracken
- Applied Sport, Technology, Exercise and Medicine Research Centre, Swansea University, Swansea, United Kingdom
| | - Harald Sourij
- Cardiovascular Diabetology Research Group, Division of Endocrinology and Diabetology, Medical University of Graz, Graz, Austria; Zayed Center for Health Sciences, United Arab Emirates University, United Arab Emirates
| | - Othmar Moser
- Cardiovascular Diabetology Research Group, Division of Endocrinology and Diabetology, Medical University of Graz, Graz, Austria.
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20
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21
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Lee MH, Vogrin S, Paldus B, Jayawardene D, Jones HM, McAuley SA, Obeyesekere V, Gooley J, La Gerche A, MacIsaac RJ, Sundararajan V, Jenkins AJ, Ward GM, O'Neal DN. Glucose and Counterregulatory Responses to Exercise in Adults With Type 1 Diabetes and Impaired Awareness of Hypoglycemia Using Closed-Loop Insulin Delivery: A Randomized Crossover Study. Diabetes Care 2020; 43:480-483. [PMID: 31796571 DOI: 10.2337/dc19-1433] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2019] [Accepted: 11/03/2019] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To evaluate exercise-related glucose and counterregulatory responses (CRR) in adults with type 1 diabetes with impaired awareness of hypoglycemia (IAH) using hybrid closed-loop (HCL) insulin delivery to maintain glucose homeostasis. RESEARCH DESIGN AND METHODS Twelve participants undertook 45-min high-intensity intermittent exercise (HIIE) and moderate-intensity exercise (MIE) in random order. The primary outcome was continuous glucose monitoring (CGM) time in range (70-180 mg/dL) for 24-h post-exercise commencement. RESULTS CGM time in range was similar for HIIE and MIE (median 79.5% [interquartile range 73.2, 87.6] vs. 76.1% [70.3, 83.9], P = 0.37), and time with levels <54mg/dL post-exercise commencement was 0%. HIIE induced greater increases in cortisol (P = 0.002), noradrenaline (P = 0.005), and lactate (P = 0.002), with no differences in adrenaline, dopamine, growth hormone, or glucagon responses. CONCLUSIONS IAH adults using HCL undertaking HIIE and MIE exhibit heterogeneity in CRR. Novel findings were a preserved cortisol response and variable catecholamine responses to HIIE.
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Affiliation(s)
- Melissa H Lee
- University of Melbourne, Department of Medicine, Melbourne, Australia.,Department of Endocrinology and Diabetes, St Vincent's Hospital Melbourne, Melbourne, Australia
| | - Sara Vogrin
- University of Melbourne, Department of Medicine, Melbourne, Australia
| | - Barbora Paldus
- University of Melbourne, Department of Medicine, Melbourne, Australia
| | | | - Hannah M Jones
- University of Melbourne, Department of Medicine, Melbourne, Australia.,Department of Endocrinology and Diabetes, St Vincent's Hospital Melbourne, Melbourne, Australia
| | - Sybil A McAuley
- University of Melbourne, Department of Medicine, Melbourne, Australia.,Department of Endocrinology and Diabetes, St Vincent's Hospital Melbourne, Melbourne, Australia
| | - Varuni Obeyesekere
- Department of Endocrinology and Diabetes, St Vincent's Hospital Melbourne, Melbourne, Australia
| | - Judith Gooley
- University of Melbourne, Department of Medicine, Melbourne, Australia
| | - André La Gerche
- Department of Cardiology, St Vincent's Hospital Melbourne, Melbourne, Australia.,Clinical Research Domain, Baker Heart and Diabetes Institute, Melbourne, Australia
| | - Richard J MacIsaac
- University of Melbourne, Department of Medicine, Melbourne, Australia.,Department of Endocrinology and Diabetes, St Vincent's Hospital Melbourne, Melbourne, Australia
| | - Vijaya Sundararajan
- University of Melbourne, Department of Medicine, Melbourne, Australia.,Department of Public Health, La Trobe University, Melbourne, Australia
| | - Alicia J Jenkins
- University of Melbourne, Department of Medicine, Melbourne, Australia.,Department of Endocrinology and Diabetes, St Vincent's Hospital Melbourne, Melbourne, Australia.,NHMRC Clinical Trials Centre at the University of Sydney, Sydney, Australia
| | - Glenn M Ward
- Department of Endocrinology and Diabetes, St Vincent's Hospital Melbourne, Melbourne, Australia.,Department of Pathology, University of Melbourne, Melbourne, Australia
| | - David N O'Neal
- University of Melbourne, Department of Medicine, Melbourne, Australia .,Department of Endocrinology and Diabetes, St Vincent's Hospital Melbourne, Melbourne, Australia
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22
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Nolan J, Rush A, Kaye J. Glycaemic stability of a cyclist with Type 1 diabetes: 4011 km in 20 days on a ketogenic diet. Diabet Med 2019; 36:1503-1507. [PMID: 31197870 DOI: 10.1111/dme.14049] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/11/2019] [Indexed: 11/28/2022]
Abstract
BACKGROUND Maintaining glycaemic control during exercise presents a significant challenge for people living with Type 1 diabetes. Significant glycaemic variability has been observed in athletes with Type 1 diabetes in competitive contexts. While very-low-carbohydrate ketogenic diets have been shown to minimize glycaemic excursions, no published data have examined if this translates to exercise. CASE REPORT We report the case of a 37-year-old man with Type 1 diabetes who successfully undertook a 4011 km cycle across Australia over 20 consecutive days whilst consuming a very-low-carbohydrate ketogenic diet. Continuous glucose monitoring data capture was 98.4% for the ride duration and showed remarkable glycaemic stability, with a standard deviation of 2.1 mmol/l (average interstitial glucose 6.1 mmol/l) and 80.4% of time spent within a range of 3.9-10 mmol/l. Interstitial glucose was <3 mmol/l for 2.1% of this time, with only a single episode of symptomatic hypoglycaemia prompting brief interruption of exercise for carbohydrate administration. CONCLUSION This case demonstrates the viability of a very-low-carbohydrate ketogenic diet in an individual with Type 1 diabetes undertaking exercise. While the effect of a very-low-carbohydrate ketogenic diet is yet to be examined more broadly in athletes with Type 1 diabetes, the glycaemic stability observed suggests that fat adaptation may attenuate glycaemic swings and reduce reliance on carbohydrate consumption during exercise for maintaining euglycaemia.
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Affiliation(s)
- J Nolan
- Department of Endocrinology and Diabetes, Sir Charles Gairdner Hospital, Nedlands
| | - A Rush
- Type 1 Diabetes Family Centre, Osborne Park, WA, Australia
| | - J Kaye
- Department of Endocrinology and Diabetes, Sir Charles Gairdner Hospital, Nedlands
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23
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Andrade EF, de Oliveira Silva V, Orlando DR, Pereira LJ. Mechanisms Involved in Glycemic Control Promoted by Exercise in Diabetics. Curr Diabetes Rev 2019; 15:105-110. [PMID: 29446746 DOI: 10.2174/1573399814666180214144717] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2017] [Revised: 01/22/2018] [Accepted: 01/31/2018] [Indexed: 01/14/2023]
Abstract
INTRODUCTION Diabetes mellitus is a metabolic disease characterized by high glycemic levels for long periods. This disease has a high prevalence in the world population, being currently observed an increase in its incidence. This fact is mainly due to the sedentary lifestyle and hypercaloric diets. Non-pharmacological interventions for glycemic control include exercise, which promotes changes in skeletal muscle and adipocytes. Thus, increased glucose uptake by skeletal muscle and decreased insulin resistance through modulating adipocytes are the main factors that improve glycemic control against diabetes. CONCLUSION It was sought to elucidate mechanisms involved in the improvement of glycemic control in diabetics in front of the exercise.
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Affiliation(s)
| | | | - Débora Ribeiro Orlando
- Department of Agricultural Sciences, Federal University of Jequitinhonha and Mucuri Valleys, Unai, Brazil
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24
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Kudva YC, Ahmann AJ, Bergenstal RM, Gavin JR, Kruger DF, Midyett LK, Miller E, Harris DR. Approach to Using Trend Arrows in the FreeStyle Libre Flash Glucose Monitoring Systems in Adults. J Endocr Soc 2018; 2:1320-1337. [PMID: 30474069 PMCID: PMC6243139 DOI: 10.1210/js.2018-00294] [Citation(s) in RCA: 56] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2018] [Accepted: 10/23/2018] [Indexed: 12/11/2022] Open
Abstract
The use of personal continuous glucose monitoring (CGM) has expanded dramatically among individuals with diabetes. CGM systems provide retrospective data, as well as the current glucose value and trend arrow data, which indicate the direction and velocity of changing glucose. In 2017, Aleppo and colleagues developed a simplified approach for adults with diabetes to safely adjust rapid-acting insulin doses using trend arrow information in the Dexcom G5 CGM system. Since then, the FreeStyle Libre and FreeStyle Libre 14-day CGM systems have become available in the United States; however, guidance on using trend arrow data that take the unique features of these systems into consideration is lacking. Specifically, the FreeStyle Libre systems do not have automatic alarms, which impact how the system and trend arrow data are used. The Endocrine Society convened an expert panel to address this gap and develop an approach to adjusting rapid-acting insulin doses for adults using trend arrows in the FreeStyle Libre systems. We based our approach on previous work and expanded upon engagement and scanning recommendations, and we incorporated pre-exercise planning specific to these systems. Our approach provides insulin dose adjustments as discrete insulin units based on an individual’s insulin sensitivity and directionality of the trend arrow. We focus on the needs of patients treated with multiple daily injections because these individuals currently make up a greater proportion of individuals on intensive insulin therapy. Our recommendations are intended to provide a safe, practical approach to using trend arrows in the FreeStyle Libre systems.
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Affiliation(s)
- Yogish C Kudva
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota
| | - Andrew J Ahmann
- Division of Endocrinology, Diabetes, and Clinical Nutrition, Oregon Health and Science University, Portland, Oregon
| | - Richard M Bergenstal
- International Diabetes Center, Park Nicollet Health Services, Minneapolis, Minnesota
| | - James R Gavin
- Emory University School of Medicine, Atlanta, Georgia
| | - Davida F Kruger
- Division of Endocrinology, Diabetes, and Bone and Mineral Disorders, Henry Ford Health System, Detroit, Michigan
| | | | - Eden Miller
- High Lakes Health Care, St. Charles Hospital, Bend, Oregon
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25
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Duda-Sobczak A, Falkowski B, Araszkiewicz A, Zozulinska-Ziolkiewicz D. Association Between Self-reported Physical Activity and Skin Autofluorescence, a Marker of Tissue Accumulation of Advanced Glycation End Products in Adults With Type 1 Diabetes: A Cross-sectional Study. Clin Ther 2018; 40:872-880. [DOI: 10.1016/j.clinthera.2018.02.016] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2017] [Accepted: 02/22/2018] [Indexed: 01/03/2023]
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26
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Aleppo G, Laffel LM, Ahmann AJ, Hirsch IB, Kruger DF, Peters A, Weinstock RS, Harris DR. A Practical Approach to Using Trend Arrows on the Dexcom G5 CGM System for the Management of Adults With Diabetes. J Endocr Soc 2017; 1:1445-1460. [PMID: 29344577 PMCID: PMC5760210 DOI: 10.1210/js.2017-00388] [Citation(s) in RCA: 63] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2017] [Accepted: 11/03/2017] [Indexed: 11/19/2022] Open
Affiliation(s)
- Grazia Aleppo
- Division of Endocrinology, Metabolism and Molecular Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois 60611
| | - Lori M Laffel
- Pediatric, Adolescent and Young Adult Programs, Joslin Diabetes Center, Harvard Medical School, Boston, Massachusetts 02215
| | - Andrew J Ahmann
- Division of Endocrinology, Diabetes and Clinical Nutrition, Oregon Health & Science University, Portland, Oregon 97239
| | - Irl B Hirsch
- Department of Medicine, University of Washington, Seattle, Washington 98195
| | - Davida F Kruger
- Division of Endocrinology, Diabetes and Bone & Mineral, Henry Ford Health System, Detroit, Michigan 48202
| | - Anne Peters
- Keck School of Medicine, University of Southern California, Los Angeles, California 90033
| | - Ruth S Weinstock
- Department of Medicine, SUNY Upstate Medical University, Syracuse, New York 13210
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27
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Laffel LM, Aleppo G, Buckingham BA, Forlenza GP, Rasbach LE, Tsalikian E, Weinzimer SA, Harris DR. A Practical Approach to Using Trend Arrows on the Dexcom G5 CGM System to Manage Children and Adolescents With Diabetes. J Endocr Soc 2017; 1:1461-1476. [PMID: 29344578 PMCID: PMC5760209 DOI: 10.1210/js.2017-00389] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2017] [Accepted: 11/03/2017] [Indexed: 01/15/2023] Open
Abstract
After assessing previously published methods, we developed a practical approach to adjusting insulin doses using rtCGM trend arrows in pediatric patients with diabetes.
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Affiliation(s)
- Lori M Laffel
- Pediatric, Adolescent and Young Adult Programs, Joslin Diabetes Center, Harvard Medical School, Boston, Massachusetts 02215
| | - Grazia Aleppo
- Division of Endocrinology, Metabolism and Molecular Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois 60611
| | - Bruce A Buckingham
- Department of Pediatric Endocrinology, Stanford University, Stanford, California 94305
| | - Gregory P Forlenza
- Barbara Davis Center, University of Colorado Denver, Aurora, Colorado 80045
| | - Lisa E Rasbach
- Division of Pediatric Endocrinology, Johns Hopkins Children's Center, Baltimore, Maryland 21287
| | - Eva Tsalikian
- Division of Endocrinology and Diabetes, Department of Pediatrics, University of Iowa Carver College of Medicine, Iowa City, Iowa 52242
| | - Stuart A Weinzimer
- Department of Pediatrics, Yale University School of Medicine, New Haven, Connecticut 06510
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Abstract
PURPOSE OF REVIEW Exercise is recommended as therapeutic intervention for people at risk to develop type 2 diabetes to prevent or treat the disease. Recent studies on the influence of obesity and type 2 diabetes on the outcome of exercise programs are discussed. RECENT FINDINGS Poor glycemic control before an intervention can be a risk factor of reduced therapeutic benefit from exercise. But the acute metabolic response to exercise and the transcriptional profile of the working muscle is similar in healthy controls and type 2 diabetic patients, including but not limited to intact activation of skeletal muscle AMP-activated kinase signaling, glucose uptake and expression of peroxisome proliferator-activated receptor gamma coactivator 1α. The increase in plasma acylcarnitines during exercise is not influenced by type 2 diabetes or obesity. The hepatic response to exercise is dependent on the glucagon/insulin ratio and the exercise-induced increase in hepatokines such as fibroblast growth factor 21 and follistatin is impaired in type 2 diabetes and obesity, but consequences for the benefit from exercise are unknown yet. SUMMARY Severe metabolic dysregulation can reduce the benefit from exercise, but the intact response of key metabolic regulators in exercising skeletal muscle of diabetic patients demonstrates the effectiveness of exercise programs to treat the disease.
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Affiliation(s)
- Peter Plomgaard
- aThe Centre of Inflammation and Metabolism, Centre for Physical Activity Research bDepartment of Clinical Biochemistry, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark cDivision of Endocrinology, Diabetology, Angiology, Nephrology, Pathobiochemistry and Clinical Chemistry, Department of Internal Medicine IV dInstitute for Diabetes Research and Metabolic Diseases of the Helmholtz Center Munich at the University of Tuebingen eGerman Center for Diabetes Research (DZD), Tuebingen, Germany
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29
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Nadella S, Indyk JA, Kamboj MK. Management of diabetes mellitus in children and adolescents: engaging in physical activity. Transl Pediatr 2017; 6:215-224. [PMID: 28795013 PMCID: PMC5532192 DOI: 10.21037/tp.2017.05.01] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Regular physical activity is an important component in the management of both type 1 and type 2 diabetes mellitus (T1DM and T2DM), as it has the potential to improve glycemic control, delay cardiovascular complications, and increase overall well-being. Unfortunately, many children and adolescents with diabetes do not partake in regular exercise and physical activity for multiple reasons. This review identifies the barriers to participation from the aspect of the patient, caregiver, and the healthcare provider. The management of physical activity of children and adolescents with diabetes mellitus is unique and requires an understanding of exercise physiology and how it differs in these children and adolescents from those without the condition. These individuals are at risk for important and potentially life threatening complications including, but not limited to, severe or delayed nocturnal hypoglycemia. It is essential to identify these risks as well as, monitor and manage adjustments to carbohydrate intake and insulin dosing through basal-bolus regimen or insulin pump adjustments appropriately before, during, and after the exercise activity. This review discusses these issues and also outlines differences in management between patients with T1DM and T2DM.
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Affiliation(s)
- Silpa Nadella
- Emory University School of Medicine, Atlanta, GA, USA
| | - Justin A Indyk
- Section of Endocrinology, The Ohio State University, Nationwide Children's Hospital, Columbus, OH, USA
| | - Manmohan K Kamboj
- Section of Endocrinology, The Ohio State University, Nationwide Children's Hospital, Columbus, OH, USA
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30
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Farinha JB, Krause M, Rodrigues-Krause J, Reischak-Oliveira A. Exercise for type 1 diabetes mellitus management: General considerations and new directions. Med Hypotheses 2017; 104:147-153. [DOI: 10.1016/j.mehy.2017.05.033] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2017] [Revised: 05/05/2017] [Accepted: 05/28/2017] [Indexed: 12/17/2022]
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Riddell MC, Gallen IW, Smart CE, Taplin CE, Adolfsson P, Lumb AN, Kowalski A, Rabasa-Lhoret R, McCrimmon RJ, Hume C, Annan F, Fournier PA, Graham C, Bode B, Galassetti P, Jones TW, Millán IS, Heise T, Peters AL, Petz A, Laffel LM. Exercise management in type 1 diabetes: a consensus statement. Lancet Diabetes Endocrinol 2017; 5:377-390. [PMID: 28126459 DOI: 10.1016/s2213-8587(17)30014-1] [Citation(s) in RCA: 507] [Impact Index Per Article: 72.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2016] [Revised: 11/20/2016] [Accepted: 11/21/2016] [Indexed: 12/28/2022]
Abstract
Type 1 diabetes is a challenging condition to manage for various physiological and behavioural reasons. Regular exercise is important, but management of different forms of physical activity is particularly difficult for both the individual with type 1 diabetes and the health-care provider. People with type 1 diabetes tend to be at least as inactive as the general population, with a large percentage of individuals not maintaining a healthy body mass nor achieving the minimum amount of moderate to vigorous aerobic activity per week. Regular exercise can improve health and wellbeing, and can help individuals to achieve their target lipid profile, body composition, and fitness and glycaemic goals. However, several additional barriers to exercise can exist for a person with diabetes, including fear of hypoglycaemia, loss of glycaemic control, and inadequate knowledge around exercise management. This Review provides an up-to-date consensus on exercise management for individuals with type 1 diabetes who exercise regularly, including glucose targets for safe and effective exercise, and nutritional and insulin dose adjustments to protect against exercise-related glucose excursions.
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Affiliation(s)
- Michael C Riddell
- Muscle Health Research Centre, York University, Toronto, ON, Canada.
| | - Ian W Gallen
- Royal Berkshire NHS Foundation Trust Centre for Diabetes and Endocrinology, Royal Berkshire Hospital, Reading, UK
| | - Carmel E Smart
- Hunter Medical Research Institute, School of Health Sciences, University of Newcastle, Rankin Park, NSW, Australia
| | - Craig E Taplin
- Division of Endocrinology and Diabetes, Department of Pediatrics, University of Washington, Seattle Children's Hospital, Seattle, WA, USA
| | - Peter Adolfsson
- Department of Pediatrics, The Hospital of Halland, Kungsbacka, Sweden; Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Alistair N Lumb
- Oxford Centre for Diabetes, Endocrinology and Metabolism, Churchill Hospital, Oxford, UK
| | - Aaron Kowalski
- Juvenile Diabetes Research Foundation, New York, NY, USA
| | - Remi Rabasa-Lhoret
- Department of Nutrition and Institut de Recherches Cliniques de Montréal, Faculty of Medicine, Université de Montréal, Montreal, QC, Canada
| | - Rory J McCrimmon
- Division of Molecular and Clinical Medicine, School of Medicine, University of Dundee, Dundee, UK
| | | | - Francesca Annan
- Children and Young People's Diabetes Service, University College London Hospitals NHS Foundation Trust, London, UK
| | - Paul A Fournier
- School of Sport Science, Exercise, and Health, Perth, WA, Australia
| | | | - Bruce Bode
- Atlanta Diabetes Associates, Atlanta, GA, USA
| | - Pietro Galassetti
- Department of Pediatrics, University of California Irvine, Irvine, CA, USA; AstraZeneca, Gaithersburg, MD, USA
| | - Timothy W Jones
- The University of Western Australia, Perth, WA, Australia; Department of Endocrinology and Diabetes, Princess Margaret Hospital for Children, Perth, WA, Australia; Telethon Kids Institute, Perth, WA, Australia
| | - Iñigo San Millán
- Department of Physical Medicine and Rehabilitation, University of Colorado, School of Medicine, Aurora, CO, USA
| | | | - Anne L Peters
- Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | | | - Lori M Laffel
- Division of Endocrinology, Boston Children's Hospital, Boston, MA, USA; Pediatric, Adolescent and Young Adult Section, Joslin Diabetes Center, Boston, MA, USA
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Farabi SS, Carley DW, Quinn L. Glucose Variations and Activity Are Strongly Coupled in Sleep and Wake in Young Adults With Type 1 Diabetes. Biol Res Nurs 2016; 19:249-257. [PMID: 28413931 DOI: 10.1177/1099800416685177] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Glucose variations are common throughout sleep and wakefulness in people with type 1 diabetes mellitus (T1DM). The objective of this investigation was to characterize the time-varying coupling between glucose and unstructured physical activity over a 60-hr period in young adults with T1DM. The hypothesis was that coupling would differ during sleep versus wakefulness and would exhibit circadian variations. METHOD Young adults with T1DM treated with an insulin pump participated in the study. Glucose variations were monitored with a continuous glucose monitoring system, and activity was assessed using an activity-monitoring band worn on the nondominant wrist. Simultaneous glucose and physical activity data across a continuous 60-hr period were used for analysis. Wavelet coherence analysis was employed to quantify the coupling between physical activity and glucose. Cosinor analysis was used to assess whether glucose/activity coherence exhibited significant circadian variations. RESULTS Participants comprised 23 adults, aged 18-30 years, with T1DM. Coherence analysis demonstrated substantial coupling between physical activity and glucose variations during both wakefulness and sleep. For rapid (10-30 min) fluctuations, mean coherence was higher during sleep than wakefulness ( F = 10.86, p = .003). Rapid glucose variations consistently led to changes in activity ( p = .001) during sleep but not during wake. Cosinor analysis revealed significant circadian modulation of glucose/activity coupling, especially for fluctuation periods 2-4 hr. CONCLUSIONS Unstructured physical activity and glucose variations demonstrated strong time- and frequency-dependent coupling over a 60-hr period in young adults with T1DM, with sleep/wake differences and circadian modulation evident in this relationship.
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Affiliation(s)
- Sarah S Farabi
- 1 Endocrinology, Metabolism & Diabetes, Division of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - David W Carley
- 2 Center for Narcolepsy, Sleep and Health Research, University of Illinois at Chicago, Chicago, IL, USA.,3 Department of Biobehavioral Health Science, University of Illinois at Chicago, Chicago, IL, USA.,4 Department of Medicine, University of Illinois at Chicago, Chicago, IL, USA.,5 Department of Bioengineering, University of Illinois at Chicago, Chicago, IL, USA
| | - Lauretta Quinn
- 3 Department of Biobehavioral Health Science, University of Illinois at Chicago, Chicago, IL, USA
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33
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de Carvalho AK, da Silva S, Serafini E, de Souza DR, Farias HR, de Bem Silveira G, Silveira PCL, de Souza CT, Portela LV, Muller AP. Prior Exercise Training Prevent Hyperglycemia in STZ Mice by Increasing Hepatic Glycogen and Mitochondrial Function on Skeletal Muscle. J Cell Biochem 2016; 118:678-685. [DOI: 10.1002/jcb.25658] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2016] [Accepted: 07/21/2016] [Indexed: 02/06/2023]
Affiliation(s)
- Afonso Kopczynski de Carvalho
- Departamento de Bioquímica; ICBS; UFRGS; Programa de Pós Graduação em Ciências Biológicas-Bioquímica; Rua Ramiro Barcelos, 2600 anexo Porto Alegre Rio Grande do Sul CEP 90035-003 Brazil
| | - Sabrina da Silva
- Unidade de Ciências da Saúde; Laboratório de Bioquímica e Fisiologia do Exercício Universidade do Extremo Sul Catarinense-UNESC; Av. Universitária, 1105-Bairro Universitário Criciúma Santa Catarina CEP 88806-000 Brazil
| | - Edenir Serafini
- Unidade de Ciências da Saúde; Laboratório de Bioquímica e Fisiologia do Exercício Universidade do Extremo Sul Catarinense-UNESC; Av. Universitária, 1105-Bairro Universitário Criciúma Santa Catarina CEP 88806-000 Brazil
| | - Daniela Roxo de Souza
- Unidade de Ciências da Saúde; Laboratório de Bioquímica e Fisiologia do Exercício Universidade do Extremo Sul Catarinense-UNESC; Av. Universitária, 1105-Bairro Universitário Criciúma Santa Catarina CEP 88806-000 Brazil
| | - Hemelin Resende Farias
- Unidade de Ciências da Saúde; Laboratório de Bioquímica e Fisiologia do Exercício Universidade do Extremo Sul Catarinense-UNESC; Av. Universitária, 1105-Bairro Universitário Criciúma Santa Catarina CEP 88806-000 Brazil
| | - Gustavo de Bem Silveira
- Unidade de Ciências da Saúde; Laboratório de Bioquímica e Fisiologia do Exercício Universidade do Extremo Sul Catarinense-UNESC; Av. Universitária, 1105-Bairro Universitário Criciúma Santa Catarina CEP 88806-000 Brazil
| | - Paulo Cesar Lock Silveira
- Unidade de Ciências da Saúde; Laboratório de Bioquímica e Fisiologia do Exercício Universidade do Extremo Sul Catarinense-UNESC; Av. Universitária, 1105-Bairro Universitário Criciúma Santa Catarina CEP 88806-000 Brazil
| | - Claudio Teodoro de Souza
- Unidade de Ciências da Saúde; Laboratório de Bioquímica e Fisiologia do Exercício Universidade do Extremo Sul Catarinense-UNESC; Av. Universitária, 1105-Bairro Universitário Criciúma Santa Catarina CEP 88806-000 Brazil
| | - Luis Valmor Portela
- Departamento de Bioquímica; ICBS; UFRGS; Programa de Pós Graduação em Ciências Biológicas-Bioquímica; Rua Ramiro Barcelos, 2600 anexo Porto Alegre Rio Grande do Sul CEP 90035-003 Brazil
| | - Alexandre Pastoris Muller
- Unidade de Ciências da Saúde; Laboratório de Bioquímica e Fisiologia do Exercício Universidade do Extremo Sul Catarinense-UNESC; Av. Universitária, 1105-Bairro Universitário Criciúma Santa Catarina CEP 88806-000 Brazil
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