Glycemia Around Exercise in Adults with Type 1 Diabetes Using Automated and Nonautomated Insulin Delivery Pumps: A Switch Pilot Trial

In an in-patient switch study, 10 adults with type 1 diabetes (T1D) performed 45 min of moderate-intensity exercise on 2 occasions: (1) when using their usual insulin pump (UP) and (2) after transitioning to automated insulin delivery (AID) treatment (MiniMed™ 780G). Consensus glucose management guidelines for performing exercise were applied. Plasma glucose concentrations measured over a 3-h monitoring period were stratified into time below range (TBR, 10.0 mmol/L).Overall, TBR (UP: 11 ± 21 vs. AID: 3% ± 10%, P = 0.413), TIR (UP: 53 ± 27 vs. AID: 66% ± 39%, P = 0.320), and TAR (UP: 37 ± 34 vs. AID: 31% ± 41%, P = 0.604) were similar between arms. A proportionately low number of people experienced exercise-induced hypoglycemia (UP: n = 2 vs. AID: n = 1, P = 1.00).In conclusion, switching to AID therapy did not alter patterns of glycemia around sustained moderate-intensity exercise in adults with T1D

Similar risk of exercise-related hypoglycaemia for insulin degludec to that for insulin glargine in patients with type 1 diabetes: a randomized cross-over trial

We compared changes in blood glucose (BG) and risk of hypoglycaemia during and after exercise in 40 patients with type 1 diabetes (T1D) treated with insulin degludec (IDeg) or insulin glargine (IGlar) in a randomized, open-label, two-period, crossover trial. After individual titration and a steady-state period, patients performed 30 min of moderate-intensity cycle ergometer exercise (65% peak rate of oxygen uptake). BG, counter-regulatory hormones and hypoglycaemic episodes were measured frequently during and for 24 h after exercise. BG changes during exercise were similar with IDeg and IGlar [estimated treatment difference (ETD) for maximum BG decrease: 0.14 mmol/l; 95% confidence interval (CI) -0.15, 0.42; p = 0.34], as was mean BG (ETD -0.16 mmol/l; 95% CI -0.36, 0.05; p = 0.13). No hypoglycaemic episodes occurred during exercise. Post-exercise mean BG, counter-regulatory hormone response and number of hypoglycaemic episodes in 24 h after starting exercise were similar with IDeg (18 events in 13 patients) and IGlar (23 events in 15 patients). This clinical trial showed that, in patients with T1D treated with a basal-bolus regimen, the risk of hypoglycaemia induced by moderate-intensity exercise was low with IDeg and similar to that with IGlar

Bolus insulin dose depends on previous‐day race intensity during 5 days of professional road‐cycle racing in athletes with type 1 diabetes: A prospective observational study

AimsTo assess insulin therapy, macronutrient intake and glycaemia in professional cyclists with type 1 diabetes (T1D) over a 5‐day Union Cycliste Internationale road‐cycle race.Material and methodsIn this prospective observational study, seven professional cyclists with T1D (age 28 ± 4 years, body mass index 20.9 ± 0.9 kg/m2, glycated haemoglobin concentration 56 ± 7 mmol/mol [7.3% ± 0.6%]) were monitored during a five‐stage professional road cycling race. Real‐time continuous glucose monitoring (rtCGM) data, smart insulin pen dose data and macronutrient intake were assessed by means of repeated‐measure one‐way ANOVA and post hoc testing. Associations between exercise physiological markers and rtCGM data, insulin doses and macronutrient intake were assessed via linear regression modelling (P ≤ 0.05).ResultsBolus insulin dose was significantly reduced over the 5‐day period (P = 0.03), while carbohydrate intake (P = 0.24) and basal insulin doses remained unchanged (P = 0.64). A higher mean previous‐day race intensity was associated with a lower mean sensor glucose level (P = 0.03), less time above range level 2 (>13.9 mmol/L [250 mg/dL]; P = 0.05) and lower doses of bolus insulin (P = 0.04) on the subsequent day. No significant associations were found for any other glycaemic range and glycaemic variability (P > 0.05).ConclusionsThis is the first study to demonstrate the influence of previous‐day race intensity on subsequent bolus insulin dose requirements in professional cyclists with T1D. These data may help inform therapeutic strategies to ensure safe exercise performance

Efficacy of carbohydrate supplementation compared to bolus insulin dose reduction around exercise in adults with type 1 diabetes: a retrospective controlled analysis

IntroductionIndividuals with type 1 diabetes try to manage the risk of exercise-induced hypoglycemia by means of pre-exercise/pre-meal bolus insulin dose reductions and/or consuming additional carbohydrates during exercise. Both strategies have proven to be effective in offsetting the occurrence against hypoglycemia, it is unclear as to which one is more beneficial. Consequently, the aim of this study was to assess the efficacy of carbohydrate supplementation in comparison to bolus insulin dose reduction to prevent hypoglycemia during moderate-intensity exercise in individuals with type 1 diabetes.MethodsThis was a retrospective controlled analysis of two independent clinical trials. All participants performed a continuous moderate-intensity cycle ergometer exercise session for ∼45 minutes. Two different therapy management groups and a control group were compared: Group (A) supplemented 15 – 30 g carbohydrates at a glycemic threshold of 7.0 mmol/L during exercise, group (B) reduced their individual bolus insulin dose by 50% with their last meal prior to exercise and group (C) remained as a control.ResultsNo hypoglycemic events occurred in group A, which differed to each four events recorded in groups B (p = 0.02) and C (p = 0.02).ConclusionCarbohydrate supplementation was superior to bolus insulin reductions in the prevention of hypoglycemia during exercise in people with type 1 diabetes

Type 1 diabetes and physical activity: An assessment of knowledge and needs in healthcare practitioners

This study examined healthcare practitioners’ knowledge and confidence in providing physical activity guidance to people with type 1 diabetes. Data collection occurred in the form of a 23-question, open-ended survey and semi-structured interviews exploring practitioners’ knowledge regarding exercise and type 1 diabetes. Participants had rarely received formal training regarding physical activity for people with type 1 diabetes. They indicated limited knowledge of specific physical activity guidelines, either for the general population or for people with type 1 diabetes. However, participants reported feeling relatively confident in their ability to advise people with type 1 diabetes regarding physical activity. The disparity between practitioners’ knowledge and confidence in advising people with type 1 diabetes about physical activity raises concerns regarding the accuracy of the information being provided to individuals with the condition

The endocrine pancreas during exercise in people with and without type 1 diabetes: Beyond the beta-cell

Although important for digestion and metabolism in repose, the healthy endocrine pancreas also plays a key role in facilitating energy transduction around physical exercise. During exercise, decrements in pancreatic β-cell mediated insulin release opposed by increments in α-cell glucagon secretion stand chief among the hierarchy of glucose-counterregulatory responses to decreasing plasma glucose levels. As a control hub for several major glucose regulatory hormones, the endogenous pancreas is therefore essential in ensuring glucose homeostasis. Type 1 diabetes (T1D) is pathophysiological condition characterised by a destruction of pancreatic β-cells resulting in pronounced aberrations in glucose control. Yet beyond the beta-cell perhaps less considered is the impact of T1D on all other pancreatic endocrine cell responses during exercise and whether they differ to those observed in healthy man. For physicians, understanding how the endocrine pancreas responds to exercise in people with and without T1D may serve as a useful model from which to identify whether there are clinically relevant adaptations that need consideration for glycaemic management. From a physiological perspective, delineating differences or indeed similarities in such responses may help inform appropriate exercise test interpretation and subsequent program prescription. With more complex advances in automated insulin delivery (AID) systems and emerging data on exercise algorithms, a timely update is warranted in our understanding of the endogenous endocrine pancreatic responses to physical exercise in people with and without T1D. By placing our focus here, we may be able to offer a nexus of better understanding between the clinical and engineering importance of AIDs requirements during physical exercise

Overcoming Marginalization and Disengagement in Adult Education: Adult Educators’ Contributions to the Scholarship of Engagement

As adult educators whose work has had an impact on shaping the discourse on scholarly engagement, service-learning and community-based education, we will describe our different approaches to this movement and share our diverse practical experiences fostering greater community engagement in the areas of teaching, research and service

Workplace delivery of a dietitian-led cardiovascular disease and type 2 diabetes prevention programme: A qualitative study of participants’ experiences in the context of Basic Needs Theory

The Medical Research Council recommends strong theoretical underpinning in the design and evaluation of lifestyle intervention programmes (LIPs). This qualitative study aimed to use Basic Needs Theory (BNT) as a framework to explore participants’ perspectives on a workplace dietitian-led LIP. Specifically, experiences with LIP engagement and initiation and maintenance of behaviour change were evaluated. Fifteen semi-structured face-to-face interviews were conducted with participants who had previously completed a workplace cardiovascular disease and type 2 diabetes prevention programme, which involved advice and motivational support with making dietary and lifestyle changes. Interviews were audio recorded and transcribed verbatim. To evaluate the narrative, interpretative phenomenological analyses were used with BNT as the theoretical framework. A total of 12 themes were identified in relation to the three concepts of BNT – autonomy, competence and relatedness – and organised into three domains: intervention engagement, behaviour change initiation and behaviour change maintenance. Line manager and colleague support to attend was reported to have a strong influence on intervention engagement, and the importance of dietitian and peer guidance in initiating behaviour changes was highlighted. Differences between participants who maintained behavioural changes compared to those who relapsed included autonomously seeking support (relatedness) through family, friends, healthcare professionals and commercial slimming organisations. BNT provided an insightful theoretical framework to evaluate factors that underpinned the effectiveness of a dietitian-led cardiovascular and type 2 diabetes prevention LIP. Attendance and retention in workplace LIPs can depend on participants’ managerial and colleague support, so recruitment processes should consider targeting managers in marketing and promotional activities. Workplace LIPs may increase the likelihood of behaviour change maintenance by including methods that foster longer term participant relatedness and emotional support

Insulin therapy and dietary adjustments to normalize glycemia and prevent nocturnal hypoglycemia after evening exercise in type 1 diabetes: a randomized controlled trial

Introduction Evening-time exercise is a frequent cause of severe hypoglycemia in type 1 diabetes, fear of which deters participation in regular exercise. Recommendations for normalizing glycemia around exercise consist of prandial adjustments to bolus insulin therapy and food composition, but this carries only short-lasting protection from hypoglycemia. Therefore, this study aimed to examine the impact of a combined basal-bolus insulin dose reduction and carbohydrate feeding strategy on glycemia and metabolic parameters following evening exercise in type 1 diabetes. Methods Ten male participants (glycated hemoglobin: 52.4±2.2 mmol/mol), treated with multiple daily injections, completed two randomized study-days, whereby administration of total daily basal insulin dose was unchanged (100%), or reduced by 20% (80%). Participants attended the laboratory at ∼08:00 h for a fasted blood sample, before returning in the evening. On arrival (∼17:00 h), participants consumed a carbohydrate meal and administered a 75% reduced rapid-acting insulin dose and 60 min later performed 45 min of treadmill running. At 60 min postexercise, participants consumed a low glycemic index (LGI) meal and administered a 50% reduced rapid-acting insulin dose, before returning home. At ∼23:00 h, participants consumed a LGI bedtime snack and returned to the laboratory the following morning (∼08:00 h) for a fasted blood sample. Venous blood samples were analyzed for glucose, glucoregulatory hormones, non-esterified fatty acids, β-hydroxybutyrate, interleukin 6, and tumor necrosis factor α. Interstitial glucose was monitored for 24 h pre-exercise and postexercise. Results Glycemia was similar until 6 h postexercise, with no hypoglycemic episodes. Beyond 6 h glucose levels fell during 100%, and nine participants experienced nocturnal hypoglycemia. Conversely, all participants during 80% were protected from nocturnal hypoglycemia, and remained protected for 24 h postexercise. All metabolic parameters were similar. Conclusions Reducing basal insulin dose with reduced prandial bolus insulin and LGI carbohydrate feeding provides protection from hypoglycemia during and for 24 h following evening exercise. This strategy is not associated with hyperglycemia, or adverse metabolic disturbances

Managing type 1 diabetes in the active population

Many high-profile athletes participate across a wide range of sports with type 1 diabetes. Team Type 1 encourages and supports those with type 1 diabetes to participate in physical activity, with professional cycling’s Team Novo Nordisk composed entirely of individuals with type 1 diabetes. Type 1 diabetes is likely to present early in an athlete’s career, a time when athletes may present with fatigue due to increased training loads. All physicians need to distinguish between possible causes of fatigue in these athletes.Type 1 diabetes is an autoimmune condition with T-cell-mediated destruction of the pancreatic β cells of the islets of Langerhans, resulting in failure to produce sufficient insulin. The clinical outcome is an inability to adequately control glucose metabolism. Effective glucose metabolism is crucial in long-duration and high-intensity exercise. Self-administered exogenous insulin is required as a treatment to manage blood glucose.The physiological response to exercise is a progressive decrease in insulin and increase in the pancreatic α-cell-derived antagonist hormone glucagon, while exercise also increases insulin sensitivity (increased ‘sensitivity’ means that for a given dose, there is a more pronounced effect—insulin does its job ‘better’). In addition, there is an exercise-induced rise in sympathoadrenal hormones (epinephrine and norepinephrine). This hormonal response influences circulating glucose and fat use, and is usually well-regulated. This is not the case in athletes with type 1 diabetes, where there is a substantial risk of both hyperglycaemia and hypoglycaemia. Patients often have the low bottom of range blood glucose for many hours after exercise. Individual with type 1 diabetes often need 48 hours to reset their autonomic function and replenish glycogen stores