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Sarteau AC, Kahkoska AR, Crandell J, Igudesman D, Corbin KD, Kichler JC, Maahs DM, Muntis F, Pratley R, Seid M, Zaharieva D, Mayer-Davis E. More hypoglycemia not associated with increasing estimated adiposity in youth with type 1 diabetes. Pediatr Res 2023; 93:708-714. [PMID: 35729217 PMCID: PMC10958738 DOI: 10.1038/s41390-022-02129-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Revised: 04/08/2022] [Accepted: 05/17/2022] [Indexed: 11/09/2022]
Abstract
BACKGROUND Despite the widespread clinical perception that hypoglycemia may drive weight gain in youth with type 1 diabetes (T1D), there is an absence of published evidence supporting this hypothesis. METHODS We estimated the body fat percentage (eBFP) of 211 youth (HbA1c 8.0-13.0%, age 13-16) at baseline, 6, and 18 months of the Flexible Lifestyles Empowering Change trial using validated equations. Group-based trajectory modeling assigned adolescents to sex-specific eBFP groups. Using baseline 7-day blinded continuous glucose monitoring data, "more" vs. "less" percent time spent in hypoglycemia was defined by cut-points using sample median split and clinical guidelines. Adjusted logistic regression estimated the odds of membership in an increasing eBFP group comparing youth with more vs. less baseline hypoglycemia. RESULTS More time spent in clinical hypoglycemia (defined by median split) was associated with 0.29 the odds of increasing eBFP in females (95% CI: 0.12, 0.69; p = 0.005), and 0.33 the odds of stable/increasing eBFP in males (95% CI: 0.14, 0.78; p = 0.01). CONCLUSIONS Hypoglycemia may not be a major driver of weight gain in US youth with T1D and HbA1c ≥8.0. Further studies in different sub-groups are needed to clarify for whom hypoglycemia may drive weight gain and focus future etiological studies and interventions. IMPACT We contribute epidemiological evidence that hypoglycemia may not be a major driver of weight gain in US youth with type 1 diabetes and HbA1c ≥8.0% and highlight the need for studies to prospectively test this hypothesis rooted in clinical perception. Future research should examine the relationship between hypoglycemia and adiposity together with psychosocial, behavioral, and other clinical factors among sub-groups of youth with type 1 diabetes (i.e., who meet glycemic targets or experience a frequency/severity of hypoglycemia above a threshold) to further clarify for whom hypoglycemia may drive weight gain and progress etiological understanding of and interventions for healthy weight maintenance.
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Affiliation(s)
| | - Anna R Kahkoska
- Department of Nutrition, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Jamie Crandell
- School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Department of Biostatistics, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Daria Igudesman
- Department of Nutrition, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Karen D Corbin
- Translational Research Institute, AdventHealth Orlando, Orlando, FL, USA
| | - Jessica C Kichler
- Department of Psychology, University of Windsor, Windsor, ON, Canada
| | - David M Maahs
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USA
- Stanford Diabetes Research Center and Health Research and Policy (Epidemiology), Stanford, CA, USA
| | - Frank Muntis
- Department of Nutrition, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Richard Pratley
- Translational Research Institute, AdventHealth Orlando, Orlando, FL, USA
| | - Michael Seid
- Cincinnati Children's Hospital Medical Center, University of Cincinnati Medical School, Cincinnati, OH, USA
| | - Dessi Zaharieva
- Stanford Diabetes Research Center and Health Research and Policy (Epidemiology), Stanford, CA, USA
| | - Elizabeth Mayer-Davis
- Department of Nutrition, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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Igudesman D, Crandell J, Corbin K, Muntis F, Zaharieva D, Thomas J, Bulik C, Carroll I, Pence B, Pratley R, Kosorok M, Maahs D, Mayer-Davis E. The Gut Microbiota and Short-Chain Fatty Acids in Association With Glycemia and Adiposity in Young Adults With Type 1 Diabetes: The ACT1ON Ancillary Gut Microbiome Pilot Study. Curr Dev Nutr 2022. [PMCID: PMC9193984 DOI: 10.1093/cdn/nzac069.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Objectives Co-managing glycemia and adiposity is the cornerstone of cardiometabolic risk reduction among people with type 1 diabetes (T1D) but targets are often not met. The gut microbiota and microbiota-derived short-chain fatty acids (SFCA) influence glycemia and adiposity but have not been sufficiently investigated in longstanding T1D. We hypothesized that an increased abundance of SCFA-producing gut microbes, fecal SCFA, and gut microbial diversity were associated with improved glycemia but increased adiposity among young adults with longstanding T1D. Methods Participants provided stool samples at up to four time points. 16S rRNA gene sequencing determined the abundance of SCFA-producing gut microbes. Gas-chromatography mass-spectrometry determined total and specific SCFA (acetate, butyrate, and propionate). Dual-energy x-ray absorptiometry (% body fat or lean mass) and anthropometrics (body mass index [BMI]) measured adiposity. Continuous glucose monitoring (time in range [70–180 mg/dl], above range [>180 mg/dl], and below range [54–69 mg/dl]) and hemoglobin A1c assessed glycemia. Adjusted and Bonferroni-corrected generalized estimating equations modeled the associations of SCFA-producing gut microbes, fecal SCFA, and gut microbial diversity with glycemia and adiposity. COVID-19 interrupted data collection, so models were repeated with restriction to pre-COVID visits. Results Data were available for up to 45 participants at 101 visits, including 40 participants at 54 visits pre-COVID. The abundance of Eubacterium hallii was associated inversely with BMI (all data). Pre-COVID, increased fecal propionate was associated with increased time above range and reduced time in target and below range; and the increased abundance of four SCFA-producing intestinal microbes (Ruminococcus gnavus, Ruminococcus 2, Eubacterium ventriosum, and Lachnospira) was associated with reduced adiposity (% body fat or BMI), of which two microbes were also associated with increased % lean mass. Conclusions Unexpectedly, fecal propionate was associated with detriment to glycemia, while several SCFA-producing gut microbes were associated with benefit to adiposity. Future mechanistic studies may determine whether these associations have causal linkages in T1D. Funding Sources National Institute of Diabetes and Digestive and Kidney Diseases.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | - David Maahs
- AdventHealth Translational Research Institute
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Yavelberg L, Zaharieva D, Cinar A, Riddell MC, Jamnik V. A Pilot Study Validating Select Research-Grade and Consumer-Based Wearables Throughout a Range of Dynamic Exercise Intensities in Persons With and Without Type 1 Diabetes: A Novel Approach. J Diabetes Sci Technol 2018; 12:569-576. [PMID: 29320885 PMCID: PMC6154246 DOI: 10.1177/1932296817750401] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND The increasing popularity of wearable technology necessitates the evaluation of their accuracy to differentiate physical activity (PA) intensities. These devices may play an integral role in customizing PA interventions for primary prevention and secondary management of chronic diseases. For example, in persons with type 1 diabetes (T1D), PA greatly affects glucose concentrations depending on the intensity, mode (ie, aerobic, anaerobic, mixed), and duration. This variability in glucose responses underscores the importance of implementing dependable wearable technology in emerging avenues such as artificial pancreas systems. METHODS Participants completed three 40-minute, dynamic non-steady-state exercise sessions, while outfitted with multiple research (Fitmate, Metria, Bioharness) and consumer (Garmin, Fitbit) grade wearables. The data were extracted according to the devices' maximum sensitivity (eg, breath by breath, beat to beat, or minute time stamps) and averaged into minute-by-minute data. The variables of interest, heart rate (HR), breathing frequency, and energy expenditure (EE), were compared to validated criterion measures. RESULTS Compared to deriving EE by laboratory indirect calorimetry standard, the Metria activity patch overestimates EE during light-to-moderate PA intensities (L-MI) and moderate-to-vigorous PA intensities (M-VI) (mean ± SD) (0.28 ± 1.62 kilocalories· minute-1, P < .001, 0.64 ± 1.65 kilocalories· minute-1, P < .001, respectively). The Metria underestimates EE during vigorous-to-maximal PA intensity (V-MI) (-1.78 ± 2.77 kilocalories · minute-1, P < .001). Similarly, compared to Polar HR monitor, the Bioharness underestimates HR at L-MI (-1 ± 8 bpm, P < .001) and M-VI (5 ± 11 bpm, P < .001), respectively. A significant difference in EE was observed for the Garmin device, compared to the Fitmate ( P < .001) during continuous L-MI activity. CONCLUSIONS Overall, our study demonstrates that current research-grade wearable technologies operate within a ~10% error for both HR and EE during a wide range of dynamic exercise intensities. This level of accuracy for emerging research-grade instruments is considered both clinically and practically acceptable for research-based or consumer use. In conclusion, research-grade wearable technology that uses EE kilocalories · minute-1 and HR reliably differentiates PA intensities.
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Affiliation(s)
- Loren Yavelberg
- Department of Kinesiology and Health
Science, Faculty of Health, Physical Activity and Chronic Disease Unit, York
University, Toronto, ON, Canada
| | - Dessi Zaharieva
- Department of Kinesiology and Health
Science, Faculty of Health, Physical Activity and Chronic Disease Unit, York
University, Toronto, ON, Canada
| | - Ali Cinar
- Department of Biomedical Engineering,
Illinois Institute of Technology, Chicago, IL, USA
| | - Michael C. Riddell
- Department of Kinesiology and Health
Science, Faculty of Health, Physical Activity and Chronic Disease Unit, York
University, Toronto, ON, Canada
| | - Veronica Jamnik
- Department of Kinesiology and Health
Science, Faculty of Health, Physical Activity and Chronic Disease Unit, York
University, Toronto, ON, Canada
- Veronica Jamnik, PhD, Department of
Kinesiology and Health Science, Faculty of Health, Physical Activity and Chronic
Disease Unit, York University, 4700 Keele St, Toronto, ON M3J 1P3, Canada.
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Zaharieva D, Yavelberg L, Jamnik V, Cinar A, Turksoy K, Riddell MC. The Effects of Basal Insulin Suspension at the Start of Exercise on Blood Glucose Levels During Continuous Versus Circuit-Based Exercise in Individuals with Type 1 Diabetes on Continuous Subcutaneous Insulin Infusion. Diabetes Technol Ther 2017; 19:370-378. [PMID: 28613947 PMCID: PMC5510047 DOI: 10.1089/dia.2017.0010] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Exercise causes glycemic disturbances in individuals with type 1 diabetes (T1D). Continuous moderate-intensity aerobic exercise (CON) generally lowers blood glucose (BG) levels and often leads to hypoglycemia. In comparison, circuit-based exercise (CIRC) may attenuate the drop in BG. The goal of this study is to contrast the effects of basal insulin suspension at the onset of two different forms of exercise (CON vs. CIRC). METHODS Twelve individuals (six men and six women) with T1D on insulin pump therapy were recruited for the study. All participants completed a maximal aerobic fitness test and two 40-min exercise sessions, consisting of either continuous treadmill walking or a circuit workout. Basal insulin infusion was stopped at the onset of exercise and resumed in recovery. After providing an initial reference value, volunteers were blinded to their [BG] and were asked to estimate their levels during exercise. RESULTS Oxygen consumption (47.5 ± 7.5 vs. 54.5 ± 13.5 mL·kg-1·min-1, P = 0.03) and heart rate (122 ± 20 vs. 144 ± 20 bpm, P = 0.003) were lower in CON vs. CIRC. Despite the lower workload, BG levels dropped more with CON vs. CIRC (delta BG = -3.8 ± 1.5 vs. -0.5 ± 3.0 mmol/L for CON vs. CIRC, respectively, P = 0.001). Participants were able to estimate their BG more accurately during CON (r = 0.83) vs. CIRC (r = 0.33) based on a regression analysis. CONCLUSION Despite a lower intensity of exercise, with full basal insulin suspension at the start of exercise, CON results in a larger drop in BG vs. CIRC. These findings have implications for single hormone-based artificial pancreas development for exercise. While this study does not negate the importance of frequent capillary BG monitoring during exercise, it does suggest that if persons are knowledgeable about their pre-exercise BG levels, they can accurately perceive the changes in BG during CON, but not during CIRC.
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Affiliation(s)
- Dessi Zaharieva
- School of Kinesiology and Health Science, Faculty of Health, Muscle Health Research Centre and Physical Activity and Chronic Disease Unit, York University, Toronto, Canada
| | - Loren Yavelberg
- School of Kinesiology and Health Science, Faculty of Health, Muscle Health Research Centre and Physical Activity and Chronic Disease Unit, York University, Toronto, Canada
| | - Veronica Jamnik
- School of Kinesiology and Health Science, Faculty of Health, Muscle Health Research Centre and Physical Activity and Chronic Disease Unit, York University, Toronto, Canada
| | - Ali Cinar
- Department of Biomedical Engineering, Illinois Institute of Technology, Chicago, Illinois
- Chemical and Biological Engineering, Illinois Institute of Technology, Chicago, Illinois
| | - Kamuran Turksoy
- Department of Biomedical Engineering, Illinois Institute of Technology, Chicago, Illinois
| | - Michael C. Riddell
- School of Kinesiology and Health Science, Faculty of Health, Muscle Health Research Centre and Physical Activity and Chronic Disease Unit, York University, Toronto, Canada
- LMC Diabetes & Endocrinology, Toronto, Canada
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Beaudry JL, Dunford EC, Teich T, Zaharieva D, Hunt H, Belanoff JK, Riddell MC. Effects of selective and non-selective glucocorticoid receptor II antagonists on rapid-onset diabetes in young rats. PLoS One 2014; 9:e91248. [PMID: 24642683 PMCID: PMC3958344 DOI: 10.1371/journal.pone.0091248] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2013] [Accepted: 02/10/2014] [Indexed: 12/11/2022] Open
Abstract
The blockade of glucocorticoid (GC) action through antagonism of the glucocorticoid receptor II (GRII) has been used to minimize the undesirable effects of chronically elevated GC levels. Mifepristone (RU486) is known to competitively block GRII action, but not exclusively, as it antagonizes the progesterone receptor. A number of new selective GRII antagonists have been developed, but limited testing has been completed in animal models of overt type 2 diabetes mellitus. Therefore, two selective GRII antagonists (C113176 and C108297) were tested to determine their effects in our model of GC-induced rapid-onset diabetes (ROD). Male Sprague-Dawley rats (∼ six weeks of age) were placed on a high-fat diet (60%), surgically implanted with pellets containing corticosterone (CORT) or wax (control) and divided into five treatment groups. Each group was treated with either a GRII antagonist or vehicle for 14 days after surgery: CORT pellets (400 mg/rat) + antagonists (80 mg/kg/day); CORT pellets + drug vehicle; and wax pellets (control) + drug vehicle. After 10 days of CORT treatment, body mass gain was increased with RU486 (by ∼20% from baseline) and maintained with C113176 administration, whereas rats given C108297 had similar body mass loss (∼15%) to ROD animals. Fasting glycemia was elevated in the ROD animals (>20 mM), normalized completely in animals treated with RU486 (6.2±0.1 mM, p<0.05) and improved in animals treated with C108297 and C113176 (14.0±1.6 and 8.8±1.6 mM, p<0.05 respectively). Glucose intolerance was normalized with RU486 treatment, whereas acute insulin response was improved with RU486 and C113176 treatment. Also, peripheral insulin resistance was attenuated with C113176 treatment along with improved levels of β-cell function while C108297 antagonism only provided modest improvements. In summary, C113176 is an effective agent that minimized some GC-induced detrimental metabolic effects and may provide an alternative to the effective, but non-selective, GRII antagonist RU486.
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Affiliation(s)
- Jacqueline L. Beaudry
- School of Kinesiology and Health Science, Faculty of Health, Muscle Health Research Center and Physical Activity and Chronic Disease Unit, York University, Toronto, Ontario, Canada
| | - Emily C. Dunford
- School of Kinesiology and Health Science, Faculty of Health, Muscle Health Research Center and Physical Activity and Chronic Disease Unit, York University, Toronto, Ontario, Canada
| | - Trevor Teich
- School of Kinesiology and Health Science, Faculty of Health, Muscle Health Research Center and Physical Activity and Chronic Disease Unit, York University, Toronto, Ontario, Canada
| | - Dessi Zaharieva
- School of Kinesiology and Health Science, Faculty of Health, Muscle Health Research Center and Physical Activity and Chronic Disease Unit, York University, Toronto, Ontario, Canada
| | - Hazel Hunt
- Corcept Therapeutics, Menlo Park, California, United States of America
| | | | - Michael C. Riddell
- School of Kinesiology and Health Science, Faculty of Health, Muscle Health Research Center and Physical Activity and Chronic Disease Unit, York University, Toronto, Ontario, Canada
- * E-mail:
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