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Vigorous Intervals and Hypoglycemia in Type 1 Diabetes: A Randomized Cross Over Trial.

ABSTRACT: Adding vigorous-intensity intervals (VII) to moderate-intensity exercise prevents immediate declines in blood glucose in type 1 diabetes (T1D) however the intensity required to minimize post-exercise hypoglycemia is unknown. To examine this question, ten sedentary T1D individuals completed four treadmill exercise sessions: a control session of 45?minutes of walking at 45-55% of heart rate reserve (HRR) and three sessions consisting of 60?seconds (VII) at 70%, 80%, or 90% of HRR every 4?minutes during exercise at 45-55% of HRR. We used continuous glucose monitoring (CGM) to measure time ?3.9?mmol/L, glucose variability, hypoglycemia frequency and area under the curve (AUC) for hypoglycemia and hyperglycemia for 12?hours post-exercise. We also examined growth hormone and cortisol responses during and following exercise. In the 12?hours post-exercise, the percentage of time ?3.9?mmol/L, glucose variability, and AUC for hypoglycemia and hyperglycemia were similar across conditions. The frequency of hypoglycemic events was highest after the 90% intervals compared to the control arm (12 vs 3 events, p?=?0.03). There was a trend towards elevated growth hormone with increasing exercise intensity but cortisol levels were similar across conditions. Adding VII to moderate intensity exercise may increase hypoglycemia risk at higher intensities.

SUBMITTER: Rempel M

PROVIDER: S-EPMC6203731 | biostudies-literature | 2018 Oct

REPOSITORIES: biostudies-literature

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Vigorous Intervals and Hypoglycemia in Type 1 Diabetes: A Randomized Cross Over Trial.

Rempel Meaghan M Yardley Jane E JE MacIntosh Andrea A Hay Jacqueline L JL Bouchard Danielle D Cornish Stephen S Marks Seth D SD Hai Yan Y Gordon Joseph W JW McGavock Jonathan J

Scientific reports 20181026 1

Adding vigorous-intensity intervals (VII) to moderate-intensity exercise prevents immediate declines in blood glucose in type 1 diabetes (T1D) however the intensity required to minimize post-exercise hypoglycemia is unknown. To examine this question, ten sedentary T1D individuals completed four treadmill exercise sessions: a control session of 45 minutes of walking at 45-55% of heart rate reserve (HRR) and three sessions consisting of 60 seconds (VII) at 70%, 80%, or 90% of HRR every 4 minutes d ...[more]

PMID: 30367116

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Project description:BackgroundIn the clinic setting both fasting levels of glucose and the area under the curve (AUC) of glucose, by determination of HbA1c levels, are used for risk assessments, in type 2 diabetes (NIDDM). However little is known about postprandial levels, and hence AUC, regarding other traditional risk factors such as insulin and blood-lipids and how this is affected by different diets.ObjectiveTo study postprandial effects of three diets, during a single day, in NIDDM.MethodsA low-fat diet (45-56 energy-% from carbohydrates), and a low-carbohydrate diet (16-24 energy-% from carbohydrates) was compared with a Mediterranean-style diet (black coffee for breakfast and the same total-caloric intake as the other two diets for lunch with red wine, 32-35 energy-% from carbohydrates) in a randomized cross-over design. Total-caloric intake/test-day at the clinic from food was 1025-1080 kCal in men and 905-984 kCal in women. The test meals were consumed at a diabetes ward under supervision.ResultsTwenty-one participants were recruited and 19 completed the studies. The low-carbohydrate diet induced lower insulin and glucose excursions compared with the low-fat diet (p<0.0005 for both AUC). The insulin-response following the single Mediterranean-style lunch-meal was more pronounced than during the low-fat diet lunch (insulin increase-ratio of the low-fat diet: 4.35 ± 2.2, of Mediterranean-style diet: 8.12 ± 5.2, p = 0.001) while postprandial glucose levels were similar. The increase-ratio of insulin correlated with the elevation of the incretin glucose-dependent insulinotropic-polypeptide following the Mediterranean-style diet lunch (Spearman, r = 0.64, p = 0.003).ConclusionsThe large Mediterranean-style lunch-meal induced similar postprandial glucose-elevations as the low-fat meal despite almost double amount of calories due to a pronounced insulin-increase. This suggests that accumulation of caloric intake from breakfast and lunch to a single large Mediterranean style lunch-meal in NIDDM might be advantageous from a metabolic perspective.Trial registrationClinicalTrials.gov NCT01522157 NCT01522157.

Project description:AimsNon-severe hypoglycemia (NS-H) is challenging for people living with type 1 diabetes (PWT1D) and often results from relative iatrogenic hyper-insulinemia. Current guidelines recommend a one-size-fits-all approach of 15-20 g of simple carbohydrates (CHO) every 15 min regardless of the triggering conditions of the NS-H event. We aimed to test different amounts of CHO to treat insulin-induced NS-H at various glucose ranges.MethodsThis is a randomized, four-way, crossover study involving PWT1D, testing NS-H treatment outcomes with 16 g vs. 32 g CHO at two plasma glucose (PG) ranges: A: 3.0-3.5 mmol/L and B: <3.0 mmol/L. Across all study arms, participants consumed an additional 16 g of CHO if PG was still <3.0 mmol/L at 15 min and <4.0 mmol/L at 45 min post-initial treatment. Subcutaneous insulin was used in a fasting state to induce NS-H. Participants had frequent venous sampling of PG, insulin, and glucagon levels.ResultsParticipants (n = 32; 56% female participants) had a mean (SD) age of 46.1 (17.1) years, had HbA1c at 54.0 (6.8 mmol/mol) [7.1% (0.9%)], and had a diabetes duration of 27.5 (17.0) years; 56% were insulin pump users. We compared NS-H correction parameters between 16 g and 32 g of CHO for range A, 3.0-3.5 mmol/L (n = 32), and range B, <3.0 mmol/L (n = 29). Change in PG at 15 min for A: 0.1 (0.8) mmol/L vs. 0.6 (0.9) mmol/L, p = 0.02; and for B: 0.8 (0.9) mmol/L vs. 0.8 (1.0) mmol/L, p = 1.0. Percentage of participants with corrected episodes at 15 min: (A) 19% vs. 47%, p = 0.09; (B) 21% vs. 24%, p = 1.0. A second treatment was necessary in (A) 50% vs. 15% of participants, p = 0.001; (B) 45% vs. 34% of participants, p = 0.37. No statistically significant differences in insulin and glucagon parameters were observed.ConclusionsNS-H, in the context of hyper-insulinemia, is difficult to treat in PWT1D. Initial consumption of 32 g of CHO revealed some advantages at the 3.0-3.5 mmol/L range. This was not reproduced at lower PG ranges since participants needed additional CHO regardless of the amount of initial consumption.Clinical trial registrationClinicalTrials.gov, identifier NCT03489967.

Project description:ImportanceContinuous glucose monitoring (CGM) provides real-time assessment of glucose levels and may be beneficial in reducing hypoglycemia in older adults with type 1 diabetes.ObjectiveTo determine whether CGM is effective in reducing hypoglycemia compared with standard blood glucose monitoring (BGM) in older adults with type 1 diabetes.Design, setting, and participantsRandomized clinical trial conducted at 22 endocrinology practices in the United States among 203 adults at least 60 years of age with type 1 diabetes.InterventionsParticipants were randomly assigned in a 1:1 ratio to use CGM (n = 103) or standard BGM (n = 100).Main outcomes and measuresThe primary outcome was CGM-measured percentage of time that sensor glucose values were less than 70 mg/dL during 6 months of follow-up. There were 31 prespecified secondary outcomes, including additional CGM metrics for hypoglycemia, hyperglycemia, and glucose control; hemoglobin A1c (HbA1c); and cognition and patient-reported outcomes, with adjustment for multiple comparisons to control for false-discovery rate.ResultsOf the 203 participants (median age, 68 [interquartile range {IQR}, 65-71] years; median type 1 diabetes duration, 36 [IQR, 25-48] years; 52% female; 53% insulin pump use; mean HbA1c, 7.5% [SD, 0.9%]), 83% used CGM at least 6 days per week during month 6. Median time with glucose levels less than 70 mg/dL was 5.1% (73 minutes per day) at baseline and 2.7% (39 minutes per day) during follow-up in the CGM group vs 4.7% (68 minutes per day) and 4.9% (70 minutes per day), respectively, in the standard BGM group (adjusted treatment difference, -1.9% (-27 minutes per day); 95% CI, -2.8% to -1.1% [-40 to -16 minutes per day]; P <.001). Of the 31 prespecified secondary end points, there were statistically significant differences for all 9 CGM metrics, 6 of 7 HbA1c outcomes, and none of the 15 cognitive and patient-reported outcomes. Mean HbA1c decreased in the CGM group compared with the standard BGM group (adjusted group difference, -0.3%; 95% CI, -0.4% to -0.1%; P <.001). The most commonly reported adverse events using CGM and standard BGM, respectively, were severe hypoglycemia (1 and 10), fractures (5 and 1), falls (4 and 3), and emergency department visits (6 and 8).Conclusions and relevanceAmong adults aged 60 years or older with type 1 diabetes, continuous glucose monitoring compared with standard blood glucose monitoring resulted in a small but statistically significant improvement in hypoglycemia over 6 months. Further research is needed to understand the long-term clinical benefit.Trial registrationClinicalTrials.gov Identifier: NCT03240432.

Project description:BackgroundFood insecurity, defined as inconsistent food access owing to cost, leads to poor health.ObjectiveTo test whether a medically tailored meal delivery program improved dietary quality in individuals with type 2 diabetes and food insecurity.DesignRandomized cross-over clinical trial.ParticipantsForty-four adults with diabetes, hemoglobin A1c > 8.0%, and food insecurity (defined as at least one positive item on the two-item "Hunger Vital Sign").InterventionIn the Community Servings: Food as Medicine for Diabetes cross-over clinical trial (NCT02426138), conducted from June 2015 to July 2017, we randomly assigned the order of "on-meals" (home delivery of 10 meals/week for 12 weeks delivered by Community Servings, a non-profit organization) and "off-meals" (12 weeks usual care and a Choose MyPlate healthy eating brochure) periods.Main measuresThe primary outcome was Healthy Eating Index 2010 score (HEI), assessed by three 24-h food recalls in both periods. Higher HEI score (range 0-100; clinically significant difference 5) represents better dietary quality. Secondary outcomes included food insecurity and self-reported hypoglycemia.Key resultsMean "on-meal" HEI score was 71.3 (SD 7.5) while mean "off-meal" HEI score was 39.9 (SD 7.8) (difference 31.4 points, p < 0.0001). Participants experienced improvements in almost all sub-categories of HEI score, with increased consumption of vegetables, fruits, and whole grains and decreased solid fats, alcohol, and added sugar consumption. Participants also reported lower food insecurity (42% "on-meal" vs. 62% "off-meal," p = 0.047), less hypoglycemia (47% "on-meal" vs. 64% "off-meal," p = 0.03), and fewer days where mental health interfered with quality of life (5.65 vs. 9.59 days out of 30, p = 0.03).ConclusionsFor food-insecure individuals with diabetes, medically tailored meals improved dietary quality and food insecurity and reduced hypoglycemia. Longer-term studies should evaluate effects on diabetes control (e.g., hemoglobin A1c) and patient-reported outcomes (e.g., well-being).

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Vigorous Intervals and Hypoglycemia in Type 1 Diabetes: A Randomized Cross Over Trial.

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Vigorous Intervals and Hypoglycemia in Type 1 Diabetes: A Randomized Cross Over Trial.

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