Introduction: Despite the rapid advances of diabetes technologies, postprandial glucose management remains a challenge for people living with type 1 diabetes (pwT1D). We aim to assess the efficacy of single-hormone (SH) compared to dual-hormone (DH) automated insulin delivery (AID) systems in postprandial glucose management. Methods: Post-hoc analysis of a randomized controlled crossover inpatient trial including three standardized meals (taken at 8am, 12 pm, and 5pm) during a 24-hour period, comparing SH-AID and DH-AID among pwT1D. Data from meals of each participant was pooled. Primary outcome was time in range % (TIR%, 70 to 180 mg/dL), calculated by continuous glucose monitoring during the 4-hour postprandial period. Paired t-test was used to compare the two groups. Results: Eighteen adult participants were included (mean age [SD] 43 [14] years, mean duration of T1D 20 [11] years, mean HbA1c 7.6% [1.0], mean daily insulin intake 26.70 [11.04] units). Postprandial TIR% was similar between SH and DH-AID (66.4% vs 70.2%, p=0.443). Less time in postprandial hypoglycemia (<70 mg/dL) was observed in the DH-AID group compared to SH-AID (5.4% vs 11.9%, p=0.019). No difference was observed in postprandial time spent in hyperglycemia (>180 mg/dL), glycemic variability indices or insulin intake between the two groups. Conclusion: Compared with SH-AID, DH-AID reduces postprandial hypoglycemia, while other postprandial glucose metrics remain similar among adult pwT1D. Disclosure M. Lebbar: None. J. Molveau: None. V. Boudreau: None. R. Rabasa-lhoret: Consultant; Dexcom, Inc., Abbott, Janssen Pharmaceuticals, Inc., Novo Nordisk Canada Inc., Sanofi, Lilly, Tandem Diabetes Care, Inc., Insulet Corporation. Z. Wu: Other Relationship; Eli Lilly and Company.
For people living with type 1 diabetes (PWT1D) post-prandial exercise remains a challenge for the maintenance of glycemic control even with automated insulin delivery systems (AID) . During the postprandial phase, elevated insulin levels, rapid changes in glucose levels with increased CGM lag time make it difficult for AID algorithms to mitigate the risk of hypoglycemia by solely relying on basal rate modulation. The main objective of this study was to assess the safety and efficacy of AID using a combination strategy of pre-meal exercise announcement and meal bolus reduction during exercise bouts performed 1- and 2-hours post-meal. Thirteen adults PWT1D chronically treated with AID (6 females; A1c = 7.9 ± 0.6%; Age= 53,5 ± 15,5 years; T1D duration= 29.0 ± 16.0 years) were included. Participants performed in a randomized crossover fashion 2 60-min exercise sessions (60% of VO2peak) , 1 (60Ex) and 2-h (120Ex) post-meal. A standardized meal was given at 8AM with a 33% insulin bolus reduction and exercise was announced to the AID algorithm (target glucose increased from 6 to 9 mmol/L) up to the end of each exercise session. Plasma glucose was collected regularly. Plasma glucose times in range (3.9-10.0 mmol/L) and above range (>10.0 mmol/L) from exercise onset to 90-min-post-exercise, were similar between Ex60 and Ex120 (63.7 ± 41.4% Ex60 vs. 65.9 ±24.9% Ex120, p=0.3; 36.1 ± 41.6% Ex60 vs. 34.1 ± 24.9% Ex120, p=0.4, respectively) . No hypoglycemic events (<3.9 mmol/L) occurred during the study. The mean reduction in plasma glucose levels were similar during exercise in both conditions (-2.6 ± 1.4 mmol/L Ex60 vs. -3.5 ± 2.2 mmol/L Ex120, p=0.2) Conclusion: combining pre-meal exercise announcement with a meal bolus reduction of 33% was effective and safe at preventing postprandial exercise hypoglycemia in PWT1D treated with AID whether exercise was performed 1 or 2-h after a meal. Disclosure M.Raffray: None. R.Rabasa-lhoret: Consultant; HLS Therapeutics Inc., Pfizer Inc., Other Relationship; Abbott Diabetes, AstraZeneca, Boehringer Ingelheim International GmbH, Dexcom, Inc., Eli Lilly and Company, Insulet Corporation, Janssen Pharmaceuticals, Inc., Medtronic, Merck & Co., Inc., Novo Nordisk Canada Inc., Sanofi, Vertex Pharmaceuticals Incorporated, Research Support; Canadian Institutes of Health Research, Cystic Fibrosis Canada, Diabetes Canada, Fondation Francophone pour la Recherche en Diabète (FFRD) , JDRF, National Institutes of Health, Société Francophone du Diabète (SFD) , Speaker's Bureau; Canadian Medical & Surgical Knowledge Translation Research Group (CMS) , CPD Network, Tandem Diabetes Care, Inc. É.Myette-côté: None. J.Molveau: None. M.Devaux: None. Z.Wu: Other Relationship; Eli Lilly and Company. Funding National Institutes of Health (A12BC345678)
Introduction: To limit hypoglycemic risk of during postprandial aerobic exercise the importance of reducing prandial insulin dose have been established with exercise starting 90-min after the meal. People with type 1 diabetes also exercise closer or further away of their mealtime and hypoglycemic risk associated with those timings may be different. Objective: We aimed to evaluate the effect of two different timings for exercise onset (60-min vs. 120-min post-meal) during moderate intensity exercise. Methods: 37 participants (25 M/ 12 F; HbA1c: 7.4 ± 0.9%) received an ultra-rapid insulin dose reduced by 50% and performed 1 hour of continuous moderate intensity exercise (at 60% of VO2peak) started either 60-min (EX60min) or 120-min (EX120min) after breakfast. Venous blood glucose was measured every 10-min during exercise. Results: Decrease in blood glucose between exercise onset and nadir (lowest point during exercise) was more important with EX120min (-68.5 ± 43.2 mg/dL, EX60min vs. -75.7 ± 39.6 mg/dL, EX120min, p=0.015). The number of hypoglycemic events during exercise and during recovery (90-min post-exercise) were similar between EX60min and EX120min (3 vs. 4 and 3 vs. 0, respectively). Postprandial glucose excursion before exercise onset was reduced with Ex60min compared to Ex120min. Conclusion: For postprandial aerobic exercise, with a reduced insulin meal bolus, hypoglycemic risk is comparable if exercise is started at 60 or 120min after the meal. Guidelines established with exercise starting 90min after the meal can probably be used for earlier or later timing. Disclosure J.Molveau: None. É.Myette-côté: None. S.Tagougui: None. N.Taleb: Consultant; Viatris Inc. E.Heyman: None. C.Suppere: None. R.Rabasa-lhoret: Consultant; Dexcom, Inc., Abbott, Janssen Pharmaceuticals, Inc., Novo Nordisk Canada Inc., Sanofi, Lilly, Tandem Diabetes Care, Inc., Insulet Corporation.
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