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Martins TBFDS, Gomes OV, Soltani P, Oliveira THR, de Brito-Gomes JL. Sex-Related Glycemic and Cardiovascular Responses After Continuous and Interval Aerobic Sessions in Patients With Type 1 Diabetes: A Randomized Crossover Study. Am J Cardiol 2024; 228:48-55. [PMID: 39094945 DOI: 10.1016/j.amjcard.2024.07.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2024] [Revised: 07/01/2024] [Accepted: 07/20/2024] [Indexed: 08/04/2024]
Abstract
We aimed to investigate sex-related glycemic and cardiovascular responses after intensity- (moderate) and duration- (30 minutes) matched interval aerobic exercise (IAE) and continuous (CAE) aerobic exercise sessions in patients with type 1 diabetes mellitus (T1DM). A total of 19 volunteers (10 women) participated in 2 randomized and crossover sessions (1:1). Heart rate, systolic and diastolic blood pressure, double product, and blood glucose (BG) levels were measured before (PRE), immediately after (POST-0), and 20 minutes after (POST-20) each session. The rates of perceived exertion (RPE) and enjoyment levels (ELs) were assessed after each session. Generalized estimating equations were used to analyze the data (condition × time × sex). Regarding sex-related changes, men showed BG reductions at POST-0 and POST-20 after CAE (∆: -3.7 and -3.7 mmol/L, respectively) and only at POST-0 after IAE (∆: -1.6 mmol/L), with 1 episode of hypoglycemia occurring in the latter group. In contrast, women showed reduced BG values only after CAE at both time points (∆: -1.4 and -1.7 mmol/L) compared with PRE values. The decrease in BG levels at both time points was higher for men after CAE than IAE. Cardiovascular responses, RPEs, and ELs were similar between exercise sessions, except for blood pressure, which showed higher values in men. In conclusion, lower BG levels were observed after CAE, with greater reductions in men. Similar cardiovascular, RPE, and EL responses were found across sexes and sessions. Consideration of sex-specific recommendations may be warranted when prescribing aerobic exercise, particularly, for men with irregular physical activity levels.
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Affiliation(s)
- Tamy Beatriz Freire de Sá Martins
- Department of Medicine, Universidade Federal do Vale do São Francisco, Petrolina, Brazil; Department of Physical Education, Universidade Federal do Vale do São Francisco, Petrolina, Brazil
| | - Orlando Vieira Gomes
- Department of Medicine, Universidade Federal do Vale do São Francisco, Petrolina, Brazil
| | - Pooya Soltani
- School of Digital, Technology, Innovation and Business, Staffordshire University, Stoke-on-Trent, United Kingdom
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Molveau J, Myette-Côté É, Tagougui S, Taleb N, St-Amand R, Suppère C, Bourdeau V, Heyman E, Rabasa-Lhoret R. Assessing the influence of insulin type (ultra-rapid vs rapid insulin) and exercise timing on postprandial exercise-induced hypoglycaemia risk in individuals with type 1 diabetes: a randomised controlled trial. Diabetologia 2024:10.1007/s00125-024-06234-0. [PMID: 39069599 DOI: 10.1007/s00125-024-06234-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2024] [Accepted: 06/10/2024] [Indexed: 07/30/2024]
Abstract
AIMS/HYPOTHESIS The relationship between pre-meal insulin type, exercise timing and the risk of postprandial exercise-induced hypoglycaemia in people living with type 1 diabetes is unknown. We aimed to evaluate the effects of exercise timing (60 vs 120 min post meal) and different insulin types (aspart vs ultra-rapid aspart) on hypoglycaemic risk. METHODS This was a four-way crossover randomised trial including 40 individuals with type 1 diabetes using multiple daily injections (mean HbA1c 56 mmol/mol [7.4%]). Participants, who were recruited from the Montreal Clinical Research Institute, undertook 60 min cycling sessions (60% ofV ˙ O 2 peak ) after breakfast (60 min [EX60min] or 120 min [EX120min] post meal) with 50% of their usual insulin dose (aspart or ultra-rapid aspart). Eligibility criteria included age ≥18 years old, clinical diagnosis of type 1 diabetes for at least 1 year and HbA1c ≤80 mmol/mol (9.5%). Participants were allocated using sequentially numbered, opaque sealed envelopes. Participants were masked to their group assignment, and each participant was allocated a unique identification number to ensure anonymisation. The primary outcome was change in blood glucose levels between exercise onset and nadir. RESULTS Prior to exercise onset, time spent in hyperglycaemia was lower for EX60min vs EX120min (time >10.0 mmol/l: 56.6% [1.2-100%] vs 78.0% [52.7-97.9%]; p<0.001). The glucose reduction between exercise onset and nadir was less pronounced with EX60min vs EX120min (-3.8±2.7 vs -4.7±2.5 mmol/l; p<0.001). A similar number of hypoglycaemic events occurred during both exercise timings. Blood glucose between exercise onset and nadir decreased less with ultra-rapid aspart compared with aspart (-4.1±2.3 vs -4.4±2.8 mmol/l; p=0.037). While a similar number of hypoglycaemic events during exercise were observed, less post-exercise hypoglycaemia occurred with ultra-rapid aspart (n=0, 0%, vs n=15, 38%; p=0.003). No interactions between insulin types and exercise timings were found. CONCLUSIONS/INTERPRETATION EX60min blunted the pre-exercise glucose increase following breakfast and was associated with a smaller glucose reduction during exercise. Ultra-rapid aspart led to a smaller blood glucose reduction during exercise and might be associated with diminished post-exercise hypoglycaemia. TRIAL REGISTRATION ClinicalTrials.gov NCT03659799 FUNDING: This study was funded by Novo Nordisk Canada.
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Affiliation(s)
- Joséphine Molveau
- Institut de recherches cliniques de Montréal, Montréal, QC, Canada
- Département de Nutrition, Faculté de Médecine, Université de Montréal, Montréal, QC, Canada
- ULR 7369 - URePSSS - Unité de Recherche Pluridisciplinaire Sport Santé Société, Université de Lille, Université d'Artois, Université du Littoral Côte d'Opale, Lille, France
| | - Étienne Myette-Côté
- Institut de recherches cliniques de Montréal, Montréal, QC, Canada
- Department of Applied Human Sciences, Faculty of Science, University of Prince Edward Island, Charlottetown, PE, Canada
| | - Sémah Tagougui
- ULR 7369 - URePSSS - Unité de Recherche Pluridisciplinaire Sport Santé Société, Université de Lille, Université d'Artois, Université du Littoral Côte d'Opale, Lille, France
| | - Nadine Taleb
- Institut de recherches cliniques de Montréal, Montréal, QC, Canada
- Division of Endocrinology, Centre Hospitalier de l'Université de Montréal (CHUM), Montréal, QC, Canada
| | - Roxane St-Amand
- Institut de recherches cliniques de Montréal, Montréal, QC, Canada
| | - Corinne Suppère
- Institut de recherches cliniques de Montréal, Montréal, QC, Canada
| | - Valérie Bourdeau
- Institut de recherches cliniques de Montréal, Montréal, QC, Canada
| | - Elsa Heyman
- ULR 7369 - URePSSS - Unité de Recherche Pluridisciplinaire Sport Santé Société, Université de Lille, Université d'Artois, Université du Littoral Côte d'Opale, Lille, France
- Institut Universitaire de France (IUF), Paris, France
| | - Rémi Rabasa-Lhoret
- Institut de recherches cliniques de Montréal, Montréal, QC, Canada.
- Département de Nutrition, Faculté de Médecine, Université de Montréal, Montréal, QC, Canada.
- ULR 7369 - URePSSS - Unité de Recherche Pluridisciplinaire Sport Santé Société, Université de Lille, Université d'Artois, Université du Littoral Côte d'Opale, Lille, France.
- Division of Endocrinology, Centre Hospitalier de l'Université de Montréal (CHUM), Montréal, QC, Canada.
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Helleputte S, Stautemas J, Jansseune L, De Backer T, Marlier J, Lapauw B, Calders P. Glycemic Management Around Postprandial Exercise in People With Type 1 Diabetes: Challenge Accepted. J Clin Endocrinol Metab 2024; 109:2039-2052. [PMID: 38330239 DOI: 10.1210/clinem/dgae079] [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: 09/11/2023] [Revised: 02/01/2024] [Accepted: 02/06/2024] [Indexed: 02/10/2024]
Abstract
CONTEXT The precise glycemic impact and clinical relevance of postprandial exercise in type 1 diabetes (T1D) has not been clarified yet. OBJECTIVE This work aimed to examine acute, subacute, and late effects of postprandial exercise on blood glucose (BG). METHODS A randomized, controlled trial comprised 4 laboratory visits, with 24-hour follow-up at home. Participants included adults with T1D (n = 8), aged 44 ± 13 years, with body mass index of 24 ± 2.1. Intervention included 30 minutes of rest (CONTROL), walking (WALK), moderate-intensity (MOD), or intermittent high-intensity (IHE) exercise performed 60 minutes after a standardized meal. Main outcome measures included BG change during exercise/control (acute), and secondary outcomes included the subacute (≤2 h after) and late glycemic effects (≤24 h after). RESULTS Exercise reduced postprandial glucose (PPG) excursion compared to CONTROL, with a consistent BG decline in all patients for all modalities (mean declines -45 ± 24, -71 ± 39, and -35 ± 21 mg/dL, during WALK, MOD, and IHE, respectively (P < .001). For this decline, clinical superiority was demonstrated separately for each exercise modality vs CONTROL. Noninferiority of WALK vs MOD was not demonstrated, noninferiority of WALK vs IHE was demonstrated, and equivalence of IHE vs MOD was not demonstrated. Hypoglycemia did not occur during exercise. BG increased in the hour after exercise (more than after CONTROL; P < .001). More than half of participants showed hyperglycemia after exercise necessitating insulin correction. There were more nocturnal hypoglycemic events after exercise vs CONTROL (P < .05). CONCLUSION Postprandial exercise of all modalities is effective, safe, and feasible if necessary precautions are taken (ie, prandial insulin reductions), as exercise lowered maximal PPG excursion and caused a consistent and clinically relevant BG decline during exercise while there was no hypoglycemia during or shortly after exercise. However, there seem to be 2 remaining challenges: subacute postexercise hyperglycemia and nocturnal hypoglycemia.
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Affiliation(s)
- Simon Helleputte
- Faculty of Medicine and Health Sciences, Ghent University, Ghent 9000, Belgium
- Fonds Wetenschappelijk Onderzoek (FWO) Flanders, Brussel 1000, Belgium
| | - Jan Stautemas
- Faculty of Medicine and Health Sciences, Ghent University, Ghent 9000, Belgium
| | - Laura Jansseune
- Faculty of Medicine and Health Sciences, Ghent University, Ghent 9000, Belgium
| | - Tine De Backer
- Faculty of Medicine and Health Sciences, Ghent University, Ghent 9000, Belgium
- Department of Cardiology, Ghent University Hospital, Ghent 9000, Belgium
- Department of Internal Medicine & Paediatrics, Ghent University, Ghent 9000, Belgium
| | - Joke Marlier
- Department of Endocrinology, Ghent University Hospital, Ghent 9000, Belgium
| | - Bruno Lapauw
- Faculty of Medicine and Health Sciences, Ghent University, Ghent 9000, Belgium
- Department of Internal Medicine & Paediatrics, Ghent University, Ghent 9000, Belgium
- Department of Endocrinology, Ghent University Hospital, Ghent 9000, Belgium
| | - Patrick Calders
- Faculty of Medicine and Health Sciences, Ghent University, Ghent 9000, Belgium
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Taylor GS, Smith K, Scragg J, McDonald TJ, Shaw JA, West DJ, Roberts LD. The metabolome as a diagnostic for maximal aerobic capacity during exercise in type 1 diabetes. Diabetologia 2024; 67:1413-1428. [PMID: 38662134 PMCID: PMC11153288 DOI: 10.1007/s00125-024-06153-0] [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: 12/18/2023] [Accepted: 03/07/2024] [Indexed: 04/26/2024]
Abstract
AIMS/HYPOTHESIS Our aim was to characterise the in-depth metabolic response to aerobic exercise and the impact of residual pancreatic beta cell function in type 1 diabetes. We also aimed to use the metabolome to distinguish individuals with type 1 diabetes with reduced maximal aerobic capacity in exercise defined byV ˙ O 2peak . METHODS Thirty participants with type 1 diabetes (≥3 years duration) and 30 control participants were recruited. Groups did not differ in age or sex. After quantification of peak stimulated C-peptide, participants were categorised into those with undetectable (<3 pmol/l), low (3-200 pmol/l) or high (>200 pmol/l) residual beta cell function. Maximal aerobic capacity was assessed byV ˙ O 2peak test and did not differ between control and type 1 diabetes groups. All participants completed 45 min of incline treadmill walking (60%V ˙ O 2peak ) with venous blood taken prior to exercise, immediately post exercise and after 60 min recovery. Serum was analysed using targeted metabolomics. Metabolomic data were analysed by multivariate statistics to define the metabolic phenotype of exercise in type 1 diabetes. Receiver operating characteristic (ROC) curves were used to identify circulating metabolomic markers of maximal aerobic capacity (V ˙ O 2peak ) during exercise in health and type 1 diabetes. RESULTS Maximal aerobic capacity (V ˙ O 2peak ) inversely correlated with HbA1c in the type 1 diabetes group (r2=0.17, p=0.024). Higher resting serum tricarboxylic acid cycle metabolites malic acid (fold change 1.4, p=0.001) and lactate (fold change 1.22, p=1.23×10-5) differentiated people with type 1 diabetes. Higher serum acylcarnitines (AC) (AC C14:1, F value=12.25, p=0.001345; AC C12, F value=11.055, p=0.0018) were unique to the metabolic response to exercise in people with type 1 diabetes. C-peptide status differentially affected metabolic responses in serum ACs during exercise (AC C18:1, leverage 0.066; squared prediction error 3.07). The malic acid/pyruvate ratio in rested serum was diagnostic for maximal aerobic capacity (V ˙ O 2peak ) in people with type 1 diabetes (ROC curve AUC 0.867 [95% CI 0.716, 0.956]). CONCLUSIONS/INTERPRETATION The serum metabolome distinguishes high and low maximal aerobic capacity and has diagnostic potential for facilitating personalised medicine approaches to manage aerobic exercise and fitness in type 1 diabetes.
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Affiliation(s)
- Guy S Taylor
- Human Nutrition & Exercise Research Centre, Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Kieran Smith
- Human Nutrition & Exercise Research Centre, Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
- The Oxford Centre for Diabetes, Endocrinology and Metabolism, Churchill Hospital, University of Oxford, Oxford, UK
| | - Jadine Scragg
- Human Nutrition & Exercise Research Centre, Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | | | - James A Shaw
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Daniel J West
- Human Nutrition & Exercise Research Centre, Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK.
| | - Lee D Roberts
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK.
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Chaieb IA, Kacem FH, Mnif M, Turki M, Heyman E, Hammouda O, Taleb N, Abid M, Zouari M, Rabasa-Lhoret R, Bouzid MA, Tagougui S. Impact of Time of Day on Glycemia in Response to Postprandial Supramaximal Sprints in Adults With Type 1 Diabetes. Can J Diabetes 2024:S1499-2671(24)00124-2. [PMID: 38950773 DOI: 10.1016/j.jcjd.2024.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2024] [Revised: 06/19/2024] [Accepted: 06/21/2024] [Indexed: 07/03/2024]
Abstract
OBJECTIVES In this study we explore the impact of postprandial exercise timing (morning vs evening) on glycemia in individuals with type 1 diabetes (T1D) during short all-out sprints on a cycle ergometer. METHODS Ten healthy physically sedentary male (n=7) and female (n=3) volunteers with type 1 diabetes, 22.8±2.8 years of age, and with a diabetes duration of 9.7±5.5 years and glycated hemoglobin level of 8.6±1.2%, underwent comprehensive screening and assessment of their physical health and fitness status before study participation, under the guidance of a physician. Each participant underwent 2 postprandial exercise sessions on separate days: the first in the morning at 8:00 AM and second in the evening at 8:00 PM, both conducted 60 minutes after a standardized meal. RESULTS Morning exercise showed a less pronounced reduction in plasma glucose (PG) levels compared with evening exercise (-2.01±1.24 vs -3.56±1.6 mmol/L, p=0.03). In addition, higher cortisol levels were observed in the morning vs evening (128.59±34 vs 67.79±26 ng/mL, p<0.001). CONCLUSIONS Morning repeated sprint exercise conducted in the postprandial state consistent with the protective effect of higher cortisol levels resulted in a smaller reduction in PG levels compared with evening exercise. This highlights the potential influence of exercise timing on glycemic responses and cortisol secretion in the management of T1D.
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Affiliation(s)
- Ilyess Aouin Chaieb
- Research Laboratory, Education, Motricity, Sport and Health, EM2S, LR19JS01, University of Sfax, Tunisia; High Institute of Sport and Physical Education of Sfax, University of Sfax, Sfax, Tunisia
| | - Faten Hadj Kacem
- Endocrinology Department, Hedi Chaker University Hospital, Sfax, Tunisia
| | - Mouna Mnif
- Endocrinology Department, Hedi Chaker University Hospital, Sfax, Tunisia
| | - Mouna Turki
- Research Laboratory, Molecular Bases of Human Pathology, LR19ES13, Faculty of Medicine, University of Sfax, Sfax, Tunisia
| | - Elsa Heyman
- University of Lille, University of Artois, University of Littoral Côte d'Opale, ULR 7369, Unité de Recherche Pluridisciplinaire Sport Santé Société, Lille, France
| | - Omar Hammouda
- Research Laboratory, Molecular Bases of Human Pathology, LR19ES13, Faculty of Medicine, University of Sfax, Sfax, Tunisia; LINP2, UFR STAPS, University of Paris Nanterre, Nanterre, France
| | - Nadine Taleb
- Centre de recherche de l'Université de Montréal, Montréal, Québec, Canada
| | - Mohamed Abid
- Endocrinology Department, Hedi Chaker University Hospital, Sfax, Tunisia
| | - Mariem Zouari
- Research Laboratory, Education, Motricity, Sport and Health, EM2S, LR19JS01, University of Sfax, Tunisia; High Institute of Sport and Physical Education of Sfax, University of Sfax, Sfax, Tunisia
| | | | - Mohamed Amine Bouzid
- Research Laboratory, Education, Motricity, Sport and Health, EM2S, LR19JS01, University of Sfax, Tunisia; High Institute of Sport and Physical Education of Sfax, University of Sfax, Sfax, Tunisia
| | - Sémah Tagougui
- University of Lille, University of Artois, University of Littoral Côte d'Opale, ULR 7369, Unité de Recherche Pluridisciplinaire Sport Santé Société, Lille, France.
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Al-Ozairi E, Irshad M, Al-Ozairi A, Al-Kandari J, Taghadom E, Varghese A, Megahed A, Abdullah A, Murad S, Gray SR. Seasonal differences in physical activity, sedentary behaviour, and sleep patterns in people with type 1 diabetes in Kuwait. Diabetes Metab Syndr 2024; 18:103046. [PMID: 38830288 DOI: 10.1016/j.dsx.2024.103046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Revised: 05/20/2024] [Accepted: 05/22/2024] [Indexed: 06/05/2024]
Abstract
AIMS The main aim of the current study was to measure physical activity, sedentary behaviors and sleep levels across the different seasons in people with type 1 diabetes in Kuwait. METHODS A prospective cross-sectional study was conducted from August 2021 to September 2022. Physical activity and sleep metrics were measured over a 7-day period with a wrist-worn accelerometer (GENEActiv). Overall physical activity was measured as a Euclidean Norm Minus One in milli gravitational units (mg). Accelerometer metrics were compared across the seasons and between the sex. RESULTS A total of 784 people with type 1 diabetes participated. Mean daily physical activity was 25.2 mg (SD = 7.3). Seasonal differences were seen in overall physical activity (p = 0.05), inactivity (p = 0.04), light activity (p = 0.001), the intensity gradient (p = 0.001) and sleep efficiency (p = 0.02). Poorer metrics were generally seen in Spring and Summer. Overall physical activity, moderate and vigorous physical activity, and inactivity were significantly higher in males compared to females (p ≤ 0.02). Females had a longer sleeping duration (p = 0.02), and higher sleep efficiency (p = 0.04) and light physical activity (p = 0.01). Overall physical activity and the intensity gradient were negatively associated with HbA1c (both p = 0.01). CONCLUSIONS Physical activity levels were generally low and sleep poor in people with type 1 diabetes in Kuwait and these varied by sex and season. The current data are useful to target and develop interventions to improve physical activity and glycemic control.
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Affiliation(s)
| | | | - Abdullah Al-Ozairi
- Dasman Diabetes Institute, Kuwait City, Kuwait; Department of Psychological Medicine, Faculty of Medicine, Kuwait University, Kuwait
| | - Jumana Al-Kandari
- Dasman Diabetes Institute, Kuwait City, Kuwait; Ministry of Health, Kuwait City, Kuwait
| | - Etab Taghadom
- Dasman Diabetes Institute, Kuwait City, Kuwait; Ministry of Health, Kuwait City, Kuwait
| | | | | | | | - Sahar Murad
- Dasman Diabetes Institute, Kuwait City, Kuwait
| | - Stuart R Gray
- School of Cardiovascular and Metabolic Health, University of Glasgow, UK.
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7
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Sander SE, Johansen RF, Caunt S, Søndergaard E, Rolver MG, Sandbæk A, Heller S, Kristensen PL, Molsted S. A Cross-sectional Study on the Impact of Educational Status on Physical Activity Level in Danish and English Adults With Type 1 Diabetes. Can J Diabetes 2024; 48:204-210.e1. [PMID: 38218396 DOI: 10.1016/j.jcjd.2024.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Revised: 12/06/2023] [Accepted: 01/04/2024] [Indexed: 01/15/2024]
Abstract
OBJECTIVES Physical activity is associated with improved health in people with type 1 diabetes. However, physical activity level may be associated with socioeconomic status. The primary aim of this study was to investigate the association between education level and physical activity level among people with type 1 diabetes. METHODS In this cross-sectional study, data on physical activity level (high or low) was measured using the Saltin-Grimby Physical Activity Level Scale, and education level (low, medium, or high) was self-reported. RESULTS Respondents were recruited from outpatient clinics (Steno Diabetes Centre Aarhus, Denmark; Nordsjællands Hospital, Denmark; or Sheffield Diabetes and Endocrine Centre, United Kingdom), by health-care personnel from September 2019 to July 2021. A total of 324 people with type 1 diabetes were included (54% male, median age 50 years [interquartile range 30-60 years]). Education level was low in 10%, medium in 33%, and high in 57%. A logistic regression analysis, adjusted for age, sex, cohabitation status and nationality, found that a medium vs. high education level was associated with lower odds of a high physical activity level (odds ratio [OR] 0.55, 95% confidence interval [CI] 0.32-0.94, p=0.029), while no association was found for low vs. high education level with high physical activity level (OR 0.56, 95% CI 0.25-1.29, p=0.173). CONCLUSIONS Medium education level compared with a high education level was associated with a lower level of physical activity in people with type 1 diabetes. Health-care professionals are advised to be attentive of physical activity levels among people with type 1 diabetes.
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Affiliation(s)
- Sarah Elton Sander
- Department of Clinical Research, Nordsjællands Hospital, Hillerød, Denmark.
| | | | - Sharon Caunt
- Academic Directorate of Diabetes and Endocrinology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom
| | - Esben Søndergaard
- Steno Diabetes Centre Aarhus, Aarhus, Denmark; Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Monica Gylling Rolver
- Department of Clinical Research, Nordsjællands Hospital, Hillerød, Denmark; Department of Endocrinology and Nephrology, Nordsjællands Hospital, Hillerød, Denmark
| | - Anni Sandbæk
- Department of Clinical Research, Nordsjællands Hospital, Hillerød, Denmark
| | - Simon Heller
- Academic Directorate of Diabetes and Endocrinology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom; Division of Clinical Medicine, School of Medicine and Population Health, University of Sheffield, Sheffield, United Kingdom
| | - Peter Lommer Kristensen
- Department of Endocrinology and Nephrology, Nordsjællands Hospital, Hillerød, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Stig Molsted
- Department of Clinical Research, Nordsjællands Hospital, Hillerød, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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8
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D’Souza NC, Kesibi D, Yeung C, Shakeri D, D’Souza AI, Macpherson AK, Riddell MC. The Impact of Sex, Body Mass Index, Age, Exercise Type and Exercise Duration on Interstitial Glucose Levels during Exercise. SENSORS (BASEL, SWITZERLAND) 2023; 23:9059. [PMID: 38005447 PMCID: PMC10674905 DOI: 10.3390/s23229059] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Revised: 11/03/2023] [Accepted: 11/06/2023] [Indexed: 11/26/2023]
Abstract
The impact of age, sex and body mass index on interstitial glucose levels as measured via continuous glucose monitoring (CGM) during exercise in the healthy population is largely unexplored. We conducted a multivariable generalized estimating equation (GEE) analysis on CGM data (Dexcom G6, 10 days) collected from 119 healthy exercising individuals using CGM with the following specified covariates: age; sex; BMI; exercise type and duration. Females had lower postexercise glycemia as compared with males (92 ± 18 vs. 100 ± 20 mg/dL, p = 0.04) and a greater change in glycemia during exercise from pre- to postexercise (p = 0.001) or from pre-exercise to glucose nadir during exercise (p = 0.009). Younger individuals (i.e., <20 yrs) had higher glucose during exercise as compared with all other age groups (all p < 0.05) and less CGM data in the hypoglycemic range (<70 mg/dL) as compared with those aged 20-39 yrs (p < 0.05). Those who were underweight, based on body mass index (BMI: <18.5 kg/m2), had higher pre-exercise glycemia than the healthy BMI group (104 ± 20 vs. 97 ± 17 mg/dL, p = 0.02) but similar glucose levels after exercise. Resistance exercise was associated with less of a drop in glycemia as compared with aerobic or mixed forms of exercise (p = 0.008) and resulted in a lower percent of time in the hypoglycemic (p = 0.04) or hyperglycemic (glucose > 140 mg/dL) (p = 0.03) ranges. In summary, various factors such as age, sex and exercise type appear to have subtle but potentially important influence on CGM measurements during exercise in healthy individuals.
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Affiliation(s)
- Ninoschka C. D’Souza
- School of Kinesiology and Health Science, Faculty of Health, York University, Toronto, ON M3J 1P3, Canada; (N.C.D.); (D.K.); (C.Y.); (D.S.); (A.K.M.)
| | - Durmalouk Kesibi
- School of Kinesiology and Health Science, Faculty of Health, York University, Toronto, ON M3J 1P3, Canada; (N.C.D.); (D.K.); (C.Y.); (D.S.); (A.K.M.)
| | - Christopher Yeung
- School of Kinesiology and Health Science, Faculty of Health, York University, Toronto, ON M3J 1P3, Canada; (N.C.D.); (D.K.); (C.Y.); (D.S.); (A.K.M.)
| | - Dorsa Shakeri
- School of Kinesiology and Health Science, Faculty of Health, York University, Toronto, ON M3J 1P3, Canada; (N.C.D.); (D.K.); (C.Y.); (D.S.); (A.K.M.)
| | | | - Alison K. Macpherson
- School of Kinesiology and Health Science, Faculty of Health, York University, Toronto, ON M3J 1P3, Canada; (N.C.D.); (D.K.); (C.Y.); (D.S.); (A.K.M.)
| | - Michael C. Riddell
- School of Kinesiology and Health Science, Faculty of Health, York University, Toronto, ON M3J 1P3, Canada; (N.C.D.); (D.K.); (C.Y.); (D.S.); (A.K.M.)
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9
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Lloyd EM, Pinniger GJ, Murphy RM, Grounds MD. Slow or fast: Implications of myofibre type and associated differences for manifestation of neuromuscular disorders. Acta Physiol (Oxf) 2023; 238:e14012. [PMID: 37306196 DOI: 10.1111/apha.14012] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Revised: 05/30/2023] [Accepted: 06/06/2023] [Indexed: 06/13/2023]
Abstract
Many neuromuscular disorders can have a differential impact on a specific myofibre type, forming the central premise of this review. The many different skeletal muscles in mammals contain a spectrum of slow- to fast-twitch myofibres with varying levels of protein isoforms that determine their distinctive contractile, metabolic, and other properties. The variations in functional properties across the range of classic 'slow' to 'fast' myofibres are outlined, combined with exemplars of the predominantly slow-twitch soleus and fast-twitch extensor digitorum longus muscles, species comparisons, and techniques used to study these properties. Other intrinsic and extrinsic differences are discussed in the context of slow and fast myofibres. These include inherent susceptibility to damage, myonecrosis, and regeneration, plus extrinsic nerves, extracellular matrix, and vasculature, examined in the context of growth, ageing, metabolic syndrome, and sexual dimorphism. These many differences emphasise the importance of carefully considering the influence of myofibre-type composition on manifestation of various neuromuscular disorders across the lifespan for both sexes. Equally, understanding the different responses of slow and fast myofibres due to intrinsic and extrinsic factors can provide deep insight into the precise molecular mechanisms that initiate and exacerbate various neuromuscular disorders. This focus on the influence of different myofibre types is of fundamental importance to enhance translation for clinical management and therapies for many skeletal muscle disorders.
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Affiliation(s)
- Erin M Lloyd
- Department of Anatomy, Physiology and Human Biology, School of Human Sciences, The University of Western Australia, Perth, Western Australia, Australia
- Curtin Health Innovation Research Institute, Curtin Medical School, Curtin University, Bentley, Western Australia, Australia
| | - Gavin J Pinniger
- Department of Anatomy, Physiology and Human Biology, School of Human Sciences, The University of Western Australia, Perth, Western Australia, Australia
| | - Robyn M Murphy
- Department of Biochemistry and Chemistry, School of Agriculture, Biomedicine and Environment, La Trobe University, Melbourne, Victoria, Australia
| | - Miranda D Grounds
- Department of Anatomy, Physiology and Human Biology, School of Human Sciences, The University of Western Australia, Perth, Western Australia, Australia
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10
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Talbo MK, Lebbar M, Wu Z, Vanasse A, Lalanne-Mistrih ML, Brazeau AS, Rabasa-Lhoret R. Gender differences in reported frequency and consequences of hypoglycemia among adults living with type 1 diabetes: results from the BETTER registry. Diabetes Res Clin Pract 2023:110822. [PMID: 37423499 DOI: 10.1016/j.diabres.2023.110822] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 07/05/2023] [Accepted: 07/07/2023] [Indexed: 07/11/2023]
Abstract
AIMS To evaluate the frequency and consequences of level 2 (L2H, glucose level <3.0 mmol/L with autonomous management) and level 3 hypoglycemia (L3H requiring external assistance to treat), in adults living with type 1 diabetes (T1D), while investigating the role of gender. METHODS Cross-sectional analysis of self-reported retrospective data from a Canadian registry of 900 adults living with T1D using logistic regression models adjusted for age, T1D management modalities, hypoglycemia history, and validated patient-reported outcomes scales. Changes in diabetes management, seeking healthcare resources, and impacts on daily well-being were explored. RESULTS Of the 900 adults (66% women, mean age 43.7 ± 14.8 years, mean T1D duration 25.5 ± 14.6 years), 87% used wearable diabetes technology. L3H in the past year was reported by 15% participants, similar between genders. Women reported more L2Hstudy analysis than men (median (Q1, Q3): 4 (2, 10) vs 3 (1,8), p=0.015), and were more likely to report persistent fatigue after both L2H and L3H (Odds ratio [95% confidence interval]: 1.95 [1.16, 3.28] and 1.86 [1.25, 2.75], respectively) and anxiety (1.70 [1.05, 2.75]) after a L3H. CONCLUSIONS The findings suggest taking a gender-based differential approach when addressing hypoglycemia and its various consequences for people living with T1D.
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Affiliation(s)
- Meryem K Talbo
- School of Human Nutrition, McGill University, 21111 Lakeshore Dr, Sainte-Anne-de-Bellevue, Quebec, H9X 3V9, Canada
| | - Maha Lebbar
- Institut de Recherches Cliniques de Montréal, 110 Pine Ave W, Montréal, Québec, H2W 1R7, Canada; Département de nutrition, Faculté de médecine, Université de Montréal, 2405 Chem. de la Côte-Sainte-Catherine, Montréal, Québec, H3T 1A8, Canada
| | - Zekai Wu
- Institut de Recherches Cliniques de Montréal, 110 Pine Ave W, Montréal, Québec, H2W 1R7, Canada; Department of Medicine, Division of Experimental Medicine, McGill University, 1001 Decarie Boulevard, Montreal, Quebec, H4A 3J1, Canada
| | - Andréane Vanasse
- Institut de Recherches Cliniques de Montréal, 110 Pine Ave W, Montréal, Québec, H2W 1R7, Canada
| | - Marie-Laure Lalanne-Mistrih
- Institut de Recherches Cliniques de Montréal, 110 Pine Ave W, Montréal, Québec, H2W 1R7, Canada; University of French West Indies, Guadeloupe, France
| | - Anne-Sophie Brazeau
- School of Human Nutrition, McGill University, 21111 Lakeshore Dr, Sainte-Anne-de-Bellevue, Quebec, H9X 3V9, Canada; Montreal Diabetes Research Center, 900 Saint-Denis, Montreal, QC H2X 0A9, Canada.
| | - Remi Rabasa-Lhoret
- Institut de Recherches Cliniques de Montréal, 110 Pine Ave W, Montréal, Québec, H2W 1R7, Canada; Département de nutrition, Faculté de médecine, Université de Montréal, 2405 Chem. de la Côte-Sainte-Catherine, Montréal, Québec, H3T 1A8, Canada; Department of Medicine, Division of Experimental Medicine, McGill University, 1001 Decarie Boulevard, Montreal, Quebec, H4A 3J1, Canada; Montreal Diabetes Research Center, 900 Saint-Denis, Montreal, QC H2X 0A9, Canada; Département de médecine, Service d'endocrinologie, Centre hospitalier de l'Université de Montréal, 1000, rue Saint-Denis, Montréal, Québec, H2X 0C1, Canada
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11
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Helleputte S, Yardley JE, Scott SN, Stautemas J, Jansseune L, Marlier J, De Backer T, Lapauw B, Calders P. Effects of postprandial exercise on blood glucose levels in adults with type 1 diabetes: a review. Diabetologia 2023; 66:1179-1191. [PMID: 37014379 DOI: 10.1007/s00125-023-05910-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Accepted: 03/03/2023] [Indexed: 04/05/2023]
Abstract
People with type 1 diabetes experience challenges in managing blood glucose around exercise. Previous studies have examined glycaemic responses to different exercise modalities but paid little attention to participants' prandial state, although this is an important consideration and will enhance our understanding of the effects of exercise in order to improve blood glucose management around activity. This review summarises available data on the glycaemic effects of postprandial exercise (i.e. exercise within 2 h after a meal) in people with type 1 diabetes. Using a search strategy on electronic databases, literature was screened until November 2022 to identify clinical trials evaluating acute (during exercise), subacute (≤2 h after exercise) and late (>2 h to ≤24 h after exercise) effects of postprandial exercise in adults with type 1 diabetes. Studies were systematically organised and assessed by exercise modality: (1) walking exercise (WALK); (2) continuous exercise of moderate intensity (CONT MOD); (3) continuous exercise of high intensity (CONT HIGH); and (4) interval training (intermittent high-intensity exercise [IHE] or high-intensity interval training [HIIT]). Primary outcomes were blood glucose change and hypoglycaemia occurrence during and after exercise. All study details and results per outcome were listed in an evidence table. Twenty eligible articles were included: two included WALK sessions, eight included CONT MOD, seven included CONT HIGH, three included IHE and two included HIIT. All exercise modalities caused consistent acute glycaemic declines, with the largest effect size for CONT HIGH and the smallest for HIIT, depending on the duration and intensity of the exercise bout. Pre-exercise mealtime insulin reductions created higher starting blood glucose levels, thereby protecting against hypoglycaemia, in spite of similar declines in blood glucose during activity between the different insulin reduction strategies. Nocturnal hypoglycaemia occurred after higher intensity postprandial exercise, a risk that could be diminished by a post-exercise snack with concomitant bolus insulin reduction. Research on the optimal timing of postprandial exercise is inconclusive. In summary, individuals with type 1 diabetes exercising postprandially should substantially reduce insulin with the pre-exercise meal to avoid exercise-induced hypoglycaemia, with the magnitude of the reduction depending on the exercise duration and intensity. Importantly, pre-exercise blood glucose and timing of exercise should be considered to avoid hyperglycaemia around exercise. To protect against late-onset hypoglycaemia, a post-exercise meal with insulin adjustments might be advisable, especially for exercise in the evening or with a high-intensity component.
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Affiliation(s)
- Simon Helleputte
- Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium.
- Fonds Wetenschappelijk Onderzoek (FWO) Vlaanderen, Flanders, Belgium.
| | - Jane E Yardley
- Augustana Faculty, University of Alberta, Edmonton, Alberta, Canada
- Alberta Diabetes Institute, Edmonton, Alberta, Canada
- Faculty of Kinesiology, Sport and Recreation, University of Alberta, Edmonton, Alberta, Canada
- Women and Children's Health Research Institute, Edmonton, Alberta, Canada
| | - Sam N Scott
- Team Novo Nordisk Professional Cycling Team, Atlanta, GA, USA
| | - Jan Stautemas
- Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Laura Jansseune
- Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Joke Marlier
- Department of Endocrinology, Ghent University Hospital, Ghent, Belgium
| | - Tine De Backer
- Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
- Department of Cardiology, Ghent University Hospital, Ghent, Belgium
| | - Bruno Lapauw
- Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
- Department of Endocrinology, Ghent University Hospital, Ghent, Belgium
| | - Patrick Calders
- Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
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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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Abstract
Regular physical activity improves cardiometabolic and musculoskeletal health, helps with weight management, improves cognitive and psychosocial functioning, and is associated with reduced mortality related to cancer and diabetes mellitus. However, turnover rates of glucose in the blood increase dramatically during exercise, which often results in either hypoglycaemia or hyperglycaemia as well as increased glycaemic variability in individuals with type 1 diabetes mellitus (T1DM). A complex neuroendocrine response to an acute exercise session helps to maintain circulating levels of glucose in a fairly tight range in healthy individuals, while several abnormal physiological processes and limitations of insulin therapy limit the capacity of people with T1DM to exercise in a normoglycaemic state. Knowledge of the acute and chronic effects of exercise and regular physical activity is critical for the formulation of clinical strategies for the management of insulin and nutrition for active patients with T1DM. Emerging diabetes-related technologies, such as continuous glucose monitors, automated insulin delivery systems and the administration of solubilized glucagon, are demonstrating efficacy for preserving glucose homeostasis during and after exercise in this population of patients. This Review highlights the beneficial effects of regular exercise and details the complex endocrine and metabolic responses to different types of exercise for adults with T1DM. An overview of basic clinical strategies for the preservation of glucose homeostasis using emerging technologies is also provided.
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Affiliation(s)
- Michael C Riddell
- Muscle Health Research Centre, School of Kinesiology and Health Science, York University, Toronto, Ontario, Canada.
- LMC Diabetes and Endocrinology, Toronto, Ontario, Canada.
| | - Anne L Peters
- Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
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15
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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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16
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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] [MESH Headings] [Grants] [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 PediatricsKungsbacka HospitalKungsbackaSweden
- Institute of Clinical Sciences, Sahlgrenska AcademyUniversity of GothenburgGothenburgSweden
| | - Craig E. Taplin
- Department of Endocrinology and DiabetesPerth Children's HospitalNedlandsWestern AustraliaAustralia
- Telethon Kids InstituteUniversity of Western AustraliaPerthWestern AustraliaAustralia
- Centre for Child Health ResearchUniversity of Western AustraliaPerthWestern AustraliaAustralia
| | - Dessi P. Zaharieva
- Division of Endocrinology, Department of PediatricsSchool of Medicine, Stanford UniversityStanfordCaliforniaUSA
| | - John Pemberton
- Department of Endocrinology and DiabetesBirmingham Women's and Children's HospitalBirminghamUK
| | - Elizabeth A. Davis
- Department of Endocrinology and DiabetesPerth Children's HospitalNedlandsWestern AustraliaAustralia
- Telethon Kids InstituteUniversity of Western AustraliaPerthWestern AustraliaAustralia
- Centre for Child Health ResearchUniversity of Western AustraliaPerthWestern AustraliaAustralia
| | | | - Jonathan McGavock
- Faculty of Kinesiology and Recreation ManagementUniversity of ManitobaWinnipegManitobaCanada
- Diabetes Research Envisioned and Accomplished in Manitoba (DREAM) ThemeChildren's Hospital Research Institute of ManitobaWinnipegManitobaCanada
- Department of Pediatrics and Child HealthUniversity of ManitobaWinnipegManitobaCanada
- Diabetes Action Canada SPOR NetworkTorontoOntarioCanada
| | - Othmar Moser
- Division Exercise Physiology and Metabolism, Department of Sport ScienceUniversity of BayreuthBayreuthGermany
- Interdisciplinary Metabolic Medicine Trials Unit, Division of Endocrinology and Diabetology, Department of Internal MedicineMedical University of GrazGrazAustria
| | - Agnieszka Szadkowska
- Department of Pediatrics, Diabetology, Endocrinology & NephrologyMedical University of LodzLodzPoland
| | - Prudence Lopez
- Department of PaediatricsJohn Hunter Children's HospitalNewcastleNew South WalesAustralia
- University of NewcastleNewcastleNew South WalesAustralia
| | - Jeerunda Santiprabhob
- Siriraj Diabetes CenterFaculty of Medicine Siriraj Hospital, Mahidol UniversityBangkokThailand
- Division of Endocrinology and Metabolism, Department of PediatricsFaculty of Medicine Siriraj Hospital, Mahidol UniversityBangkokThailand
| | | | | | - Linda A. DiMeglio
- Department of Pediatrics, Division of Pediatric Endocrinology and DiabetologyIndiana University School of Medicine, Riley Hospital for ChildrenIndianapolisIndianaUSA
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17
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O’Neill CC, Locke EJ, Sipf DA, Thompson JH, Drebushenko EK, Berger NS, Segich BS, Kolwicz SC. The Effects of Exercise Training on Glucose Homeostasis and Muscle Metabolism in Type 1 Diabetic Female Mice. Metabolites 2022; 12:metabo12100948. [PMID: 36295850 PMCID: PMC9608674 DOI: 10.3390/metabo12100948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 05/26/2022] [Accepted: 10/01/2022] [Indexed: 01/13/2023] Open
Abstract
Although exercise training is an important recommendation for the management of type 1 diabetes (T1D), most of the available research studies predominantly focus on male subjects. Given the importance of sex as a biological variable, additional studies are required to improve the knowledge gap regarding sex differences in T1D research. Therefore, the purpose of this study was to examine the role of exercise training in mediating changes in glucose homeostasis and skeletal muscle metabolism in T1D female mice. Female mice were injected with streptozotocin (STZ) to induce T1D. Two weeks after STZ injection, control (CON) and STZ mice were exercise trained on a treadmill for 4 weeks. Aerobic exercise training failed to improve glucose tolerance, prevent the decrease in body weight and adipose tissue mass, or attenuate muscle atrophy in T1D female mice. However, insulin sensitivity was improved in T1D female mice after exercise training. Aerobic exercise training maintained skeletal muscle triglyceride content but did not prevent depletion of skeletal muscle or liver glycogen in T1D mice. Gene expression analysis suggested that T1D resulted in decreased glucose transport, decreased ketone body oxidation, and increased fatty acid metabolism in the skeletal muscle, which was not altered by exercise training. These data demonstrate that 4 weeks of aerobic exercise training of a moderate intensity is insufficient to counteract the negative effects of T1D in female mice, but does lead to an improvement in insulin sensitivity.
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18
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AlBurno H, Mercken L, de Vries H, Al Mohannadi D, Schneider F. Determinants of healthful eating and physical activity among adolescents and young adults with type 1 diabetes in Qatar: A qualitative study. PLoS One 2022; 17:e0270984. [PMID: 35793375 PMCID: PMC9258857 DOI: 10.1371/journal.pone.0270984] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2021] [Accepted: 06/21/2022] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND In Qatar, as in the rest of the world, the sharp rise in the prevalence of type 1 diabetes (T1D) is a leading cause for concern, in terms associated with morbidity, mortality, and increasing health costs. Besides adhering to medication, the outcome of diabetes management is also dependent on patient adherence to the variable self-care behaviors including healthful eating (HE) and physical activity (PA). Yet, dietary intake and PA in adolescents and young adults (AYAs) with T1D are known to fall short of recommended guidelines. The aim of this study was to develop an in-depth understanding of the behavioral determinants of HE and PA adherence among Arab AYAs within the age range of 17-24 years with T1D attending Hamad General Hospital. METHODS Semi-structured, face-to-face individual interviews were conducted with 20 participants. Interviews were based on an integrative health behavior change model, the I-Change model (ICM). All interviews were audio-recorded, transcribed verbatim, and analyzed using the framework method. RESULTS More participants reported non-adherence than adherence. Several motivational determinants of adherence to HE and PA were identified. The majority of participants were cognizant of their own behaviors towards HE and PA. Yet, some did not link low adherence to HE and PA with increased risks of health problems resulting from T1D. Facilitators to adherence were identified as being convinced of the advantages of HE and PA, having support and high self-efficacy, a high level of intention, and a good health care system. CONCLUSION The suboptimal adherence in AYAs to HE and PA needs more attention. Supportive actions are needed to encourage adherence to a healthy lifestyle to achieve benefits in terms of glycemic control and overall health outcomes, with a special focus on adolescents. Interventions are needed to foster motivation by addressing the relevant determinants in order to promote adherence to these two behaviors in AYAs with T1D.
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Affiliation(s)
- Hanan AlBurno
- Care and Public Health Research Institute (CAPHRI), Maastricht University, Netherlands, The Netherlands
| | - Liesbeth Mercken
- Care and Public Health Research Institute (CAPHRI), Maastricht University, Netherlands, The Netherlands
- Faculty of Psychology, Department of Health Psychology, Open University of The Netherlands, Heerlen, The Netherlands
| | - Hein de Vries
- Care and Public Health Research Institute (CAPHRI), Maastricht University, Netherlands, The Netherlands
| | - Dabia Al Mohannadi
- Department of Endocrinology and Diabetes, Hamad General Hospital, Doha, Qatar
| | - Francine Schneider
- Care and Public Health Research Institute (CAPHRI), Maastricht University, Netherlands, The Netherlands
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19
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Tagougui S, Legault L, Heyman E, Messier V, Suppere C, Potter KJ, Pigny P, Berthoin S, Taleb N, Rabasa-Lhoret R. Anticipated Basal Insulin Reduction to Prevent Exercise-Induced Hypoglycemia in Adults and Adolescents Living with Type 1 Diabetes. Diabetes Technol Ther 2022; 24:307-315. [PMID: 35099281 DOI: 10.1089/dia.2021.0375] [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] [Indexed: 11/13/2022]
Abstract
Objective: We investigated the effect of two key timings for basal insulin rate reduction on exercise-induced glucose changes and explored the association between circulating insulin concentrations and muscle vasoreactivity. Research Design and Methods: Twenty adults and adolescents performed 60-min exercise sessions (ergocycle) at 60% VO2peak, 240 min after a standardized lunch. In a randomized order, we compared an 80% basal insulin reduction applied 40 min (T-40) or 90 min (T-90) before exercise onset. Near-infrared spectroscopy was used to investigate muscle hemodynamics at vastus lateralis. Glucose and insulin plasma concentrations were measured. Results: Reduction in plasma glucose (PG) level during exercise was attenuated during T-90 versus T-40 strategy (-0.89 ± 1.89 mmol/L vs. -2.17 ± 2.49 mmol/L, respectively; P = 0.09). Linear mixed model analysis showed that PG dropped by an additional 0.01 mM per minute in T-40 versus T-90 (time × strategy interaction, P < 0.05). The absolute number of hypoglycemic events was not different between the two strategies, but they occurred later with T-90. Free insulin tends to decrease more during the pre-exercise period in the T-90 strategy (P = 0.08). Although local muscle vasodilatation (ΔTHb) was comparable between the two strategies, we found that PG dropped more in cases of higher exercise-induced skeletal muscle vasodilatation (ΔTHb × time interaction P < 0.005, e: -0.0086 mM/min and additional mM of ΔTHb). Conclusion: T-90 timing reduced exercise-induced drop in PG and delayed the occurrence of hypoglycemic episodes compared with T-40 timing without a significant reduction in the number of events requiring treatment. Trial registration: ClinicalTrials.gov identifier: NCT03349489.
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Affiliation(s)
- Sémah Tagougui
- Montreal Clinical Research Institute (IRCM), Montreal, Canada
- Département de nutrition, Université de Montréal, Montreal, Canada
- Univ. Lille, Univ. Artois, Univ. Littoral Côte d'Opale, ULR 7369 - URePSSS - Unité de Recherche Pluridisciplinaire Sport Santé Société, Lille, France
| | - Laurent Legault
- Montreal Clinical Research Institute (IRCM), Montreal, Canada
- McGill University Health Center (MUHC), Montreal Children's Hospital, Montreal, Canada
| | - Elsa Heyman
- Univ. Lille, Univ. Artois, Univ. Littoral Côte d'Opale, ULR 7369 - URePSSS - Unité de Recherche Pluridisciplinaire Sport Santé Société, Lille, France
| | | | - Corinne Suppere
- Montreal Clinical Research Institute (IRCM), Montreal, Canada
| | | | - Pascal Pigny
- Laboratoire de Biochimie-Hormonologie, CHU Lille, Centre de Biologie-Pathologie, Lille, France
| | - Serge Berthoin
- Univ. Lille, Univ. Artois, Univ. Littoral Côte d'Opale, ULR 7369 - URePSSS - Unité de Recherche Pluridisciplinaire Sport Santé Société, Lille, France
| | - Nadine Taleb
- Montreal Clinical Research Institute (IRCM), Montreal, Canada
- Division of Biomedical Sciences, Faculty of Medicine, Université de Montréal, Montréal, Canada
- Endocrinology Division, Montreal Diabetes Research Center (MDRC), Montreal University Hospital (CHUM), Montreal, Canada
| | - Rémi Rabasa-Lhoret
- Montreal Clinical Research Institute (IRCM), Montreal, Canada
- Département de nutrition, Université de Montréal, Montreal, Canada
- Endocrinology Division, Montreal Diabetes Research Center (MDRC), Montreal University Hospital (CHUM), Montreal, Canada
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20
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Can Resistance Exercise Be a Tool for Healthy Aging in Post-Menopausal Women with Type 1 Diabetes? INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18168716. [PMID: 34444464 PMCID: PMC8393224 DOI: 10.3390/ijerph18168716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Revised: 08/12/2021] [Accepted: 08/15/2021] [Indexed: 11/25/2022]
Abstract
Due to improvements in diabetes care, people with type 1 diabetes (T1D) are living longer. Studies show that post-menopausal T1D women have a substantially elevated cardiovascular risk compared to those without T1D. As T1D may also accelerate age-related bone and muscle loss, the risk of frailty may be considerable for T1D women. Exercise and physical activity may be optimal preventative therapies to maintain health and prevent complications in this population: They are associated with improvements in, or maintenance of, cardiovascular health, bone mineral density, and muscle mass in older adults. Resistance exercise, in particular, may provide important protection against age-related frailty, due to its specific effects on bone and muscle. Fear of hypoglycemia can be a barrier to exercise in those with T1D, and resistance exercise may cause less hypoglycemia than aerobic exercise. There are currently no exercise studies involving older, post-menopausal women with T1D. As such, it is unknown whether current guidelines for insulin adjustment/carbohydrate intake for activity are appropriate for this population. This review focuses on existing knowledge about exercise in older adults and considers potential future directions around resistance exercise as a therapeutic intervention for post-menopausal T1D women.
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21
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Noueiri B, Nassif N. Dental Treatment Effect on Blood Glucose Level Fluctuation in Type 1 Unbalanced Diabetic Children. Int J Clin Pediatr Dent 2021; 14:497-501. [PMID: 34824503 PMCID: PMC8585890 DOI: 10.5005/jp-journals-10005-1985] [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] [Indexed: 11/23/2022] Open
Abstract
Diabetic patients struggle to maintain their blood glucose near normal levels to avoid the occurrence of hypo- or hyperglycemia discomfort. Dental practitioners must foresee such complications as they can also take place during dental treatment. AIM AND OBJECTIVE This study aims to evaluate the impact of the type and duration of dental treatment on the blood glucose level (BGL) fluctuation in type 1 unbalanced diabetic children [hemoglobin A1c (HbA1c) >7]. MATERIAL AND METHODS A cross-sectional approach was conducted on 83 type 1 unbalanced diabetic children (HbA1c) > 7%, aged between 7 years and 12 years, divided into 40 females and 43 males in the Department of Pediatric Dentistry at the Lebanese University in Beirut. For dental treatments, diabetic children were scheduled for morning sessions 60-90 minutes after breakfast intake and a habitual insulin shot. Only patients with a BGL between 70 mg/dL and 300 mg/dL underwent dental treatments. The type, the duration of the dental session, and the BGL at the baseline (T0), and at the end of the session (T1) were recorded. The dental acts were classified into simple (without local anesthesia) and unpleasant with a solution of 2% lignocaine with 1:200,000 epinephrine. Statistical analyses were performed. RESULTS Fifty of 83 showed a decrease in their BGLs after dental treatments, 20 an increase, and 13 no change. For both genders, in simple acts, a statistical significance was noted (p = 0.0002) for the female and (p = 0.0014) for the males. CONCLUSION Treatment unbalanced diabetic children can be safely done by taking some precautions and measures to avoid a hypo- or hyperglycemia episode. HOW TO CITE THIS ARTICLE Noueiri B, Nassif N. Dental Treatment Effect on Blood Glucose Level Fluctuation in Type 1 Unbalanced Diabetic Children. Int J Clin Pediatr Dent 2021;14(4):497-501.
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Affiliation(s)
- Balsam Noueiri
- Department of Pediatric Dentistry, Lebanese University, Beirut, Lebanon
| | - Nahla Nassif
- Department of Pediatric Dentistry, Lebanese University, Beirut, Lebanon
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22
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Särnblad S, Ponsot E, Leprêtre PM, Kadi F. Acute effects of aerobic continuous, intermittent, and resistance exercise on glycemia in adolescents males with type 1 diabetes. Pediatr Diabetes 2021; 22:610-617. [PMID: 33650298 DOI: 10.1111/pedi.13194] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Revised: 01/22/2021] [Accepted: 02/05/2021] [Indexed: 12/28/2022] Open
Abstract
OBJECTIVE Increased levels of physical activity is often associated with reduced HbA1c in individuals with diabetes. However, the effect on glycemic control differs between different programs of exercise. The aim of this study was to compare the acute effects on glycemia of resistance and two aerobic continuous and intermittent exercise bouts in adolescent males with type 1 diabetes. RESEARCH DESIGN AND METHODS Eight active males with type 1 diabetes (17.5 ± 0.8 years, BMI: 20.8 ± 2.2 kg/m2 , HbA1c: 7.2 ± 0.5% [54.9 ± 5.3 mmol/mol]) performed four experimental sessions-nonexercise (control), resistance exercise (RE) and two isocaloric continuous (CE) and intermittent (IE) cycling exercise trials-in a randomized order. Each session consisted of 45 min of exercise (except for the control modality) and 60 min of passive recovery. Venous blood was drawn for assessment of plasma glucose (PG). A two-way repeated-measures ANOVA was used for statistical comparisons. RESULTS A significant time-to-exercise interaction effect on PG was detected. PG significantly decreased during IE (-5.1 ± 1.6 mmol/L) and CE (-5.4 ± 1.8 mmol/L) but not during RE (-1.0 ± 1.4 mmol/L, ns). Additionally, decreases in PG after IE and CE were sustained throughout the recovery period. CONCLUSIONS While intermittent and continuous aerobic exercises are associated with a lowering of glycemia in male adolescents with type 1 diabetes, glycemia remained stable without significant alterations after resistance exercise. These findings hold important implications related to clinical exercise advice and disease management in adolescents with type 1 diabetes.
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Affiliation(s)
- Stefan Särnblad
- Department of Pediatrics, School of Medical Sciences, Örebro University, Örebro, SE, Sweden
| | - Elodie Ponsot
- School of Health Sciences, Örebro University, Örebro, SE, Sweden
| | - Pierre-Marie Leprêtre
- School of Health Sciences, Örebro University, Örebro, SE, Sweden.,Faculty of Sport Sciences, University of Picardie Jules Verne, Amiens, France.,Cardiovascular Rehabilitation Unit, Hospital center of Corbie, Corbie, France
| | - Fawzi Kadi
- School of Health Sciences, Örebro University, Örebro, SE, Sweden
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23
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Scott SN, Fontana FY, Cocks M, Morton JP, Jeukendrup A, Dragulin R, Wojtaszewski JFP, Jensen J, Castol R, Riddell MC, Stettler C. Post-exercise recovery for the endurance athlete with type 1 diabetes: a consensus statement. Lancet Diabetes Endocrinol 2021; 9:304-317. [PMID: 33864810 DOI: 10.1016/s2213-8587(21)00054-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Revised: 02/19/2021] [Accepted: 02/19/2021] [Indexed: 02/07/2023]
Abstract
There has been substantial progress in the knowledge of exercise and type 1 diabetes, with the development of guidelines for optimal glucose management. In addition, an increasing number of people living with type 1 diabetes are pushing their physical limits to compete at the highest level of sport. However, the post-exercise recovery routine, particularly with a focus on sporting performance, has received little attention within the scientific literature, with most of the focus being placed on insulin or nutritional adaptations to manage glycaemia before and during the exercise bout. The post-exercise recovery period presents an opportunity for maximising training adaption and recovery, and the clinical management of glycaemia through the rest of the day and overnight. The absence of clear guidance for the post-exercise period means that people with type 1 diabetes should either develop their own recovery strategies on the basis of individual trial and error, or adhere to guidelines that have been developed for people without diabetes. This Review provides an up-to-date consensus on post-exercise recovery and glucose management for individuals living with type 1 diabetes. We aim to: (1) outline the principles and time course of post-exercise recovery, highlighting the implications and challenges for endurance athletes living with type 1 diabetes; (2) provide an overview of potential strategies for post-exercise recovery that could be used by athletes with type 1 diabetes to optimise recovery and adaptation, alongside improved glycaemic monitoring and management; and (3) highlight the potential for technology to ease the burden of managing glycaemia in the post-exercise recovery period.
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Affiliation(s)
- Sam N Scott
- Department of Diabetes, Endocrinology, Nutritional Medicine and Metabolism, Bern University Hospital, University of Bern, Bern, Switzerland; Team Novo Nordisk Professional Cycling Team, Atlanta, GA, USA
| | - Federico Y Fontana
- Department of Diabetes, Endocrinology, Nutritional Medicine and Metabolism, Bern University Hospital, University of Bern, Bern, Switzerland; Team Novo Nordisk Professional Cycling Team, Atlanta, GA, USA
| | - Matt Cocks
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, UK
| | - James P Morton
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, UK
| | - Asker Jeukendrup
- School of Sport and Exercise Sciences, University of Birmingham, Birmingham, UK
| | - Radu Dragulin
- Department of Diabetes, Endocrinology, Nutritional Medicine and Metabolism, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Jørgen F P Wojtaszewski
- Section of Molecular Physiology, Department of Nutrition, Exercise and Sports, University of Copenhagen, Copenhagen, Denmark
| | - Jørgen Jensen
- Department of Physical Performance, Norwegian School of Sport Sciences, Oslo, Norway
| | - Rafael Castol
- Team Novo Nordisk Professional Cycling Team, Atlanta, GA, USA
| | - Michael C Riddell
- School of Kinesiology and Health Science, Muscle Health Research Centre, York University, Toronto, ON, Canada
| | - Christoph Stettler
- Department of Diabetes, Endocrinology, Nutritional Medicine and Metabolism, Bern University Hospital, University of Bern, Bern, Switzerland.
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24
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Yardley JE, Sigal RJ. Glucose management for exercise using continuous glucose monitoring: should sex and prandial state be additional considerations? Diabetologia 2021; 64:932-934. [PMID: 33409571 DOI: 10.1007/s00125-020-05373-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Accepted: 11/06/2020] [Indexed: 12/27/2022]
Affiliation(s)
- Jane E Yardley
- Augustana Faculty, University of Alberta, Camrose, AB, Canada.
- Physical Activity and Diabetes Laboratory, Alberta Diabetes Institute, Li Ka Shing Centre for Health Research Innovation, Edmonton, AB, Canada.
- Faculty of Kinesiology, Sport and Recreation, University of Alberta, Edmonton, AB, Canada.
- Women and Children's Health Research Institute, University of Alberta, Edmonton, AB, Canada.
| | - Ronald J Sigal
- Department of Medicine, Cumming School of Medicine, Faculty of Medicine, University of Calgary, Calgary, AB, Canada
- Department of Cardiac Sciences, Cumming School of Medicine, Faculty of Medicine, University of Calgary, Calgary, AB, Canada
- Department of Community Health Sciences, Cumming School of Medicine, Faculty of Medicine, University of Calgary, Calgary, AB, Canada
- Faculty of Kinesiology, University of Calgary, Calgary, AB, Canada
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25
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Viñals C, Beneyto A, Martín-SanJosé JF, Furió-Novejarque C, Bertachi A, Bondia J, Vehi J, Conget I, Giménez M. Artificial Pancreas With Carbohydrate Suggestion Performance for Unannounced and Announced Exercise in Type 1 Diabetes. J Clin Endocrinol Metab 2021; 106:55-63. [PMID: 32852548 DOI: 10.1210/clinem/dgaa562] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Accepted: 08/14/2020] [Indexed: 12/16/2022]
Abstract
OBJECTIVE To evaluate the safety and performance of a new multivariable closed-loop (MCL) glucose controller with automatic carbohydrate recommendation during and after unannounced and announced exercise in adults with type 1 diabetes (T1D). RESEARCH DESIGN AND METHODS A randomized, 3-arm, crossover clinical trial was conducted. Participants completed a heavy aerobic exercise session including three 15-minute sets on a cycle ergometer with 5 minutes rest in between. In a randomly determined order, we compared MCL control with unannounced (CLNA) and announced (CLA) exercise to open-loop therapy (OL). Adults with T1D, insulin pump users, and those with hemoglobin (Hb)A1c between 6.0% and 8.5% were eligible. We investigated glucose control during and 3 hours after exercise. RESULTS Ten participants (aged 40.8 ± 7.0 years; HbA1c of 7.3 ± 0.8%) participated. The use of the MCL in both closed-loop arms decreased the time spent <70 mg/dL of sensor glucose (0.0%, [0.0-16.8] and 0.0%, [0.0-19.2] vs 16.2%, [0.0-26.0], (%, [percentile 10-90]) CLNA and CLA vs OL respectively; P = 0.047, P = 0.063) and the number of hypoglycemic events when compared with OL (CLNA 4 and CLA 3 vs OL 8; P = 0.218, P = 0.250). The use of the MCL system increased the proportion of time within 70 to 180 mg/dL (87.8%, [51.1-100] and 91.9%, [58.7-100] vs 81.1%, [65.4-87.0], (%, [percentile 10-90]) CLNA and CLA vs OL respectively; P = 0.227, P = 0.039). This was achieved with the administration of similar doses of insulin and a reduced amount of carbohydrates. CONCLUSIONS The MCL with automatic carbohydrate recommendation performed well and was safe during and after both unannounced and announced exercise, maintaining glucose mostly within the target range and reducing the risk of hypoglycemia despite a reduced amount of carbohydrate intake.Register Clinicaltrials.gov: NCT03577158.
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Affiliation(s)
- Clara Viñals
- Diabetes Unit, Endocrinology and Nutrition Department Hospital Clínic de Barcelona, Spain
| | - Aleix Beneyto
- Institute of Informatics and Applications, University of Girona, Girona, Spain
| | - Juan-Fernando Martín-SanJosé
- Instituto Universitario de Automática e Informática Industrial, Universitat Politècnica de València, València, Spain
| | - Clara Furió-Novejarque
- Instituto Universitario de Automática e Informática Industrial, Universitat Politècnica de València, València, Spain
| | - Arthur Bertachi
- Federal University of Technology-Paraná (UTFPR), Guarapuava, Brazil
| | - Jorge Bondia
- Instituto Universitario de Automática e Informática Industrial, Universitat Politècnica de València, València, Spain
- Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Madrid, Spain
| | - Josep Vehi
- Institute of Informatics and Applications, University of Girona, Girona, Spain
- Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Madrid, Spain
| | - Ignacio Conget
- Diabetes Unit, Endocrinology and Nutrition Department Hospital Clínic de Barcelona, Spain
- Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Madrid, Spain
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Marga Giménez
- Diabetes Unit, Endocrinology and Nutrition Department Hospital Clínic de Barcelona, Spain
- Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Madrid, Spain
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
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26
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Parker L, Morrison DJ, Wadley GD, Shaw CS, Betik AC, Roberts‐Thomson K, Kaur G, Keske MA. Prior exercise enhances skeletal muscle microvascular blood flow and mitigates microvascular flow impairments induced by a high‐glucose mixed meal in healthy young men. J Physiol 2020; 599:83-102. [DOI: 10.1113/jp280651] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Accepted: 10/09/2020] [Indexed: 01/11/2023] Open
Affiliation(s)
- Lewan Parker
- Institute for Physical Activity and Nutrition (IPAN) School of Exercise and Nutrition Sciences Deakin University Geelong Australia
| | - Dale J. Morrison
- Institute for Physical Activity and Nutrition (IPAN) School of Exercise and Nutrition Sciences Deakin University Geelong Australia
| | - Glenn D. Wadley
- Institute for Physical Activity and Nutrition (IPAN) School of Exercise and Nutrition Sciences Deakin University Geelong Australia
| | - Christopher S. Shaw
- Institute for Physical Activity and Nutrition (IPAN) School of Exercise and Nutrition Sciences Deakin University Geelong Australia
| | - Andrew C. Betik
- Institute for Physical Activity and Nutrition (IPAN) School of Exercise and Nutrition Sciences Deakin University Geelong Australia
| | - Katherine Roberts‐Thomson
- Institute for Physical Activity and Nutrition (IPAN) School of Exercise and Nutrition Sciences Deakin University Geelong Australia
| | - Gunveen Kaur
- Institute for Physical Activity and Nutrition (IPAN) School of Exercise and Nutrition Sciences Deakin University Geelong Australia
| | - Michelle A. Keske
- Institute for Physical Activity and Nutrition (IPAN) School of Exercise and Nutrition Sciences Deakin University Geelong Australia
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27
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Francescato MP, Ajčević M, Accardo A. Carbohydrate Requirement for Exercise in Type 1 Diabetes: Effects of Insulin Concentration. J Diabetes Sci Technol 2020; 14:1116-1121. [PMID: 30767503 PMCID: PMC7645145 DOI: 10.1177/1932296819826962] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Physical activity is a keystone of a healthy lifestyle as well as of management of patients with type 1 diabetes. The risk of exercise-induced hypoglycemia, however, is a great challenge for these patients. The glycemic response to exercise depends upon several factors concerning the patient him/herself (eg, therapy, glycemic control, training level) and the characteristics of the exercise performed. Only in-depth knowledge of these factors will allow to develop individualized strategies minimizing the risk of hypoglycemia. The main factors affecting the exercise-induced hypoglycemia in patients with T1D have been analyzed, including the effects of insulin concentration. A model is discussed, which has the potential to become the basis for providing patients with individualized suggestions to keep constant glucose levels on each exercise occasion.
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Affiliation(s)
- Maria Pia Francescato
- Department of Medicine, University of Udine, Udine, Italy
- Maria Pia Francescato, MD, Department of Medicine, University of Udine, p. le M. Kolbe 4, 33100 Udine, Italy.
| | - Miloš Ajčević
- Department of Engineering and Architecture, University of Trieste, Trieste, Italy
| | - Agostino Accardo
- Department of Engineering and Architecture, University of Trieste, Trieste, Italy
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28
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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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29
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Cockcroft EJ, Narendran P, Andrews RC. Exercise‐induced hypoglycaemia in type 1 diabetes. Exp Physiol 2020; 105:590-599. [DOI: 10.1113/ep088219] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Accepted: 11/26/2019] [Indexed: 12/30/2022]
Affiliation(s)
| | - P. Narendran
- Department of DiabetesUniversity Hospitals Birmingham NHS Foundation Trust Birmingham UK
- Institute of Immunology and ImmunotherapyUniversity of Birmingham Birmingham UK
| | - R. C. Andrews
- University of Exeter Medical School Exeter UK
- Department of DiabetesTaunton and Somerset NHS Foundation Trust Taunton UK
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30
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Yardley JE. Exercise and the Artificial Pancreas: Trying to Predict the Unpredictable in Patients With Type 1 Diabetes? Can J Diabetes 2020; 44:119-120. [DOI: 10.1016/j.jcjd.2020.01.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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31
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Monaco CMF, Bellissimo CA, Hughes MC, Ramos SV, Laham R, Perry CGR, Hawke TJ. Sexual dimorphism in human skeletal muscle mitochondrial bioenergetics in response to type 1 diabetes. Am J Physiol Endocrinol Metab 2020; 318:E44-E51. [PMID: 31794260 PMCID: PMC6985789 DOI: 10.1152/ajpendo.00411.2019] [Citation(s) in RCA: 9] [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: 12/15/2022]
Abstract
Sexual dimorphism in mitochondrial respiratory function has been reported in young women and men without diabetes, which may have important implications for exercise. The purpose of this study was to determine if sexual dimorphism exists in skeletal muscle mitochondrial bioenergetics in people with type 1 diabetes (T1D). A resting muscle microbiopsy was obtained from women and men with T1D (n = 10/8, respectively) and without T1D (control; n = 8/7, respectively). High-resolution respirometry and spectrofluorometry were used to measure mitochondrial respiratory function, hydrogen peroxide (mH2O2) emission and calcium retention capacity (mCRC) in permeabilized myofiber bundles. The impact of T1D on mitochondrial bioenergetics between sexes was interrogated by comparing the change between women and men with T1D relative to the average values of their respective sex-matched controls (i.e., delta). These aforementioned analyses revealed that men with T1D have increased skeletal muscle mitochondrial complex I sensitivity but reduced complex II sensitivity and capacity in comparison to women with T1D. mH2O2 emission was lower in women compared with men with T1D at the level of complex I (succinate driven), whereas mCRC and mitochondrial protein content remained similar between sexes. In conclusion, women and men with T1D exhibit differential responses in skeletal muscle mitochondrial bioenergetics. Although larger cohort studies are certainly required, these early findings nonetheless highlight the importance of considering sex as a variable in the care and treatment of people with T1D (e.g., benefits of different exercise prescriptions).
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Affiliation(s)
- Cynthia M F Monaco
- Department of Pathology and Molecular Medicine, McMaster University, Health Sciences Centre, Hamilton, Ontario, Canada
| | - Catherine A Bellissimo
- School of Kinesiology and Health Sciences, Muscle Health Research Centre, York University, Toronto, Ontario, Canada
| | - Meghan C Hughes
- School of Kinesiology and Health Sciences, Muscle Health Research Centre, York University, Toronto, Ontario, Canada
| | - Sofhia V Ramos
- School of Kinesiology and Health Sciences, Muscle Health Research Centre, York University, Toronto, Ontario, Canada
| | - Robert Laham
- School of Kinesiology and Health Sciences, Muscle Health Research Centre, York University, Toronto, Ontario, Canada
| | - Christopher G R Perry
- School of Kinesiology and Health Sciences, Muscle Health Research Centre, York University, Toronto, Ontario, Canada
| | - Thomas J Hawke
- Department of Pathology and Molecular Medicine, McMaster University, Health Sciences Centre, Hamilton, Ontario, Canada
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32
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Prahalad P, Zaharieva DP, Addala A, New C, Scheinker D, Desai M, Hood KK, Maahs DM. Improving Clinical Outcomes in Newly Diagnosed Pediatric Type 1 Diabetes: Teamwork, Targets, Technology, and Tight Control-The 4T Study. Front Endocrinol (Lausanne) 2020; 11:360. [PMID: 32733375 PMCID: PMC7363838 DOI: 10.3389/fendo.2020.00360] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Accepted: 05/07/2020] [Indexed: 12/12/2022] Open
Abstract
Many youth with type 1 diabetes (T1D) do not achieve hemoglobin A1c (HbA1c) targets. The mean HbA1c of youth in the USA is higher than much of the developed world. Mean HbA1c in other nations has been successfully modified following benchmarking and quality improvement methods. In this review, we describe the novel 4T approach-teamwork, targets, technology, and tight control-to diabetes management in youth with new-onset T1D. In this program, the diabetes care team (physicians, nurse practitioners, certified diabetes educators, dieticians, social workers, psychologists, and exercise physiologists) work closely to deliver diabetes education from diagnosis. Part of the education curriculum involves early integration of technology, specifically continuous glucose monitoring (CGM), and developing a curriculum around using the CGM to maintain tight control and optimize quality of life.
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Affiliation(s)
- Priya Prahalad
- Division of Endocrinology, Department of Pediatrics, Stanford University, Stanford, CA, United States
- *Correspondence: Priya Prahalad
| | - Dessi P. Zaharieva
- Division of Endocrinology, Department of Pediatrics, Stanford University, Stanford, CA, United States
| | - Ananta Addala
- Division of Endocrinology, Department of Pediatrics, Stanford University, Stanford, CA, United States
| | - Christin New
- Division of Endocrinology, Department of Pediatrics, Stanford University, Stanford, CA, United States
| | - David Scheinker
- Division of Endocrinology, Department of Pediatrics, Stanford University, Stanford, CA, United States
- Department of Management Science and Engineering, Stanford University, Stanford, CA, United States
| | - Manisha Desai
- Quantitative Sciences Unit, Division of Biomedical Informatics Research, Stanford University, Stanford, CA, United States
- Stanford Diabetes Research Center, Stanford, CA, United States
| | - Korey K. Hood
- Division of Endocrinology, Department of Pediatrics, Stanford University, Stanford, CA, United States
- Stanford Diabetes Research Center, Stanford, CA, United States
| | - David M. Maahs
- Division of Endocrinology, Department of Pediatrics, Stanford University, Stanford, CA, United States
- Stanford Diabetes Research Center, Stanford, CA, United States
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33
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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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Tagougui S, Taleb N, Molvau J, Nguyen É, Raffray M, Rabasa-Lhoret R. Artificial Pancreas Systems and Physical Activity in Patients with Type 1 Diabetes: Challenges, Adopted Approaches, and Future Perspectives. J Diabetes Sci Technol 2019; 13:1077-1090. [PMID: 31409125 PMCID: PMC6835182 DOI: 10.1177/1932296819869310] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Physical activity is important for patients living with type 1 diabetes (T1D) but limited by the challenges associated with physical activity induced glucose variability. Optimizing glycemic control without increasing the risk of hypoglycemia is still a hurdle despite many advances in insulin formulations, delivery methods, and continuous glucose monitoring systems. In this respect, the artificial pancreas (AP) system is a promising therapeutic option for a safer practice of physical activity in the context of T1D. It is important that healthcare professionals as well as patients acquire the necessary knowledge about how the AP system works, its limits, and how glucose control is regulated during physical activity. This review aims to examine the current state of knowledge on exercise-related glucose variations especially hypoglycemic risk in T1D and to discuss their effects on the use and development of AP systems. Though effective and highly promising, these systems warrant further research for an optimized use around exercise.
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Affiliation(s)
- Sémah Tagougui
- Montreal Clinical Research Institute, Montreal, Quebec, Canada
- Department of Nutrition, Faculty of Medicine, Montreal, Quebec, Canada
- Univ. Lille, Univ. Artois, Univ. Littoral Côte d’Opale, EA 7369 - URePSSS - Unité de Recherche Pluridisciplinaire Sport Santé Société, Lille, France
| | - Nadine Taleb
- Montreal Clinical Research Institute, Montreal, Quebec, Canada
- Department of Biomedical Sciences, Faculty of Medicine, Édouard-Montpetit, Montreal, Quebec, Canada
| | | | - Élisabeth Nguyen
- Montreal Clinical Research Institute, Montreal, Quebec, Canada
- Department of Nutrition, Faculty of Medicine, Montreal, Quebec, Canada
| | - Marie Raffray
- Montreal Clinical Research Institute, Montreal, Quebec, Canada
| | - Rémi Rabasa-Lhoret
- Montreal Clinical Research Institute, Montreal, Quebec, Canada
- Department of Nutrition, Faculty of Medicine, Montreal, Quebec, Canada
- Division of Endocrinology, Centre Hospitalier de l’université de Montréal, Montreal, Quebec, Canada
- Montreal Diabetes Research Center & Endocrinology division, Quebec, Canada
- Rémi Rabasa-Lhoret, Montreal Clinical Research Institute, 110, avenue des Pins Ouest, Montreal, Quebec, Canada H2W 1R7.
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