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Lau H, Janitz TM, Sikarin A, Kasozi RN, Pujalte GGA. Sports Endocrinology. Prim Care 2024; 51:523-533. [PMID: 39067976 DOI: 10.1016/j.pop.2024.04.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/30/2024]
Abstract
Sports endocrinology holds a unique importance in understanding and optimizing an active and healthy lifestyle. Active patients with diabetes will need to consider modifying medications, especially insulin. The use of the dual energy x-ray absorptiometry and Fracture Risk Assessment Tool scores is important as both initiate and monitor bone health treatment. Menstrual disorders and energy imbalances are some special concerns when treating female athletes, calling for a multidisciplinary treatment team. Performance agents are popular and have made their way into recreational sports.
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Affiliation(s)
- Henry Lau
- Department of Family Medicine, Tidelands Health, 4320 Holmestown Road, Myrtle Beach, SC 29588, USA
| | - Tyler M Janitz
- Department of Family Medicine, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL 32224, USA
| | - Alec Sikarin
- Department of Family Medicine, Tidelands Health, 4320 Holmestown Road, Myrtle Beach, SC 29588, USA
| | - Ramla N Kasozi
- Department of Family Medicine, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL 32224, USA.
| | - George G A Pujalte
- Department of Family Medicine, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL 32224, USA.
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2
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Trujillo LM, von Oetinger A. [Double diabetes mellitus. Double challenge for the exercise prescription. Systematic review]. Rehabilitacion (Madr) 2024; 58:100866. [PMID: 39141969 DOI: 10.1016/j.rh.2024.100866] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2023] [Revised: 07/09/2024] [Accepted: 07/17/2024] [Indexed: 08/16/2024]
Abstract
Double diabetes (DD) refers to patients with type 1 diabetes who have developed insulin resistance. The objective of this review is to update relevant information on the prescription of physical activity, pharmacological adjustments and consumption of carbohydrates in DD. A systematic search for scientific articles was carried out in the following databases: PubMed, Cochrane, EBSCO, WoS, ScienceDirect and Medline. The evidence analyzed shows that both physical activity (PA) and physical exercise (PE) are essential to achieve metabolic control in people with DD. Physiological considerations such as: insulin adjustments, insulin injection sites, time to perform PA and PE, absolute and relative contraindications are essential to avoid complications, especially hypoglycemia.
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Affiliation(s)
- L M Trujillo
- Centro de estudios del movimiento humano, Escuela de Kinesiología, Facultad de Odontología y Salud, Universidad Diego Portales, Santiago, Chile; Escuela de Kinesiología, Facultad de Ciencias de la Salud, Universidad de Las Américas, Santiago, Chile
| | - A von Oetinger
- Centro de estudios del movimiento humano, Escuela de Kinesiología, Facultad de Odontología y Salud, Universidad Diego Portales, Santiago, Chile; Universidad Autónoma de Chile, Santiago, Chile.
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3
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Jafar A, Kobayati A, Tsoukas MA, Haidar A. Personalized insulin dosing using reinforcement learning for high-fat meals and aerobic exercises in type 1 diabetes: a proof-of-concept trial. Nat Commun 2024; 15:6585. [PMID: 39097566 PMCID: PMC11297938 DOI: 10.1038/s41467-024-50764-5] [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: 07/17/2023] [Accepted: 07/19/2024] [Indexed: 08/05/2024] Open
Abstract
In type 1 diabetes, high-fat meals require more insulin to prevent hyperglycemia while meals followed by aerobic exercises require less insulin to prevent hypoglycemia, but the adjustments needed vary between individuals. We propose a decision support system with reinforcement learning to personalize insulin doses for high-fat meals and postprandial aerobic exercises. We test this system in a single-arm 16-week study in 15 adults on multiple daily injections therapy (NCT05041621). The primary objective of this study is to assess the feasibility of the novel learning algorithm. This study looks at glucose outcomes and patient reported outcomes. The postprandial incremental area under the glucose curve is improved from the baseline to the evaluation period for high-fat meals (378 ± 222 vs 38 ± 223 mmol/L/min, p = 0.03) and meals followed by exercises (-395 ± 192 vs 132 ± 181 mmol/L/min, p = 0.007). The postprandial time spent below 3.9 mmol/L is reduced after high-fat meals (5.3 ± 1.6 vs 1.8 ± 1.5%, p = 0.003) and meals followed by exercises (5.3 ± 1.2 vs 1.4 ± 1.1%, p = 0.003). Our study shows the feasibility of automatically personalizing insulin doses for high-fat meals and postprandial exercises. Randomized controlled trials are warranted.
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Affiliation(s)
- Adnan Jafar
- Department of Biomedical Engineering, McGill University, Montreal, QC, Canada
- The Research Institute of McGill University Health Centre, Montreal, QC, Canada
| | - Alessandra Kobayati
- The Research Institute of McGill University Health Centre, Montreal, QC, Canada
| | - Michael A Tsoukas
- The Research Institute of McGill University Health Centre, Montreal, QC, Canada
| | - Ahmad Haidar
- Department of Biomedical Engineering, McGill University, Montreal, QC, Canada.
- The Research Institute of McGill University Health Centre, Montreal, QC, Canada.
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4
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De Cock D, Schreurs L, Steenackers N, Pazmino S, Cools W, Eykerman L, Thiels H, Mathieu C, Van der Schueren B. The effect of physical activity on glycaemic control in people with type 1 diabetes mellitus: A systematic literature review and meta-analysis. Diabet Med 2024:e15415. [PMID: 39034472 DOI: 10.1111/dme.15415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Revised: 03/11/2024] [Accepted: 07/11/2024] [Indexed: 07/23/2024]
Abstract
AIMS Type 1 diabetes mellitus (T1DM) is characterised by insulin deficiency. Due to perceived physical activity (PA)-related hypoglycaemia, a minority of people with T1DM exercise regularly. However, the relationship between T1DM and PA remains poorly understood. Our aim was to summarise the existing literature on the effects of PA on short-term glucose control (glycated haemoglobin or time in range) in people with T1DM. METHODS We searched seven electronic databases (PubMed, Embase, Cochrane library, Cinahl, SPORTDiscus, PEDro and Web Of Science) and two sources of the grey literature (ClinicalTrials.gov and ICTRP). All reviews were screened via title/abstract and full text by two independent reviewers (LE and HT), conflicts were solved by a third independent reviewer (DDC). We excluded animal studies, case reports, non-English articles, qualitative studies, conference abstracts and articles without full-text access. A meta-analysis using random effects model was performed to study the effect of PA on haemoglobin A1c (HbA1c) levels in people with T1DM. RESULTS We obtained 19,201 unique references across nine different electronic databases. After screening and snowballing, 68 articles were found investigating the effect of PA on glycaemic control in people with T1DM. Overall, HbA1c levels in the PA group (mean difference = 0.29% (0.20%-0.39%)), were lower compared with the control group. CONCLUSION An overall small beneficial effect of PA on glycaemic control in people with T1DM was found. Caution is advised when interpreting the results of this meta-analysis, given variations in study type, duration, frequency and intensity of physical activity across included studies.
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Affiliation(s)
- Diederik De Cock
- Biostatistics and Medical Informatics Research Group, Department of Public Health, Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel (VUB), Brussels, Belgium
- Clinical and Experimental Endocrinology, Department of Chronic Diseases and Metabolism, KULeuven, Leuven, Belgium
| | - Lucas Schreurs
- Biostatistics and Medical Informatics Research Group, Department of Public Health, Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel (VUB), Brussels, Belgium
| | - Nele Steenackers
- Clinical and Experimental Endocrinology, Department of Chronic Diseases and Metabolism, KULeuven, Leuven, Belgium
| | - Sofia Pazmino
- Clinical and Experimental Endocrinology, Department of Chronic Diseases and Metabolism, KULeuven, Leuven, Belgium
| | - Wilfried Cools
- Biostatistics and Medical Informatics Research Group, Department of Public Health, Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel (VUB), Brussels, Belgium
| | - Lauren Eykerman
- Clinical and Experimental Endocrinology, Department of Chronic Diseases and Metabolism, KULeuven, Leuven, Belgium
| | - Hannah Thiels
- Clinical and Experimental Endocrinology, Department of Chronic Diseases and Metabolism, KULeuven, Leuven, Belgium
| | - Chantal Mathieu
- Clinical and Experimental Endocrinology, Department of Chronic Diseases and Metabolism, KULeuven, Leuven, Belgium
- Department of Endocrinology, University Hospitals Leuven, Leuven, Belgium
| | - Bart Van der Schueren
- Clinical and Experimental Endocrinology, Department of Chronic Diseases and Metabolism, KULeuven, Leuven, Belgium
- Department of Endocrinology, University Hospitals Leuven, Leuven, Belgium
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5
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Zucchini S, Tumini S, Scaramuzza AE, Bonfanti R, Delvecchio M, Franceschi R, Iafusco D, Lenzi L, Mozzillo E, Passanisi S, Piona C, Rabbone I, Rapini N, Rigamonti A, Ripoli C, Salzano G, Savastio S, Schiaffini R, Zanfardino A, Cherubini V. Recommendations for recognizing, risk stratifying, treating, and managing children and adolescents with hypoglycemia. Front Endocrinol (Lausanne) 2024; 15:1387537. [PMID: 38894740 PMCID: PMC11183505 DOI: 10.3389/fendo.2024.1387537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2024] [Accepted: 05/17/2024] [Indexed: 06/21/2024] Open
Abstract
There has been continuous progress in diabetes management over the last few decades, not least due to the widespread dissemination of continuous glucose monitoring (CGM) and automated insulin delivery systems. These technological advances have radically changed the daily lives of people living with diabetes, improving the quality of life of both children and their families. Despite this, hypoglycemia remains the primary side-effect of insulin therapy. Based on a systematic review of the available scientific evidence, this paper aims to provide evidence-based recommendations for recognizing, risk stratifying, treating, and managing patients with hypoglycemia. The objective of these recommendations is to unify the behavior of pediatric diabetologists with respect to the timely recognition and prevention of hypoglycemic episodes and the correct treatment of hypoglycemia, especially in patients using CGM or advanced hybrid closed-loop systems. All authors have long experience in the specialty and are members of the Italian Society of Pediatric Endocrinology and Diabetology. The goal of treating hypoglycemia is to raise blood glucose above 70 mg/dL (3.9 mmol/L) and to prevent further decreases. Oral glucose at a dose of 0.3 g/kg (0.1 g/kg for children using "smart pumps" or hybrid closed loop systems in automated mode) is the preferred treatment for the conscious individual with blood glucose <70 mg/dL (3.9 mmol/L), although any form of carbohydrate (e.g., sucrose, which consists of glucose and fructose, or honey, sugary soft drinks, or fruit juice) containing glucose may be used. Using automatic insulin delivery systems, the oral glucose dose can be decreased to 0.1 g/kg. Practical flow charts are included to aid clinical decision-making. Although representing the official position of the Italian Society of Pediatric Endocrinology and Diabetology (ISPED), these guidelines are applicable to the global audience and are especially pertinent in the era of CGM and other advanced technologies.
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Affiliation(s)
- Stefano Zucchini
- Study Group of Diabetology of the Italian Society for Pediatric Endocrinology and Diabetes (I.S.P.E.D.,) University Hospital of Ferrara, Ferrara, Italy
| | - Stefano Tumini
- Department of Maternal and Child Health, UOSD Regional Center of Pediatric Diabetology, Annunziata Hospital, Chieti, Italy
| | - Andrea Enzo Scaramuzza
- Division of Pediatrics, Pediatric Diabetes, Endocrinology and Nutrition, Azienda Socio Sanitaria Territoriale (ASST) Cremona, Cremona, Italy
| | - Riccardo Bonfanti
- UO Pediatric Diabetes Research Institute, Ospedale San Raffaele, Milan, Italy
| | - Maurizio Delvecchio
- Department of Biotechnological and Applied Clinical Sciences, University of L’Aquila, L’Aquila, Italy
| | - Roberto Franceschi
- Department of Pediatrics, S. Chiara Hospital of Trento, APSS, Trento, Italy
| | - Dario Iafusco
- Department of Woman, Child and General and Specialistic Surgery, Regional Center of Pediatric Diabetes, University of Campania ‘L. Vanvitelli’, Naples, Italy
| | - Lorenzo Lenzi
- Diabetology Unit, Pediatric Department, Anna Meyer Children’s Hospital, Florence, Italy
| | - Enza Mozzillo
- Section of Pediatrics, Regional Center of Pediatric Diabetes, University Federico II, Naples, Italy
| | - Stefano Passanisi
- Department of Human Pathology of Adulthood and Childhood G. Barresi, University of Messina, Messina, Italy
| | - Claudia Piona
- Pediatric Diabetes and Metabolic Disorders Unit, Regional Center for Pediatric Diabetes, Department of Surgery, Dentistry, Pediatrics, and Gynecology, University of Verona, Verona, Italy
| | - Ivana Rabbone
- Division of Pediatrics, Department of Health Sciences, University of Piemonte Orientale, Novara, Italy
| | - Novella Rapini
- Diabetes Unit, Bambino Gesú Childrens’ Hospital, Rome, Italy
| | - Andrea Rigamonti
- UO Pediatric Diabetes Research Institute, Ospedale San Raffaele, Milan, Italy
| | - Carlo Ripoli
- Pediatric Diabetology Unit, Department of Pediatrics, ASL 8 Cagliari, Cagliari, Italy
| | - Giuseppina Salzano
- Department of Human Pathology of Adulthood and Childhood G. Barresi, University of Messina, Messina, Italy
| | - Silvia Savastio
- Division of Pediatrics, Department of Health Sciences, University of Piemonte Orientale, Novara, Italy
| | | | - Angela Zanfardino
- Department of Woman, Child and General and Specialistic Surgery, Regional Center of Pediatric Diabetes, University of Campania ‘L. Vanvitelli’, Naples, Italy
| | - Valentino Cherubini
- Department of Women’s and Children’s Health, Azienda Ospedaliero-Universitaria, Ospedali Riuniti di Ancona, ‘Salesi Hospital’, Ancona, Italy
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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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Schroeder AE, Rosenkranz RR, Yarrow LK, Haub MD, Rosenkranz SK. Recovery Phase Nutrition and Insulin Strategies for a Collegiate Distance Runner with Type 1 Diabetes Mellitus: A Case Study. Sports (Basel) 2023; 11:214. [PMID: 37999431 PMCID: PMC10674803 DOI: 10.3390/sports11110214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Revised: 10/12/2023] [Accepted: 10/26/2023] [Indexed: 11/25/2023] Open
Abstract
PURPOSE There is scant published research regarding nutrition and insulin strategies for athletic performance in collegiate distance runners with type 1 diabetes mellitus (CDRT1). Acute carbohydrate supplementation (CHOsup) and insulin reduction used to minimize hypoglycemia during exercise may result in deteriorated glycemic control post exercise in CDRT1. The present case study of a CDRT1 investigated outcomes associated with a moderate-carbohydrate (ModCHO) diet and 24 h insulin adjustment during recovery phases for improved glycemic control and reduced use of acute strategies. METHODS During an 8-day period, a female CDRT1 followed a ModCHO (~4 g/kg/day) nutrition program. Recovery phase adjustments to insulin doses were made using an equation developed to estimate reduced insulin needs post exercise, as a function of exercise intensity and duration. Daily training was performed in the fasted state at 6:00 a.m. and included additional exercise strategies to reduce glycemic variability when needed. Daily blood glucose time-in-range (TIR) and use of CHOsup were assessed. Athlete well-being was determined using the Student-Athlete Well-Being Scale (SAWS)TM at baseline, and days 1, 3, and 7. RESULTS Throughout the 8-day period, mean TIR increased (77% versus < 50%) and the magnitude of glycemic excursions decreased (~3.8-15 versus ~3.0-26 mmol/L) relative to a prior comparison period. Minimal pre-exercise CHOsup was employed and CHOsup during exercise was not required. Additionally, the athlete achieved a new lifetime best in the 5000 m run and maintained positive well-being. CONCLUSION The present case study provides examples of recovery phase strategies (i.e., ModCHO diet and 24 h insulin adjustments) that may support glycemic control and athletic performance in CDRT1 and provides potential considerations for nutrition and insulin strategies for use by athletes and coaches.
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Affiliation(s)
- Amie E. Schroeder
- Department of Food, Nutrition, Dietetics and Health, College of Health and Human Sciences, Kansas State University, Manhattan, KS 66506, USA; (R.R.R.); (L.K.Y.); (M.D.H.); (S.K.R.)
| | - Richard R. Rosenkranz
- Department of Food, Nutrition, Dietetics and Health, College of Health and Human Sciences, Kansas State University, Manhattan, KS 66506, USA; (R.R.R.); (L.K.Y.); (M.D.H.); (S.K.R.)
- Department of Kinesiology and Nutrition Sciences, School of Integrated Health Sciences, University of Nevada Las Vegas, Las Vegas, NV 89154, USA
| | - Linda K. Yarrow
- Department of Food, Nutrition, Dietetics and Health, College of Health and Human Sciences, Kansas State University, Manhattan, KS 66506, USA; (R.R.R.); (L.K.Y.); (M.D.H.); (S.K.R.)
| | - Mark D. Haub
- Department of Food, Nutrition, Dietetics and Health, College of Health and Human Sciences, Kansas State University, Manhattan, KS 66506, USA; (R.R.R.); (L.K.Y.); (M.D.H.); (S.K.R.)
| | - Sara K. Rosenkranz
- Department of Food, Nutrition, Dietetics and Health, College of Health and Human Sciences, Kansas State University, Manhattan, KS 66506, USA; (R.R.R.); (L.K.Y.); (M.D.H.); (S.K.R.)
- Department of Kinesiology and Nutrition Sciences, School of Integrated Health Sciences, University of Nevada Las Vegas, Las Vegas, NV 89154, USA
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8
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Hamasaki H. The Effect of Exercise on Cardiovascular Autonomic Nervous Function in Patients with Diabetes: A Systematic Review. Healthcare (Basel) 2023; 11:2668. [PMID: 37830705 PMCID: PMC10572826 DOI: 10.3390/healthcare11192668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Revised: 09/22/2023] [Accepted: 09/29/2023] [Indexed: 10/14/2023] Open
Abstract
BACKGROUND Diabetic neuropathy, including autonomic neuropathy, is a severe complication in patients with poorly controlled diabetes. Specifically, cardiovascular autonomic neuropathy (CAN) plays a significant prognostic role in cardiovascular morbidity and mortality. Exercise, an essential component of diabetes treatment, may have a therapeutic effect on patients with diabetes complicated by CAN. However, it remains unclear whether exercise has a therapeutic or protective effect in diabetes patients with CAN. METHODS The author conducted a systematic search of PubMed/MEDLINE, Embase, and The Cochrane Library, resulting in the identification of eight eligible randomized controlled trials for this review. RESULTS Exercise, including aerobic exercise combined with resistance training (RT), high-intensity interval training, and progressive RT, has shown a beneficial effect on cardiac autonomic function (CAF) in patients with type 2 diabetes, as measured by heart rate variability, heart rate recovery, and baroreflex sensitivity. However, most studies had low quality. Moreover, there were no relevant studies examining the effect of exercise on CAF in older patients, patients with poorly controlled diabetes, and patients with type 1 diabetes. CONCLUSIONS Exercise has the potential to manage patients with CAN by balancing sympathetic and parasympathetic nervous system functions; however, further studies are warranted in the future.
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Katz A, Shulkin A, Talbo MK, Housni A, Yardley J, Brazeau AS, Rabasa-Lhoret R. Hyperglycemia-related anxiety during competition in an elite athlete with type 1 diabetes: A case report. DIABETES & METABOLISM 2023; 49:101476. [PMID: 37689238 DOI: 10.1016/j.diabet.2023.101476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Revised: 08/31/2023] [Accepted: 09/04/2023] [Indexed: 09/11/2023]
Abstract
AIM Managing blood glucose (BG) levels during intense physical activity is challenging for elite athletes with type 1 diabetes (T1D), as it can lead to unpredictable hyper- or hypoglycemia, which can affect performance. This case study presents an 18-year-old male hockey goalie with hyperglycemia-related anxiety during competition and its impact on his T1D management. METHODS Mixed-methods approach, incorporating qualitative data from an unstructured interview and responses from the Hyperglycemia Avoidance Scale along with quantitative data retrieved from Diasend and laboratory results. RESULTS The athlete experiences physical and cognitive symptoms during hyperglycemia, affecting his performance. Hyperglycemia-related anxiety influences insulin dosage adjustments and eating habits on game days. Glycemic variability analysis reveals lower BG levels during game time. CONCLUSION Hyperglycemia-related anxiety leads to modified therapeutic and lifestyle regimens on competition day. Tailored treatment programs are needed for elite athletes with T1D and hyperglycemia-related anxiety.
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Affiliation(s)
- Alexandra Katz
- Montreal Clinical Research Institute, Montreal, Quebec, Canada; Faculté de Médecine, Université de Montréal, Montreal, Quebec, Canada; School of Human Nutrition, McGill University, Montreal, Quebec, Canada.
| | - Aidan Shulkin
- Faculté de Médecine, Université de Montréal, Montreal, Quebec, Canada
| | - Meryem K Talbo
- School of Human Nutrition, McGill University, Montreal, Quebec, Canada
| | - Asmaa Housni
- School of Human Nutrition, McGill University, Montreal, Quebec, Canada
| | - Jane Yardley
- Augustana Faculty, University of Alberta, Camrose, Alberta, Canada; Alberta Diabetes Institute, Edmonton, Alberta, Canada; Women and Children's Health Research Institute, Edmonton, Alberta, Canada; Faculty of Kinesiology, Sport and Recreation, University of Alberta, Edmonton, Alberta, Canada
| | | | - Rémi Rabasa-Lhoret
- Montreal Clinical Research Institute, Montreal, Quebec, Canada; Service d'Endocrinologie du Centre Hospitalier de l'Université de Montréal (CHUM), Montreal, Quebec, Canada
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10
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Alobaid AM, Zulyniak MA, Ajjan RA, Brož J, Hopkins M, Campbell MD. Barriers to Exercise in Adults With Type 1 Diabetes and Insulin Resistance. Can J Diabetes 2023; 47:503-508. [PMID: 37121543 DOI: 10.1016/j.jcjd.2023.04.016] [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: 01/10/2023] [Revised: 04/05/2023] [Accepted: 04/24/2023] [Indexed: 05/02/2023]
Abstract
OBJECTIVE Our aim in this study was to assess attitudes toward exercise and quality of life (QoL) in adults with type 1 diabetes (T1D) with and without insulin resistance (IR). METHODS We pooled baseline pretreatment data from a subset of individuals with T1D from 2 randomized controlled trials. Estimated glucose disposal rate (eGDR), a validated surrogate marker of IR, was calculated using an established formula to classify individuals according to IR status with a cutpoint of <6 mg/kg/min for the determination of IR. Self-reported barriers to exercise were obtained using a validated questionnaire, the Barriers to Physical Activity in T1D (BAPAD-1). In addition, QoL was determined using the 36-item Short Form (SF-36) questionnaire. Differences between dichotomized variables were assessed using the independent t test, Mann-Whitney U test, or Fisher exact test. Linear regression was employed to explore the association of eGDR with BAPAD-1 and QoL scores, with sequential adjustment for potential confounders. RESULTS Of the 85 individuals included in our study, 39 were classified as having IR. The mean BAPAD-1 total score was higher for individuals with IR (IR: 3.87±0.61; non-IR: 2.83±0.55; p<0.001). The highest exercise barrier scores for individuals with IR were risk of hypoglycemia (5.67±1.26) and risk of hyperglycemia (5.23±1.20), whereas the highest scoring exercise barrier scores for non-IR individuals were not diabetes-related, with low level of fitness (3.91±1.26) and physical health status, excluding diabetes (3.67±1.48), ranked highest. QoL scores were comparable between groups (p>0.05). CONCLUSIONS Risk of hypoglycemia was the greatest barrier to exercise in individuals with T1D with IR, whereas non-diabetes-related barriers to exercise were more salient in individuals with T1D without IR.
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Affiliation(s)
- Anwar M Alobaid
- School of Food Science and Nutrition, University of Leeds, Leeds, United Kingdom; Ministry of Health, Farwaniya Hospital, Kuwait City, Kuwait
| | - Michael A Zulyniak
- School of Food Science and Nutrition, University of Leeds, Leeds, United Kingdom
| | - Ramzi A Ajjan
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, United Kingdom
| | - Jan Brož
- Department of Internal Medicine, Second Medical Faculty, Charles University, Prague, Czech Republic
| | - Mark Hopkins
- School of Food Science and Nutrition, University of Leeds, Leeds, United Kingdom
| | - Matthew D Campbell
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, United Kingdom; School of Nursing and Health Sciences, University of Sunderland, Sunderland, United Kingdom; Wellcome-MRC Institute of Metabolic Science, University of Cambridge, Cambridge, United Kingdom.
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11
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Gómez-Peralta F, Menéndez E, Conde S, Conget I, Novials A. Physical activity patterns in type 1 diabetes in Spain: The SED1 study. BMC Sports Sci Med Rehabil 2023; 15:92. [PMID: 37491278 PMCID: PMC10369829 DOI: 10.1186/s13102-023-00695-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Accepted: 07/03/2023] [Indexed: 07/27/2023]
Abstract
AIMS To describe the physical activity (PA) frequency and intensity in the Spanish type 1 diabetes mellitus (T1D) population and its association with their glycemic control. METHODS A cross-sectional observational study was carried out in 75 Spanish public hospitals (the SED1 study). T1D patients over 14years of age self-completed the International Physical Activity Questionnaire (IPAQ) to determine their level of exercise. The relationship between PA frequency and intensity in T1D patients and glycemic control and the diabetes therapeutic education received were analyzed. RESULTS A total of 592 patients were evaluable. A 6.8% of the sample performed light PA, 20.9% moderate and 72.3% vigorous. Estimated PA presented a high inter-individual variability. Men consumed more energy (METS) than women, these differences being more noticeable in vigorous METS (2865.80 in men vs 1352.12 in women). Women invested more min/week in the domestic and garden area (639.03 vs 344.39, p = 0,022). A correlation between glycemic control and the METs was not observed. CONCLUSIONS The Spanish T1D population performed PA in a higher frequency and intensity than the general population. A relationship between PA and glycemic control couldn´t be shown. However, limitations of the study should be kept in mind to discard a long-term positive influence.
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Affiliation(s)
- F Gómez-Peralta
- Endocrinology and Nutrition Unit, Hospital General de Segovia, Segovia, Spain.
- Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Barcelona, Spain.
| | - E Menéndez
- Endocrinology and Nutrition Service, Hospital Universitario Central Asturias, Oviedo, Spain
| | - S Conde
- Centro de Salud de Barbastro, Huesca, Spain
| | - I Conget
- Endocrinology and Nutrition Unit, Hospital Clínic, Barcelona, Spain
| | - A Novials
- Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Barcelona, Spain
- Endocrinology and Nutrition Unit, Hospital Clínic, Barcelona, Spain
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12
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Cannataro R, Cione E, Cerullo G, Rondanelli M, Micheletti P, Crisafulli O, Micheli ML, D'Antona G. Type 1 diabetes management in a competitive athlete: A five-year case report. Physiol Rep 2023; 11:e15740. [PMID: 37402564 PMCID: PMC10319554 DOI: 10.14814/phy2.15740] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Revised: 05/17/2023] [Accepted: 05/18/2023] [Indexed: 07/06/2023] Open
Abstract
Type I diabetes has an incidence of 15 per 100,000 people. Though it is a metabolic disorder, it can be seen in top, even professional athletes. Physical activity is recommended to manage diabetes, but there is a lack of specific knowledge on diabetes management and exercise from dedicated medical staff. This bias leads to suboptimal diabetes management, causing frequent hyper and hypoglycemia, a dysregulation of glycated hemoglobin, blood glucose out of control, and consequent needs to often intervene with extra insulin or carbohydrates. For 5 years, we followed a highly competitive male Caucasian athlete Vovinam Viet Vo Dao, with type I diabetes, aged 17. We monitored his glycated hemoglobin, the insulin drug administered, and glycemia blood level averages. We obtained, over time, a decrease in glycated hemoglobin by almost -22% and insulin administered by -37.33%, and average blood glycemia levels diminished by almost -27%. In addition, we carried out bioimpedance analysis and stratigraphy on the abdomen. Federation trainers supervised all physical training; we recorded an improvement in the general condition, underlined in particular by an increase in phase angle (from bioimpedance) of +17%.
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Affiliation(s)
- Roberto Cannataro
- Galascreen LaboratoriesUniversity of CalabriaRendeItaly
- Department of Pharmacy, Health and Nutritional SciencesUniversity of CalabriaRendeItaly
| | - Erika Cione
- Galascreen LaboratoriesUniversity of CalabriaRendeItaly
- Department of Pharmacy, Health and Nutritional SciencesUniversity of CalabriaRendeItaly
| | | | - Mariangela Rondanelli
- Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Mondino FoundationPaviaItaly
- Centro di Ricerca Interdipartimentale nelle Attività Motorie e Sportive (CRIAMS)‐Sport Medicine Centre, University of PaviaPaviaItaly
| | - Piero Micheletti
- Centro di Ricerca Interdipartimentale nelle Attività Motorie e Sportive (CRIAMS)‐Sport Medicine Centre, University of PaviaPaviaItaly
| | - Oscar Crisafulli
- Centro di Ricerca Interdipartimentale nelle Attività Motorie e Sportive (CRIAMS)‐Sport Medicine Centre, University of PaviaPaviaItaly
| | - Matteo Levi Micheli
- Department of Experimental and Clinical MedicineUniversity of FlorenceFlorenceItaly
- M. Marella Laboratory of Motor Sciences Applied to MedicineFlorenceItaly
| | - Giuseppe D'Antona
- Centro di Ricerca Interdipartimentale nelle Attività Motorie e Sportive (CRIAMS)‐Sport Medicine Centre, University of PaviaPaviaItaly
- Department of Public Health, Experimental and Forensic MedicineUniversity of PaviaPaviaItaly
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13
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Martin-Rivera F, Maroto-Izquierdo S, García-López D, Alarcón-Gómez J. Exercise interventions for patients with type 1 diabetes mellitus: A narrative review with practical recommendations. World J Diabetes 2023; 14:539-548. [PMID: 37273254 PMCID: PMC10236987 DOI: 10.4239/wjd.v14.i5.539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 01/08/2023] [Accepted: 04/11/2023] [Indexed: 05/15/2023] Open
Abstract
Type 1 diabetes mellitus (T1DM) is a chronic endocrine disease that results from autoimmune destruction of pancreatic insulin-producing β cells, which can lead to microvascular (e.g., retinopathy, neuropathy, and nephropathy) and macro-vascular complications (e.g., coronary arterial disease, peripheral artery disease, stroke, and heart failure) as a consequence of chronic hyperglycemia. Despite the widely available and compelling evidence that regular exercise is an efficient strategy to prevent cardiovascular disease and to improve functional capacity and psychological well-being in people with T1DM, over 60% of individuals with T1DM do not exercise regularly. It is, therefore, crucial to devise approaches to motivate patients with T1DM to exercise, to adhere to a training program, and to inform them of its specific characteristics (e.g., exercise mode, intensity, volume, and frequency). Moreover, given the metabolic alterations that occur during acute bouts of exercise in T1DM patients, exercise prescription in this population should be carefully analyzed to maximize its benefits and to reduce its potential risks.
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Affiliation(s)
- Fernando Martin-Rivera
- Department of Physical Education and Sports, University of Valencia, Valencia 46010, Spain
| | - Sergio Maroto-Izquierdo
- Department of Health Sciences, Miguel de Cervantes European University, Valladolid 47012, Spain
| | - David García-López
- Department of Health Sciences, Miguel de Cervantes European University, Valladolid 47012, Spain
| | - Jesús Alarcón-Gómez
- Department of Physical Education and Sports, University of Valencia, Valencia 46010, Spain
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14
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Ivandic M, Cigrovski Berkovic M, Ormanac K, Sabo D, Omanovic Kolaric T, Kuna L, Mihaljevic V, Canecki Varzic S, Smolic M, Bilic-Curcic I. Management of Glycemia during Acute Aerobic and Resistance Training in Patients with Diabetes Type 1: A Croatian Pilot Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:4966. [PMID: 36981876 PMCID: PMC10049388 DOI: 10.3390/ijerph20064966] [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: 02/08/2023] [Revised: 03/07/2023] [Accepted: 03/08/2023] [Indexed: 06/18/2023]
Abstract
(1) Background: The increased risk of developing hypoglycemia and worsening of glycemic stability during exercise is a major cause of concern for patients with type 1 diabetes mellitus (T1DM). (2) Aim: This pilot study aimed to assess glycemic stability and hypoglycemic episodes during and after aerobic versus resistance exercises using a flash glucose monitoring system in patients with T1DM. (3) Participants and Methods: We conducted a randomized crossover prospective study including 14 adult patients with T1DM. Patients were randomized according to the type of exercise (aerobic vs. resistance) with a recovery period of three days between a change of groups. Glucose stability and hypoglycemic episodes were evaluated during and 24 h after the exercise. Growth hormone (GH), cortisol, and lactate levels were determined at rest, 0, 30, and 60 min post-exercise period. (4) Results: The median age of patients was 53 years, with a median HbA1c of 7.1% and a duration of diabetes of 30 years. During both training sessions, there was a drop in glucose levels immediately after the exercise (0'), followed by an increase at 30' and 60', although the difference was not statistically significant. However, glucose levels significantly decreased from 60' to 24 h in the post-exercise period (p = 0.001) for both types of exercise. Glycemic stability was comparable prior to and after exercise for both training sessions. No differences in the number of hypoglycemic episodes, duration of hypoglycemia, and average glucose level in 24 h post-exercise period were observed between groups. Time to hypoglycemia onset was prolonged after the resistance as opposed to aerobic training (13 vs. 8 h, p = NS). There were no nocturnal hypoglycemic episodes (between 0 and 6 a.m.) after the resistance compared to aerobic exercise (4 vs. 0, p = NS). GH and cortisol responses were similar between the two sessions, while lactate levels were significantly more increased after resistance training. (5) Conclusion: Both exercise regimes induced similar blood glucose responses during and immediately following acute exercise.
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Affiliation(s)
- Marul Ivandic
- Department of Internal Medicine, University Hospital Osijek, 31000 Osijek, Croatia
| | | | - Klara Ormanac
- Department of Pharmacology, Faculty of Medicine Osijek, J. J. Strossmayer University of Osijek, 31000 Osijek, Croatia
| | - Dea Sabo
- Department of Pharmacology, Faculty of Medicine Osijek, J. J. Strossmayer University of Osijek, 31000 Osijek, Croatia
| | - Tea Omanovic Kolaric
- Department of Pharmacology, Faculty of Medicine Osijek, J. J. Strossmayer University of Osijek, 31000 Osijek, Croatia
- Department of Pharmacology and Biochemistry, Faculty of Dental Medicine and Health Osijek, J. J. Strossmayer University of Osijek, 31000 Osijek, Croatia
| | - Lucija Kuna
- Department of Pharmacology and Biochemistry, Faculty of Dental Medicine and Health Osijek, J. J. Strossmayer University of Osijek, 31000 Osijek, Croatia
| | - Vjera Mihaljevic
- Department of Pharmacology and Biochemistry, Faculty of Dental Medicine and Health Osijek, J. J. Strossmayer University of Osijek, 31000 Osijek, Croatia
| | | | - Martina Smolic
- Department of Pharmacology, Faculty of Medicine Osijek, J. J. Strossmayer University of Osijek, 31000 Osijek, Croatia
- Department of Pharmacology and Biochemistry, Faculty of Dental Medicine and Health Osijek, J. J. Strossmayer University of Osijek, 31000 Osijek, Croatia
| | - Ines Bilic-Curcic
- Department of Internal Medicine, University Hospital Osijek, 31000 Osijek, Croatia
- Department of Pharmacology, Faculty of Medicine Osijek, J. J. Strossmayer University of Osijek, 31000 Osijek, Croatia
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15
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Hughes AS, Chapman KS, Nguyen H, Liu J, Bispham J, Winget M, Weinzimer SA, Wolf WA. Severe Hypoglycemia and the Use of Glucagon Rescue Agents: An Observational Survey in Adults With Type 1 Diabetes. Clin Diabetes 2023; 41:399-410. [PMID: 37456102 PMCID: PMC10338275 DOI: 10.2337/cd22-0099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/08/2023]
Abstract
Severe hypoglycemia (SH) is the most frequent and potentially serious complication affecting individuals with type 1 diabetes and can have major clinical and psychosocial consequences. Glucagon is the only approved treatment for SH that can be administered by non-health care professionals (HCPs); however, reports on the experiences and emotions of people with type 1 diabetes associated with SH and glucagon rescue use are limited. This survey study demonstrated that an increasing number of individuals with type 1 diabetes have current and filled prescriptions for glucagon and have been educated about glucagon rescue use by an HCP. Despite this positive trend, challenges with SH remain, including a high level of health care resource utilization, considerable out-of-pocket expenses for glucagon kits, a high prevalence of hypoglycemia unawareness, and a negative emotional impact on individuals with diabetes. Nocturnal and exercise-related hypoglycemia were concerns for most survey participants.
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Affiliation(s)
- Allyson S. Hughes
- Department of Primary Care, Ohio University Heritage College of Osteopathic Medicine, Athens, OH
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16
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Torres Roldan VD, Urtecho M, Nayfeh T, Firwana M, Muthusamy K, Hasan B, Abd-Rabu R, Maraboto A, Qoubaitary A, Prokop L, Lieb DC, McCall AL, Wang Z, Murad MH. A Systematic Review Supporting the Endocrine Society Guidelines: Management of Diabetes and High Risk of Hypoglycemia. J Clin Endocrinol Metab 2023; 108:592-603. [PMID: 36477885 DOI: 10.1210/clinem/dgac601] [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: 10/08/2022] [Indexed: 12/12/2022]
Abstract
CONTEXT Interventions targeting hypoglycemia in people with diabetes are important for improving quality of life and reducing morbidity and mortality. OBJECTIVE To support development of the Endocrine Society Clinical Practice Guideline for management of individuals with diabetes at high risk for hypoglycemia. METHODS We searched several databases for studies addressing 10 questions provided by a guideline panel from the Endocrine Society. Meta-analysis was conducted when feasible. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology was used to assess certainty of evidence. RESULTS We included 149 studies reporting on 43 344 patients. Continuous glucose monitoring (CGM) reduced episodes of severe hypoglycemia in patients with type 1 diabetes (T1D) and reduced the proportion of patients with hypoglycemia (blood glucose [BG] levels <54 mg/dL). There were no data on use of real-time CGM with algorithm-driven insulin pumps vs multiple daily injections with BG testing in people with T1D. CGM in outpatients with type 2 diabetes taking insulin and/or sulfonylureas reduced time spent with BG levels under 70 mg/dL. Initiation of CGM in hospitalized patients at high risk for hypoglycemia reduced episodes of hypoglycemia with BG levels lower than 54 mg/dL and time spent under 54 mg/dL. The proportion of patients with hypoglycemia with BG levels lower than 70 mg/dL and lower than 54 mg/dL detected by CGM was significantly higher than point-of-care BG testing. We found no data evaluating continuation of personal CGM in the hospital. Use of an inpatient computerized glycemic management program utilizing electronic health record data was associated with fewer patients with and episodes of hypoglycemia with BG levels lower than 70 mg/dL and fewer patients with severe hypoglycemia compared with standard care. Long-acting basal insulin analogs were associated with less hypoglycemia. Rapid-acting insulin analogs were associated with reduced severe hypoglycemia, though there were more patients with mild to moderate hypoglycemia. Structured diabetes education programs reduced episodes of severe hypoglycemia and time below 54 mg/dL in outpatients taking insulin. Glucagon formulations not requiring reconstitution were associated with longer times to recovery from hypoglycemia, although the proportion of patients who recovered completely from hypoglycemia was not different between the 2 groups. CONCLUSION This systematic review summarized the best available evidence about several interventions addressing hypoglycemia in people with diabetes. This evidence base will facilitate development of clinical practice guidelines by the Endocrine Society.
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Affiliation(s)
| | - Meritxell Urtecho
- Mayo Clinic Evidence-Based Practice Center, Rochester, MN 55902, USA
| | - Tarek Nayfeh
- Mayo Clinic Evidence-Based Practice Center, Rochester, MN 55902, USA
| | - Mohammed Firwana
- Mayo Clinic Evidence-Based Practice Center, Rochester, MN 55902, USA
| | | | - Bashar Hasan
- Mayo Clinic Evidence-Based Practice Center, Rochester, MN 55902, USA
| | - Rami Abd-Rabu
- Mayo Clinic Evidence-Based Practice Center, Rochester, MN 55902, USA
| | - Andrea Maraboto
- Knowledge and Evaluation Research Unit, Department of Medicine, Mayo Clinic, Rochester, MN 55902, USA
| | - Amjad Qoubaitary
- College of Arts and Science, University of San Francisco, San Francisco, CA 94117, USA
| | - Larry Prokop
- Department of Library Services, Mayo Clinic, Rochester, MN 55902, USA
| | - David C Lieb
- Division of Endocrine and Metabolic Disorders, Department of Internal Medicine, Eastern Virginia Medical School, Norfolk, VA 23501-1980, USA
| | - Anthony L McCall
- Division of Endocrinology and Metabolism, Department of Medicine, University of Virginia School of Medicine, Charlottesville, VA 22908, USA
| | - Zhen Wang
- Mayo Clinic Evidence-Based Practice Center, Rochester, MN 55902, USA
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17
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Wake AD. Protective effects of physical activity against health risks associated with type 1 diabetes: "Health benefits outweigh the risks". World J Diabetes 2022; 13:161-184. [PMID: 35432757 PMCID: PMC8984568 DOI: 10.4239/wjd.v13.i3.161] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2021] [Revised: 12/08/2021] [Accepted: 02/20/2022] [Indexed: 02/06/2023] Open
Abstract
The magnitude of diabetes mellitus (DM) has increased in recent decades, where the number of cases and the proportion of the disease have been gradually increasing over the past few decades. The chronic complications of DM affect many organ systems and account for the majority of morbidity and mortality associated with the disease. The prevalence of type 1 DM (T1DM) is increasing globally, and it has a very significant burden on countries and at an individual level. T1DM is a chronic illness that requires ongoing medical care and patient self-management to prevent complications. This study aims to discuss the health benefits of physical activity (PA) in T1DM patients. The present review article was performed following a comprehensive literature search. The search was conducted using the following electronic databases: "Cochrane Library", Web of Science, PubMed, HINARI, EMBASE, Google for grey literature, Scopus, African journals Online, and Google Scholar for articles published up to June 21, 2021. The present review focused on the effects of PA on many outcomes such as blood glucose (BG) control, physical fitness, endothelial function, insulin sensitivity, well-being, the body defense system, blood lipid profile, insulin resistance, cardiovascular diseases (CVDs), insulin requirements, blood pressure (BP), and mortality. It was found that many studies recommended the use of PA for the effective management of T1DM. PA is a component of comprehensive lifestyle modifications, which is a significant approach for the management of T1DM. It provides several health benefits, such as improving BG control, physical fitness, endothelial function, insulin sensitivity, well-being, and the body defense system. Besides this, it reduces the blood lipid profile, insulin resistance, CVDs, insulin requirements, BP, and mortality. Overall, PA has significant and essential protective effects against the health risks associated with T1DM. Even though PA has several health benefits for patients with T1DM, these patients are not well engaged in PA due to barriers such as a fear of exercise-induced hypoglycemia in particular. However, several effective strategies have been identified to control exercise-induced hypoglycemia in these patients. Finally, the present review concludes that PA should be recommended for the management of patients with T1DM due to its significant health benefits and protective effects against associated health risks. It also provides suggestions for the future direction of research in this field.
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Affiliation(s)
- Addisu Dabi Wake
- Department of Nursing, College of Health Sciences, Arsi University, Asella 193/4, Ethiopia
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18
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Cabral MD, Patel DR, Greydanus DE, Deleon J, Hudson E, Darweesh S. Medical perspectives on pediatric sports medicine–Selective topics. Dis Mon 2022; 68:101327. [DOI: 10.1016/j.disamonth.2022.101327] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Franc S, Benhamou P, Borot S, Chaillous L, Delemer B, Doron M, Guerci B, Hanaire H, Huneker E, Jeandidier N, Amadou C, Renard E, Reznik Y, Schaepelynck P, Simon C, Thivolet C, Thomas C, Hannaert P, Charpentier G. No more hypoglycaemia on days with physical activity and unrestricted diet when using a closed-loop system for 12 weeks: A post hoc secondary analysis of the multicentre, randomized controlled Diabeloop WP7 trial. Diabetes Obes Metab 2021; 23:2170-2176. [PMID: 34009725 PMCID: PMC8453744 DOI: 10.1111/dom.14442] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 05/06/2021] [Accepted: 05/16/2021] [Indexed: 12/15/2022]
Abstract
A post hoc analysis of the Diabeloop WP7 multicentre, randomized controlled trial was performed to investigate the efficacy of the Diabeloop Generation-1 (DBLG1) closed-loop system in controlling the hypoglycaemia induced by physical activity (PA) in real-life conditions. Glycaemic outcomes were compared between days with and without PA in 56 patients with type 1 diabetes (T1D) using DBLG1 for 12 weeks. After the patient announces a PA, DBLG1 reduces insulin delivery and, if necessary, calculates the amount of preventive carbohydrates (CHO). Daily time spent in the interstitial glucose range less than 70 mg/dL was not significantly different between days with and without PA (2.0% ± 1.5% vs. 2.2% ± 1.1%), regardless of the intensity or duration of the PA. Preventive CHO intake recommended by the system was significantly higher in days with PA (41.1 ± 35.5 vs. 21.8 ± 28.5 g/day; P < .0001), and insulin delivery was significantly lower (31.5 ± 10.5 vs. 34.0 ± 10.5 U/day; P < .0001). The time spent in hyperglycaemia and the glycaemic variation coefficient increased significantly on days with PA. In real-life conditions, the use of DBLG1 avoids PA-induced hypoglycaemia. Insulin adjustments and preventive CHO recommendation may explain this therapeutic benefit.
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Affiliation(s)
- Sylvia Franc
- Department of DiabetesSud‐Francilien HospitalCorbeil‐EssonnesFrance
- Centre d'Etude et de Recherche pour l'Intensification du Traitement du Diabète (CERITD)EvryFrance
- Laboratoire de Biologie de l'Exercice pour la Performance et la Santé, Université Evry Val d'Essonne, Institut de Recherches Biomédicales des Armées, Université Paris SaclayEvryFrance
| | | | - Sophie Borot
- Department of Endocrinology, Metabolism, Diabetes and NutritionCentre Hospitalier Universitaire Jean MinjozBesançonFrance
| | | | - Brigitte Delemer
- Department of Endocrinology, Diabetes and NutritionReims University HospitalReimsFrance
| | - Maeva Doron
- Université Grenoble Alpes, Commissariat à l'Energie Atomique, Laboratoire d'électronique et de technologie de l'information, Département micro Technologies pour la Biologie et la SantéGrenobleFrance
| | - Bruno Guerci
- Endocrinology‐Diabetes Care UnitUniversity of LorraineVandoeuvre Lès NancyFrance
| | - Hélène Hanaire
- Department of Diabetology, Metabolic Diseases and NutritionCHU Toulouse, University of ToulouseToulouseFrance
| | | | - Nathalie Jeandidier
- Department of Endocrinology, Diabetes and NutritionCHRU of Strasbourg (UDS)StrasbourgFrance
| | - Coralie Amadou
- Department of DiabetesSud‐Francilien HospitalCorbeil‐EssonnesFrance
- University Paris‐SaclayOrsayFrance
| | - Eric Renard
- Department of Endocrinology, Diabetes and NutritionMontpellier University Hospital, and Institute of Functional Genomics, CNRS, INSERM, University of MontpellierMontpellierFrance
| | - Yves Reznik
- Department of EndocrinologyUniversity of Caen Côte de Nacre Regional Hospital CenterCaenFrance
| | - Pauline Schaepelynck
- Department of Nutrition‐Endocrinology‐Metabolic DisordersMarseille University Hospital, Sainte Marguerite HospitalMarseilleFrance
| | - Chantal Simon
- Department of Endocrinology, Diabetes and NutritionCentre Hospitalier Lyon SudLyonFrance
| | | | - Claire Thomas
- Laboratoire de Biologie de l'Exercice pour la Performance et la Santé, Université Evry Val d'Essonne, Institut de Recherches Biomédicales des Armées, Université Paris SaclayEvryFrance
| | - Patrick Hannaert
- School of Medicine and Pharmacy of PoitiersIschémie Reperfusion en Transplantation d'Organes Mécanismes et Innovations Thérapeutiques, Institut National de la Santé et de la Recherche Médicale, Unité Mixte de Recherche 1082PoitiersFrance
| | - Guillaume Charpentier
- Centre d'Etude et de Recherche pour l'Intensification du Traitement du Diabète (CERITD)EvryFrance
- Laboratoire de Biologie de l'Exercice pour la Performance et la Santé, Université Evry Val d'Essonne, Institut de Recherches Biomédicales des Armées, Université Paris SaclayEvryFrance
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20
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Wagenmakers AJM. The clinical and metabolic benefits of exercise for people with type 1 diabetes. Exp Physiol 2020; 105:562-564. [PMID: 32270575 DOI: 10.1113/ep088493] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Accepted: 03/05/2020] [Indexed: 02/02/2023]
Affiliation(s)
- Anton J M Wagenmakers
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, L3 3 AF, UK
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