Glucose and Counterregulatory Responses to Exercise in Adults With Type 1 Diabetes and Impaired Awareness of Hypoglycemia Using Closed-Loop Insulin Delivery: A Randomized Crossover Study

Abstract

To evaluate exercise-related glucose and counterregulatory responses (CRR) in adults with type 1 diabetes with impaired awareness of hypoglycemia (IAH) using hybrid closed-loop (HCL) insulin delivery to maintain glucose homeostasis. RESEARCH DESIGN AND METHODSTwelve participants undertook 45-min high-intensity intermittent exercise (HIIE) and moderate-intensity exercise (MIE) in random order. The primary outcome was continuous glucose monitoring (CGM) time in range (70-180 mg/dL) for 24-h postexercise commencement. RESULTSCGM time in range was similar for HIIE and MIE (median 79.5% [interquartile range 73.2, 87.6] vs. 76.1% [70.3, 83.9], P 5 0.37), and time with levels <54mg/dL postexercise commencement was 0%. HIIE induced greater increases in cortisol (P 5 0.002), noradrenaline (P 5 0.005), and lactate (P 5 0.002), with no differences in adrenaline, dopamine, growth hormone, or glucagon responses.

First Randomized Controlled Trial of Hybrid Closed Loop Versus Multiple Daily Injections or Insulin Pump Using Self-Monitoring of Blood Glucose in Free-Living Adults with Type 1 Diabetes Undertaking Exercise

“…Venous glucose, ketones, lactate and counter-regulatory hormones were assessed in samples collected at 15 min intervals from 60 min pre-to 210 min post-exercise. 5 The primary outcome was masked CGM time-in-range 70 to 180 mg/dL for 24 h post-exercise commencement. Secondary outcomes were CGM metrics for 24 h and 2 h post-exercise, ketones, lactate, and counter-regulatory hormones.…”

Impacto del ejercicio en la glucosa en pacientes con diabetes tipo 1 usuarios de sistema hibrido de asa cerrada con uso de objetivo temporal

“…El perfil de glucosa durante el ejercicio de resistencia mostró una estabilidad de los niveles de glucosa durante la actividad física y bajo riesgo de hipoglucemia durante las 36 horas después del ejercicio, a diferencia de otros estudios con pocos pacientes donde se ha utilizado monitoreo continuo de glucosa no integrado, donde el ejercicio de resistencia condujo a niveles más bajos de glucosa intersticial en la cuarta y quinta hora después del ejercicio (12). Nuestros hallazgos pueden estar relacionados con el buen control metabólico de los pacientes al inicio del estudio, el uso de un dispositivo de última generación y el uso del modo automático posterior al terminar el ejercicio.…”

“…Realizar ejercicio es todo un reto para los pacientes con DM1. La implementación de la tecnología ha permitido a los pacientes realizar ejercicio de forma segura, con reducción de la hipoglucemia (12). En los usuarios de SHAC, el ejercicio aeróbico disminuye los niveles de glucosa de forma temprana y significativa, mientras que en el ejercicio de resistencia los niveles de glucosa permanecen estables.…”

No more hypoglycaemia on days with physical activity and unrestricted diet when using a closed‐loop system for 12 weeks: A post hoc secondary analysis of the multicentre, randomized controlled Diabeloop WP7 trial

“…Physiological factors that may contribute to glycaemic control during PA were not studied (e.g. counter‐regulations involving the autonomic nervous system and/or glucagon) 23 . Besides TIR (CGM 70‐180 mg/dL), TBR (CGM <70 mg/dL) and TAR (CGM >180 mg/dL), other glycaemic excursions were not analysed.…”

“…counter‐regulations involving the autonomic nervous system and/or glucagon). 23 Besides TIR (CGM 70‐180 mg/dL), TBR (CGM <70 mg/dL) and TAR (CGM >180 mg/dL), other glycaemic excursions were not analysed. The algorithm of the CL system does not distinguish PA performed in the postprandial versus the postabsorptive state.…”