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Cuerda Del Pino A, Martín-San Agustín R, José Laguna Sanz A, Díez JL, Palanca A, Rossetti P, Gumbau-Gimenez M, Ampudia-Blasco FJ, Bondia J. Accuracy of Two Continuous Glucose Monitoring Devices During Aerobic and High-Intensity Interval Training in Individuals with Type 1 Diabetes. Diabetes Technol Ther 2024; 26:411-419. [PMID: 38215205 DOI: 10.1089/dia.2023.0535] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2024]
Abstract
Background: This study aimed to evaluate the accuracy of Dexcom G6 (DG6) and FreeStyle Libre-2 (FSL2) during aerobic training and high-intensity interval training (HIIT) in individuals with type 1 diabetes. Methods: Twenty-six males (mean age 29.3 ± 6.3 years and mean duration of diabetes 14.9 ± 6.1 years) participated in this study. Interstitial glucose levels were measured using DG6 and FSL2, while plasma glucose levels were measured every 10 min using YSI 2500 as the reference for glucose measurements in this study. The measurements began 20 min before the start of exercise and continued for 20 min after exercise. Seven measurements were taken for each subject and exercise. Results: Both DG6 and FSL2 devices showed significant differences compared to YSI glucose data for both aerobic and HIIT exercises. Continuous glucose monitoring (CGM) devices exhibited superior performance during HIIT than aerobic training, with DG6 showing a mean absolute relative difference of 14.03% versus 31.98%, respectively. In the comparison between the two devices, FSL2 demonstrated significantly higher effectiveness in aerobic training, yet its performance was inferior to DG6 during HIIT. According to the 40/40 criteria, both sensors performed similarly, with marks over 93% for all ranges and both exercises, and above 99% for HIIT and in the >180 mg/dL range, which is in accordance with FDA guidelines. Conclusions: The findings suggest that the accuracy of DG6 and FSL2 deteriorates during and immediately after exercise but remains acceptable for both devices during HIIT. However, accuracy is compromised with DG6 during aerobic exercise. This study is the first to compare the accuracy of two CGMs, DG6, and FSL2, during two exercise modalities, using plasma glucose YSI measurements as the gold standard for comparisons. It was registered at clinicaltrials.gov (NCT06080542).
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Affiliation(s)
- Alba Cuerda Del Pino
- Clinimetry and Technological Development in Therapeutic Exercise Research Group (CLIDET), Department of Physiotherapy, University of Valencia, Valencia, Spain
| | - Rodrigo Martín-San Agustín
- Clinimetry and Technological Development in Therapeutic Exercise Research Group (CLIDET), Department of Physiotherapy, University of Valencia, Valencia, Spain
| | - Alejandro José Laguna Sanz
- Clinimetry and Technological Development in Therapeutic Exercise Research Group (CLIDET), Department of Physiotherapy, University of Valencia, Valencia, Spain
- Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Instituto de Salud Carlos III, Madrid, Spain
- Instituto Universitario de Automática e Informática Industrial, Universitat Politècnica de València, València, Spain
| | - José-Luis Díez
- Clinimetry and Technological Development in Therapeutic Exercise Research Group (CLIDET), Department of Physiotherapy, University of Valencia, Valencia, Spain
- Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Instituto de Salud Carlos III, Madrid, Spain
- Instituto Universitario de Automática e Informática Industrial, Universitat Politècnica de València, València, Spain
| | - Ana Palanca
- Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Instituto de Salud Carlos III, Madrid, Spain
- Cardiometabolic Risk and Diabetes Research Group, INCLIVA Biomedical Research Institute, Valencia, Spain
| | - Paolo Rossetti
- Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Instituto de Salud Carlos III, Madrid, Spain
- Department of Endocrinology and Nutrition, University and Polytechnic La Fe Hospital of Valencia, Valencia, Spain
| | - Maria Gumbau-Gimenez
- Clinimetry and Technological Development in Therapeutic Exercise Research Group (CLIDET), Department of Physiotherapy, University of Valencia, Valencia, Spain
| | - F Javier Ampudia-Blasco
- Clinimetry and Technological Development in Therapeutic Exercise Research Group (CLIDET), Department of Physiotherapy, University of Valencia, Valencia, Spain
- Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Instituto de Salud Carlos III, Madrid, Spain
- Cardiometabolic Risk and Diabetes Research Group, INCLIVA Biomedical Research Institute, Valencia, Spain
- Department of Endocrinology and Nutrition, Clinic University Hospital of Valencia, Valencia, Spain
- Department of Medicine, University of Valencia, Valencia, Spain
| | - Jorge Bondia
- Clinimetry and Technological Development in Therapeutic Exercise Research Group (CLIDET), Department of Physiotherapy, University of Valencia, Valencia, Spain
- Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Instituto de Salud Carlos III, Madrid, Spain
- Instituto Universitario de Automática e Informática Industrial, Universitat Politècnica de València, València, Spain
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2
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Lei M, Ling P, Ni Y, Chen D, Wang C, Yang D, Yang X, Xu W, Yan J. The efficacy of glucose-responsive insulin and glucagon delivery on exercise-induced hypoglycaemia among adults with type 1 diabetes mellitus: A meta-analysis of randomized controlled trials. Diabetes Obes Metab 2024; 26:1524-1528. [PMID: 38149727 DOI: 10.1111/dom.15422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Revised: 11/30/2023] [Accepted: 12/01/2023] [Indexed: 12/28/2023]
Affiliation(s)
- Mengyun Lei
- Guangdong Provincial Key Laboratory of Diabetology, Department of Endocrinology and Metabolism, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Ping Ling
- Guangdong Provincial Key Laboratory of Diabetology, Department of Endocrinology and Metabolism, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Ying Ni
- Guangdong Provincial Key Laboratory of Diabetology, Department of Endocrinology and Metabolism, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Danrui Chen
- Guangdong Provincial Key Laboratory of Diabetology, Department of Endocrinology and Metabolism, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Chaofan Wang
- Guangdong Provincial Key Laboratory of Diabetology, Department of Endocrinology and Metabolism, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Daizhi Yang
- Guangdong Provincial Key Laboratory of Diabetology, Department of Endocrinology and Metabolism, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Xubin Yang
- Guangdong Provincial Key Laboratory of Diabetology, Department of Endocrinology and Metabolism, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Wen Xu
- Guangdong Provincial Key Laboratory of Diabetology, Department of Endocrinology and Metabolism, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Jinhua Yan
- Guangdong Provincial Key Laboratory of Diabetology, Department of Endocrinology and Metabolism, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
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Li Z, Calhoun P, Rickels MR, Gal RL, Beck RW, Jacobs PG, Clements MA, Patton SR, Castle JR, Martin CK, Gillingham MB, Doyle FJ, Riddell MC. Factors Affecting Reproducibility of Change in Glucose During Exercise: Results From the Type 1 Diabetes and EXercise Initiative. J Diabetes Sci Technol 2024:19322968241234687. [PMID: 38456512 DOI: 10.1177/19322968241234687] [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: 03/09/2024]
Abstract
AIMS To evaluate factors affecting within-participant reproducibility in glycemic response to different forms of exercise. METHODS Structured exercise sessions ~30 minutes in length from the Type 1 Diabetes Exercise Initiative (T1DEXI) study were used to assess within-participant glycemic variability during and after exercise. The effect of several pre-exercise factors on the within-participant glycemic variability was evaluated. RESULTS Data from 476 adults with type 1 diabetes were analyzed. A participant's change in glucose during exercise was reproducible within 15 mg/dL of the participant's other exercise sessions only 32% of the time. Participants who exercised with lower and more consistent glucose level, insulin on board (IOB), and carbohydrate intake at exercise start had less variability in glycemic change during exercise. Participants with lower mean glucose (P < .001), lower glucose coefficient of variation (CV) (P < .001), and lower % time <70 mg/dL (P = .005) on sedentary days had less variable 24-hour post-exercise mean glucose. CONCLUSIONS Reproducibility of change in glucose during exercise was low in this cohort of adults with T1D, but more consistency in pre-exercise glucose levels, IOB, and carbohydrates may increase this reproducibility. Mean glucose variability in the 24 hours after exercise is influenced more by the participant's overall glycemic control than other modifiable factors.
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Affiliation(s)
- Zoey Li
- JAEB Center for Health Research, Tampa, FL, USA
| | | | - Michael R Rickels
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Robin L Gal
- JAEB Center for Health Research, Tampa, FL, USA
| | - Roy W Beck
- JAEB Center for Health Research, Tampa, FL, USA
| | - Peter G Jacobs
- Department of Biomedical Engineering, Oregon Health and Science University, Portland, OR, USA
| | | | | | - Jessica R Castle
- Harold Schnitzer Diabetes Health Center, Oregon Health & Science University, Portland, OR, USA
| | - Corby K Martin
- Pennington Biomedical Research Center, Louisiana State University, Baton Rouge, LA, USA
| | - Melanie B Gillingham
- Department of Molecular and Medical Genetics, Oregon Health & Science University, Portland, OR, USA
| | - Francis J Doyle
- Harvard John A. Paulson School of Engineering and Applied Sciences, Harvard University, Cambridge, MA, USA
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4
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Zimmer RT, Birnbaumer P, Sternad C, Zunner BEM, Schierbauer J, Fritsch M, Fröhlich-Reiterer E, Hofmann P, Sourij H, Aberer F, Moser O. Impact of a 4-week intensive track and field training intervention on glycaemia in adolescents with type 1 diabetes: The ChilDFiT1 study. Diabetes Obes Metab 2024; 26:631-641. [PMID: 37985360 DOI: 10.1111/dom.15352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Revised: 10/10/2023] [Accepted: 10/17/2023] [Indexed: 11/22/2023]
Abstract
AIM To investigate the safety and efficacy of track and field training compared with intensification of insulin treatment only in adolescents with type 1 diabetes (T1D). MATERIALS AND METHODS Eighteen adolescents (seven females) with T1D were included (age 15.1 ± 1.1 years, HbA1c 7.3% ± 1.0% [56.3 ± 10.9 mmol/mol]). After a 4-week observational control phase, participants were randomized to either stand-alone intensive glycaemic management (IT; telemedicine or on-site visits, three times/week) or additionally performed track and field exercise (EX; three 60-minute sessions/week) for 4 weeks. Glycaemia was assessed via continuous glucose monitoring during observational control and intervention phases. RESULTS Time in range (70-180 mg/dL; 3.9-10.0 mmol/L) significantly improved from the observational control phase to the exercise intervention phase in EX (69% ± 13% vs. 72% ± 11%, P = .049), but not in IT (59% ± 22% vs. 62% ± 16%, P = .399). Time below range 1 (54-69 mg/dL; < 3.9 mmol/L) improved in IT (3.1% ± 1.9% vs. 2.0% ± 0.8%, P = .017) and remained stable in EX (2.0% ± 1.7 vs. 1.9% ± 1.1%, P = .999). The EX group's HbA1c ameliorated preintervention to postintervention (mean difference: ΔHbA1c -0.19% ± 0.17%, P = .042), which was not seen within the IT group (ΔHbA1c -0.16% ± 0.37%, P = .40). Glucose standard deviation was reduced significantly in EX (55 ± 11 vs. 51 ± 10 mg/dL [3.1 ± 0.6 vs. 2.8 ± 0.6 mmol/L], P = .011), but not in IT (70 ± 24 vs. 63 ± 18 mg/dL [3.9 ± 1.3 vs. 3.5 ± 1.0 mmol/L], P = .186). CONCLUSION Track and field training combined with intensive glycaemic management improved glycaemia in adolescents with T1D, which was not observed in the non-exercise group.
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Affiliation(s)
- Rebecca T Zimmer
- Division of Exercise Physiology and Metabolism, BaySpo-Bayreuth Center of Sport Science, University Bayreuth, Bayreuth, Germany
| | - Philipp Birnbaumer
- Exercise Physiology, Training & Training Therapy Research Group, Institute of Human Movement Science, Sport and Health, University of Graz, Graz, Austria
| | - Christoph Sternad
- Interdisciplinary Metabolic Medicine Trials Unit, Division of Endocrinology and Diabetology, Medical University of Graz, Graz, Austria
| | - Beate E M Zunner
- Division of Exercise Physiology and Metabolism, BaySpo-Bayreuth Center of Sport Science, University Bayreuth, Bayreuth, Germany
| | - Janis Schierbauer
- Division of Exercise Physiology and Metabolism, BaySpo-Bayreuth Center of Sport Science, University Bayreuth, Bayreuth, Germany
| | - Maria Fritsch
- Department of Pediatrics and Adolescent Medicine, Division of General Pediatrics, Medical University Graz, Graz, Austria
| | - Elke Fröhlich-Reiterer
- Department of Pediatrics and Adolescent Medicine, Division of General Pediatrics, Medical University Graz, Graz, Austria
| | - Peter Hofmann
- Exercise Physiology, Training & Training Therapy Research Group, Institute of Human Movement Science, Sport and Health, University of Graz, Graz, Austria
| | - Harald Sourij
- Interdisciplinary Metabolic Medicine Trials Unit, Division of Endocrinology and Diabetology, Medical University of Graz, Graz, Austria
| | - Felix Aberer
- Division of Exercise Physiology and Metabolism, BaySpo-Bayreuth Center of Sport Science, University Bayreuth, Bayreuth, Germany
- Interdisciplinary Metabolic Medicine Trials Unit, Division of Endocrinology and Diabetology, Medical University of Graz, Graz, Austria
| | - Othmar Moser
- Division of Exercise Physiology and Metabolism, BaySpo-Bayreuth Center of Sport Science, University Bayreuth, Bayreuth, Germany
- Interdisciplinary Metabolic Medicine Trials Unit, Division of Endocrinology and Diabetology, Medical University of Graz, Graz, Austria
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Cipryan L, Kosek V, García CJ, Dostal T, Bechynska K, Hajslova J, Hofmann P. A lipidomic and metabolomic signature of a very low-carbohydrate high-fat diet and high-intensity interval training: an additional analysis of a randomized controlled clinical trial. Metabolomics 2023; 20:10. [PMID: 38141101 DOI: 10.1007/s11306-023-02071-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Accepted: 11/28/2023] [Indexed: 12/24/2023]
Abstract
INTRODUCTION Regular physical activity and dietary variety are modifiable and influential factors of health outcomes. However, the cumulative effects of these behaviors are not well understood. Metabolomics may have a promising research potential to extend our knowledge and use it in the attempts to find a long-term and sustainable personalized approach in exercise and diet recommendations. OBJECTIVE The main aim was to investigate the effect of the 12 week very low carbohydrate high fat (VLCHF) diet and high-intensity interval training (HIIT) on lipidomic and metabolomic profiles in individuals with overweight and obesity. METHODS The participants (N = 91) were randomly allocated to HIIT (N = 22), VLCHF (N = 25), VLCHF + HIIT (N = 25) or control (N = 19) groups for 12 weeks. Fasting plasma samples were collected before the intervention and after 4, 8 and 12 weeks. The samples were then subjected to untargeted lipidomic and metabolomic analyses using reversed phase ultra-high-performance liquid chromatography coupled to high-resolution mass spectrometry. RESULTS The VLCHF diet affected plasma lipids considerably while the effect of HIIT was unremarkable. Already after 4 weeks of intervention substantial changes of plasma lipids were found in both VLCHF diet groups. The changes persisted throughout the entire 12 weeks of the VLCHF diet. Specifically, acyl carnitines, plasmalogens, fatty acyl esters of hydroxy fatty acid, sphingomyelin, ceramides, cholesterol esters, fatty acids and 4-hydroxybutyric were identified as lipid families that increased in the VLCHF diet groups whereas lipid families of triglycerides and glycerophospholipids decreased. Additionally, metabolomic analysis showed a decrease of theobromine. CONCLUSIONS This study deciphers the specific responses to a VLCHF diet, HIIT and their combination by analysing untargeted lipidomic and metabolomic profile. VLCHF diet caused divergent changes of plasma lipids and other metabolites when compared to the exercise and control group which may contribute to a better understanding of metabolic changes and the appraisal of VLCHF diet benefits and harms. CLINICAL TRIAL REGISTRY NUMBER NCT03934476, registered 1st May 2019 https://clinicaltrials.gov/ct2/show/NCT03934476?term=NCT03934476&draw=2&rank=1 .
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Affiliation(s)
- Lukas Cipryan
- Department of Human Movement Studies and Human Motion Diagnostic Centre, The University of Ostrava, Ostrava, Czech Republic
| | - Vit Kosek
- Department of Food Analysis and Nutrition, Faculty of Food and Biochemical Technology, University of Chemistry and Technology, 16628, Prague, Czech Republic.
| | - Carlos J García
- Department of Food Analysis and Nutrition, Faculty of Food and Biochemical Technology, University of Chemistry and Technology, 16628, Prague, Czech Republic
| | - Tomas Dostal
- Department of Human Movement Studies and Human Motion Diagnostic Centre, The University of Ostrava, Ostrava, Czech Republic
| | - Kamila Bechynska
- Department of Food Analysis and Nutrition, Faculty of Food and Biochemical Technology, University of Chemistry and Technology, 16628, Prague, Czech Republic
| | - Jana Hajslova
- Department of Food Analysis and Nutrition, Faculty of Food and Biochemical Technology, University of Chemistry and Technology, 16628, Prague, Czech Republic
| | - Peter Hofmann
- Institute of Human Movement Science, Sport and Health, Exercise Physiology, Training and Training Therapy Research Group, University of Graz, Graz, Austria
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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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Kraft AM, Velasco Garrido M, Herold R, Harth V, Preisser AM. Physical workload and cardiopulmonary parameters in relation to individual capacity of bulk waste workers - a cross-sectional field-study. J Occup Med Toxicol 2023; 18:29. [PMID: 38102679 PMCID: PMC10724959 DOI: 10.1186/s12995-023-00389-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Accepted: 09/07/2023] [Indexed: 12/17/2023] Open
Abstract
PURPOSE Waste collection is considered particularly heavy work, although no previous study has yet investigated the strain of bulk waste collection. The aim of this study is to determine the workload of bulk waste workers in practice. METHOD We conducted a cross-sectional field-study. Fourteen male volunteers from the bulk waste collection of the municipal sanitation department in Hamburg, Germany, were included. Performance was determined by cardiopulmonary exercise testing under laboratory conditions. During the shift, each worker was accompanied by a researcher, and heart rate (HR) was recorded under field conditions using an HR watch with a belt system. We examined mean HR, relative heart rate (RHR), relative aerobic strain (RAS), calculated oxygen uptake ([Formula: see text]) and individual ventilatory threshold 1 (VT1) as parameters of workload during their daily work. RESULTS During the shift, HR was scaled: 102 bpm (SD 10.2), RHR: 36.9%, [Formula: see text]: 1267 ml/min (SD 161), RAS: 49.4% (SD 9.3), and [Formula: see text] in relation to VT1: 75% (SD 18.5). There was no significant difference between oxygen consumption during the main task of lifting and carrying bulky waste and the individual [Formula: see text] at VT1. CONCLUSION Although the burden of the main task of lifting and carrying bulky waste is very high (at VT1 for more than 3 h), interruptions from other tasks or formal breaks spread the burden over the entire shift. The total workload exceeded most recommendations in the literature across the different work periods. However, the total burden remains below VT1, the only parameter that takes individual endurance performance into account. We recommend again VT1 as an individual upper limit for prolonged occupational work.
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Affiliation(s)
- Alexander Michael Kraft
- Institute for Occupational and Maritime Medicine, University Medical Center Hamburg-Eppendorf, Seewartenstrasse 10, 20459, Hamburg, Germany
| | - Marcial Velasco Garrido
- Institute for Occupational and Maritime Medicine, University Medical Center Hamburg-Eppendorf, Seewartenstrasse 10, 20459, Hamburg, Germany
| | - Robert Herold
- Institute for Occupational and Maritime Medicine, University Medical Center Hamburg-Eppendorf, Seewartenstrasse 10, 20459, Hamburg, Germany
| | - Volker Harth
- Institute for Occupational and Maritime Medicine, University Medical Center Hamburg-Eppendorf, Seewartenstrasse 10, 20459, Hamburg, Germany
| | - Alexandra Marita Preisser
- Institute for Occupational and Maritime Medicine, University Medical Center Hamburg-Eppendorf, Seewartenstrasse 10, 20459, Hamburg, Germany.
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Müller A, Moser O, Sternad C, Aziz F, Unteregger C, Kojzar H, Mursic I, Sourij C, Pferschy P, Tripolt N, Aberer F, Sourij H. Effects of 8 weeks of aerobic endurance training on functional capacity and metabolic variables in people with type 1 diabetes: A secondary outcome analysis of the ULTRAFLEXI-1 study. Diabetes Obes Metab 2023; 25:3826-3830. [PMID: 37580976 DOI: 10.1111/dom.15245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Revised: 07/20/2023] [Accepted: 07/31/2023] [Indexed: 08/16/2023]
Affiliation(s)
- Alexander Müller
- Trials Unit for Interdisciplinary Metabolic Medicine, Division of Endocrinology and Diabetology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Othmar Moser
- Trials Unit for Interdisciplinary Metabolic Medicine, Division of Endocrinology and Diabetology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
- Exercise Physiology & Metabolism, Institute of Sports Science, University of Bayreuth, Bayreuth, Germany
| | - Christoph Sternad
- Trials Unit for Interdisciplinary Metabolic Medicine, Division of Endocrinology and Diabetology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Faisal Aziz
- Trials Unit for Interdisciplinary Metabolic Medicine, Division of Endocrinology and Diabetology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Christina Unteregger
- Trials Unit for Interdisciplinary Metabolic Medicine, Division of Endocrinology and Diabetology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Harald Kojzar
- Trials Unit for Interdisciplinary Metabolic Medicine, Division of Endocrinology and Diabetology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Ines Mursic
- Trials Unit for Interdisciplinary Metabolic Medicine, Division of Endocrinology and Diabetology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Caren Sourij
- Division of Cardiology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Peter Pferschy
- Trials Unit for Interdisciplinary Metabolic Medicine, Division of Endocrinology and Diabetology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Norbert Tripolt
- Trials Unit for Interdisciplinary Metabolic Medicine, Division of Endocrinology and Diabetology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Felix Aberer
- Trials Unit for Interdisciplinary Metabolic Medicine, Division of Endocrinology and Diabetology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Harald Sourij
- Trials Unit for Interdisciplinary Metabolic Medicine, Division of Endocrinology and Diabetology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
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Kistkins S, Mihailovs T, Lobanovs S, Pīrāgs V, Sourij H, Moser O, Bļizņuks D. Comparative Analysis of Predictive Interstitial Glucose Level Classification Models. SENSORS (BASEL, SWITZERLAND) 2023; 23:8269. [PMID: 37837098 PMCID: PMC10574913 DOI: 10.3390/s23198269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Revised: 10/02/2023] [Accepted: 10/04/2023] [Indexed: 10/15/2023]
Abstract
BACKGROUND New methods of continuous glucose monitoring (CGM) provide real-time alerts for hypoglycemia, hyperglycemia, and rapid fluctuations of glucose levels, thereby improving glycemic control, which is especially crucial during meals and physical activity. However, complex CGM systems pose challenges for individuals with diabetes and healthcare professionals, particularly when interpreting rapid glucose level changes, dealing with sensor delays (approximately a 10 min difference between interstitial and plasma glucose readings), and addressing potential malfunctions. The development of advanced predictive glucose level classification models becomes imperative for optimizing insulin dosing and managing daily activities. METHODS The aim of this study was to investigate the efficacy of three different predictive models for the glucose level classification: (1) an autoregressive integrated moving average model (ARIMA), (2) logistic regression, and (3) long short-term memory networks (LSTM). The performance of these models was evaluated in predicting hypoglycemia (<70 mg/dL), euglycemia (70-180 mg/dL), and hyperglycemia (>180 mg/dL) classes 15 min and 1 h ahead. More specifically, the confusion matrices were obtained and metrics such as precision, recall, and accuracy were computed for each model at each predictive horizon. RESULTS As expected, ARIMA underperformed the other models in predicting hyper- and hypoglycemia classes for both the 15 min and 1 h horizons. For the 15 min forecast horizon, the performance of logistic regression was the highest of all the models for all glycemia classes, with recall rates of 96% for hyper, 91% for norm, and 98% for hypoglycemia. For the 1 h forecast horizon, the LSTM model turned out to be the best for hyper- and hypoglycemia classes, achieving recall values of 85% and 87% respectively. CONCLUSIONS Our findings suggest that different models may have varying strengths and weaknesses in predicting glucose level classes, and the choice of model should be carefully considered based on the specific requirements and context of the clinical application. The logistic regression model proved to be more accurate for the next 15 min, particularly in predicting hypoglycemia. However, the LSTM model outperformed logistic regression in predicting glucose level class for the next hour. Future research could explore hybrid models or ensemble approaches that combine the strengths of multiple models to further enhance the accuracy and reliability of glucose predictions.
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Affiliation(s)
- Svjatoslavs Kistkins
- Research Institute of Pauls Stradins Clinical University Hospital, LV-1002 Riga, Latvia; (S.K.); (V.P.)
| | - Timurs Mihailovs
- Institute of Smart Computing Technologies, Riga Technical University, LV-1048 Riga, Latvia; (T.M.); (D.B.)
| | - Sergejs Lobanovs
- Research Institute of Pauls Stradins Clinical University Hospital, LV-1002 Riga, Latvia; (S.K.); (V.P.)
| | - Valdis Pīrāgs
- Research Institute of Pauls Stradins Clinical University Hospital, LV-1002 Riga, Latvia; (S.K.); (V.P.)
| | - Harald Sourij
- Interdisciplinary Metabolic Medicine Trials Unit, Division of Endocrinology and Diabetology, Medical University of Graz, 8010 Graz, Austria;
| | - Othmar Moser
- Division of Exercise Physiology and Metabolism, Institute of Sport Science, University of Bayreuth, 95447 Bayreuth, Germany;
| | - Dmitrijs Bļizņuks
- Institute of Smart Computing Technologies, Riga Technical University, LV-1048 Riga, Latvia; (T.M.); (D.B.)
- SIA “R4U”, LV-1016 Riga, Latvia
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10
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Schützenhöfer M, Birnbaumer P, Hofmann P. Accelerometer-Derived Intensity Thresholds Are Equivalent to Standard Ventilatory Thresholds in Incremental Running Exercise. Sports (Basel) 2023; 11:171. [PMID: 37755848 PMCID: PMC10538147 DOI: 10.3390/sports11090171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 08/10/2023] [Accepted: 08/24/2023] [Indexed: 09/28/2023] Open
Abstract
Accelerometer cut-points are commonly used to prescribe the amount of physical activity, but this approach includes no individual performance measures. As running kinetics change with intensity, acceleration measurements may provide more individual information. Therefore, the aim was to determine two intensity thresholds from accelerometer measures. A total of 33 participants performed a maximal incremental running test with spirometric and acceleration (Axivity AX3) measures at the left and right tibia. Ventilatory equivalents (VE/VO2, VE/VCO2) were used to determine a first and second ventilatory threshold (VT1/VT2). A first and second accelerometer threshold (ACT1/ACT2) were determined within the same regions of interest from vector magnitude (|v| = √(ax2 + ay2 + az2). Accelerometer data from the tibia presented a three-phase increase with increasing speed. Speed at VT1/VT2 (7.82 ± 0.39/10.91 ± 0.87 km/h) was slightly but significantly lower compared to the speed at ACT1/ACT2 from the left (7.71 ± 0.35/10.62 ± 0.72 km/h) and right leg (7.79 ± 0.33/10.74 ± 0.77 km/h). Correlation analysis revealed a strong relationship between speed at thresholds determined from spriometric data or accelerations (r = 0.98; p < 0.001). It is therefore possible to determine accelerometer thresholds from tibia placement during a maximal incremental running test comparable to standard ventilatory thresholds.
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Affiliation(s)
| | | | - Peter Hofmann
- Exercise Physiology, Training and Training Therapy Research Group, Institute of Human Movement Science, Sport and Health, University of Graz, 8010 Graz, Austria; (M.S.); (P.B.)
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11
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Hall B, Żebrowska A, Sikora M, Siatkowski S, Robins A. The Effect of High-Intensity Interval Exercise on Short-Term Glycaemic Control, Serum Level of Key Mediator in Hypoxia and Pro-Inflammatory Cytokines in Patients with Type 1 Diabetes-An Exploratory Case Study. Nutrients 2023; 15:3749. [PMID: 37686781 PMCID: PMC10490106 DOI: 10.3390/nu15173749] [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: 07/31/2023] [Revised: 08/22/2023] [Accepted: 08/25/2023] [Indexed: 09/10/2023] Open
Abstract
Type 1 diabetes (T1D) is associated with hyperglycaemia-induced hypoxia and inflammation. This study assessed the effects of a single bout of high-intensity interval exercise (HIIE) on glycaemia (BG) and serum level of pro-inflammatory cytokines, and an essential mediator of adaptive response to hypoxia in T1D patients. The macronutrient intake was also evaluated. Nine patients suffering from T1D for about 12 years and nine healthy individuals (CG) were enrolled and completed one session of HIIE at the intensity of 120% lactate threshold with a duration of 4 × 5 min intermittent with 5 min rests after each bout of exercise. Capillary and venous blood were withdrawn at rest, immediately after and at 24 h post-HIIE for analysis of BG, hypoxia-inducible factor alpha (HIF-1α), tumour necrosis factor alpha (TNF-α) and vascular-endothelial growth factor (VEGF). Pre-exercise BG was significantly higher in the T1D patients compared to the CG (p = 0.043). HIIE led to a significant decline in T1D patients' BG (p = 0.027) and a tendency for a lower BG at 24 h post-HIIE vs. pre-HIIE. HIF-1α was significantly elevated in the T1D patients compared to CG and there was a trend for HIF-1α to decline, and for VEGF and TNF-α to increase in response to HIIE in the T1D group. Both groups consumed more and less than the recommended amounts of protein and fat, respectively. In the T1D group, a tendency for a higher digestible carbohydrate intake and more frequent hyperglycaemic episodes on the day after HIIE were observed. HIIE was effective in reducing T1D patients' glycaemia and improving short-term glycaemic control. HIIE has the potential to improve adaptive response to hypoxia by elevating the serum level of VEGF. Patients' diet and level of physical activity should be screened on a regular basis, and they should be educated on the glycaemic effects of digestible carbohydrates.
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Affiliation(s)
- Barbara Hall
- School of Physiological and Medical Sciences, Department of Physiology, The Jerzy Kukuczka Academy of Physical Education, Mikolowska Street 72a, 40-065 Katowice, Poland; (A.Ż.); (M.S.)
| | - Aleksandra Żebrowska
- School of Physiological and Medical Sciences, Department of Physiology, The Jerzy Kukuczka Academy of Physical Education, Mikolowska Street 72a, 40-065 Katowice, Poland; (A.Ż.); (M.S.)
| | - Marcin Sikora
- School of Physiological and Medical Sciences, Department of Physiology, The Jerzy Kukuczka Academy of Physical Education, Mikolowska Street 72a, 40-065 Katowice, Poland; (A.Ż.); (M.S.)
| | - Szymon Siatkowski
- Institute of Healthy Living, The Jerzy Kukuczka Academy of Physical Education, Mikolowska Street 72a, 40-065 Katowice, Poland;
| | - Anna Robins
- School of Health and Society, University of Salford, Allerton Building, 43 Crescent, Salford M5 4WT, UK;
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12
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Armstrong M, Colberg SR, Sigal RJ. Where to Start? Physical Assessment, Readiness, and Exercise Recommendations for People With Type 1 or Type 2 Diabetes. Diabetes Spectr 2023; 36:105-113. [PMID: 37193205 PMCID: PMC10182968 DOI: 10.2337/dsi22-0016] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/18/2023]
Abstract
Exercise plays an important role in the management of diabetes and is associated with many benefits such as decreased morbidity and mortality. For people exhibiting signs and symptoms of cardiovascular disease, pre-exercise medical clearance is warranted; however, requiring broad screening requirements can lead to unnecessary barriers to initiating an exercise program. Robust evidence supports the promotion of both aerobic and resistance training, with evidence emerging on the importance of reducing sedentary time. For people with type 1 diabetes, there are special considerations, including hypoglycemia risk and prevention, exercise timing (including prandial status), and differences in glycemic responses based on biological sex.
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Affiliation(s)
- Marni Armstrong
- Medicine Strategic Clinical Network, Alberta Health Services, Alberta, Canada
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Sheri R. Colberg
- Human Movement Sciences Department, Old Dominion University, Norfolk, VA
| | - Ronald J. Sigal
- Departments of Medicine, Cardiac Sciences, and Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
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13
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McClure RD, Alcántara-Cordero FJ, Weseen E, Maldaner M, Hart S, Nitz C, Boulé NG, Yardley JE. Systematic Review and Meta-analysis of Blood Glucose Response to High-intensity Interval Exercise in Adults With Type 1 Diabetes. Can J Diabetes 2023; 47:171-179. [PMID: 36549943 DOI: 10.1016/j.jcjd.2022.11.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Revised: 11/21/2022] [Accepted: 11/22/2022] [Indexed: 11/27/2022]
Abstract
OBJECTIVES Exercise-induced hyperglycemia is recognized in type 1 diabetes (T1D) clinical guidelines, but its association with high-intensity intermittent exercise (HIIE) in acute studies is inconsistent. In this meta-analysis, we examined the available evidence of blood glucose responses to HIIE in adults with T1D. The secondary, aim was to examine predictors of blood glucose responses to HIIE. We hypothesized that there would be no consistent effect on blood glucose from HIIE, unless examined in the context of participant prandial status. METHODS We conducted a literature search using key words related to T1D and HIIE. Studies were required to include at least 6 participants with T1D with a mean age >18 years, involve an HIIE intervention, and contain pre- and postexercise measures of blood glucose. Analyses of extracted data were performed using a general inverse variance statistical method with a random effects model and a weighted multiple regression. RESULTS Nineteen interventions from 15 reports were included in the analysis. A mean overall blood glucose decrease of -1.3 mmol/L (95% confidence interval [CI], -2.3 to -0.2 mmol/L) was found during exercise, albeit with high heterogeneity (I2=84%). When performed after an overnight fast, exercise increased blood glucose by +1.7 mmol/L (95% CI, 0.4 to 3.0 mmol/L), whereas postprandial exercise decreased blood glucose by -2.1 mmol/L (95% CI, -2.8 to -1.4 mmol/L), with a statistically significant difference between groups (p<0.0001). No associations with fitness (p=0.4), sex (p=0.4), age (p=0.9), exercise duration (p=0.9), or interval duration (p=0.2) were found. CONCLUSION The effect of HIIE on blood glucose is inconsistent, but partially explained by prandial status.
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Affiliation(s)
- Reid D McClure
- Faculty of Kinesiology, Sport, and Recreation, University of Alberta, Edmonton, Alberta, Canada; Alberta Diabetes Institute, Edmonton, Alberta, Canada
| | | | - Emma Weseen
- Alberta Diabetes Institute, Edmonton, Alberta, Canada; Augustana Faculty, University of Alberta, Camrose, Alberta, Canada
| | - Miranda Maldaner
- Faculty of Kinesiology, Sport, and Recreation, University of Alberta, Edmonton, Alberta, Canada; Alberta Diabetes Institute, Edmonton, Alberta, Canada
| | - Sarah Hart
- Faculty of Kinesiology, Sport, and Recreation, University of Alberta, Edmonton, Alberta, Canada; Alberta Diabetes Institute, Edmonton, Alberta, Canada
| | - Corbin Nitz
- Alberta Diabetes Institute, Edmonton, Alberta, Canada; Augustana Faculty, University of Alberta, Camrose, Alberta, Canada
| | - Normand G Boulé
- Faculty of Kinesiology, Sport, and Recreation, University of Alberta, Edmonton, Alberta, Canada; Alberta Diabetes Institute, Edmonton, Alberta, Canada
| | - Jane E Yardley
- Faculty of Kinesiology, Sport, and Recreation, University of Alberta, Edmonton, Alberta, Canada; Alberta Diabetes Institute, Edmonton, Alberta, Canada; Augustana Faculty, University of Alberta, Camrose, Alberta, Canada; Women and Children's Health Research Institute, Edmonton, Alberta, Canada.
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14
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Yardley JE. Reassessing the evidence: prandial state dictates glycaemic responses to exercise in individuals with type 1 diabetes to a greater extent than intensity. Diabetologia 2022; 65:1994-1999. [PMID: 35978179 DOI: 10.1007/s00125-022-05781-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Accepted: 07/04/2022] [Indexed: 01/11/2023]
Abstract
Recent guidelines suggest that adding anaerobic (high intensity or resistance) activity to an exercise session can prevent blood glucose declines that occur during aerobic exercise in individuals with type 1 diabetes. This theory evolved from earlier study data showing that sustained, anaerobic activity (high intensity cycling) increases blood glucose levels in these participants. However, studies involving protocols where anaerobic (high intensity interval) and aerobic exercise are combined have extremely variable glycaemic outcomes, as do resistance exercise studies. Scrutinising earlier studies will reveal that, in addition to high intensity activity (intervals or weight lifting), these protocols had another common feature: participants were performing exercise after an overnight fast. Based on these findings, and data from recent exercise studies, it can be argued that participant prandial state may be a more dominant factor than exercise intensity where glycaemic changes in individuals with type 1 diabetes are concerned. As such, a reassessment of study outcomes and an update to exercise recommendations for those with type 1 diabetes may be warranted.
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Affiliation(s)
- Jane E Yardley
- Augustana Faculty, University of Alberta, Camrose, AB, Canada.
- Physical Activity and Diabetes Laboratory, Alberta Diabetes Institute, Edmonton, AB, Canada.
- Women and Children's Health Research Institute, Edmonton, AB, Canada.
- Faculty of Kinesiology, Sport and Recreation, University of Alberta, Edmonton, AB, Canada.
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15
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Adolfsson P, Taplin CE, Zaharieva DP, Pemberton J, Davis EA, Riddell MC, McGavock J, Moser O, Szadkowska A, Lopez P, Santiprabhob J, Frattolin E, Griffiths G, DiMeglio LA. ISPAD Clinical Practice Consensus Guidelines 2022: Exercise in children and adolescents with diabetes. Pediatr Diabetes 2022; 23:1341-1372. [PMID: 36537529 PMCID: PMC10107219 DOI: 10.1111/pedi.13452] [Citation(s) in RCA: 32] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/07/2022] [Indexed: 12/24/2022] Open
Affiliation(s)
- Peter Adolfsson
- Department of Pediatrics, Kungsbacka Hospital, Kungsbacka, Sweden.,Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Craig E Taplin
- Department of Endocrinology and Diabetes, Perth Children's Hospital, Nedlands, Western Australia, Australia.,Telethon Kids Institute, University of Western Australia, Perth, Western Australia, Australia.,Centre for Child Health Research, University of Western Australia, Perth, Western Australia, Australia
| | - Dessi P Zaharieva
- Division of Endocrinology, Department of Pediatrics, School of Medicine, Stanford University, Stanford, California, USA
| | - John Pemberton
- Department of Endocrinology and Diabetes, Birmingham Women's and Children's Hospital, Birmingham, UK
| | - Elizabeth A Davis
- Department of Endocrinology and Diabetes, Perth Children's Hospital, Nedlands, Western Australia, Australia.,Telethon Kids Institute, University of Western Australia, Perth, Western Australia, Australia.,Centre for Child Health Research, University of Western Australia, Perth, Western Australia, Australia
| | - Michael C Riddell
- Muscle Health Research Centre, York University, Toronto, Ontario, Canada
| | - Jonathan McGavock
- Faculty of Kinesiology and Recreation Management, University of Manitoba, Winnipeg, Manitoba, Canada.,Diabetes Research Envisioned and Accomplished in Manitoba (DREAM) Theme, Children's Hospital Research Institute of Manitoba, Winnipeg, Manitoba, Canada.,Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, Manitoba, Canada.,Diabetes Action Canada SPOR Network, Toronto, Ontario, Canada
| | - Othmar Moser
- Division Exercise Physiology and Metabolism, Department of Sport Science, University of Bayreuth, Bayreuth, Germany.,Interdisciplinary Metabolic Medicine Trials Unit, Division of Endocrinology and Diabetology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Agnieszka Szadkowska
- Department of Pediatrics, Diabetology, Endocrinology & Nephrology, Medical University of Lodz, Lodz, Poland
| | - Prudence Lopez
- Department of Paediatrics, John Hunter Children's Hospital, Newcastle, New South Wales, Australia.,University of Newcastle, Newcastle, New South Wales, Australia
| | - Jeerunda Santiprabhob
- Siriraj Diabetes Center, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.,Division of Endocrinology and Metabolism, Department of Pediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | | | | | - Linda A DiMeglio
- Department of Pediatrics, Division of Pediatric Endocrinology and Diabetology, Indiana University School of Medicine, Riley Hospital for Children, Indianapolis, Indiana, USA
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16
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Pemberton JS, Barrett TG, Dias RP, Kershaw M, Krone R, Uday S. An effective and cost-saving structured education program teaching dynamic glucose management strategies to a socio-economically deprived cohort with type 1 diabetes in a VIRTUAL setting. Pediatr Diabetes 2022; 23:1045-1056. [PMID: 35689452 DOI: 10.1111/pedi.13381] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2021] [Revised: 05/16/2022] [Accepted: 06/07/2022] [Indexed: 12/01/2022] Open
Abstract
OBJECTIVES Compare the clinical and cost-effectiveness of an established face to face (F2F) structured education program to a new remote (VIRTUAL) program teaching dynamic glucose management (DynamicGM) to children and young people with type 1 diabetes (CYPD) using continuous glucose monitoring (CGM). To ascertain the most effective DynamicGM strategies predicting time in range (TIR) (3.9-10.0 mmol/L) and incorporating these into a user-friendly teaching aid. DESIGN AND METHODS Effectiveness of the F2F and VIRTUAL programs were ascertained by comparing the mean change (Δ) from baseline to 6 months in HbA1c, TIR and severe hypoglycemia. Delivery cost for the two programs were evaluated. Factors predicting TIR in the combined cohort were determined and incorporated into a user-friendly infographic. RESULTS First 50 graduates per group were evaluated. The mean difference in Δ HbA1c, Δ TIR and Δ episodes of severe hypoglycemia between VIRTUAL and F2F groups were 1.16 (p = 0.47), 0.76 (p = 0.78) and -0.06 (p = 0.61) respectively. Delivery cost per 50 CYPD for VIRTUAL and F2F were $5752 and $7020, respectively. The strongest predictors of TIR (n = 100) were short bursts of exercise (10-40 min) to lower hyperglycemia (p < 0.001), using trend arrow adjustment tools (p < 0.001) and adjusting pre-meal bolus timing based on trend arrows (p < 0.01). These strategies were translated into a GAME (Stop highs), SET (Stay in target), MATCH (Prevent lows) mnemonic. CONCLUSION Teaching DynamicGM VIRTUALLY is just as effective as F2F delivery and cost saving. Short bursts of exercise and using CGM trend arrows to adjust insulin dose and timing improves TIR.
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Affiliation(s)
- John S Pemberton
- Department of Endocrinology and Diabetes, Birmingham Children's Hospital, Birmingham Women's, and Children's NHS Foundation Trust, Birmingham, UK
| | - Timothy G Barrett
- Department of Endocrinology and Diabetes, Birmingham Children's Hospital, Birmingham Women's, and Children's NHS Foundation Trust, Birmingham, UK.,College of Medical and Dental Sciences, Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
| | - Renuka P Dias
- Department of Endocrinology and Diabetes, Birmingham Children's Hospital, Birmingham Women's, and Children's NHS Foundation Trust, Birmingham, UK.,College of Medical and Dental Sciences, Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK
| | - Melanie Kershaw
- Department of Endocrinology and Diabetes, Birmingham Children's Hospital, Birmingham Women's, and Children's NHS Foundation Trust, Birmingham, UK
| | - Ruth Krone
- Department of Endocrinology and Diabetes, Birmingham Children's Hospital, Birmingham Women's, and Children's NHS Foundation Trust, Birmingham, UK
| | - Suma Uday
- Department of Endocrinology and Diabetes, Birmingham Children's Hospital, Birmingham Women's, and Children's NHS Foundation Trust, Birmingham, UK.,College of Medical and Dental Sciences, Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK
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17
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Mascarenhas LPG, de Lima VA, Rebesco DB, França SN, Cordeiro GR, Mota J, Leite N. Acute changes in glucose induced by continuous or intermittent exercise in children and adolescents with type 1 diabetes. ARCHIVES OF ENDOCRINOLOGY AND METABOLISM 2022; 66:176-181. [PMID: 35315983 PMCID: PMC9832903 DOI: 10.20945/2359-3997000000444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Objective To estimate the rate of change during exercise and during recovery in moderate-continuous exercise (MCE) and high-intensity intermittent exercise (HIIE) in children and adolescents with type 1 diabetes (T1D). Methods Participants performed 2 sessions of exercise: thirty minutes of continuous activity on a cycle ergometer (60% of VO2max) and thirty minutes (60% VO2max) interspersed with five bouts of maximum intensity lasting ten seconds every five minutes. Capillary blood glucose was measured before and after each test. The glucose rate of change in exercise (RoCE) was calculated (final blood glucose - onset blood glucose/exercise time), and the glucose rate of change in recovery (RoCR) (blood glucose 30 minutes after exercise - end of exercise blood glucose/recovery time). Results The study included thirty-one participants (aged 13 ± 1.88 years). A lower blood glucose reduction was observed in the HIIE group, as well as better recovery values before, after, and thirty minutes after the test, respectively (333.14 ± 69.53, 226.19 ± 68.05 and 201.77 ± 66.84 versus 211.36 ± 91.03, 155.98 ± 82,68 and 165.76 ± 72.94). Covariance analyses showed a significant difference in glycemic variation between continuous and intermittent protocols immediately after exercise (-2.90 versus -2.08) and during the recovery period (-0.677 versus -0.389). Conclusion HIIE led to a lower glucose reduction rate per minute during exercise and better recovery in the first 30 minutes after exercise compared to MCE in children and adolescents with T1D.
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Affiliation(s)
- Luis Paulo Gomes Mascarenhas
- Programa de Pós-graduação Interdisciplinar em Desenvolvimento Comunitário, Departamento de Educação Física, Universidade Estadual do Centro Oeste (UNICENTRO), Irati, PR, Brasil
| | - Valderi Abreu de Lima
- Departamento de Educação Física, Núcleo de Qualidade de Vida, Universidade Federal do Paraná (UFPR), Curitiba, PR, Brasil,
| | - Denise Barth Rebesco
- Programa de Pós-graduação Interdisciplinar em Desenvolvimento Comunitário, Departamento de Educação Física, Universidade Estadual do Centro Oeste (UNICENTRO), Irati, PR, Brasil
| | - Suzana Nesi França
- Unidade de Endocrinologia Pediátrica, Departamento de Pediatria, Universidade Federal do Paraná (UFPR), Curitiba, PR, Brasil
| | - Gabriel Ribeiro Cordeiro
- Programa de Pós-graduação Interdisciplinar em Desenvolvimento Comunitário, Departamento de Educação Física, Universidade Estadual do Centro Oeste (UNICENTRO), Irati, PR, Brasil
| | - Jorge Mota
- Centro de Investigação em Actividade Física, Saúde e Lazer (CIAFEL), Faculdade de Desporto, Universidade do Porto, Porto, Portugal
| | - Neiva Leite
- Departamento de Educação Física, Núcleo de Qualidade de Vida, Universidade Federal do Paraná (UFPR), Curitiba, PR, Brasil
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18
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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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19
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Kesting S, Weeber P, Schönfelder M, Pfluger A, Wackerhage H, von Luettichau I. A Bout of High-Intensity Interval Training (HIIT) in Children and Adolescents during Acute Cancer Treatment-A Pilot Feasibility Study. Cancers (Basel) 2022; 14:1468. [PMID: 35326619 PMCID: PMC8945900 DOI: 10.3390/cancers14061468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Revised: 02/28/2022] [Accepted: 03/10/2022] [Indexed: 02/04/2023] Open
Abstract
Low- and moderate-intensity exercise is safe and feasible during childhood cancer treatment. The feasibility of a bout of high-intensity interval training (HIIT) in this population has not been analyzed to date. Pediatric cancer patients aged between 6 and 18 years were selected based on clinical conditions to perform ten sets of 15 s HIIT (>90% of estimated maximal heart rate (HRmax)) and 1 min active recovery on a bicycle ergometer within the first three chemotherapy courses. We assessed safety and feasibility criteria and the following parameters: perceived exertion rate, heart rate, and lactate and adrenaline concentrations. Out of 212 eligible patients, 11 patients aged 13.9 ± 3.6 years (n = 7 ♂) with lymphoma, leukemia, rhabdomyosarcoma, nephroblastoma, and synovial sarcoma completed the bout of HIIT without serious adverse events. During exercise, patients reached a BORG value maxima of 16 ± 1.2, and their heart rates rose from 78 ± 17 beats per minute (bpm) at rest to 178 ± 12 bpm after exercise (90 ± 6% estimated HRmax). The power-to-weight ratio was 2 ± 0.5 W/kg (watt per kilogram). Blood lactate concentrations increased from 1.09 ± 0.50 mmol/L (millimole per liter) at rest to 5.05 ± 1.88 mmol/L post-exercise. Our preliminary data suggest that HIIT is applicable only in a small number of childhood cancer patients. Individually adapted exercise protocols for patients with multiple impairments are needed.
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Affiliation(s)
- Sabine Kesting
- Kinderklinik München Schwabing, Department of Pediatrics and Children’s Cancer Research Center, TUM School of Medicine, Technical University of Munich, 80804 Munich, Germany; (P.W.); (I.v.L.)
- Chair of Preventive Pediatrics, Department of Sport and Health Sciences, Technical University of Munich, 80992 Munich, Germany
- Pediatric Oncology Network Bavaria, KIONET Bavaria, 91054 Erlangen, Germany;
| | - Peter Weeber
- Kinderklinik München Schwabing, Department of Pediatrics and Children’s Cancer Research Center, TUM School of Medicine, Technical University of Munich, 80804 Munich, Germany; (P.W.); (I.v.L.)
- Exercise Biology, Department of Sport and Health Sciences, Technical University of Munich, 80809 Munich, Germany; (M.S.); (A.P.)
| | - Martin Schönfelder
- Exercise Biology, Department of Sport and Health Sciences, Technical University of Munich, 80809 Munich, Germany; (M.S.); (A.P.)
| | - Anja Pfluger
- Exercise Biology, Department of Sport and Health Sciences, Technical University of Munich, 80809 Munich, Germany; (M.S.); (A.P.)
| | - Henning Wackerhage
- Pediatric Oncology Network Bavaria, KIONET Bavaria, 91054 Erlangen, Germany;
| | - Irene von Luettichau
- Kinderklinik München Schwabing, Department of Pediatrics and Children’s Cancer Research Center, TUM School of Medicine, Technical University of Munich, 80804 Munich, Germany; (P.W.); (I.v.L.)
- Pediatric Oncology Network Bavaria, KIONET Bavaria, 91054 Erlangen, Germany;
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20
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Sun J, Wang M, Huang Z, Zhong W, Yang Y. Comparative analysis of long-acting growth hormone and short-acting growth hormone in the treatment of growth hormone deficiency. Minerva Pediatr (Torino) 2021; 74:243-245. [PMID: 34286944 DOI: 10.23736/s2724-5276.21.06513-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Jia Sun
- Department of Pediatrics, Wuhan Wuchang Hospital, Wuchang Hospital Affiliated to Wuhan University of Science and Technology, Wuhan, China
| | - Mian Wang
- Department of Pediatrics, Wuhan Wuchang Hospital, Wuchang Hospital Affiliated to Wuhan University of Science and Technology, Wuhan, China
| | - Zhongyan Huang
- Department of Pediatrics, Wuhan Wuchang Hospital, Wuchang Hospital Affiliated to Wuhan University of Science and Technology, Wuhan, China
| | - Wenjuan Zhong
- Department of Pediatrics, Wuhan Wuchang Hospital, Wuchang Hospital Affiliated to Wuhan University of Science and Technology, Wuhan, China
| | - Yahui Yang
- Department of Pediatrics, Wuhan Wuchang Hospital, Wuchang Hospital Affiliated to Wuhan University of Science and Technology, Wuhan, China -
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21
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Muniz-Pardos B, Angeloudis K, Guppy FM, Keramitsoglou I, Sutehall S, Bosch A, Tanisawa K, Hosokawa Y, Ash GI, Schobersberger W, Grundstein AJ, Casa DJ, Morrissey MC, Yamasawa F, Zelenkova I, Racinais S, Pitsiladis Y. Wearable and telemedicine innovations for Olympic events and elite sport. J Sports Med Phys Fitness 2021; 61:1061-1072. [PMID: 34256539 DOI: 10.23736/s0022-4707.21.12752-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Rapid advances in wearable technologies and real-time monitoring have resulted in major inroads in the world of recreational and elite sport. One such innovation is the application of real-time monitoring, which comprises a smartwatch application and ecosystem, designed to collect, process and transmit a wide range of physiological, biomechanical, bioenergetic and environmental data using cloud-based services. We plan to assess the impact of this wireless technology during Tokyo 2020, where this technology could help characterize the physiological and thermal strain experienced by an athlete, as well as determine future management of athletes during a medical emergency as a result of a more timely and accurate diagnosis. Here we describe some of the innovative technologies developed for numerous sports at Tokyo 2020 ranging from race walking (20 km and 50 km events), marathon, triathlon, road cycling (including the time trial event), mountain biking, to potentially team sports played outdoors. A more symbiotic relationship between sport, health and technology needs to be encouraged that harnesses the unique demands of elite sport (e.g., the need for unobtrusive devices that provide real-time feedback) and serves as medical and preventive support for the athlete's care. The implementation of such applications would be particularly welcome in the field of medicine (i.e., telemedicine applications) and the workplace (with particular relevance to emergency services, the military and generally workers under extreme environmental conditions). Laboratory and field-based studies are required in simulated scenarios to validate such emerging technologies, with the field of sport serving as an excellent model to understand and impact disease.
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Affiliation(s)
- Borja Muniz-Pardos
- GENUD Research Group, Faculty of Health and Sport Sciences, University of Zaragoza, Zaragoza, Spain
| | | | - Fergus M Guppy
- Center for Stress and Age-Related Disease, University of Brighton, Brighton, UK.,School of Pharmacy and Biomolecular Sciences, University of Brighton, Brighton, UK
| | | | - Shaun Sutehall
- Division of Physiological Sciences, Department of Human Biology, University of Cape Town, Cape Town, South Africa
| | - Andrew Bosch
- Division of Physiological Sciences, Department of Human Biology, University of Cape Town, Cape Town, South Africa
| | - Kumpei Tanisawa
- Faculty of Sport Sciences, Waseda University, Tokorozawa, Japan
| | - Yuri Hosokawa
- Faculty of Sport Sciences, Waseda University, Tokorozawa, Japan
| | - Garrett I Ash
- Center for Medical Informatics, Yale School of Medicine, New Haven, CT, USA.,Pain Research, Informatics, Multi-morbidities, and Education (PRIME) Center, Veterans Affairs Connecticut Healthcare System, West Haven, CT, USA
| | - Wolfgang Schobersberger
- Institute for Sports Medicine, Alpine Medicine and Health Tourism (ISAG), Tirol Kliniken Innsbruck and Private University UMIT TIROL, Hall, Austria
| | | | - Douglas J Casa
- Korey Stringer Institute, University of Connecticut, Storrs, CT, USA
| | | | | | - Irina Zelenkova
- GENUD Research Group, Faculty of Health and Sport Sciences, University of Zaragoza, Zaragoza, Spain
| | - Sébastien Racinais
- Department and Research and Scientific Support, Aspetar Orthopedic and Sports Medicine Hospital, Doha, Qatar
| | - Yannis Pitsiladis
- Center for Stress and Age-Related Disease, University of Brighton, Brighton, UK - .,International Federation of Sports Medicine (FIMS), Lausanne, Switzerland.,Center for Exercise Sciences and Sports Medicine, FIMS Collaborating Center of Sports Medicine, Rome, Italy.,European Federation of Sports Medicine Associations (EFSMA), Lausanne, Switzerland
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22
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Risch L, Mayer F, Cassel M. Doppler Flow Response Following Running Exercise Differs Between Healthy and Tendinopathic Achilles Tendons. Front Physiol 2021; 12:650507. [PMID: 33833692 PMCID: PMC8021791 DOI: 10.3389/fphys.2021.650507] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Accepted: 02/23/2021] [Indexed: 01/29/2023] Open
Abstract
Background The relationship between exercise-induced intratendinous blood flow (IBF) and tendon pathology or training exposure is unclear. Objective This study investigates the acute effect of running exercise on sonographic detectable IBF in healthy and tendinopathic Achilles tendons (ATs) of runners and recreational participants. Methods 48 participants (43 ± 13 years, 176 ± 9 cm, 75 ± 11 kg) performed a standardized submaximal 30-min constant load treadmill run with Doppler ultrasound “Advanced dynamic flow” examinations before (Upre) and 5, 30, 60, and 120 min (U5-U120) afterward. Included were runners (>30 km/week) and recreational participants (<10 km/week) with healthy (Hrun, n = 10; Hrec, n = 15) or tendinopathic (Trun, n = 13; Trec, n = 10) ATs. IBF was assessed by counting number [n] of intratendinous vessels. IBF data are presented descriptively (%, median [minimum to maximum range] for baseline-IBF and IBF-difference post-exercise). Statistical differences for group and time point IBF and IBF changes were analyzed with Friedman and Kruskal-Wallis ANOVA (α = 0.05). Results At baseline, IBF was detected in 40% (3 [1–6]) of Hrun, in 53% (4 [1–5]) of Hrec, in 85% (3 [1–25]) of Trun, and 70% (10 [2–30]) of Trec. At U5 IBF responded to exercise in 30% (3 [−1–9]) of Hrun, in 53% (4 [−2–6]) of Hrec, in 70% (4 [−10–10]) of Trun, and in 80% (5 [1–10]) of Trec. While IBF in 80% of healthy responding ATs returned to baseline at U30, IBF remained elevated until U120 in 60% of tendinopathic ATs. Within groups, IBF changes from Upre-U120 were significant for Hrec (p < 0.01), Trun (p = 0.05), and Trec (p < 0.01). Between groups, IBF changes in consecutive examinations were not significantly different (p > 0.05) but IBF-level was significantly higher at all measurement time points in tendinopathic versus healthy ATs (p < 0.05). Conclusion Irrespective of training status and tendon pathology, running leads to an immediate increase of IBF in responding tendons. This increase occurs shortly in healthy and prolonged in tendinopathic ATs. Training exposure does not alter IBF occurrence, but IBF level is elevated in tendon pathology. While an immediate exercise-induced IBF increase is a physiological response, prolonged IBF is considered a pathological finding associated with Achilles tendinopathy.
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Affiliation(s)
- Lucie Risch
- University Outpatient Clinic, Sports Medicine and Orthopedics, University of Potsdam, Potsdam, Germany
| | - Frank Mayer
- University Outpatient Clinic, Sports Medicine and Orthopedics, University of Potsdam, Potsdam, Germany.,Faculty of Health Sciences, University of Potsdam, Potsdam, Germany
| | - Michael Cassel
- University Outpatient Clinic, Sports Medicine and Orthopedics, University of Potsdam, Potsdam, Germany.,Faculty of Health Sciences, University of Potsdam, Potsdam, Germany
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23
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Valli G, Minnock D, Tarantino G, Neville RD. Delayed effect of different exercise modalities on glycaemic control in type 1 diabetes mellitus: A systematic review and meta-analysis. Nutr Metab Cardiovasc Dis 2021; 31:705-716. [PMID: 33549457 DOI: 10.1016/j.numecd.2020.12.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 12/02/2020] [Accepted: 12/07/2020] [Indexed: 12/23/2022]
Abstract
BACKGROUND AND AIMS Despite the crucial role of exercise in the prevention of comorbidities and complications in type 1 diabetes mellitus (T1DM), people living with the disease are often insufficiently physically active, mainly due to the fear of hypoglycaemia. Research using continuous glucose monitoring (CGM) devices has shown that exercise affects glycaemic control in T1DM for over 24 h. The aim of this systematic review and meta-analysis is, therefore, to investigate the delayed effects of different exercise modalities on glycaemic control in adults with T1DM. METHODS AND RESULTS The literature search of experimental studies was conducted on PubMed, SPORTDiscus and EMBASE from January 2000 to September 2019. Twelve studies using CGM devices were included. Compared to endurance, intermittent exercise increased the time spent in hypoglycaemia (0.62, 0.07 to 1.18; standardised effect size, 95% CI) and reduced the mean interstitial glucose concentration (-0.88, -1.45 to -0.33). No differences emerged in the time spent in hyperglycaemia (-0.07, -0.58 to 0.45) or in the proportion of exercisers experiencing hypoglycaemic events (0.82, 0.45 to 1.49; proportion ratio, 95% CI) between conditions. The systematic review also found a reduced risk of hypoglycaemia if exercise is performed in the morning rather than in the afternoon, and with a 50% rapid-acting insulin reduction. It was not possible to determine the benefits of resistance exercise. CONCLUSIONS For the first time, we systematically investigated the delayed effect of exercise in adults with T1DM, highlighted undetected effects, shortcomings in the existing literature, and provided suggestions to design future comparable studies.
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Affiliation(s)
- Giacomo Valli
- Neuromuscular Physiology Laboratory, Department of Biomedical Sciences, University of Padova, Italy.
| | - Dean Minnock
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Ireland
| | - Giampiero Tarantino
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Ireland
| | - Ross D Neville
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Ireland
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24
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Yao Z, Lin P, Wang C, Wang K, Sun Y. Administration of metrnl delays the onset of diabetes in non-obese diabetic mice. Endocr J 2021; 68:179-188. [PMID: 33162409 DOI: 10.1507/endocrj.ej20-0351] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Type 1 diabetes is a chronic metabolic disease characterized by hyperglycemia due to progressive destruction of pancreatic beta cells via autoimmune attack. Meteorin-like protein (metrnl) is a secreted protein homologous to the neurotrophin metrn and it is induced after exercise in the skeletal muscle. In our paper published previously, we showed that the serum level of metrnl was significantly correlated with the lipid profile, glucose profile and insulin resistance. In this experiment, we asked whether intravenous administration of metrnl could delay the onset of diabetes in non-obese diabetic (NOD) mice. 4-week-old NOD mice were injected intravenously with metrnl. Blood glucose levels were measured weekly. Insulitis scoring, intraperitoneal glucose tolerance test, adoptive T cell transfer, flow cytometry analysis and real-time PCR were performed to investigate the underlying mechanism. The results showed that intravenous administration of metrnl delayed the onset of diabetes in NOD mice. Histology of pancreas showed a decreased infiltration of leukocytes, which was in association with augmentation of regulatory T cells, suppression of autoreactive T cells and altered cytokine secretion. To sum up, the present study showed that intravenous administration of metrnl ameliorated islet lymphocyte infiltration and modulated immune cell responses, raising the possibility that it might be beneficial in improving islet function clinically.
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Affiliation(s)
- Zhina Yao
- Center for Reproductive Medicine, Reproductive Hospital Affiliated with Shandong University, Jinan, 250012, Shandong, PR China
| | - Peng Lin
- Department of Endocrine, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, 250012, Shandong, PR China
| | - Chuan Wang
- Department of Endocrine, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, 250012, Shandong, PR China
| | - Kexin Wang
- Department of General Surgery, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, 250012, Shandong, PR China
| | - Yu Sun
- Department of Endocrine, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, 250012, Shandong, PR China
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25
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A Comprehensive Review of Continuous Glucose Monitoring Accuracy during Exercise Periods. SENSORS 2021; 21:s21020479. [PMID: 33445438 PMCID: PMC7828017 DOI: 10.3390/s21020479] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Revised: 12/29/2020] [Accepted: 01/05/2021] [Indexed: 12/15/2022]
Abstract
Continuous Glucose Monitoring (CGM) has been a springboard of new diabetes management technologies such as integrated sensor-pump systems, the artificial pancreas, and more recently, smart pens. It also allows patients to make better informed decisions compared to a few measurements per day from a glucometer. However, CGM accuracy is reportedly affected during exercise periods, which can impact the effectiveness of CGM-based treatments. In this review, several studies that used CGM during exercise periods are scrutinized. An extensive literature review of clinical trials including exercise and CGM in type 1 diabetes was conducted. The gathered data were critically analysed, especially the Mean Absolute Relative Difference (MARD), as the main metric of glucose accuracy. Most papers did not provide accuracy metrics that differentiated between exercise and rest (non-exercise) periods, which hindered comparative data analysis. Nevertheless, the statistic results confirmed that CGM during exercise periods is less accurate.
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26
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Müller-Korbsch M, Frühwald L, Heer M, Fangmeyer-Binder M, Reinhart-Mikocki D, Fasching P. Assessment of the "Second Day" Exercise Effect on Glycemic Control, Insulin Requirements, and CHO Intake in Type 1 Diabetes Adults. J Diabetes Sci Technol 2021; 15:127-133. [PMID: 31583900 PMCID: PMC7783009 DOI: 10.1177/1932296819879419] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
BACKGROUND Glucose control during consecutive days of aerobic exercise has not been well studied. We assessed glycemia, insulin requirements, and carbohydrate (CHO) needs during two consecutive days of prolonged cycling in type 1 diabetes (T1D) adults using sensor-augmented insulin pump therapy. METHODS Twenty adults with well-controlled T1D and six healthy adults (for comparison) were enrolled. Assessments were made during two consecutive days of cycling activities (30 miles per day). On day 1 (D1), basal rates were reduced 50% and CHO intake was guided by real-time continuous glucose monitoring (rtCGM) data to maintain a target range (70-180 mg/dL). On day 2 (D2), basal insulin infusion was stopped for the first hour of biking and resumed at a minimal rate during biking. Carbohydrate intake one hour before, during, and ten minutes after biking was recorded. Times within/below target range, glycemic variability, and mean glucose were calculated from rtCGM data. RESULTS Among 17 T1D participants who completed the study, mean glucose levels at the start of cycling were slightly lower on D2 vs D1: 138 ± 16 mg/dL and 122 ± 16, respectively, P = NS. Type 1 diabetes participants achieved near-normal glucose levels at the end of both cycling events; however, the reduction in glucose was most notable at one hour into the event on D2 vs D1. Carbohydrate intake was notably lower during D2 vs D1 with no difference in time <54 mg/dL (both P = NS). CONCLUSIONS Type 1 diabetes individuals using rtCGM-augmented insulin pump therapy can safely engage in consecutive days of prolonged aerobic exercise by significantly reducing insulin dosages with no increase in CHO intake.
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Affiliation(s)
- Michael Müller-Korbsch
- MedVienna Ärztezentrum, Austria
- Michael Müller-Korbsch, MD, MedVienna Ärztezentrum, Sensengasse 3, Vienna 1090, Austria.
| | - Lisa Frühwald
- 5th Medizinische Abteilung für Endokrinologie und Rheumatologie, Wilhelminenspital Austria, Vienna, Austria
| | - Michael Heer
- University of Applied Sciences Technikum Wien, Vienna, Austria
| | - Maria Fangmeyer-Binder
- 5th Medizinische Abteilung für Endokrinologie und Rheumatologie, Wilhelminenspital Austria, Vienna, Austria
| | - David Reinhart-Mikocki
- 5th Medizinische Abteilung für Endokrinologie und Rheumatologie, Wilhelminenspital Austria, Vienna, Austria
| | - Peter Fasching
- 5th Medizinische Abteilung für Endokrinologie und Rheumatologie, Wilhelminenspital Austria, Vienna, Austria
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27
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Buckley JP, Riddell M, Mellor D, Bracken RM, Ross MK, LaGerche A, Poirier P. Acute glycaemic management before, during and after exercise for cardiac rehabilitation participants with diabetes mellitus: a joint statement of the British and Canadian Associations of Cardiovascular Prevention and Rehabilitation, the International Council for Cardiovascular Prevention and Rehabilitation and the British Association of Sport and Exercise Sciences. Br J Sports Med 2020; 55:bjsports-2020-102446. [PMID: 33361136 DOI: 10.1136/bjsports-2020-102446] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/19/2020] [Indexed: 12/12/2022]
Abstract
Type 1 (T1) and type 2 (T2) diabetes mellitus (DM) are significant precursors and comorbidities to cardiovascular disease and prevalence of both types is still rising globally. Currently,~25% of participants (and rising) attending cardiac rehabilitation in Europe, North America and Australia have been reported to have DM (>90% have T2DM). While there is some debate over whether improving glycaemic control in those with heart disease can independently improve future cardiovascular health-related outcomes, for the individual patient whose blood glucose is well controlled, it can aid the exercise programme in being more efficacious. Good glycaemic management not only helps to mitigate the risk of acute glycaemic events during exercising, it also aids in achieving the requisite physiological and psycho-social aims of the exercise component of cardiac rehabilitation (CR). These benefits are strongly associated with effective behaviour change, including increased enjoyment, adherence and self-efficacy. It is known that CR participants with DM have lower uptake and adherence rates compared with those without DM. This expert statement provides CR practitioners with nine recommendations aimed to aid in the participant's improved blood glucose control before, during and after exercise so as to prevent the risk of glycaemic events that could mitigate their beneficial participation.
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Affiliation(s)
- John P Buckley
- Shrewsbury Centre for Active Living, University of Chester Faculty of Medicine and Life Sciences, Chester, Cheshire West and Chester, UK
- Institute of Sport Exercise and Health, University College London, London, UK
| | - Michael Riddell
- School of Kinesiology and Health Science, York University, Toronto, Ontario, Canada
- LMC Healthcare, Diabetes and Endocrinology, Toronto, Ontario, Canada
| | - Duane Mellor
- Aston Medical School, Aston University, Birmingham, West Midlands, UK
- Sport and Exercise Science, Swansea University College of Engineering, Swansea, Wales, UK
| | - Richard M Bracken
- Sport and Exercise Science, Swansea University College of Engineering, Swansea, Wales, UK
| | - Marie-Kristelle Ross
- Hotel-Dieu de Levis, Laval University Faculty of Medicine, Quebec city, Quebec, Canada
| | - Andre LaGerche
- Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia
- St Vincent's Hospital Melbourne Pty Ltd, Fitzroy, Victoria, Australia
| | - Paul Poirier
- Cardiology, Institut universitaire de cardiologie et de pneumologie de Québec, Quebec City, Quebec, Canada
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28
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Moser O, Riddell MC, Eckstein ML, Adolfsson P, Rabasa-Lhoret R, van den Boom L, Gillard P, Nørgaard K, Oliver NS, Zaharieva DP, Battelino T, de Beaufort C, Bergenstal RM, Buckingham B, Cengiz E, Deeb A, Heise T, Heller S, Kowalski AJ, Leelarathna L, Mathieu C, Stettler C, Tauschmann M, Thabit H, Wilmot EG, Sourij H, Smart CE, Jacobs PG, Bracken RM, Mader JK. Glucose management for exercise using continuous glucose monitoring (CGM) and intermittently scanned CGM (isCGM) systems in type 1 diabetes: position statement of the European Association for the Study of Diabetes (EASD) and of the International Society for Pediatric and Adolescent Diabetes (ISPAD) endorsed by JDRF and supported by the American Diabetes Association (ADA). Diabetologia 2020; 63:2501-2520. [PMID: 33047169 DOI: 10.1007/s00125-020-05263-9] [Citation(s) in RCA: 99] [Impact Index Per Article: 24.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Physical exercise is an important component in the management of type 1 diabetes across the lifespan. Yet, acute exercise increases the risk of dysglycaemia, and the direction of glycaemic excursions depends, to some extent, on the intensity and duration of the type of exercise. Understandably, fear of hypoglycaemia is one of the strongest barriers to incorporating exercise into daily life. Risk of hypoglycaemia during and after exercise can be lowered when insulin-dose adjustments are made and/or additional carbohydrates are consumed. Glycaemic management during exercise has been made easier with continuous glucose monitoring (CGM) and intermittently scanned continuous glucose monitoring (isCGM) systems; however, because of the complexity of CGM and isCGM systems, both individuals with type 1 diabetes and their healthcare professionals may struggle with the interpretation of given information to maximise the technological potential for effective use around exercise (i.e. before, during and after). This position statement highlights the recent advancements in CGM and isCGM technology, with a focus on the evidence base for their efficacy to sense glucose around exercise and adaptations in the use of these emerging tools, and updates the guidance for exercise in adults, children and adolescents with type 1 diabetes. Graphical abstract.
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Affiliation(s)
- Othmar Moser
- Division of Endocrinology and Diabetology, Department of Internal Medicine, Medical University of Graz, Auenbruggerplatz 2, 8036, Graz, Austria.
- Division of Exercise Physiology and Metabolism, Department of Sport Science, University of Bayreuth, Bayreuth, Germany.
| | - Michael C Riddell
- School of Kinesiology and Health Science, York University, Toronto, ON, Canada
| | - Max L Eckstein
- Division of Endocrinology and Diabetology, Department of Internal Medicine, Medical University of Graz, Auenbruggerplatz 2, 8036, Graz, Austria
| | - Peter Adolfsson
- Department of Pediatrics, The Hospital of Halland, Kungsbacka, Sweden
- Sahlgrenska Academy at University of Gothenburg, Institution of Clinical Sciences, Gothenburg, Sweden
| | - Rémi Rabasa-Lhoret
- Institut de Recherches Cliniques de Montréal, Montréal, QC, Canada
- Endocrinology Division Centre Hospitalier Universitaire de Montréal, Montréal, QC, Canada
- Nutrition Department, Faculty of Medicine, Université de Montréal, Montréal, QC, Canada
- Montreal Diabetes Research Centre, Montréal, QC, Canada
| | | | - Pieter Gillard
- Department of Endocrinology, University Hospitals Leuven, KU Leuven, Leuven, Belgium
| | - Kirsten Nørgaard
- Steno Diabetes Center Copenhagen, University of Copenhagen, Copenhagen, Denmark
| | - Nick S Oliver
- Department of Metabolism, Digestion and Reproduction, Faculty of Medicine, Imperial College, London, London, UK
| | - Dessi P Zaharieva
- Department of Pediatric Endocrinology and Diabetes, Stanford University School of Medicine, Stanford, CA, USA
| | - Tadej Battelino
- Department of Paediatric Endocrinology, Diabetes and Metabolic Diseases, UMC - University Children's Hospital, University Medical Centre Ljubljana, Ljubljana, Slovenia
- Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Carine de Beaufort
- Department of Pediatric Diabetes and Endocrinology, Centre Hospitalier Luxembourg, Luxembourg, Luxembourg
- Department of Pediatrics, Free University Brussels (VUB), Brussels, Belgium
| | | | - Bruce Buckingham
- Department of Pediatric Endocrinology and Diabetes, Stanford University School of Medicine, Stanford, CA, USA
| | - Eda Cengiz
- Department of Pediatrics, Yale School of Medicine, New Haven, CT, USA
- Bahçeşehir Üniversitesi, Istanbul, Turkey
| | - Asma Deeb
- Paediatric Endocrinology Division, Shaikh Shakhbout Medical City, Abu Dhabi, United Arab Emirates
| | | | - Simon Heller
- Department of Oncology & Metabolism, The Medical School, University of Sheffield, Sheffield, UK
- Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | | | - Lalantha Leelarathna
- Manchester Diabetes Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
- Division of Diabetes, Endocrinology and Gastroenterology, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Chantal Mathieu
- Department of Endocrinology, University Hospitals Leuven, KU Leuven, Leuven, Belgium
| | - Christoph Stettler
- Department of Diabetes, Endocrinology, Nutritional Medicine and Metabolism, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland
| | - Martin Tauschmann
- Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Vienna, Austria
| | - Hood Thabit
- Manchester Diabetes Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | - Emma G Wilmot
- Diabetes Department, Royal Derby Hospital, University Hospitals of Derby and Burton NHSFT, Derby, UK
- Faculty of Medicine & Health Sciences, University of Nottingham, Nottingham, UK
| | - Harald Sourij
- Division of Endocrinology and Diabetology, Department of Internal Medicine, Medical University of Graz, Auenbruggerplatz 2, 8036, Graz, Austria
| | - Carmel E Smart
- School of Health Sciences, University of Newcastle, Callaghan, NSW, Australia
- Department of Paediatric Diabetes and Endocrinology, John Hunter Children's Hospital, Newcastle, NSW, Australia
| | - Peter G Jacobs
- Department of Biomedical Engineering, Oregon Health & Science University, Portland, OR, USA
| | - Richard M Bracken
- Applied Sport, Technology, Exercise and Medicine Research Centre (A-STEM), College of Engineering, Swansea University, Swansea, UK
| | - Julia K Mader
- Division of Endocrinology and Diabetology, Department of Internal Medicine, Medical University of Graz, Auenbruggerplatz 2, 8036, Graz, Austria
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Moser O, Riddell MC, Eckstein ML, Adolfsson P, Rabasa‐Lhoret R, van den Boom L, Gillard P, Nørgaard K, Oliver NS, Zaharieva DP, Battelino T, de Beaufort C, Bergenstal RM, Buckingham B, Cengiz E, Deeb A, Heise T, Heller S, Kowalski AJ, Leelarathna L, Mathieu C, Stettler C, Tauschmann M, Thabit H, Wilmot EG, Sourij H, Smart CE, Jacobs PG, Bracken RM, Mader JK. Glucose management for exercise using continuous glucose monitoring (CGM) and intermittently scanned CGM (isCGM) systems in type 1 diabetes: position statement of the European Association for the Study of Diabetes (EASD) and of the International Society for Pediatric and Adolescent Diabetes (ISPAD) endorsed by JDRF and supported by the American Diabetes Association (ADA). Pediatr Diabetes 2020; 21:1375-1393. [PMID: 33047481 PMCID: PMC7702152 DOI: 10.1111/pedi.13105] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Physical exercise is an important component in the management of type 1 diabetes across the lifespan. Yet, acute exercise increases the risk of dysglycaemia, and the direction of glycaemic excursions depends, to some extent, on the intensity and duration of the type of exercise. Understandably, fear of hypoglycaemia is one of the strongest barriers to incorporating exercise into daily life. Risk of hypoglycaemia during and after exercise can be lowered when insulin-dose adjustments are made and/or additional carbohydrates are consumed. Glycaemic management during exercise has been made easier with continuous glucose monitoring (CGM) and intermittently scanned continuous glucose monitoring (isCGM) systems; however, because of the complexity of CGM and isCGM systems, both individuals with type 1 diabetes and their healthcare professionals may struggle with the interpretation of given information to maximise the technological potential for effective use around exercise (ie, before, during and after). This position statement highlights the recent advancements in CGM and isCGM technology, with a focus on the evidence base for their efficacy to sense glucose around exercise and adaptations in the use of these emerging tools, and updates the guidance for exercise in adults, children and adolescents with type 1 diabetes.
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Affiliation(s)
- Othmar Moser
- Division of Endocrinology and Diabetology, Department of Internal MedicineMedical University of GrazAustria
- Division of Exercise Physiology and Metabolism, Department of Sport Science, University of BayreuthBayreuthGermany
| | - Michael C. Riddell
- School of Kinesiology and Health ScienceYork UniversityTorontoOntarioCanada
| | - Max L. Eckstein
- Division of Endocrinology and Diabetology, Department of Internal MedicineMedical University of GrazAustria
| | - Peter Adolfsson
- Department of PediatricsThe Hospital of HallandKungsbackaSweden
- Sahlgrenska Academy at University of GothenburgInstitution of Clinical SciencesGothenburgSweden
| | - Rémi Rabasa‐Lhoret
- Institut de recherches Cliniques de MontréalMontréalQCCanada
- Endocrinology division Centre Hospitalier Universitaire de MontréalMontréalQCCanada
- Nutrition Department, Faculty of MedicineUniversité de MontréalMontréalQCCanada
- Montreal Diabetes Research CentreMontréalQCCanada
| | | | - Pieter Gillard
- Department of EndocrinologyUniversity Hospitals Leuven, KU LeuvenLeuvenBelgium
| | - Kirsten Nørgaard
- Steno Diabetes Center CopenhagenUniversity of CopenhagenCopenhagenDenmark
| | - Nick S. Oliver
- Department of Metabolism, Digestion and Reproduction, Faculty of MedicineImperial CollegeLondonLondonUK
| | - Dessi P. Zaharieva
- Department of Pediatric Endocrinology and DiabetesStanford University School of MedicineStanfordCaliforniaUSA
| | - Tadej Battelino
- Department of Paediatric Endocrinology, Diabetes and Metabolic Diseases, UMC ‐ University Children’s HospitalUniversity Medical Centre LjubljanaLjubljanaSlovenia
- Faculty of MedicineUniversity of LjubljanaLjubljanaSlovenia
| | - Carine de Beaufort
- Department of Pediatric Diabetes and EndocrinologyCentre Hospitalier LuxembourgLuxembourgLuxembourg
- Department of Pediatrics, Free University Brussels (VUB)BrusselsBelgium
| | | | - Bruce Buckingham
- Department of Pediatric Endocrinology and DiabetesStanford University School of MedicineStanfordCaliforniaUSA
| | - Eda Cengiz
- Department of Pediatrics, Yale School of MedicineNew HavenConnecticutUSA
- Bahçeşehir Üniversitesi, IstanbulTurkey
| | - Asma Deeb
- Paediatric Endocrinology DivisionShaikh Shakhbout Medical CityAbu DhabiUnited Arab Emirates
| | | | - Simon Heller
- Department of Oncology & Metabolism, The Medical SchoolUniversity of SheffieldSheffieldUK
- Sheffield Teaching Hospitals NHS Foundation Trust, SheffieldUK
| | | | - Lalantha Leelarathna
- Manchester Diabetes Centre, Manchester University NHS Foundation TrustManchester Academic Health Science CentreManchesterUK
- Division of Diabetes, Endocrinology and Gastroenterology, Faculty of Biology, Medicine and HealthUniversity of ManchesterManchesterUK
| | - Chantal Mathieu
- Department of EndocrinologyUniversity Hospitals Leuven, KU LeuvenLeuvenBelgium
| | - Christoph Stettler
- Department of Diabetes, Endocrinology, Nutritional Medicine and Metabolism, InselspitalBern University Hospital and University of BernBernSwitzerland
| | - Martin Tauschmann
- Department of Pediatrics and Adolescent MedicineMedical University of ViennaViennaAustria
| | - Hood Thabit
- Manchester Diabetes Centre, Manchester University NHS Foundation TrustManchester Academic Health Science CentreManchesterUK
| | - Emma G. Wilmot
- Diabetes Department, Royal Derby Hospital, University Hospitals of Derby and Burton NHSFTDerbyUK
- Faculty of Medicine & Health SciencesUniversity of NottinghamNottinghamUK
| | - Harald Sourij
- Division of Endocrinology and Diabetology, Department of Internal MedicineMedical University of GrazAustria
| | - Carmel E. Smart
- School of Health Sciences, University of NewcastleCallaghanNew South WalesAustralia
- Department of Paediatric Diabetes and EndocrinologyJohn Hunter Children’s HospitalNewcastleNew South WalesAustralia
| | - Peter G. Jacobs
- Department of Biomedical EngineeringOregon Health & Science UniversityPortlandOregonUSA
| | - Richard M. Bracken
- Applied Sport, Technology, Exercise and Medicine Research Centre (A‐STEM), College of EngineeringSwansea UniversitySwanseaUK
| | - Julia K. Mader
- Division of Endocrinology and Diabetology, Department of Internal MedicineMedical University of GrazAustria
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Moser O, Eckstein ML, West DJ, Goswami N, Sourij H, Hofmann P. Type 1 Diabetes and Physical Exercise: Moving (forward) as an Adjuvant Therapy. Curr Pharm Des 2020; 26:946-957. [PMID: 31912769 DOI: 10.2174/1381612826666200108113002] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Accepted: 11/25/2019] [Indexed: 02/08/2023]
Abstract
Type 1 diabetes is characterized by an autoimmune β-cell destruction resulting in endogenous insulin deficiency, potentially leading to micro- and macrovascular complications. Besides an exogenous insulin therapy and continuous glucose monitoring, physical exercise is recommended in adults with type 1 diabetes to improve overall health. The close relationship between physical exercise, inflammation, muscle contraction, and macronutrient intake has never been discussed in detail about type 1 diabetes. The aim of this narrative review was to detail the role of physical exercise in improving clinical outcomes, physiological responses to exercise and different nutrition and therapy strategies around exercise. Physical exercise has several positive effects on glucose uptake and systemic inflammation in adults with type 1 diabetes. A new approach via personalized therapy adaptations must be applied to target beneficial effects on complications as well as on body weight management. In combination with pre-defined macronutrient intake around exercise, adults with type 1 diabetes can expect similar physiological responses to physical exercise, as seen in their healthy counterparts. This review highlights interesting findings from recent studies related to exercise and type 1 diabetes. However, there is limited research available accompanied by a proper number of participants in the cohort of type 1 diabetes. Especially for this group of patients, an increased understanding of the impact of physical exercise can improve its effectiveness as an adjuvant therapy to move (forward).
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Affiliation(s)
- Othmar Moser
- Cardiovascular Diabetology Research Group, Division of Endocrinology and Diabetology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Max L Eckstein
- Cardiovascular Diabetology Research Group, Division of Endocrinology and Diabetology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Daniel J West
- Institute of Cellular Medicine, Newcastle University, Newcastle, United Kingdom
| | - Nandu Goswami
- Physiology Division, Otto Loewi Research Center, Medical University of Graz, Graz, Austria
| | - Harald Sourij
- Cardiovascular Diabetology Research Group, Division of Endocrinology and Diabetology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Peter Hofmann
- Exercise Physiology, Training & Training Therapy Research Group, Institute of Sports Science, University of Graz, Graz, Austria
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Hásková A, Radovnická L, Petruželková L, Parkin CG, Grunberger G, Horová E, Navrátilová V, Kádě O, Matoulek M, Prázný M, Šoupal J. Real-time CGM Is Superior to Flash Glucose Monitoring for Glucose Control in Type 1 Diabetes: The CORRIDA Randomized Controlled Trial. Diabetes Care 2020; 43:2744-2750. [PMID: 32859607 PMCID: PMC7576432 DOI: 10.2337/dc20-0112] [Citation(s) in RCA: 79] [Impact Index Per Article: 19.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Accepted: 08/03/2020] [Indexed: 02/03/2023]
Abstract
OBJECTIVE The aim of this trial was to compare the efficacy of real-time and intermittently scanned continuous glucose monitoring (rtCGM and isCGM, respectively) in maintaining optimal glycemic control. RESEARCH DESIGN AND METHODS In this randomized study, adults with type 1 diabetes (T1D) and normal hypoglycemia awareness (Gold score <4) used rtCGM (Guardian Connect Mobile) or isCGM (FreeStyle Libre) during 4 days of physical activity (exercise phase) and in the subsequent 4 weeks at home (home phase). Primary end points were time in hypoglycemia (<3.9 mmol/L [<70 mg/dL]) and time in range (3.9-10.0 mmol/L [70-180 mg/dL]). The isCGM group wore an additional masked Enlite sensor (iPro2) for 6 days to check for bias between the different sensors used by the rtCGM and isCGM systems. RESULTS Sixty adults with T1D (mean age 38 ± 13 years; A1C 62 ± 12 mmol/mol [7.8 ± 1.1%]) were randomized to rtCGM (n = 30) or isCGM (n = 30). All participants completed the study. Percentage of time in hypoglycemia (<3.9 mmol/L [<70 mg/dL]) was lower among rtCGM versus isCGM participants in the exercise phase (6.8 ± 5.5% vs. 11.4 ± 8.6%, respectively; P = 0.018) and during the home phase (5.3 ± 2.5% vs. 7.3 ± 4.4%, respectively; P = 0.035). Hypoglycemia differences were significant and most notable during the night. rtCGM participants spent more time in range (3.9-10 mmol/L [70-180 mg/dL]) than isCGM participants throughout both the exercise (78.5 ± 10.2% vs. 69.7 ± 16%, respectively; P = 0.0149) and home (75.6 ± 9.7% vs. 67.4 ± 17.8%, respectively; P = 0.0339) phases. The results were robust to the insignificant bias between rtCGM and isCGM sensors that masked CGM found in the isCGM arm. CONCLUSIONS rtCGM was superior to isCGM in reducing hypoglycemia and improving time in range in adults with T1D with normal hypoglycemia awareness, demonstrating the value of rtCGM alarms during exercise and in daily diabetes self-management.
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Affiliation(s)
- Aneta Hásková
- 3rd Department of Internal Medicine, 1st Faculty of Medicine, Charles University, Prague, Czech Republic
| | | | - Lenka Petruželková
- Department of Paediatrics, 2nd Faculty of Medicine, Charles University, Prague, Czech Republic
| | | | | | - Eva Horová
- 3rd Department of Internal Medicine, 1st Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Vendula Navrátilová
- 3rd Department of Internal Medicine, 1st Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Ondřej Kádě
- 3rd Department of Internal Medicine, 1st Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Martin Matoulek
- 3rd Department of Internal Medicine, 1st Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Martin Prázný
- 3rd Department of Internal Medicine, 1st Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Jan Šoupal
- 3rd Department of Internal Medicine, 1st Faculty of Medicine, Charles University, Prague, Czech Republic
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Moser O, Dietrich M, McCarthy O, Bracken RM, Eckstein ML. Bolus insulin dose depends on previous-day race intensity during 5 days of professional road-cycle racing in athletes with type 1 diabetes: A prospective observational study. Diabetes Obes Metab 2020; 22:1714-1721. [PMID: 32383791 PMCID: PMC7540083 DOI: 10.1111/dom.14083] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Revised: 05/03/2020] [Accepted: 05/05/2020] [Indexed: 12/14/2022]
Abstract
AIMS To assess insulin therapy, macronutrient intake and glycaemia in professional cyclists with type 1 diabetes (T1D) over a 5-day Union Cycliste Internationale road-cycle race. MATERIAL AND METHODS In this prospective observational study, seven professional cyclists with T1D (age 28 ± 4 years, body mass index 20.9 ± 0.9 kg/m2 , glycated haemoglobin concentration 56 ± 7 mmol/mol [7.3% ± 0.6%]) were monitored during a five-stage professional road cycling race. Real-time continuous glucose monitoring (rtCGM) data, smart insulin pen dose data and macronutrient intake were assessed by means of repeated-measure one-way ANOVA and post hoc testing. Associations between exercise physiological markers and rtCGM data, insulin doses and macronutrient intake were assessed via linear regression modelling (P ≤ 0.05). RESULTS Bolus insulin dose was significantly reduced over the 5-day period (P = 0.03), while carbohydrate intake (P = 0.24) and basal insulin doses remained unchanged (P = 0.64). A higher mean previous-day race intensity was associated with a lower mean sensor glucose level (P = 0.03), less time above range level 2 (>13.9 mmol/L [250 mg/dL]; P = 0.05) and lower doses of bolus insulin (P = 0.04) on the subsequent day. No significant associations were found for any other glycaemic range and glycaemic variability (P > 0.05). CONCLUSIONS This is the first study to demonstrate the influence of previous-day race intensity on subsequent bolus insulin dose requirements in professional cyclists with T1D. These data may help inform therapeutic strategies to ensure safe exercise performance.
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Affiliation(s)
- Othmar Moser
- Cardiovascular Diabetology Research Group, Division of Endocrinology and Diabetology, Department of Internal MedicineMedical University of GrazGrazAustria
| | - Marlene Dietrich
- Cardiovascular Diabetology Research Group, Division of Endocrinology and Diabetology, Department of Internal MedicineMedical University of GrazGrazAustria
| | - Olivia McCarthy
- Applied Sport, Technology, Exercise and Medicine Research Centre (A‐STEM), College of EngineeringSwansea UniversitySwanseaUK
| | - Richard M. Bracken
- Applied Sport, Technology, Exercise and Medicine Research Centre (A‐STEM), College of EngineeringSwansea UniversitySwanseaUK
| | - Max L. Eckstein
- Cardiovascular Diabetology Research Group, Division of Endocrinology and Diabetology, Department of Internal MedicineMedical University of GrazGrazAustria
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33
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Yardley JE. Fasting May Alter Blood Glucose Responses to High-Intensity Interval Exercise in Adults With Type 1 Diabetes: A Randomized, Acute Crossover Study. Can J Diabetes 2020; 44:727-733. [PMID: 33160882 DOI: 10.1016/j.jcjd.2020.09.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Revised: 09/03/2020] [Accepted: 09/10/2020] [Indexed: 12/28/2022]
Abstract
OBJECTIVES In individuals with type 1 diabetes (T1D), changes in blood glucose (BG) during high-intensity interval exercise (HIIE) are smaller than those observed during aerobic exercise. Study outcomes, however, have been variable, with some demonstrating significant BG decreases and others showing BG increases. This study compared BG outcomes between fasting (AME) and postprandial (PME) HIIE in T1D to test the hypothesis that AME would produce a BG increase, yet PME would cause BG to decline. METHODS Twelve (6 men and 6 women) physically active individuals with T1D performed two 45-minute exercise sessions (AME at 7:00 AM, PME at 5:00 PM) in random order, separated by at least 48 hours. Sessions consisted of a 10-minute warmup (50%VO2peak), followed by 10-second sprints every 2 minutes for 24 minutes, and then an 11-minute cooldown. Capillary glucose was measured pre- and postexercise, and then 60 minutes postexercise. Interstitial glucose was recorded for 24 hours postexercise using continuous glucose monitoring. RESULTS AME caused capillary glucose to increase (from 7.6±1.4 to 9.2±2.9 mmol/L during exercise, and 9.9±2.8 mmol/L in recovery), whereas PME produced a decline in capillary glucose (from 9.9±3.1 to 9.5±3.4 mmol/L during exercise and 8.9±2.7 mmol/L during recovery; time × treatment interaction, p=0.014). PME was associated with a higher frequency of hyperglycemic events in the 6 hours and overnight (midnight to 6:00 AM) after exercise. CONCLUSIONS Fasting HIIE results in a different BG trajectory than postprandial exercise in T1D, and may be beneficial for hypoglycemia avoidance during exercise.
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Affiliation(s)
- Jane E Yardley
- Augustana Faculty, University of Alberta, Camrose, Alberta, Canada; Physical Activity and Diabetes Laboratory, Alberta Diabetes Institute, Li Ka Shing Centre for Health Research Innovation, Edmonton, Alberta, Canada; Faculty of Kinesiology, Sport and Recreation, University of Alberta, Edmonton, Alberta, Canada; Women's and Children's Health Research Institute, University of Alberta, Edmonton, Alberta, Canada.
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Assaloni R, Pellino VC, Puci MV, Ferraro OE, Lovecchio N, Girelli A, Vandoni M. Coronavirus disease (Covid-19): How does the exercise practice in active people with type 1 diabetes change? A preliminary survey. Diabetes Res Clin Pract 2020; 166:108297. [PMID: 32623042 PMCID: PMC7332427 DOI: 10.1016/j.diabres.2020.108297] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Revised: 06/05/2020] [Accepted: 06/29/2020] [Indexed: 02/07/2023]
Abstract
AIMS Coronavirus disease (Covid-19) could lead persons with pre-existing medical conditions to severe respiratory infections. The Italian Government introduced quarantine to limit viral transmission. This measure could lead people with type 1 diabetes (PWT1D) to disrupt daily care routine including PA practice with difficulties in glycemia management. This study aims to explore PA level in PWT1D before and during quarantine and to describe variation in glycemia values. METHODS An online survey investigating medical factors and the perceived and PA level in pre-established period before and after the introduction of quarantine was developed. Comparison between pre and post quarantine was assessed by Wilcoxon Signed Ranks test for continuous variables. RESULTS A total of 154 subjects satisfied the eligibility criteria (54.5% males, 44.8 ± 12.5 years). We found a decrease of PA level (Godin Scale Score 25 ± 1.7vs38.6 ± 1.7 points), steps number and minutes of exercise (respectively 12.606 ± 5026vs4.760 ± 3.145 and 66±4 vs 38±3) and an increase of glycemia values (142.1 ± 25.4 mg/dLvs150.8 ± 29.4 mg/dL). CONCLUSIONS PWT1D reported a decrease in exercise and worst glycemia. Although PWT1D tried to remain active, their PA level was inadequate to prevent glycemia rising. The difficult to maintain a glycemic control could expose patients to diabetes complications and to an higher risk to counteract infections.
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Affiliation(s)
| | - Vittoria Carnevale Pellino
- LAMA (Laboratory of Adapted Motor Activity - Department of Public Health, Experimental Medicine & Forensic Science, University of Pavia, Italy), Italy; Department of Industrial Engineering, University of Tor Vergata, Rome, Italy
| | - Mariangela V Puci
- Unit of Biostatistics and Clinical Epidemiology, Department of Public Health, Experimental and Forensic Medicine, University of Pavia, Pavia, Italy
| | - Ottavia E Ferraro
- Unit of Biostatistics and Clinical Epidemiology, Department of Public Health, Experimental and Forensic Medicine, University of Pavia, Pavia, Italy
| | - Nicola Lovecchio
- LAMA (Laboratory of Adapted Motor Activity - Department of Public Health, Experimental Medicine & Forensic Science, University of Pavia, Italy), Italy
| | | | - Matteo Vandoni
- LAMA (Laboratory of Adapted Motor Activity - Department of Public Health, Experimental Medicine & Forensic Science, University of Pavia, Italy), Italy.
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No Disadvantage to Insulin Pump Off vs Pump On During Intermittent High-Intensity Exercise in Adults With Type 1 Diabetes. Can J Diabetes 2020; 44:162-168. [DOI: 10.1016/j.jcjd.2019.05.015] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2019] [Revised: 05/22/2019] [Accepted: 05/31/2019] [Indexed: 11/21/2022]
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Lee AS, Way KL, Johnson NA, Twigg SM. High-intensity interval exercise and hypoglycaemia minimisation in adults with type 1 diabetes: A randomised cross-over trial. J Diabetes Complications 2020; 34:107514. [PMID: 31918984 DOI: 10.1016/j.jdiacomp.2019.107514] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Revised: 12/15/2019] [Accepted: 12/24/2019] [Indexed: 12/13/2022]
Abstract
AIMS We aimed to examine the feasibility and safety of undertaking high-intensity interval exercise (HIIE) with evening basal insulin dose reduction on exercise-related hypoglycaemia following an afternoon bout of HIIE, compared with moderate-intensity continuous exercise and a non-exercise control day in adults with type 1 diabetes in a free-living environment. METHODS Twelve adults with type 1 diabetes participated in a randomised, crossover trial (9 female/3 male, mean age 40.4 ± 9.9 years, duration 16.5 ± 9.8 years, HbA1c 8.0 ± 0.8%). Each participant undertook five conditions: a non-exercise day, and four exercise conditions on separate afternoons: a moderate-intensity continuous exercise bout; and three HIIE bouts with 10%, 20% and 30% evening basal insulin reduction. Post-exercise glucose response was measured for 24 h by continuous glucose monitoring and compared across conditions. RESULTS HIIE with 10%, 20% and 30% evening basal insulin dose reduction was not associated with an increase in hypoglycaemia compared with moderate-intensity continuous exercise, or the non-exercise day. There was no difference in hyperglycaemia, time-in-range or glucose variability across all exercise regimens and the non-exercise day (p > .05). CONCLUSIONS Exercise-related hypoglycaemia was not increased following afternoon HIIE when diabetes management strategies incorporating evening basal insulin dose reduction were utilised.
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Affiliation(s)
- Angela S Lee
- Department of Endocrinology, Diabetes Centre, Royal Prince Alfred Hospital, Sydney, NSW, Australia; Sydney Medical School, Faculty of Medicine and Health, Charles Perkins Centre, University of Sydney, Sydney, NSW, Australia
| | - Kimberley L Way
- School of Health Sciences, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia; The Boden Collaboration, University of Sydney, Sydney, NSW, Australia
| | - Nathan A Johnson
- School of Health Sciences, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia; The Boden Collaboration, University of Sydney, Sydney, NSW, Australia
| | - Stephen M Twigg
- Department of Endocrinology, Diabetes Centre, Royal Prince Alfred Hospital, Sydney, NSW, Australia; Sydney Medical School, Faculty of Medicine and Health, Charles Perkins Centre, University of Sydney, Sydney, NSW, Australia.
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Tumini S, Comegna L, Fioretti E, Guidone P, Levantini G, Panichi D, Catenaro M, Rossi I, Amaro F, Graziano G, Rossi MC, Cipriano P. Effectiveness and safety of flexible therapeutic schemes including first- and secondgeneration basal insulins during a pediatric summer diabetes camp. Pediatr Rep 2020; 12:8254. [PMID: 32308970 PMCID: PMC7160858 DOI: 10.4081/pr.2020.8254] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Accepted: 02/28/2020] [Indexed: 11/23/2022] Open
Abstract
Outcomes of insulin analogues in pediatric diabetes camps are poorly investigated; no data is available about insulin degludec (IDeg).Our aim was to assess impact of insulin therapy adopted by the participants to a 4-day diabetes camp held in 2017, hypothesizing a possible excess risk of hypoglycemia in patients treated with IDeg. Overall, 40 children with type 1 diabetes (mean age 13.4±3.0 years; 62.5% males) attended the camp (20.0% on continuous subcutaneous insulin infusion and 80.0% on multiple daily injections - MDI). Among children in MDI regimen, 71.9% were treated with IDeg as basal insulin and 28.1% with glargine U100 (IGlar). All patients used Lispro or Aspart as short-acting insulin. Daily plan of the camp included educational sessions, physical exercise, 3 main meals and 2 snacks. At the arrival, IGlar and short-acting insulin doses were revised according to existing guidelines, while IDeg dose was revised based on an empirical individualized approach. At the arrival, insulin doses were reduced in 22 participants (-19.4±10.5%), while doses were increased in 17 children (+17.8±12.7%), based on individual needs. No statistically significant between-group difference emerged in mean blood glucose and glucose variability. No excess risk of hypoglycemia was found in the IDeg group. The study suggests similar effectiveness and safety of different insulin schemes when associated with appropriate diabetes education and management, and flexible dose adjustments. Despite its longer halflife and the lack of a validated algorithm, IDeg was not associated with an excess risk of hypoglycemia.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Giusi Graziano
- CORESEARCH - Center for Outcomes Research and Clinical Epidemiology, Pescara, Italy
| | - Maria Chiara Rossi
- CORESEARCH - Center for Outcomes Research and Clinical Epidemiology, Pescara, Italy
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Yardley JE. The Athlete with Type 1 Diabetes: Transition from Case Reports to General Therapy Recommendations. Open Access J Sports Med 2019; 10:199-207. [PMID: 31827338 PMCID: PMC6902845 DOI: 10.2147/oajsm.s149257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Accepted: 11/27/2019] [Indexed: 12/03/2022] Open
Abstract
Fear of hypoglycemia is a common barrier to exercise and physical activity for individuals with type 1 diabetes. While some of the earliest studies in this area involved only one or two participants, the link between exercise, exogenous insulin, and hypoglycemia was already clear, with the only suggested management strategies being to decrease insulin dosage and/or consume carbohydrates before and after exercise. Over the past 50 years, a great deal of knowledge has been developed around the impact of different types and intensities of exercise on blood glucose levels in this population. Recent decades have also seen the development of technologies such as continuous glucose monitors, faster-acting insulins and commercially available insulin pumps to allow for the real-time observation of interstitial glucose levels, and more precise adjustments to insulin dosage before, during and after activity. As such, there are now evidence-based exercise and physical activity guidelines for individuals with type 1 diabetes. While the risk of hypoglycemia has not been completely eliminated, therapy recommendations have evolved considerably. This review discusses the evolution of the knowledge and the technology related to type 1 diabetes and exercise that have allowed this evolution to take place.
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Affiliation(s)
- Jane E Yardley
- Faculty of Kinesiology, Sport, and Recreation, University of Alberta, Edmonton, Canada.,Alberta Diabetes Institute, Edmonton, Canada.,Augustana Faculty, University of Alberta, Camrose, Canada.,Women's and Children's Research Institute, Edmonton, Canada
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Carbohydrate Intake in the Context of Exercise in People with Type 1 Diabetes. Nutrients 2019; 11:nu11123017. [PMID: 31835538 PMCID: PMC6950062 DOI: 10.3390/nu11123017] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Revised: 12/02/2019] [Accepted: 12/06/2019] [Indexed: 02/06/2023] Open
Abstract
Although the benefits of regular exercise on cardiovascular risk factors are well established for people with type 1 diabetes (T1D), glycemic control remains a challenge during exercise. Carbohydrate consumption to fuel the exercise bout and/or for hypoglycemia prevention is an important cornerstone to maintain performance and avoid hypoglycemia. The main strategies pertinent to carbohydrate supplementation in the context of exercise cover three aspects: the amount of carbohydrates ingested (i.e., quantity in relation to demands to fuel exercise and avoid hypoglycemia), the timing of the intake (before, during and after the exercise, as well as circadian factors), and the quality of the carbohydrates (encompassing differing carbohydrate types, as well as the context within a meal and the associated macronutrients). The aim of this review is to comprehensively summarize the literature on carbohydrate intake in the context of exercise in people with T1D.
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Toghi-Eshghi SR, Yardley JE. Morning (Fasting) vs Afternoon Resistance Exercise in Individuals With Type 1 Diabetes: A Randomized Crossover Study. J Clin Endocrinol Metab 2019; 104:5217-5224. [PMID: 31211392 DOI: 10.1210/jc.2018-02384] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Accepted: 06/12/2019] [Indexed: 02/04/2023]
Abstract
OBJECTIVE To determine the effect of morning exercise in the fasting condition vs afternoon exercise on blood glucose responses to resistance exercise (RE). RESEARCH DESIGN AND METHODS For this randomized crossover design, 12 participants with type 1 diabetes mellitus [nine females; aged 31 ± 8.9 years; diabetes duration, 19.1 ± 8.3 years; HbA1c, 7.4% ± 0.8% (57.4 ± 8.5 mmol/mol)] performed ∼40 minutes of RE (three sets of eight repetitions, seven exercises, at the individual's predetermined eight repetition maximum) at either 7 am (fasting) or 5 pm. Sessions were performed at least 48 hours apart. Venous blood samples were collected immediately preexercise, immediately postexercise, and 60 minutes postexercise. Interstitial glucose was monitored overnight postexercise by continuous glucose monitoring (CGM). RESULTS Data are presented as mean ± SD. Blood glucose rose during fasting morning exercise (9.5 ± 3.0 to 10.4 ± 3.0 mmol/L), whereas it declined with afternoon exercise (8.2 ± 2.5 to 7.4 ± 2.6 mmol/L; P = 0.031 for time-by-treatment interaction). Sixty minutes postexercise, blood glucose concentration was significantly higher after fasting morning exercise than after afternoon exercise (10.9 ± 3.2 vs 7.9 ± 2.9 mmol/L; P = 0.019). CGM data indicated more glucose variability (2.7 ± 1.1 vs 2.0 ± 0.7 mmol/L; P = 0.019) and more frequent hyperglycemia (12 events vs five events; P = 0.025) after morning RE than after afternoon RE. CONCLUSIONS Compared with afternoon RE, morning (fasting) RE was associated with distinctly different blood glucose responses and postexercise profiles.
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Affiliation(s)
- Saeed Reza Toghi-Eshghi
- Faculty of Kinesiology, Sport, and Recreation, University of Alberta, Edmonton, Alberta, Canada
| | - Jane E Yardley
- Faculty of Kinesiology, Sport, and Recreation, University of Alberta, Edmonton, Alberta, Canada
- Alberta Diabetes Institute, Edmonton, Alberta, Canada
- Augustana Faculty, University of Alberta, Camrose, Alberta, Canada
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Draz RS, Serry ZMH, Rahmy AF, El Bardesi MS, Taha MM. Electroacupuncture Versus Aerobic Interval Training on Liver Functions in Patients with Nonalcoholic Fatty Liver. J Altern Complement Med 2019; 26:51-57. [PMID: 31657614 DOI: 10.1089/acm.2019.0182] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Background: Nonalcoholic fatty liver disease (NAFLD) is considered one of the most common and most important conditions affecting the liver, because of its increasing prevalence all over the world. It is usually associated with elevated liver enzymes and ranges from simple steatosis to liver cirrhosis. This study was conducted to compare the effects of electroacupuncture (EA) versus aerobic interval training (AIT) exercise and how they affect liver functions in people suffering from nonalcoholic fatty liver. Methods: This study was carried out on 50 female patients suffering from NAFLD with age ranging from 30 to 55 years; they were randomly divided into two equal groups: group A received (EA) stimulation at points of liver 3 (LR3), liver 14 (LR14), gall bladder 34 (GB34), and stomach 36 (ST36), whereas group B received AIT exercise. All patients in both groups A and B received 3 sessions per week for 6 weeks (receiving noninterrupted 18 sessions) in addition to their standard medications. Evaluation of all patients in both groups A and B was carried out before and after the treatment program by measuring the levels of alanine aminotransferase (ALT), aspartate aminotransferase (AST), triglycerides (TGs), and C-reactive protein (CRP). Results: There is a significant decrease (p < 0.05) of ALT, AST, TGs, and CRP within each group, A and B, after 6 weeks of treatment sessions. A significant difference post-treatment was found between both groups in ALT, AST, and TGs (p < 0.05). However, there was no significant difference in CRP (p > 0.05) between both groups post-treatment. Conclusions: It can be concluded that both EA and AIT exercise are potent modalities that improve liver functions in people with NAFLD with better effect toward EA.
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Affiliation(s)
- Ramy Salama Draz
- Department of Physical Therapy for Cardiovascular/Respiratory Disorder and Geriatrics, Faculty of Physical Therapy, Cairo University, Giza, Egypt
| | - Zahra M H Serry
- Department of Physical Therapy for Cardiovascular/Respiratory Disorder and Geriatrics, Faculty of Physical Therapy, Cairo University, Giza, Egypt
| | - Awny Fouad Rahmy
- Department of Physical Therapy for Cardiovascular/Respiratory Disorder and Geriatrics, Faculty of Physical Therapy, Cairo University, Giza, Egypt
| | | | - Mona Mohamed Taha
- Department of Rehabilitation, College of Health and Rehabilitation Sciences, Princess Nourah bint Abdulrahman University, Riyadh, Saudi Arabia.,Department of Physical Therapy for Internal Medicine, Faculty of Physical Therapy, Cairo University, Giza, Egypt
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Piotrowicz AK, McGill MJ, Overland J, Molyneaux L, Johnson NA, Twigg SM. An on-line support tool to reduce exercise-related hypoglycaemia and improve confidence to exercise in type 1 diabetes. J Diabetes Complications 2019; 33:682-689. [PMID: 31253489 DOI: 10.1016/j.jdiacomp.2019.05.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2019] [Revised: 05/05/2019] [Accepted: 05/15/2019] [Indexed: 01/09/2023]
Abstract
OBJECTIVE Hypoglycaemia related to exercise and lack of confidence to exercise, are common in T1DM. An online educational exercise tool (ExT1D) was tested to determine whether these parameters can be improved. RESEARCH DESIGN AND METHODS Thirty two adults with T1DM (50%M, age 35.8 ± 9.5 yr diabetes duration 12.3 ± 9.9 yr, median HbA1c 7.1%[ICR 6.4-7.7] NGSPU) exercising ≥ 60 min/week enrolled in a RCT utilising ExT1D, with partial cross-over design. The primary end-point was Exercise-related hypoglycaemia (ErH) number corrected for exercise session number, with ErH defined as CGM episodes < 4.0 mM occurring within 24 h of exercise. Secondary RCT endpoints were total ErH duration, and ErH duration/episode. A pre-defined longitudinal analysis with each subject compared with their baseline was also undertaken, for the three ErH parameters, and using fear of hypoglycaemia questionnaires. RESEARCH In the RCT a 50% lower median ErH number (P = 0.6) (37% lower ErH number per exercise session (P = 0.06, NS primary endpoint) occurred in the Intervention vs Control group. A 49% lower ErH duration per episode (P = 0.2), and 80% less ErH duration (P = 0.3), were also observed in the Intervention vs Control group. In the longitudinal study, ErH number reduced by 43% (P = 0.088), ErH duration per episode by 52% (P = 0.157) and total duration of ErH fell by 71% (P = 0.015). Confidence to prevent glucose lowering by exercise also improved (P = 0.039). Post-hoc analysis showed those with the greatest ErH events at baseline benefited most. Fructosamine and HbA1c levels were unchanged from baseline. CONCLUSIONS ExT1D can reduce exercise-related hypoglycaemia and provide greater confidence to exercise.
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Affiliation(s)
- Agata K Piotrowicz
- Diabetes Centre, Department of Endocrinology, Royal Prince Alfred Hospital, Camperdown, NSW, Australia; Sydney Medical School, University of Sydney, Sydney, NSW, Australia; Charles Perkins Centre, University of Sydney, Sydney, NSW, Australia
| | - Margaret J McGill
- Diabetes Centre, Department of Endocrinology, Royal Prince Alfred Hospital, Camperdown, NSW, Australia; Sydney Medical School, University of Sydney, Sydney, NSW, Australia
| | - Jane Overland
- Diabetes Centre, Department of Endocrinology, Royal Prince Alfred Hospital, Camperdown, NSW, Australia
| | - Lynda Molyneaux
- Diabetes Centre, Department of Endocrinology, Royal Prince Alfred Hospital, Camperdown, NSW, Australia
| | - Nathan A Johnson
- Charles Perkins Centre, University of Sydney, Sydney, NSW, Australia; Faculty of Health Sciences, The University of Sydney, Sydney, NSW 2006, Australia
| | - Stephen M Twigg
- Diabetes Centre, Department of Endocrinology, Royal Prince Alfred Hospital, Camperdown, NSW, Australia; Sydney Medical School, University of Sydney, Sydney, NSW, Australia; Charles Perkins Centre, University of Sydney, Sydney, NSW, Australia.
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Farinha JB, Boff W, Dos Santos GC, Boeno FP, Ramis TR, Vieira AF, Macedo RCO, Rodrigues-Krause J, Reischak-Oliveira A. Acute glycemic responses along 10-week high-intensity training protocols in type 1 diabetes patients. Diabetes Res Clin Pract 2019; 153:111-113. [PMID: 31195026 DOI: 10.1016/j.diabres.2019.06.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Revised: 05/08/2019] [Accepted: 06/03/2019] [Indexed: 10/26/2022]
Abstract
Glycemic fluctuations were compared throughout 10-week high-intensity training protocols in T1DM patients. Differences were compared using the rate of change in glycaemia during exercise (RoCE). HIIT sessions led to lower RoCE in most weeks than other training protocols. The occurrence of level 1 hypoglycemia along sessions were similar among interventions.
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Affiliation(s)
- Juliano Boufleur Farinha
- Program of Human Movement Sciences, Faculty of Physical Education, Physiotherapy and Dance (ESEFID), Federal University of Rio Grande do Sul (UFRGS), 750 Felizardo Street, Porto Alegre, Rio Grande do Sul 90690-200, Brazil.
| | - Winston Boff
- Institute for Children with Diabetes, Conceição Hospital Group, 529 Álvares Cabral Street, Porto Alegre 91350-250, Brazil
| | - Gabriela Cristina Dos Santos
- Program of Human Movement Sciences, Faculty of Physical Education, Physiotherapy and Dance (ESEFID), Federal University of Rio Grande do Sul (UFRGS), 750 Felizardo Street, Porto Alegre, Rio Grande do Sul 90690-200, Brazil
| | - Francesco Pinto Boeno
- Program of Human Movement Sciences, Faculty of Physical Education, Physiotherapy and Dance (ESEFID), Federal University of Rio Grande do Sul (UFRGS), 750 Felizardo Street, Porto Alegre, Rio Grande do Sul 90690-200, Brazil
| | - Thiago Rozales Ramis
- Program of Human Movement Sciences, Faculty of Physical Education, Physiotherapy and Dance (ESEFID), Federal University of Rio Grande do Sul (UFRGS), 750 Felizardo Street, Porto Alegre, Rio Grande do Sul 90690-200, Brazil
| | - Alexandra Ferreira Vieira
- Program of Human Movement Sciences, Faculty of Physical Education, Physiotherapy and Dance (ESEFID), Federal University of Rio Grande do Sul (UFRGS), 750 Felizardo Street, Porto Alegre, Rio Grande do Sul 90690-200, Brazil
| | - Rodrigo Cauduro Oliveira Macedo
- Program of Human Movement Sciences, Faculty of Physical Education, Physiotherapy and Dance (ESEFID), Federal University of Rio Grande do Sul (UFRGS), 750 Felizardo Street, Porto Alegre, Rio Grande do Sul 90690-200, Brazil
| | - Josianne Rodrigues-Krause
- Program of Human Movement Sciences, Faculty of Physical Education, Physiotherapy and Dance (ESEFID), Federal University of Rio Grande do Sul (UFRGS), 750 Felizardo Street, Porto Alegre, Rio Grande do Sul 90690-200, Brazil
| | - Alvaro Reischak-Oliveira
- Program of Human Movement Sciences, Faculty of Physical Education, Physiotherapy and Dance (ESEFID), Federal University of Rio Grande do Sul (UFRGS), 750 Felizardo Street, Porto Alegre, Rio Grande do Sul 90690-200, Brazil
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Pre-Exercise Blood Glucose Levels Determine the Amount of Orally Administered Carbohydrates during Physical Exercise in Individuals with Type 1 Diabetes-A Randomized Cross-Over Trial. Nutrients 2019; 11:nu11061287. [PMID: 31174360 PMCID: PMC6627914 DOI: 10.3390/nu11061287] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Revised: 02/27/2019] [Accepted: 03/04/2019] [Indexed: 12/21/2022] Open
Abstract
The aim of the study was to assess the amount of orally administered carbohydrates needed to maintain euglycemia during moderate-intensity exercise in individuals with type 1 diabetes. Nine participants with type 1 diabetes (four women, age 32.1 ± 9.0 years, BMI 25.5 ± 3.9 kg/m2, HbA1c 55 ± 7 mmol/mol (7.2 ± 0.6%)) on insulin Degludec were randomized to cycle for 55 min at moderate intensity (63 ± 7% VO2peak) for five consecutive days on either 75% or 100% of their regular basal insulin dose. The impact of pre-exercise blood glucose concentration on the carbohydrate requirement was analyzed by one-way ANOVA stratified for pre-exercise blood glucose quartiles. The effect of the basal insulin dose on the amount of orally administered carbohydrates was evaluated by Wilcoxon matched-pairs signed-rank test. The amount of orally administered carbohydrates during the continuous exercise sessions was similar for both trial arms (75% or 100% basal insulin) with median [IQR] of 36 g (9–62 g) and 36 g (9–66 g) (p = 0.78). The amount of orally administered carbohydrates was determined by pre-exercise blood glucose concentration for both trial arms (p = 0.03). Our study elucidated the importance of pre-exercise glucose concentration related orally administered carbohydrates to maintain euglycemia during exercise in individuals with type 1 diabetes.
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Scott SN, Anderson L, Morton JP, Wagenmakers AJM, Riddell MC. Carbohydrate Restriction in Type 1 Diabetes: A Realistic Therapy for Improved Glycaemic Control and Athletic Performance? Nutrients 2019; 11:E1022. [PMID: 31067747 PMCID: PMC6566372 DOI: 10.3390/nu11051022] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Revised: 04/30/2019] [Accepted: 05/03/2019] [Indexed: 12/13/2022] Open
Abstract
Around 80% of individuals with Type 1 diabetes (T1D) in the United States do not achieve glycaemic targets and the prevalence of comorbidities suggests that novel therapeutic strategies, including lifestyle modification, are needed. Current nutrition guidelines suggest a flexible approach to carbohydrate intake matched with intensive insulin therapy. These guidelines are designed to facilitate greater freedom around nutritional choices but they may lead to higher caloric intakes and potentially unhealthy eating patterns that are contributing to the high prevalence of obesity and metabolic syndrome in people with T1D. Low carbohydrate diets (LCD; <130 g/day) may represent a means to improve glycaemic control and metabolic health in people with T1D. Regular recreational exercise or achieving a high level of athletic performance is important for many living with T1D. Research conducted on people without T1D suggests that training with reduced carbohydrate availability (often termed "train low") enhances metabolic adaptation compared to training with normal or high carbohydrate availability. However, these "train low" practices have not been tested in athletes with T1D. This review aims to investigate the known pros and cons of LCDs as a potentially effective, achievable, and safe therapy to improve glycaemic control and metabolic health in people with T1D. Secondly, we discuss the potential for low, restricted, or periodised carbohydrate diets in athletes with T1D.
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Affiliation(s)
- Sam N Scott
- School of Kinesiology and Health Science, York University, Toronto, ON M3J 1P3, Canada.
| | | | - James P Morton
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, L3 3AF, UK.
| | - Anton J M Wagenmakers
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, L3 3AF, UK.
| | - Michael C Riddell
- School of Kinesiology and Health Science, York University, Toronto, ON M3J 1P3, Canada.
- LMC Diabetes & Endocrinology, 1929 Bayview Avenue, Toronto, ON M4G 3E8, Canada.
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Moser O, Eckstein ML, Mueller A, Birnbaumer P, Aberer F, Koehler G, Sourij C, Kojzar H, Holler P, Simi H, Pferschy P, Dietz P, Bracken RM, Hofmann P, Sourij H. Impact of physical exercise on sensor performance of the FreeStyle Libre intermittently viewed continuous glucose monitoring system in people with Type 1 diabetes: a randomized crossover trial. Diabet Med 2019; 36:606-611. [PMID: 30677187 DOI: 10.1111/dme.13909] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/05/2018] [Indexed: 01/10/2023]
Abstract
AIMS To evaluate the sensor performance of the FreeStyle Libre intermittently viewed continuous glucose monitoring system using reference blood glucose levels during moderate-intensity exercise while on either full or reduced basal insulin dose in people with Type 1 diabetes. METHODS Ten participants with Type 1 diabetes [four women, mean ± sd age 31.4 ± 9.0 years, BMI 25.5±3.8 kg/m2 , HbA1c 55±7 mmol/mol (7.2±0.6%)] exercised on a cycle ergometer for 55 min at a moderate intensity for 5 consecutive days at the clinical research facility, while receiving either their usual or a 75% basal insulin dose. After a 4-week washout period, participants performed the second exercise period having switched to the alternative basal insulin dose. During exercise, reference capillary blood glucose values were analysed using the fully enzymatic-amperometric method and compared with the interstitial glucose values obtained. Intermittently viewed continuous glucose monitoring accuracy was analysed according to median (interquartile range) absolute relative difference, and Clarke error grid and Bland-Altman analysis for overall glucose levels during exercise, stratified by glycaemic range and basal insulin dosing scheme (P<0.05). RESULTS A total of 845 glucose values were available during exercise to evaluate intermittently viewed continuous glucose monitoring sensor performance. The median (interquartile range) absolute relative difference between the reference values and those obtained by the sensor across the glycaemic range overall was 22 (13.9-29.7)%, and was 36.3 (24.2-45.2)% during hypoglycaemia, 22.8 (14.6-30.6)% during euglycaemia and 15.4 (9-21)% during hyperglycaemia. Usual basal insulin dose was associated with a worse sensor performance during exercise compared with the reduced (75%) basal insulin dose [median (interquartile range) absolute relative difference: 23.7 (17.2-30.7)% vs 20.5 (12-28.1)%; P<0.001). CONCLUSIONS The intermittently viewed continuous glucose monitoring sensor showed diminished accuracy during exercise. Absolute glucose readings derived from the sensor should be used cautiously and need confirmation by additional finger-prick blood glucose measurements.
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Affiliation(s)
- O Moser
- Diabetes Research Group, Medical School, Swansea University, Swansea, UK
- Applied Sport, Technology, Exercise and Medicine Research Centre (A-STEM), College of Engineering, Swansea University, Swansea, UK
| | - M L Eckstein
- Diabetes Research Group, Medical School, Swansea University, Swansea, UK
- Applied Sport, Technology, Exercise and Medicine Research Centre (A-STEM), College of Engineering, Swansea University, Swansea, UK
| | - A Mueller
- Exercise Physiology, Training and Training Therapy Research Group, Institute of Sports Science, Medical University of Graz, Graz, Austria
- Sport Science Laboratory, FH Joanneum University of Applied Science, Bad Gleichenberg, Austria
| | - P Birnbaumer
- Exercise Physiology, Training and Training Therapy Research Group, Institute of Sports Science, Medical University of Graz, Graz, Austria
| | - F Aberer
- Division of Endocrinology and Diabetology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - G Koehler
- Division of Endocrinology and Diabetology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - C Sourij
- Division of Endocrinology and Diabetology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - H Kojzar
- Division of Endocrinology and Diabetology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - P Holler
- Sport Science Laboratory, FH Joanneum University of Applied Science, Bad Gleichenberg, Austria
| | - H Simi
- Sport Science Laboratory, FH Joanneum University of Applied Science, Bad Gleichenberg, Austria
| | - P Pferschy
- Division of Endocrinology and Diabetology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - P Dietz
- Department of Physical Activity and Public Health, Institute of Sports Science, Medical University of Graz, Graz, Austria
- Institute of Occupational, Social and Environmental Medicine, University Medical Centre of the University of Mainz, Mainz, Germany
| | - R M Bracken
- Diabetes Research Group, Medical School, Swansea University, Swansea, UK
- Applied Sport, Technology, Exercise and Medicine Research Centre (A-STEM), College of Engineering, Swansea University, Swansea, UK
| | - P Hofmann
- Exercise Physiology, Training and Training Therapy Research Group, Institute of Sports Science, Medical University of Graz, Graz, Austria
| | - H Sourij
- Division of Endocrinology and Diabetology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
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Boff W, da Silva AM, Farinha JB, Rodrigues-Krause J, Reischak-Oliveira A, Tschiedel B, Puñales M, Bertoluci MC. Superior Effects of High-Intensity Interval vs. Moderate-Intensity Continuous Training on Endothelial Function and Cardiorespiratory Fitness in Patients With Type 1 Diabetes: A Randomized Controlled Trial. Front Physiol 2019; 10:450. [PMID: 31110479 PMCID: PMC6499209 DOI: 10.3389/fphys.2019.00450] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Accepted: 04/01/2019] [Indexed: 01/22/2023] Open
Abstract
This study aimed to compare the effect of high-intensity interval training (HIIT) with moderate-intensity continuous training (MCT) on endothelial function, oxidative stress and clinical fitness in patients with type 1 diabetes. Thirty-six type 1 diabetic patients (mean age 23.5 ± 6 years) were randomized into 3 groups: HIIT, MCT, and a non-exercising group (CON). Exercise was performed in a stationary cycle ergometers during 40 min, 3 times/week, for 8 weeks at 50–85% maximal heart rate (HRmax) in HIIT and 50% HRmax in MCT. Endothelial function was measured by flow-mediated dilation (FMD) [endothelium-dependent vasodilation (EDVD)], and smooth-muscle function by nitroglycerin-mediated dilation [endothelium-independent vasodilation (EIVD)]. Peak oxygen consumption (VO2peak) and oxidative stress markers were determined before and after training. Endothelial dysfunction was defined as an increase < 8% in vascular diameter after cuff release. The trial is registered at ClinicalTrials.gov, identifier: NCT03451201. Twenty-seven patients completed the 8-week protocol, 9 in each group (3 random dropouts per group). Mean baseline EDVD was similar in all groups. After training, mean absolute EDVD response improved from baseline in HIIT: + 5.5 ± 5.4%, (P = 0.0059), but remained unchanged in MCT: 0.2 ± 4.1% (P = 0.8593) and in CON: −2.6 ± 6.4% (P = 0.2635). EDVD increase was greater in HIIT vs. MCT (P = 0.0074) and CON (P = 0.0042) (ANOVA with Bonferroni). Baseline VO2peak was similar in all groups (P = 0.96). VO2peak increased 17.6% from baseline after HIIT (P = 0.0001), but only 3% after MCT (P = 0.055); no change was detected in CON (P = 0.63). EIVD was unchanged in all groups (P = 0.18). Glycemic control was similar in all groups. In patients with type 1 diabetes without microvascular complications, 8-week HIIT produced greater improvement in endothelial function and physical fitness than MCT at a similar glycemic control.
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Affiliation(s)
- Winston Boff
- Post-Graduate Program in Medical Sciences, Internal Medicine Department, School of Medicine, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
| | - Antonio M da Silva
- Department of Physiotherapy and Rehabilitation, Universidade Federal de Santa Maria (UFSM), Santa Maria, Brazil
| | - Juliano B Farinha
- Exercise Research Laboratory, School of Physical Education, UFRGS, Porto Alegre, Brazil
| | | | | | - Balduino Tschiedel
- Institute for Children with Diabetes, Hospital Criança Conceição, Grupo Hospitalar Conceição, Ministry of Health, Porto Alegre, Brazil
| | - Marcia Puñales
- Institute for Children with Diabetes, Hospital Criança Conceição, Grupo Hospitalar Conceição, Ministry of Health, Porto Alegre, Brazil
| | - Marcello C Bertoluci
- Post-Graduate Program in Medical Sciences, Internal Medicine Department, School of Medicine, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil.,Endocrinology Unit, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil
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McCarthy O, Bain SC, Deere R. Basal insulin reductions in anticipation of multiple exercise sessions in people with type 1 diabetes-a clinical perspective. ANNALS OF TRANSLATIONAL MEDICINE 2019; 6:S111. [PMID: 30740432 DOI: 10.21037/atm.2018.11.63] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Affiliation(s)
- Olivia McCarthy
- Diabetes Research Group Cymru, Medical School, Swansea University, Swansea, UK.,Applied Sport, Technology, Exercise and Medicine Research Centre (A-STEM), College of Engineering, Swansea University, Swansea, UK
| | - Steve C Bain
- Diabetes Research Group Cymru, Medical School, Swansea University, Swansea, UK
| | - Rachel Deere
- Diabetes Research Group Cymru, Medical School, Swansea University, Swansea, UK.,Applied Sport, Technology, Exercise and Medicine Research Centre (A-STEM), College of Engineering, Swansea University, Swansea, UK
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Moser O, Eckstein ML, Mueller A, Birnbaumer P, Aberer F, Koehler G, Sourij C, Kojzar H, Holler P, Simi H, Pferschy P, Dietz P, Bracken RM, Hofmann P, Sourij H. Reduction in insulin degludec dosing for multiple exercise sessions improves time spent in euglycaemia in people with type 1 diabetes: A randomized crossover trial. Diabetes Obes Metab 2019; 21:349-356. [PMID: 30221457 PMCID: PMC6587463 DOI: 10.1111/dom.13534] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Revised: 08/30/2018] [Accepted: 09/11/2018] [Indexed: 12/29/2022]
Abstract
AIMS To compare the time spent in specified glycaemic ranges in people with type 1 diabetes (T1D) during 5 consecutive days of moderate-intensity exercise while on either 100% or 75% of their usual insulin degludec (IDeg) dose. MATERIALS AND METHODS Nine participants with T1D (four women, mean age 32.1 ± 9.0 years, body mass index 25.5 ± 3.8 kg/m2 , glycated haemoglobin 55 ± 7 mmol/mol (7.2% ± 0.6%) on IDeg were enrolled in the trial. Three days before the first exercise period, participants were randomized to either 100% or 75% of their usual IDeg dose. Participants exercised on a cycle ergometer for 55 minutes at a moderate intensity for 5 consecutive days. After a 4-week wash-out period, participants performed the last exercise period for 5 consecutive days with the alternate IDeg dose. Time spent in specified glycaemic ranges, area under the curve and numbers of hypoglycaemic events were compared for the 5 days on each treatment allocation using a paired Students' t test, Wilcoxon matched-pairs signed-rank test and two-way ANOVA. RESULTS Time spent in euglycaemia over 5 days was greater for the 75% IDeg dose versus the 100% IDeg dose (4008 ± 938 minutes vs. 3566 ± 856 minutes; P = 0.04). Numbers of hypoglycaemic events (P = 0.91) and time spent in hypoglycaemia (P = 0.07) or hyperglycaemia (P = 0.38) was similar for both dosing schemes. CONCLUSIONS A 25% reduction in usual IDeg dose around regular exercise led to more time spent in euglycaemia, with small effects on time spent in hypo- and hyperglycaemia.
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Affiliation(s)
- Othmar Moser
- Diabetes Research Group, Medical School, Swansea University, Swansea, UK
- Applied Sport, Technology, Exercise and Medicine Research Centre (A-STEM), College of Engineering, Swansea University, Swansea, UK
| | - Max L Eckstein
- Diabetes Research Group, Medical School, Swansea University, Swansea, UK
- Applied Sport, Technology, Exercise and Medicine Research Centre (A-STEM), College of Engineering, Swansea University, Swansea, UK
| | - Alexander Mueller
- Exercise Physiology, Training and Training Therapy Research Group, Institute of Sports Science, University of Graz, Graz, Austria
- Sport Science Laboratory, Institute of Health and Tourism Management, FH Joanneum University of Applied Science, Bad Gleichenberg, Austria
| | - Philipp Birnbaumer
- Exercise Physiology, Training and Training Therapy Research Group, Institute of Sports Science, University of Graz, Graz, Austria
| | - Felix Aberer
- Division of Endocrinology and Diabetology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Gerd Koehler
- Division of Endocrinology and Diabetology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Caren Sourij
- Division of Endocrinology and Diabetology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Harald Kojzar
- Division of Endocrinology and Diabetology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Peter Holler
- Sport Science Laboratory, Institute of Health and Tourism Management, FH Joanneum University of Applied Science, Bad Gleichenberg, Austria
| | - Helmut Simi
- Sport Science Laboratory, Institute of Health and Tourism Management, FH Joanneum University of Applied Science, Bad Gleichenberg, Austria
| | - Peter Pferschy
- Division of Endocrinology and Diabetology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Pavel Dietz
- Department of Physical Activity and Public Health, Institute of Sports Science, University of Graz, Graz, Austria
- Institute of Occupational, Social and Environmental Medicine, University Medical Centre of the University of Mainz, Mainz, Germany
| | - Richard M Bracken
- Diabetes Research Group, Medical School, Swansea University, Swansea, UK
- Applied Sport, Technology, Exercise and Medicine Research Centre (A-STEM), College of Engineering, Swansea University, Swansea, UK
| | - Peter Hofmann
- Exercise Physiology, Training and Training Therapy Research Group, Institute of Sports Science, University of Graz, Graz, Austria
| | - Harald Sourij
- Division of Endocrinology and Diabetology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
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Riddell MC, Pooni R, Yavelberg L, Li Z, Kollman C, Brown RE, Li A, Aronson R. Reproducibility in the cardiometabolic responses to high-intensity interval exercise in adults with type 1 diabetes. Diabetes Res Clin Pract 2019; 148:137-143. [PMID: 30641168 DOI: 10.1016/j.diabres.2019.01.003] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2018] [Revised: 11/30/2018] [Accepted: 01/04/2019] [Indexed: 12/21/2022]
Abstract
AIMS Patients with type 1 diabetes (T1D) often report a rise in their blood glucose level following brief intense exercise. We sought to determine the reproducibility of the cardiometabolic responses to high-intensity interval training (HIIT). METHODS Sixteen adults with T1D, using an optimized multiple daily injection with basal insulin glargine 300 U/mL (Gla-300), performed four fasted HIIT sessions over a 4-6-week period. Exercise consisted of high-intensity interval cycling and multimodal training over 25 min. RESULTS Heart rate and rating of perceived exertion rose similarly in all sessions, as did lactate, catecholamine and growth hormone levels. Plasma glucose increased in response to HIIT in 62 of 64 visits (97%), with an overall increase of 3.7 ± 1.6 mmol/L (Mean ± SD) (P < 0.001). In within-patient comparisons, the change in plasma glucose among the four HIIT sessions was significantly correlated with a composite correlation of 0.58 ([r2 = 0.34]; 95% CI 0.35-0.80; P < 0.01). CONCLUSIONS Intersession observations of four separate HIIT sessions showed high intrasubject reproducibility in the cardiometabolic responses to exercise, including the rise in plasma glucose, when adults with T1D perform the activity in a fasted state.
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Affiliation(s)
- Michael C Riddell
- LMC Diabetes and Endocrinology, 1929 Bayview Ave., Toronto, Ontario, Canada; School of Kinesiology and Health Science, York University, 4700 Keele St., Toronto, Ontario, Canada.
| | - Rubin Pooni
- School of Kinesiology and Health Science, York University, 4700 Keele St., Toronto, Ontario, Canada.
| | - Loren Yavelberg
- School of Kinesiology and Health Science, York University, 4700 Keele St., Toronto, Ontario, Canada.
| | - Zoey Li
- JAEB Center for Health Research, 15310 Amberly Dr., Tampa, FL, USA.
| | - Craig Kollman
- JAEB Center for Health Research, 15310 Amberly Dr., Tampa, FL, USA.
| | - Ruth E Brown
- LMC Diabetes and Endocrinology, 1929 Bayview Ave., Toronto, Ontario, Canada.
| | - Aihua Li
- LMC Diabetes and Endocrinology, 1929 Bayview Ave., Toronto, Ontario, Canada.
| | - Ronnie Aronson
- LMC Diabetes and Endocrinology, 1929 Bayview Ave., Toronto, Ontario, Canada.
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