La prévention de l'hypoglycémie associée à l’activité physique chez les adultes vivant avec le diabète de type 1

Problématique : La pratique d’activité physique devrait être encouragée chez les individus avec le diabète de type 1 (DbT1), mais est limitée par la crainte de l'hypoglycémie. Les personnes traitées avec la pompe à insuline peuvent réduire temporairement la perfusion d’insuline basale. Pour un exercice à distance du repas, il s’agit de la méthode privilégiée pour prévenir l’hypoglycémie induite par l’exercice, mais aucune étude n’a validé le moment optimal pour le faire. Objectif : Comparer l’efficacité de trois moments de réduction du débit de base d’insuline de 80%, soit au moment de débuter (T0), 20 minutes (T-20) ou 40 minutes (T-40) avant un exercice de 45 minutes sur vélo stationnaire d’intensité moyenne (60%VO2peak) pratiqué 3 heures après un repas standardisé. Résultats : Aucune différence entre les stratégies quant au pourcentage du temps 4,0 mmol/L et au temps passé entre 4,0-10,0 mmol/L n’a été observée. Avec T-40, quoique non significatif, la glycémie de départ était plus élevée, moins de participants ont eu besoin de consommer des glucides avant et pendant l’exercice et le délai avant l’apparition de l’hypoglycémie était plus long en comparaison avec T0 et T-20. Conclusion : Chez les personnes avec le DbT1 et traitées par pompe à insuline, la réduction de 80% du débit basal d’insuline 40 minutes avant un exercice de 45 minutes d’intensité moyenne effectué à distance du repas n’est pas suffisante pour réduire l’hypoglycémie. D’autres études sont requises pour déterminer si cette réduction devrait être plus importante, plus hâtive ou combinée à un apport en glucides.Rational : For its benefits, physical activity should be encouraged in individuals living with type 1 diabetes (T1D) but is limited by the fear of hypoglycemia. People treated with continuous subcutaneuous insulin infusion (insulin pump) have the option to temporarily reduce basal insulin infusion rate. For an exercise practiced in the late post-prandial phase, this is the preferred method for preventing exercise-induced hypoglycemia, but no study has validated the optimal timing to reduce basal insulin infusion. Objective: To compare the efficacy of three timings to decrease basal insulin infusion rate by 80%, either at the start (T0), 20 minutes (T-20), or 40 minutes (T-40) before a 45-min exercise on a stationary bicycle at moderate intensity (60% VO2peak) performed 3 hours after a standardized meal. Results: No significant difference between the three strategies in terms of percentage of time spent under 4.0 mmol/L and time spent between 4.0 and 10.0 mmol/L was observed. With a reduction at T-40, although not significant, the glucose level at exercise onset was higher, fewer participants needed additional carbohydrates before and during exercise, and the time to first hypoglycemia was longer in comparison with T0 and T-20. Conclusion: In people living with T1D and treated with an insulin pump, an 80% reduction in basal insulin infusion 40 minutes before a 45-min moderate intensity exercise practiced in a late post-prandial state is not enough to reduce hypoglycemia. Further studies are needed to determine whether this reduction should be greater, earlier and/or combined with carbohydrates

Evaluation of , a self-guided online type 1 diabetes self-management education and support web application—a mixed methods study

Background Type 1 diabetes requires making numerous daily decisions to maintain normoglycemia. Support is an evidence-based self-guided web application for type 1 diabetes diabetes self-management. Objective Evaluate users’ satisfaction with Support and investigate changes in self-reported frequency of-, fear of- hypoglycemia, and diabetes-related self-efficacy. Methods Adults from a Quebec type 1 diabetes registry used Support . Data was collected through online surveys or extracted from the registry at 0, 6, and 12 months (number of episodes and fear of hypoglycemia). At 6 months, participants reported satisfaction with Support and diabetes-related self-efficacy. A sub-group of 16 users was interviewed about their experience . Transcripts were analyzed using inductive and deductive approaches. Results In total, 207 accounts were created (35% men, 96% White, mean age and diabetes duration: 49.3 ± 13.8 and 25.2 ± 14.7 years). At 6 months, the median [Q1; Q3] satisfaction was 40/49 [35; 45] with a mean decrease in hypoglycemia frequency of 0.43 episodes over 3 days (95% CI: −0.86; 0.00, p  = 0.051) and of −1.98 score for fear (95% CI: −3.76; −0.20, p  = 0.030). Half of the participants reported increased diabetes-related self-efficacy. Conclusions Participants reported a high level of satisfaction with Support . Its use has the potential to facilitate hypoglycemia management and increase diabetes-related self-efficacy. Trial registration This study is registered on ClinicalTrials.gov NCT04233138

sj-docx-1-dhj-10.1177_20552076231204435 - Supplemental material for Evaluation of <i>Support</i>, a self-guided online type 1 diabetes self-management education and support web application—a mixed methods study

Supplemental material, sj-docx-1-dhj-10.1177_20552076231204435 for Evaluation of Support, a self-guided online type 1 diabetes self-management education and support web application—a mixed methods study by Li Feng Xie, Asmaa Housni, Amélie Roy-Fleming, Aude Bandini, Treena Delormier, Deborah Da Costa and Anne-Sophie Brazeau in DIGITAL HEALTH</p

Erratum to: Guidelines for the use and interpretation of assays for monitoring autophagy (3rd edition) (Autophagy, 12, 1, 1-222, 10.1080/15548627.2015.1100356

non present