Establishment of a Predictive Model of Serum Glucose Changes Under Different Exercise Intensities and Durations Among Patients With Type 2 Diabetes Mellitus

Sensor-Based Assessment of Time-of-Day-Dependent Physiological Responses and Physical Performances during a Walking Football Match in Higher-Weight Men

Monitoring key physiological metrics, including heart rate and heart rate variability, has been shown to be of value in exercise science, disease management, and overall health. The purpose of this study was to investigate the diurnal variation of physiological responses and physical performances using digital biomarkers as a precise measurement tool during a walking football match (WFM) in higher-weight men. Nineteen males (mean age: 42.53 ± 12.18 years; BMI: 33.31 ± 4.31 kg·m-2) were engaged in a WFM at two different times of the day. Comprehensive evaluations of physiological parameters (e.g., cardiac autonomic function, lactate, glycemia, and oxygen saturation), along with physical performance, were assessed before, during, and after the match. Overall, there was a significant interaction (time of day x WFM) for mean blood pressure (MBP) (p = 0.007) and glycemia (p = 0.039). Glycemia decreased exclusively in the evening after WFM (p = 0.001), while mean blood pressure did not significantly change. Rating of perceived exertion was significantly higher in the evening than in the morning (p = 0.04), while the heart rate recovery after 1 min (HRR60s) of the match was lower in the evening than in the morning (p = 0.048). Overall, walking football practice seems to be safe, whatever the time of day. Furthermore, HRR60, glycemia, and (MBP) values were lower in the evening compared to the morning, suggesting that evening exercise practice could be safer for individuals with higher weight. The utilization of digital biomarkers for monitoring health status during WFM has been shown to be efficient.

Insulin Management Strategies for Exercise in Diabetes

There is no question that regular exercise can be beneficial and lead to improvements in overall cardiovascular health. However, for patients with diabetes, exercise can also lead to challenges in maintaining blood glucose balance, particularly if patients are prescribed insulin or certain oral hypoglycemic agents. Hypoglycemia is the most common adverse event associated with exercise and insulin therapy, and the fear of hypoglycemia is also the greatest barrier to exercise for many patients. With the appropriate insulin dose adjustments and, in some cases, carbohydrate supplementation, blood glucose levels can be better managed during exercise and in recovery. In general, insulin strategies that help facilitate weight loss with regular exercise and recommendations around exercise adjustments to prevent hypoglycemia and hyperglycemia are often not discussed with patients because the recommendations can be complex and may differ from one individual to the next. This is a review of the current published literature on insulin dose adjustments and starting-point strategies for patients with diabetes in preparation for safe exercise.

Development and validation of a predictive model of acute glucose response to exercise in individuals with type 2 diabetes

BACKGROUND

Our purpose was to develop and test a predictive model of the acute glucose response to exercise in individuals with type 2 diabetes.

DESIGN AND METHODS

Data from three previous exercise studies (56 subjects, 488 exercise sessions) were combined and used as a development dataset. A mixed-effects Least Absolute Shrinkage Selection Operator (LASSO) was used to select predictors among 12 potential predictors. Tests of the relative importance of each predictor were conducted using the Lindemann Merenda and Gold (LMG) algorithm. Model structure was tested using likelihood ratio tests. Model accuracy in the development dataset was assessed by leave-one-out cross-validation.Prospectively captured data (47 individuals, 436 sessions) was used as a test dataset. Model accuracy was calculated as the percentage of predictions within measurement error. Overall model utility was assessed as the number of subjects with ≤1 model error after the third exercise session. Model accuracy across individuals was assessed graphically. In a post-hoc analysis, a mixed-effects logistic regression tested the association of individuals' attributes with model error.

RESULTS

Minutes since eating, a non-linear transformation of minutes since eating, post-prandial state, hemoglobin A1c, sulfonylurea status, age, and exercise session number were identified as novel predictors. Minutes since eating, its transformations, and hemoglobin A1c combined to account for 19.6% of the variance in glucose response. Sulfonylurea status, age, and exercise session each accounted for <1.0% of the variance. In the development dataset, a model with random slopes for pre-exercise glucose improved fit over a model with random intercepts only (likelihood ratio 34.5, p < 0.001). Cross-validated model accuracy was 83.3%.In the test dataset, overall accuracy was 80.2%. The model was more accurate in pre-prandial than postprandial exercise (83.6% vs. 74.5% accuracy respectively). 31/47 subjects had ≤1 model error after the third exercise session. Model error varied across individuals and was weakly associated with within-subject variability in pre-exercise glucose (Odds ratio 1.49, 95% Confidence interval 1.23-1.75).

CONCLUSIONS

The preliminary development and test of a predictive model of acute glucose response to exercise is presented. Further work to improve this model is discussed.

Exploring the variability in acute glycemic responses to exercise in type 2 diabetes

AIM

To explore the factors associated with exercise-induced acute capillary glucose (CapBG) changes in individuals with type 2 diabetes (T2D).

METHODS

Fifteen individuals with T2D were randomly assigned to energy-matched high intensity interval exercise (HI-IE) and moderate intensity continuous exercise (MI-CE) interventions and performed a designated exercise protocol 5 days per week for 12 weeks. The duration of exercise progressed from 30 to 60 minutes. CapBG was measured immediately before and after each exercise session. Timing of food and antihyperglycemic medication intake prior to exercise was recorded.

RESULTS

Overall, the mean CapBG was lowered by 1.9 mmol/L (P < 0.001) with the change ranging from -8.9 to +2.7 mmol/L. Preexercise CapBG (44%; P < 0.001), medication (5%; P < 0.001), food intake (4%; P = 0.043), exercise duration (5%; P < 0.001), and exercise intensity (1%; P = 0.007) were all associated with CapBG changes, explaining 59% of the variability.

CONCLUSION

The greater reduction in CapBG seen in individuals with higher preexercise CapBG may suggest the importance of exercise in the population with elevated glycemia. Lower blood glucose can be achieved with moderate intensity exercise, but prolonging exercise duration and/or including brief bouts of intense exercise accentuate the reduction, which can further be magnified by performing exercise after meals and antihyperglycemic medication. This trial is registered with ClinicalTrial.gov NCT01144078.

Predictors of effects of lifestyle intervention on diabetes mellitus type 2 patients

The main aim of the study was to identify predictors of the effects of lifestyle intervention on diabetes mellitus type 2 patients by means of multivariate analysis. Data from a previously published randomised clinical trial, which compared the effects of a rehabilitation programme including standardised education and physical training sessions in the municipality's health care centre with the same duration of individual counseling in the diabetes outpatient clinic, were used. Data from 143 diabetes patients were analysed. The merged lifestyle intervention resulted in statistically significant improvements in patients' systolic blood pressure, waist circumference, exercise capacity, glycaemic control, and some aspects of general health-related quality of life. The linear multivariate regression models explained 45% to 80% of the variance in these improvements. The baseline outcomes in accordance to the logic of the regression to the mean phenomenon were the only statistically significant and robust predictors in all regression models. These results are important from a clinical point of view as they highlight the more urgent need for and better outcomes following lifestyle intervention for those patients who have worse general and disease-specific health.

Compliance with physical activity recommendations in US adults with diabetes

AIMS

To investigate whether US adults with diabetes meet both the national and American Diabetes Association (ADA) recommendations for physical activity compared with people without diabetes, and to examine the trends of this behaviour over time.

METHODS

We analysed data from large nationally representative cohorts from the 1996-2005 Behavioral Risk Factor Surveillance System. The number of participants ranged from 98 127 in 1996 to 204,977 in 2005, and the number of people with diabetes ranged from 4379 in 1996 to 13,608 in 2005. Participants were classified by their exercise status and physical activity levels. The age-standardized prevalence of physical activity participation or meeting physical activity recommendations was calculated in people with and without diabetes.

RESULTS

People with diabetes participated less in physical activity (63.1-68.9 vs. 71.7-78.3%) and met physical activity recommendations less than people without diabetes (40.2-42.9 vs. 48.0-51.5% for meeting national recommendations and 38.5-41.7 vs. 46.6-49.8% for meeting ADA recommendations). The percentage of people with diabetes who participated in physical activity in the past 10 years or met physical activity recommendations in the past 5 years did not vary, whereas significantly increasing trends were observed in people without diabetes. The odds for adults with diabetes meeting physical activity recommendations were significantly lower than in adults without diabetes even after multivariate adjustment.

CONCLUSION

People with diabetes were less likely to meet either national or ADA recommendations for physical activity than people without diabetes. Our results demonstrate the need for more efforts from health-care professionals to promote physical activity in people with diabetes.