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Young G, Dodier R, Youssef JE, Castle JR, Wilson L, Riddell MC, Jacobs PG. Design and In Silico Evaluation of an Exercise Decision Support System Using Digital Twin Models. J Diabetes Sci Technol 2024; 18:324-334. [PMID: 38390855 DOI: 10.1177/19322968231223217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/24/2024]
Abstract
BACKGROUND Managing glucose levels during exercise is challenging for individuals with type 1 diabetes (T1D) since multiple factors including activity type, duration, intensity and other factors must be considered. Current decision support tools lack personalized recommendations and fail to distinguish between aerobic and resistance exercise. We propose an exercise-aware decision support system (exDSS) that uses digital twins to deliver personalized recommendations to help people with T1D maintain safe glucose levels (70-180 mg/dL) and avoid low glucose (<70 mg/dL) during and after exercise. METHODS We evaluated exDSS using various exercise and meal scenarios recorded from a large, free-living study of aerobic and resistance exercise. The model inputs were heart rate, insulin, and meal data. Glucose responses were simulated during and after 30-minute exercise sessions (676 aerobic, 631 resistance) from 247 participants. Glucose outcomes were compared when participants followed exDSS recommendations, clinical guidelines, or did not modify behavior (no intervention). RESULTS exDSS significantly improved mean time in range for aerobic (80.2% to 92.3%, P < .0001) and resistance (72.3% to 87.3%, P < .0001) exercises compared with no intervention, and versus clinical guidelines (aerobic: 82.2%, P < .0001; resistance: 80.3%, P < .0001). exDSS reduced time spent in low glucose for both exercise types compared with no intervention (aerobic: 15.1% to 5.1%, P < .0001; resistance: 18.2% to 6.6%, P < .0001) and was comparable with following clinical guidelines (aerobic: 4.5%, resistance: 8.1%, P = N.S.). CONCLUSIONS The exDSS tool significantly improved glucose outcomes during and after exercise versus following clinical guidelines and no intervention providing motivation for clinical evaluation of the exDSS system.
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Affiliation(s)
- Gavin Young
- School of Medicine, Oregon Health & Science University, Portland, OR, USA
- Artificial Intelligence for Medical Systems Lab, Department of Biomedical Engineering, Oregon Health & Science University, Portland, OR, USA
| | - Robert Dodier
- Artificial Intelligence for Medical Systems Lab, Department of Biomedical Engineering, Oregon Health & Science University, Portland, OR, USA
| | - Joseph El Youssef
- Harold Schnitzer Diabetes Health Center, Division of Endocrinology, Oregon Health & Science University, Portland, OR, USA
| | - Jessica R Castle
- Harold Schnitzer Diabetes Health Center, Division of Endocrinology, Oregon Health & Science University, Portland, OR, USA
| | - Leah Wilson
- Harold Schnitzer Diabetes Health Center, Division of Endocrinology, Oregon Health & Science University, Portland, OR, USA
| | - Michael C Riddell
- School of Kinesiology & Health Science and The Muscle Health Research Centre, York University, Toronto, ON, Canada
| | - Peter G Jacobs
- Artificial Intelligence for Medical Systems Lab, Department of Biomedical Engineering, Oregon Health & Science University, Portland, OR, USA
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2
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Sammut MJ, McBey DP, Sayal AP, Melling CWJ. The Effects of Resistance Exercise Training on Skeletal Muscle Metabolism and Insulin Resistance Development in Female Rodents with Type 1 Diabetes. J Diabetes Res 2024; 2024:5549762. [PMID: 38435452 PMCID: PMC10904684 DOI: 10.1155/2024/5549762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Revised: 02/05/2024] [Accepted: 02/07/2024] [Indexed: 03/05/2024] Open
Abstract
The etiology of insulin resistance (IR) development in type 1 diabetes mellitus (T1DM) remains unclear; however, impaired skeletal muscle metabolism may play a role. While IR development has been established in male T1DM rodents, female rodents have yet to be examined in this context. Resistance exercise training (RT) has been shown to improve IR and is associated with a lower risk of hypoglycemia onset in T1DM compared to aerobic exercise. The purpose of this study was to investigate the effects of RT on IR development in female T1DM rodents. Forty Sprague Dawley eight-week-old female rats were divided into four groups: control sedentary (CS; n = 10), control trained (CT; n = 10), T1DM sedentary (DS; n = 10), and T1DM trained (DT; n = 10). Multiple low-dose streptozotocin injections were used to induce T1DM. Blood glucose levels were maintained in the 4-9 mmol/l range with intensive insulin therapy. CT and DT underwent weighted ladder climbing 5 days/week for six weeks. Intravenous glucose tolerance tests (IVGTT) were conducted on all animals following the six-week period. Results demonstrate that DS animals exhibited significantly increased weekly blood glucose measures compared to all groups including DT (p < 0.0001), despite similar insulin dosage levels. This was concomitant with a significant increase in insulin-adjusted area under the curve following IVGTT in DS (p < 0.05), indicative of a reduction in insulin sensitivity. Both DT and DS exhibited greater serum insulin concentrations compared to CT and CS (p < 0.05). DS animals also exhibited significantly greater glycogen content in white gastrocnemius muscle compared to CS and DT (p < 0.05), whereas DT and DS animals exhibited greater p-Akt: Akt ratio in the white vastus lateralis muscle and citrate synthase activity in the red vastus lateralis muscle compared to CS and CT (p < 0.05). These results indicate that female rodents with T1DM develop poor glycemic control and IR which can be attenuated with RT, possibly related to differences in intramyocellular glycogen content.
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Affiliation(s)
- Mitchell J. Sammut
- School of Kinesiology, Faculty of Health Sciences, Western University, London, ON, Canada
| | - David P. McBey
- School of Kinesiology, Faculty of Health Sciences, Western University, London, ON, Canada
| | - Amit P. Sayal
- School of Kinesiology, Faculty of Health Sciences, Western University, London, ON, Canada
| | - C. W. James Melling
- School of Kinesiology, Faculty of Health Sciences, Western University, London, ON, Canada
- Department of Physiology & Pharmacology, Schulich School of Medicine & Dentistry, Western University, London, ON, Canada
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Cuerda Del Pino A, Martín-San Agustín R, Laguna Sanz AJ, Diez JL, Palanca A, Rossetti P, Gumbau-Gimenez M, Ampudia-Blasco FJ, Bondia J. Accuracy of Two Continuous Glucose Monitoring Devices During Aerobic and High-Intensity Interval Training in Individuals with Type 1 Diabetes. Diabetes Technol Ther 2024. [PMID: 38215205 DOI: 10.1089/dia.2023.0535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2024]
Abstract
BBACKGROUND This study aimed to evaluate the accuracy of Dexcom G6 (DG6) and FreeStyle Libre-2 (FSL2) during aerobic training and HIIT in individuals with type 1 diabetes (T1D). METHODS Twenty-six males (mean age 29.3 ± 6.3 years and mean duration of diabetes 14.9 ± 6.1 years) participated in this study. Interstitial glucose levels were measured using DG6 and FSL2, while plasma glucose levels were measured every 10 min using YSI 2500 as the reference for glucose measurements in this study. The measurements began 20 min before the start of exercise and continued for 20 min after exercise. Seven measurements were taken for each subject and exercise. RESULTS Both DG6 and FSL2 devices showed significant differences compared to YSI glucose data for both aerobic and HIIT exercises. Continuous glucose monitoring (CGM) devices exhibited superior performance during HIIT than aerobic training, with DG6 showing a mean absolute relative difference (MARD) of 14.03% versus 31.98%, respectively. In the comparison between the two devices, FSL2 demonstrated significantly higher effectiveness in aerobic training, yet its performance was inferior to DG6 during HIIT. According to the 40/40 criteria, both sensors performed similarly, with marks over 93% for all ranges and both exercises, and above 99% for HIIT and in the >180 mg/dL range, which is in accordance with FDA guidelines. CONCLUSIONS The findings suggest that the accuracy of DG6 and FSL2 deteriorates during and immediately after exercise, but remains acceptable for both devices during HIIT. However, accuracy is compromised with DG6 during aerobic exercise. This study is the first to compare the accuracy of two CGMs, DG6 and FSL2, during two exercise modalities, using plasma glucose YSI measurements as the gold standard for comparisons.
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Affiliation(s)
- Alba Cuerda Del Pino
- University of Valencia, 16781, Department of Physiotherapy, Valencia, None, Spain;
| | - Rodrigo Martín-San Agustín
- University of Valencia, 16781, Department of Physiotherapy, C/Gasco Oliag 5, Valencia, None, Spain, 46010;
| | - Alejandro José Laguna Sanz
- Universidad Politécnica de Valencia, Instituto de Automática e Informática Industrial, Camino de Vera s/n, Valencia, Valencia, Spain, 46022;
| | - Jose Luis Diez
- Universitat Politecnica de Valencia, Institut d'Automàtica i Informàtica Industrial, Valencia, Spain;
| | | | - Paolo Rossetti
- Hospital Universitari i Politècnic La Fe, 16273, Endocrinology and Metabolism, Avda de Fernando Abril Martorell, n.106, Valencia, Spain, 46026;
| | - Maria Gumbau-Gimenez
- University of Valencia, 16781, Department of Physiotherapy, Valencia, None, Spain;
| | - F Javier Ampudia-Blasco
- Clinic University Hospital, Diabetes Reference Unit, Endocrinology and Nutrition Dep., Avda. Blasco Ibañez, 17, Valencia, Spain, 46010
- University of Valencia, Department of Medicine, Avda. Blasco Ibánez, 15, Valencia, Spain, 4610;
| | - Jorge Bondia
- Universitat Politècnica de València, 16774, Instituto Universitario de Automática e Informática Industrial, Camino de Vera, s/n, Valencia, Spain, 46022
- Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas, 468627, Madrid, Spain, 28029;
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Brummer J, Glasbrenner C, Hechenbichler Figueroa S, Koehler K, Höchsmann C. Continuous glucose monitoring for automatic real-time assessment of eating events and nutrition: a scoping review. Front Nutr 2024; 10:1308348. [PMID: 38264192 PMCID: PMC10804456 DOI: 10.3389/fnut.2023.1308348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Accepted: 12/13/2023] [Indexed: 01/25/2024] Open
Abstract
Background Accurate dietary assessment remains a challenge, particularly in free-living settings. Continuous glucose monitoring (CGM) shows promise in optimizing the assessment and monitoring of ingestive activity (IA, i.e., consumption of calorie-containing foods/beverages), and it might enable administering dietary Just-In-Time Adaptive Interventions (JITAIs). Objective In a scoping review, we aimed to answer the following questions: (1) Which CGM approaches to automatically detect IA in (near-)real-time have been investigated? (2) How accurate are these approaches? (3) Can they be used in the context of JITAIs? Methods We systematically searched four databases until October 2023 and included publications in English or German that used CGM-based approaches for human (all ages) IA detection. Eligible publications included a ground-truth method as a comparator. We synthesized the evidence qualitatively and critically appraised publication quality. Results Of 1,561 potentially relevant publications identified, 19 publications (17 studies, total N = 311; for 2 studies, 2 publications each were relevant) were included. Most publications included individuals with diabetes, often using meal announcements and/or insulin boluses accompanying meals. Inpatient and free-living settings were used. CGM-only approaches and CGM combined with additional inputs were deployed. A broad range of algorithms was tested. Performance varied among the reviewed methods, ranging from unsatisfactory to excellent (e.g., 21% vs. 100% sensitivity). Detection times ranged from 9.0 to 45.0 min. Conclusion Several CGM-based approaches are promising for automatically detecting IA. However, response times need to be faster to enable JITAIs aimed at impacting acute IA. Methodological issues and overall heterogeneity among articles prevent recommending one single approach; specific cases will dictate the most suitable approach.
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Zimmer RT, Auth A, Schierbauer J, Haupt S, Wachsmuth N, Zimmermann P, Voit T, Battelino T, Sourij H, Moser O. (Hybrid) Closed-Loop Systems: From Announced to Unannounced Exercise. Diabetes Technol Ther 2023. [PMID: 38133645 DOI: 10.1089/dia.2023.0293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2023]
Abstract
Physical activity and exercise have many beneficial effects on general and type 1 diabetes (T1D) specific health and are recommended for individuals with T1D. Despite these health benefits, many people with T1D still avoid exercise since glycemic management during physical activity poses substantial glycemic and psychological challenges - which hold particularly true for unannounced exercise when using an AID system. Automated insulin delivery (AID) systems have demonstrated their efficacy in improving overall glycemia and in managing announced exercise in numerous studies. They are proven to increase time in range (70-180 mg/dL) and can especially counteract nocturnal hypoglycemia, even when evening exercise was performed. AID-systems consist of a pump administering insulin as well as a CGM sensor (plus transmitter), both communicating with a control algorithm integrated into a device (insulin pump, mobile phone/smart watch). Nevertheless, without manual pre-exercise adaptions, these systems still face a significant challenge around physical activity. Automatically adapting to the rapidly changing insulin requirements during unannounced exercise and physical activity is still the Achilles' heel of current AID systems. There is an urgent need for improving current AID-systems to safely and automatically maintain glucose management without causing derailments - so that going forward, exercise announcements will not be necessary in the future. Therefore, this narrative literature review aimed to discuss technological strategies to how current AID-systems can be improved in the future and become more proficient in overcoming the hurdle of unannounced exercise. For this purpose, the current state-of-the-art therapy recommendations for AID and exercise as well as novel research approaches are presented along with potential future solutions - in order to rectify their deficiencies in the endeavor to achieve fully automated AID-systems even around unannounced exercise.
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Affiliation(s)
- Rebecca Tanja Zimmer
- University of Bayreuth, 26523, Division Exercise Physiology and Metabolism Institute of Sport Science, Bayreuth, Bavaria, Germany;
| | - Alexander Auth
- University of Bayreuth, 26523, Division Exercise Physiology and Metabolism Institute of Sport Science, Bayreuth, Bavaria, Germany;
| | - Janis Schierbauer
- University of Bayreuth, 26523, Division Exercise Physiology and Metabolism Institute of Sport Science, Bayreuth, Bavaria, Germany;
| | - Sandra Haupt
- University of Bayreuth, 26523, Division Exercise Physiology and Metabolism Institute of Sport Science, Bayreuth, Bavaria, Germany;
| | - Nadine Wachsmuth
- University of Bayreuth, 26523, Division Exercise Physiology and Metabolism Institute of Sport Science, Bayreuth, Bavaria, Germany;
| | - Paul Zimmermann
- University of Bayreuth, 26523, Division Exercise Physiology and Metabolism Institute of Sport Science, Bayreuth, Bavaria, Germany;
| | - Thomas Voit
- University of Bayreuth, 26523, Division Exercise Physiology and Metabolism Institute of Sport Science, Bayreuth, Bavaria, Germany;
| | - Tadej Battelino
- University Children's Hospital, Ljubljana, Slovenia, Department of Endocrinology, Diabetes and Metabolism, Bohoriceva 20, Ljubljana, Slovenia, 1000
- Slovenia;
| | - Harald Sourij
- Medical University of Graz, 31475, Auenbruggerplatz 15, 8036 Graz, Graz, Austria, 8036;
| | - Othmar Moser
- University of Bayreuth, 26523, Division Exercise Physiology and Metabolism Institute of Sport Science, Universitätsstraße 30, Bayreuth, Bayern, Germany, 95440;
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Lin Y, Cao X, Wang J, Liu Y. Optimal exercise combinations for patients with diabetes. Zhong Nan Da Xue Xue Bao Yi Xue Ban 2023; 48:1721-1730. [PMID: 38432863 PMCID: PMC10929948 DOI: 10.11817/j.issn.1672-7347.2023.230214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Indexed: 03/05/2024]
Abstract
OBJECTIVES Exercise is a key way to control the blood glucose, which can improve blood lipids and blood pressure, reduce glycated hemoglobin levels, and increase insulin sensitivity. It is of great significance for maintaining blood glucose homeostasis. This study aims to explore the optimal exercise combinations suitable for diabetic patients, and to provide scientific and effective personalized exercise guidance for diabetic patients. METHODS The physical examination data and questionnaire results of were collected from the Third Xiangya Hospital of Central South University. The study was involved in 3 867 diabetes from January, 2020 to December, 2021. The basic information and living habits were obtained through questionnaires. The fasting blood samples were collected to measure the levels of total cholesterol (TCh), triglyceride, high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), and fasting blood glucose. Physical measurements included height, weight, waistline, hipline, and blood pressure. Categorical variables were tested using chi-square tests, and continuous variables were tested using non-parametric Kruskal-Wallis test. Multiple linear regression model was used to analyze the relationship between exercise behaviors (frequency, duration, and intensity), years of exercise, diet habits, medicine, and fasting blood glucose. The relationship between different exercise behaviors and various indexes (BMI, blood pressure, blood lipids, blood glucose) was analyzed by multiple rising sun rose plots. The polar thermal diagram showed the relationship of exercise behaviors with the best expected effect. RESULTS Non-parametric Kruskal-Wallis test showed that there were significant differences in other indexes except LDL-C (P=0.681) among groups with different exercise behaviors (all P<0.01). The multiple rising sun rose plots showed that diabetic patients who did moderate to high intensity exercise more than 5 times a week for more than 30 min each time had a healthier BMI, blood lipid levels, blood glucose levels, and blood pressure. Polar thermal diagram showed that low-intensity exercise once or twice a week requires 30 to 60 min or more of exercise to achieve the desired results. Multiple linear regression analysis showed that frequency (β=-0.208, 95% CI -0.356 to -0.059, P=0.006), duration (β=-0.227, 95% CI -0.387 to -0.066, P=0.006), intensity of exercise (β=-0.110, 95% CI -0.218 to -0.002, P=0.046), diet habits (β=0.462, 95% CI 0.295 to 0.556, P<0.001) and medicine (β=-0.520, 95% CI -0.720 to -0.312, P<0.001) were correlated with fasting blood glucose. CONCLUSIONS Moderate to high intensity exercise for more than 30 min and 5 times a week is the most beneficial combination for diabetes. Low exercise intensity should be combined with higher exercise frequency and longer exercise time to achieve the desired effect. With the increase of exercise intensity, the relationship between low exercise frequency and long exercise time is weakened.
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Affiliation(s)
- Yanhui Lin
- Health Management Center, Third Xiangya Hospital, Central South University, Changsha 410013.
| | - Xia Cao
- Health Management Center, Third Xiangya Hospital, Central South University, Changsha 410013
| | - Jiangang Wang
- Health Management Center, Third Xiangya Hospital, Central South University, Changsha 410013
| | - Yu Liu
- Department of Ophthalmology, Third Xiangya Hospital, Central South University, Changsha 410013, China.
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Minasian V, Nazari M. The association between type 1 diabetes and exercise/physical activity and prolongation of the honeymoon phase in patients. Life Sci 2023; 332:122114. [PMID: 37739162 DOI: 10.1016/j.lfs.2023.122114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2023] [Revised: 09/14/2023] [Accepted: 09/19/2023] [Indexed: 09/24/2023]
Abstract
In type 1 diabetes (T1D), pancreatic beta cells are destroyed by the immune system, causing chronic hyperglycemia and micro and macrovascular complications. However, some people experience a 'honeymoon' phase (or partial remission) after being diagnosed with type 1 diabetes. During this phase, a substantial amount of insulin is still produced by the pancreas, helping to reduce blood sugar levels and the requirement for external insulin. The clinical significance of this phase lies in the potential for pharmacological and non-pharmacological interventions during this time frame to either slow down or arrest beta-cell destruction. Clearly, we need to continue researching novel therapies like immunomodulatory agents, but we also need to look at potentially effective therapies with acceptable side effects that can serve as a complement to the medicines currently being studied. Physical activity and exercise, regardless of its type, is one of the factors its impact on the control of diabetes is being investigated and promising results have been achieved. Although there are still limited reports in this regard, there is some evidence to suggest that regular physical exercise could prolong the honeymoon period in both adults and children. In this review, having described the immune base of type 1 diabetes, we outline the benefits of exercise on the general health of individuals with T1D. Moreover, we centered on the honeymoon and current evidence suggesting the effects of physical activity and exercise on this phase duration.
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Affiliation(s)
- Vazgen Minasian
- Faculty of Sport Sciences, Department of Exercise physiology, University of Isfahan, Isfahan, Iran.
| | - Maryam Nazari
- Faculty of Sport Sciences, Department of Exercise physiology, University of Isfahan, Isfahan, Iran.
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Young GM, Jacobs PG, Tyler NS, Nguyen TTP, Castle JR, Wilson LM, Branigan D, Gabo V, Guillot FH, Riddell MC, El Youssef J. Quantifying insulin-mediated and noninsulin-mediated changes in glucose dynamics during resistance exercise in type 1 diabetes. Am J Physiol Endocrinol Metab 2023; 325:E192-E206. [PMID: 37436961 PMCID: PMC10511169 DOI: 10.1152/ajpendo.00298.2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Revised: 05/05/2023] [Accepted: 07/04/2023] [Indexed: 07/14/2023]
Abstract
Exercise can cause dangerous fluctuations in blood glucose in people living with type 1 diabetes (T1D). Aerobic exercise, for example, can cause acute hypoglycemia secondary to increased insulin-mediated and noninsulin-mediated glucose utilization. Less is known about how resistance exercise (RE) impacts glucose dynamics. Twenty-five people with T1D underwent three sessions of either moderate or high-intensity RE at three insulin infusion rates during a glucose tracer clamp. We calculated time-varying rates of endogenous glucose production (EGP) and glucose disposal (Rd) across all sessions and used linear regression and extrapolation to estimate insulin- and noninsulin-mediated components of glucose utilization. Blood glucose did not change on average during exercise. The area under the curve (AUC) for EGP increased by 1.04 mM during RE (95% CI: 0.65-1.43, P < 0.001) and decreased proportionally to insulin infusion rate (0.003 mM per percent above basal rate, 95% CI: 0.001-0.006, P = 0.003). The AUC for Rd rose by 1.26 mM during RE (95% CI: 0.41-2.10, P = 0.004) and increased proportionally with insulin infusion rate (0.04 mM per percent above basal rate, CI: 0.03-0.04, P < 0.001). No differences were observed between the moderate and high resistance groups. Noninsulin-mediated glucose utilization rose significantly during exercise before returning to baseline roughly 30-min postexercise. Insulin-mediated glucose utilization remained unchanged during exercise sessions. Circulating catecholamines and lactate rose during exercise despite relatively small changes observed in Rd. Results provide an explanation of why RE may pose a lower overall risk for hypoglycemia.NEW & NOTEWORTHY Aerobic exercise is known to cause decreases in blood glucose secondary to increased glucose utilization in people living with type 1 diabetes (T1D). However, less is known about how resistance-type exercise impacts glucose dynamics. Twenty-five participants with T1D performed in-clinic weight-bearing exercises under a glucose clamp. Mathematical modeling of infused glucose tracer allowed for quantification of the rate of hepatic glucose production as well as rates of insulin-mediated and noninsulin-mediated glucose uptake experienced during resistance exercise.
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Affiliation(s)
- Gavin M Young
- Artificial Intelligence for Medical Systems (AIMS) Laboratory, Department of Biomedical Engineering, Oregon Health & Science University, Portland, Oregon, United States
| | - Peter G Jacobs
- Artificial Intelligence for Medical Systems (AIMS) Laboratory, Department of Biomedical Engineering, Oregon Health & Science University, Portland, Oregon, United States
| | - Nichole S Tyler
- School of Medicine, Oregon Health & Science University, Portland, Oregon, United States
| | - Thanh-Tin P Nguyen
- School of Medicine, Oregon Health & Science University, Portland, Oregon, United States
| | - Jessica R Castle
- Division of Endocrinology, Harold Schnitzer Diabetes Health Center, Oregon Health & Science University, Portland, Oregon, United States
| | - Leah M Wilson
- Division of Endocrinology, Harold Schnitzer Diabetes Health Center, Oregon Health & Science University, Portland, Oregon, United States
| | - Deborah Branigan
- Division of Endocrinology, Harold Schnitzer Diabetes Health Center, Oregon Health & Science University, Portland, Oregon, United States
| | - Virginia Gabo
- School of Medicine, Oregon Health & Science University, Portland, Oregon, United States
| | - Florian H Guillot
- School of Medicine, Oregon Health & Science University, Portland, Oregon, United States
| | - Michael C Riddell
- School of Kinesiology and Health Science, York University, Toronto, Ontario, Canada
| | - Joseph El Youssef
- Division of Endocrinology, Harold Schnitzer Diabetes Health Center, Oregon Health & Science University, Portland, Oregon, United States
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Hall B, Żebrowska A, Sikora M, Siatkowski S, Robins A. The Effect of High-Intensity Interval Exercise on Short-Term Glycaemic Control, Serum Level of Key Mediator in Hypoxia and Pro-Inflammatory Cytokines in Patients with Type 1 Diabetes-An Exploratory Case Study. Nutrients 2023; 15:3749. [PMID: 37686781 PMCID: PMC10490106 DOI: 10.3390/nu15173749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 08/22/2023] [Accepted: 08/25/2023] [Indexed: 09/10/2023] Open
Abstract
Type 1 diabetes (T1D) is associated with hyperglycaemia-induced hypoxia and inflammation. This study assessed the effects of a single bout of high-intensity interval exercise (HIIE) on glycaemia (BG) and serum level of pro-inflammatory cytokines, and an essential mediator of adaptive response to hypoxia in T1D patients. The macronutrient intake was also evaluated. Nine patients suffering from T1D for about 12 years and nine healthy individuals (CG) were enrolled and completed one session of HIIE at the intensity of 120% lactate threshold with a duration of 4 × 5 min intermittent with 5 min rests after each bout of exercise. Capillary and venous blood were withdrawn at rest, immediately after and at 24 h post-HIIE for analysis of BG, hypoxia-inducible factor alpha (HIF-1α), tumour necrosis factor alpha (TNF-α) and vascular-endothelial growth factor (VEGF). Pre-exercise BG was significantly higher in the T1D patients compared to the CG (p = 0.043). HIIE led to a significant decline in T1D patients' BG (p = 0.027) and a tendency for a lower BG at 24 h post-HIIE vs. pre-HIIE. HIF-1α was significantly elevated in the T1D patients compared to CG and there was a trend for HIF-1α to decline, and for VEGF and TNF-α to increase in response to HIIE in the T1D group. Both groups consumed more and less than the recommended amounts of protein and fat, respectively. In the T1D group, a tendency for a higher digestible carbohydrate intake and more frequent hyperglycaemic episodes on the day after HIIE were observed. HIIE was effective in reducing T1D patients' glycaemia and improving short-term glycaemic control. HIIE has the potential to improve adaptive response to hypoxia by elevating the serum level of VEGF. Patients' diet and level of physical activity should be screened on a regular basis, and they should be educated on the glycaemic effects of digestible carbohydrates.
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Affiliation(s)
- Barbara Hall
- School of Physiological and Medical Sciences, Department of Physiology, The Jerzy Kukuczka Academy of Physical Education, Mikolowska Street 72a, 40-065 Katowice, Poland; (A.Ż.); (M.S.)
| | - Aleksandra Żebrowska
- School of Physiological and Medical Sciences, Department of Physiology, The Jerzy Kukuczka Academy of Physical Education, Mikolowska Street 72a, 40-065 Katowice, Poland; (A.Ż.); (M.S.)
| | - Marcin Sikora
- School of Physiological and Medical Sciences, Department of Physiology, The Jerzy Kukuczka Academy of Physical Education, Mikolowska Street 72a, 40-065 Katowice, Poland; (A.Ż.); (M.S.)
| | - Szymon Siatkowski
- Institute of Healthy Living, The Jerzy Kukuczka Academy of Physical Education, Mikolowska Street 72a, 40-065 Katowice, Poland;
| | - Anna Robins
- School of Health and Society, University of Salford, Allerton Building, 43 Crescent, Salford M5 4WT, UK;
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Tao D, Awan-Scully R, Cole A, Gao Y, Ash GI, Gu Y, Dutheil F, Sun Y, Baker JS. Integration of exercise prescription into medical provision as a treatment for non-communicable diseases: A scoping review. Front Public Health 2023; 11:1126244. [PMID: 37501942 PMCID: PMC10369190 DOI: 10.3389/fpubh.2023.1126244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2022] [Accepted: 03/22/2023] [Indexed: 07/29/2023] Open
Abstract
Background The purpose of this scoping review is to stimulate interest and to raise awareness, among researchers, healthcare practitioners, and policymakers regarding the current scientific literature related to exercise prescription for non-communicable diseases (NCDs). Exercise prescription is a safe and cost-effective method that enables physicians to use exercise as a complementary addition to NCDs management and treatment. Methods This scoping review followed the PRISMA Extension Guidelines for Scoping Reviews (PRISMA-ScR): Checklist and Explanation. Using this framework, we considered information from qualitative and quantitative studies to identify research gaps. We provide feasible suggestions to guide future research for the implementation of exercise prescription in the healthcare environment. The literature search was conducted using SPIDER and PICO tools for qualitative, quantitative, and mixed-study designs. Inclusion criteria included articles that investigated patients with NCDs and considered exercise interventions. Systematic searches of PubMed, Web of Science, MEDLINE, EMBASE, and ScienceDirect were undertaken on 26 July 2022 and all reference lists were manually searched. Data processing was performed using EndNote 2.0 software and data charts were used for numerical summary and thematic analysis. Results There were 10,951 articles retrieved, of which 28 met the inclusion criteria. Based on the evidence, exercise was a feasible, safe, and acceptable method to prevent and manage non-communicable diseases in inpatient and outpatient settings. Six research directions were identified and discussed. In addition, implementation evidence and suggestions for policy-reconfiguration are also provided. Conclusion This scoping review summarizes the current evidence for the effectiveness of exercise in the treatment of non-communicable diseases. The review provides key findings supporting exercise prescription for the inpatient and outpatient healthcare service. We suggest that governments and healthcare policymakers globally advocate the inclusion of structured exercise prescription within the NCDs treatment setting.
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Affiliation(s)
- Dan Tao
- Research Academy of Medicine Combining Sports, Ningbo No. 2 Hospital, Ningbo, China
- Department of Government and International Studies, Hong Kong Baptist University, Kowloon Tong, Hong Kong SAR, China
| | - Roger Awan-Scully
- Department of Government and International Studies, Hong Kong Baptist University, Kowloon Tong, Hong Kong SAR, China
| | - Alistair Cole
- Department of Government and International Studies, Hong Kong Baptist University, Kowloon Tong, Hong Kong SAR, China
| | - Yang Gao
- Centre for Health and Exercise Science Research, Population Health and Medical Informatics, Hong Kong Baptist University, Kowloon Tong, Hong Kong SAR, China
| | - Garrett I. Ash
- Center for Medical Informatics, Yale School of Medicine, Yale University, New Haven, CT, United States
| | - Yaodong Gu
- Research Academy of Medicine Combining Sports, Ningbo No. 2 Hospital, Ningbo, China
| | - Frederic Dutheil
- CNRS, LaPSCo, Physiological and Psychosocial Stress, CHU Clermont-Ferrand, University Hospital of Clermont-Ferrand, Preventive and Occupational Medicine, University Clermont Auvergne, Clermont-Ferrand, France
| | - Yan Sun
- Centre for Health and Exercise Science Research, Population Health and Medical Informatics, Hong Kong Baptist University, Kowloon Tong, Hong Kong SAR, China
| | - Julien S. Baker
- Centre for Health and Exercise Science Research, Population Health and Medical Informatics, Hong Kong Baptist University, Kowloon Tong, Hong Kong SAR, China
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Clemente-Suárez VJ, Martín-Rodríguez A, Redondo-Flórez L, López-Mora C, Yáñez-Sepúlveda R, Tornero-Aguilera JF. New Insights and Potential Therapeutic Interventions in Metabolic Diseases. Int J Mol Sci 2023; 24:10672. [PMID: 37445852 DOI: 10.3390/ijms241310672] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Revised: 06/13/2023] [Accepted: 06/21/2023] [Indexed: 07/15/2023] Open
Abstract
Endocrine homeostasis and metabolic diseases have been the subject of extensive research in recent years. The development of new techniques and insights has led to a deeper understanding of the mechanisms underlying these conditions and opened up new avenues for diagnosis and treatment. In this review, we discussed the rise of metabolic diseases, especially in Western countries, the genetical, psychological, and behavioral basis of metabolic diseases, the role of nutrition and physical activity in the development of metabolic diseases, the role of single-cell transcriptomics, gut microbiota, epigenetics, advanced imaging techniques, and cell-based therapies in metabolic diseases. Finally, practical applications derived from this information are made.
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Affiliation(s)
- Vicente Javier Clemente-Suárez
- Faculty of Sports Sciences, Universidad Europea de Madrid, Tajo Street, s/n, 28670 Madrid, Spain
- Grupo de Investigación en Cultura, Educación y Sociedad, Universidad de la Costa, Barranquilla 080002, Colombia
| | | | - Laura Redondo-Flórez
- Department of Health Sciences, Faculty of Biomedical and Health Sciences, Universidad Europea de Madrid, Tajo Street s/n, 28670 Villaviciosa de Odon, Spain
| | - Clara López-Mora
- Facultad de Ciencias Biomédicas y de la Salud, Universidad Europea de Valencia, Pg. de l'Albereda, 7, 46010 València, Spain
| | - Rodrigo Yáñez-Sepúlveda
- Faculty of Education and Social Sciences, Universidad Andres Bello, Viña del Mar 2520000, Chile
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Riddell MC, Li Z, Gal RL, Calhoun P, Jacobs PG, Clements MA, Martin CK, Doyle III FJ, Patton SR, Castle JR, Gillingham MB, Beck RW, Rickels MR. Examining the Acute Glycemic Effects of Different Types of Structured Exercise Sessions in Type 1 Diabetes in a Real-World Setting: The Type 1 Diabetes and Exercise Initiative (T1DEXI). Diabetes Care 2023; 46:704-713. [PMID: 36795053 PMCID: PMC10090894 DOI: 10.2337/dc22-1721] [Citation(s) in RCA: 27] [Impact Index Per Article: 27.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Accepted: 12/27/2022] [Indexed: 02/10/2023]
Abstract
OBJECTIVE Maintenance of glycemic control during and after exercise remains a major challenge for individuals with type 1 diabetes. Glycemic responses to exercise may differ by exercise type (aerobic, interval, or resistance), and the effect of activity type on glycemic control after exercise remains unclear. RESEARCH DESIGN AND METHODS The Type 1 Diabetes Exercise Initiative (T1DEXI) was a real-world study of at-home exercise. Adult participants were randomly assigned to complete six structured aerobic, interval, or resistance exercise sessions over 4 weeks. Participants self-reported study and nonstudy exercise, food intake, and insulin dosing (multiple daily injection [MDI] users) using a custom smart phone application and provided pump (pump users), heart rate, and continuous glucose monitoring data. RESULTS A total of 497 adults with type 1 diabetes (mean age ± SD 37 ± 14 years; mean HbA1c ± SD 6.6 ± 0.8% [49 ± 8.7 mmol/mol]) assigned to structured aerobic (n = 162), interval (n = 165), or resistance (n = 170) exercise were analyzed. The mean (± SD) change in glucose during assigned exercise was -18 ± 39, -14 ± 32, and -9 ± 36 mg/dL for aerobic, interval, and resistance, respectively (P < 0.001), with similar results for closed-loop, standard pump, and MDI users. Time in range 70-180 mg/dL (3.9-10.0 mmol/L) was higher during the 24 h after study exercise when compared with days without exercise (mean ± SD 76 ± 20% vs. 70 ± 23%; P < 0.001). CONCLUSIONS Adults with type 1 diabetes experienced the largest drop in glucose level with aerobic exercise, followed by interval and resistance exercise, regardless of insulin delivery modality. Even in adults with well-controlled type 1 diabetes, days with structured exercise sessions contributed to clinically meaningful improvement in glucose time in range but may have slightly increased time below range.
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Affiliation(s)
| | - Zoey Li
- Jaeb Center for Health Research, Tampa, FL
| | | | | | - Peter G. Jacobs
- Department of Biomedical Engineering, Oregon Health & Science University, Portland, OR
| | | | - Corby K. Martin
- Pennington Biomedical Research Center, Louisiana State University, Baton Rouge, LA
| | - Francis J. Doyle III
- Harvard John A. Paulson School of Engineering and Applied Sciences, Harvard University, Cambridge, MA
| | | | - Jessica R. Castle
- Harold Schnitzer Diabetes Health Center, Oregon Health & Science University, Portland, OR
| | - Melanie B. Gillingham
- Department of Molecular and Medical Genetics, Oregon Health & Science University, Portland, OR
| | | | - Michael R. Rickels
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
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Ivandic M, Cigrovski Berkovic M, Ormanac K, Sabo D, Omanovic Kolaric T, Kuna L, Mihaljevic V, Canecki Varzic S, Smolic M, Bilic-Curcic I. Management of Glycemia during Acute Aerobic and Resistance Training in Patients with Diabetes Type 1: A Croatian Pilot Study. Int J Environ Res Public Health 2023; 20:4966. [PMID: 36981876 PMCID: PMC10049388 DOI: 10.3390/ijerph20064966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Revised: 03/07/2023] [Accepted: 03/08/2023] [Indexed: 06/18/2023]
Abstract
(1) Background: The increased risk of developing hypoglycemia and worsening of glycemic stability during exercise is a major cause of concern for patients with type 1 diabetes mellitus (T1DM). (2) Aim: This pilot study aimed to assess glycemic stability and hypoglycemic episodes during and after aerobic versus resistance exercises using a flash glucose monitoring system in patients with T1DM. (3) Participants and Methods: We conducted a randomized crossover prospective study including 14 adult patients with T1DM. Patients were randomized according to the type of exercise (aerobic vs. resistance) with a recovery period of three days between a change of groups. Glucose stability and hypoglycemic episodes were evaluated during and 24 h after the exercise. Growth hormone (GH), cortisol, and lactate levels were determined at rest, 0, 30, and 60 min post-exercise period. (4) Results: The median age of patients was 53 years, with a median HbA1c of 7.1% and a duration of diabetes of 30 years. During both training sessions, there was a drop in glucose levels immediately after the exercise (0'), followed by an increase at 30' and 60', although the difference was not statistically significant. However, glucose levels significantly decreased from 60' to 24 h in the post-exercise period (p = 0.001) for both types of exercise. Glycemic stability was comparable prior to and after exercise for both training sessions. No differences in the number of hypoglycemic episodes, duration of hypoglycemia, and average glucose level in 24 h post-exercise period were observed between groups. Time to hypoglycemia onset was prolonged after the resistance as opposed to aerobic training (13 vs. 8 h, p = NS). There were no nocturnal hypoglycemic episodes (between 0 and 6 a.m.) after the resistance compared to aerobic exercise (4 vs. 0, p = NS). GH and cortisol responses were similar between the two sessions, while lactate levels were significantly more increased after resistance training. (5) Conclusion: Both exercise regimes induced similar blood glucose responses during and immediately following acute exercise.
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Affiliation(s)
- Marul Ivandic
- Department of Internal Medicine, University Hospital Osijek, 31000 Osijek, Croatia
| | | | - Klara Ormanac
- Department of Pharmacology, Faculty of Medicine Osijek, J. J. Strossmayer University of Osijek, 31000 Osijek, Croatia
| | - Dea Sabo
- Department of Pharmacology, Faculty of Medicine Osijek, J. J. Strossmayer University of Osijek, 31000 Osijek, Croatia
| | - Tea Omanovic Kolaric
- Department of Pharmacology, Faculty of Medicine Osijek, J. J. Strossmayer University of Osijek, 31000 Osijek, Croatia
- Department of Pharmacology and Biochemistry, Faculty of Dental Medicine and Health Osijek, J. J. Strossmayer University of Osijek, 31000 Osijek, Croatia
| | - Lucija Kuna
- Department of Pharmacology and Biochemistry, Faculty of Dental Medicine and Health Osijek, J. J. Strossmayer University of Osijek, 31000 Osijek, Croatia
| | - Vjera Mihaljevic
- Department of Pharmacology and Biochemistry, Faculty of Dental Medicine and Health Osijek, J. J. Strossmayer University of Osijek, 31000 Osijek, Croatia
| | | | - Martina Smolic
- Department of Pharmacology, Faculty of Medicine Osijek, J. J. Strossmayer University of Osijek, 31000 Osijek, Croatia
- Department of Pharmacology and Biochemistry, Faculty of Dental Medicine and Health Osijek, J. J. Strossmayer University of Osijek, 31000 Osijek, Croatia
| | - Ines Bilic-Curcic
- Department of Internal Medicine, University Hospital Osijek, 31000 Osijek, Croatia
- Department of Pharmacology, Faculty of Medicine Osijek, J. J. Strossmayer University of Osijek, 31000 Osijek, Croatia
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Maurya S, Kumar IR, Singh A, Mohanty S, Nagarathna R. Evaluating the Effectiveness of Yoga As An Adjunct Therapy In Type 1 Diabetes Care: Study Protocol of A Prospective Randomised Open Label Blinded End-point Trial. Advances in Integrative Medicine 2023. [DOI: 10.1016/j.aimed.2023.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/15/2023]
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15
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Eckstein ML, Aziz F, Aberer F, Böckel S, Zimmer RT, Erlmann MP, Sourij H, Moser O. Blood glucose response to running or cycling in individuals with type 1 diabetes: A systematic review and meta-analysis. Diabet Med 2023; 40:e14981. [PMID: 36259159 DOI: 10.1111/dme.14981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Revised: 10/03/2022] [Accepted: 10/17/2022] [Indexed: 01/17/2023]
Abstract
AIMS The aim of this systematic review and meta-analysis was to assess how running and cycling influence the magnitude of blood glucose (BG) excursions in individuals with type 1 diabetes. METHODS A systematic literature search was conducted in EMBASE, PubMed, Cochrane Central Register of Controlled Trials, and ISI Web of Knowledge for publications from January 1950 until February 2021. Parameters included for analysis were population (adults and adolescents), exercise type, intensity, duration and insulin preparation. The meta-analysis was performed to estimate the pooled mean with a 95% confidence interval (CI) of delta BG levels. In addition, sub-group and meta-regression analyses were performed to assess the influence of these parameters on delta BG. RESULTS The database search identified 3192 articles of which 69 articles were included in the meta-analysis. Due to crossover designs within articles, 151 different results were included for analysis. Data from 1901 exercise tests of individuals with type 1 diabetes with a mean age of 29 ± 4 years were included. Overall, exercise tests BG decreased by -3.1 mmol/L [-3.4; -2.8] within a mean duration of 46 ± 21 min. The pooled mean decrease in BG for running was -4.1 mmol/L [-4.7; -2.4], whilst the pooled mean decrease in BG for cycling was -2.7 mmol/L [-3.0; -2.4] (p < 0.0001). Overall results can be found in Table S2. CONCLUSIONS Running led to a larger decrease in BG in comparison to cycling. Active individuals with type 1 diabetes should be aware that current recommendations for glycaemic management need to be more specific to the mode of exercise.
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Affiliation(s)
- Max L Eckstein
- BaySpo - Bayreuth Center of Sport Science, Research Group Exercise Physiology and Metabolism, University Bayreuth, Bayreuth, Germany
| | - Faisal Aziz
- Interdisciplinary Metabolic Medicine Trials Unit, Division of Endocrinology and Diabetology, Medical University of Graz, Graz, Austria
| | - Felix Aberer
- BaySpo - Bayreuth Center of Sport Science, Research Group Exercise Physiology and Metabolism, University Bayreuth, Bayreuth, Germany
- Interdisciplinary Metabolic Medicine Trials Unit, Division of Endocrinology and Diabetology, Medical University of Graz, Graz, Austria
| | - Sina Böckel
- BaySpo - Bayreuth Center of Sport Science, Research Group Exercise Physiology and Metabolism, University Bayreuth, Bayreuth, Germany
| | - Rebecca T Zimmer
- BaySpo - Bayreuth Center of Sport Science, Research Group Exercise Physiology and Metabolism, University Bayreuth, Bayreuth, Germany
| | - Maximilian P Erlmann
- BaySpo - Bayreuth Center of Sport Science, Research Group Exercise Physiology and Metabolism, University Bayreuth, Bayreuth, Germany
| | - Harald Sourij
- Interdisciplinary Metabolic Medicine Trials Unit, Division of Endocrinology and Diabetology, Medical University of Graz, Graz, Austria
| | - Othmar Moser
- BaySpo - Bayreuth Center of Sport Science, Research Group Exercise Physiology and Metabolism, University Bayreuth, Bayreuth, Germany
- Interdisciplinary Metabolic Medicine Trials Unit, Division of Endocrinology and Diabetology, Medical University of Graz, Graz, Austria
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Abstract
Regular physical activity improves cardiometabolic and musculoskeletal health, helps with weight management, improves cognitive and psychosocial functioning, and is associated with reduced mortality related to cancer and diabetes mellitus. However, turnover rates of glucose in the blood increase dramatically during exercise, which often results in either hypoglycaemia or hyperglycaemia as well as increased glycaemic variability in individuals with type 1 diabetes mellitus (T1DM). A complex neuroendocrine response to an acute exercise session helps to maintain circulating levels of glucose in a fairly tight range in healthy individuals, while several abnormal physiological processes and limitations of insulin therapy limit the capacity of people with T1DM to exercise in a normoglycaemic state. Knowledge of the acute and chronic effects of exercise and regular physical activity is critical for the formulation of clinical strategies for the management of insulin and nutrition for active patients with T1DM. Emerging diabetes-related technologies, such as continuous glucose monitors, automated insulin delivery systems and the administration of solubilized glucagon, are demonstrating efficacy for preserving glucose homeostasis during and after exercise in this population of patients. This Review highlights the beneficial effects of regular exercise and details the complex endocrine and metabolic responses to different types of exercise for adults with T1DM. An overview of basic clinical strategies for the preservation of glucose homeostasis using emerging technologies is also provided.
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Affiliation(s)
- Michael C Riddell
- Muscle Health Research Centre, School of Kinesiology and Health Science, York University, Toronto, Ontario, Canada.
- LMC Diabetes and Endocrinology, Toronto, Ontario, Canada.
| | - Anne L Peters
- Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
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Pereira WVC, Vancea DMM, de Andrade Oliveira R, de Freitas YGPC, Lamounier RN, Silva Júnior WS, Fioretti AMB, Macedo CLD, Bertoluci MC, Zagury RL. 2022: Position of Brazilian Diabetes Society on exercise recommendations for people with type 1 and type 2 diabetes. Diabetol Metab Syndr 2023; 15:2. [PMID: 36593495 PMCID: PMC9806892 DOI: 10.1186/s13098-022-00945-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2022] [Accepted: 11/04/2022] [Indexed: 01/03/2023] Open
Abstract
INTRODUCTION For individuals diagnosed with diabetes mellitus, the practice of properly oriented physical exercises brings significant benefits to the individual's health and is considered an indispensable tool for metabolic management. The individualization of exercise routines is an essential aspect for therapeutic success, despite the need to consider some general recommendations. This review is an authorized literal translation of the Brazilian Society of Diabetes (SBD) Guidelines 2021-2022, which is based on scientific evidence and provides guidance on physical activities and exercises aimed at individuals with type 1 and 2 diabetes. METHODS SBD designated 9 specialists from its "Department of Diabetes, Exercise & Sports" to author chapters on physical activities and exercises directed to individuals with type 1 and 2 diabetes. The aim of these chapters was to highlight recommendations in accordance with Evidence Levels, based on what is described in the literature. These chapters were analyzed by the SBD Central Committee, which is also responsible for the SBD 2021-2022 guidelines. Main clinical inquiries were selected to perform a narrated review by using MEDLINE via PubMed. Top available evidence, such as high-quality clinical trials, large observational studies and meta-analyses related to physical activity and exercise advisory, were analyzed. The adopted MeSh terms were [diabetes], [type 1 diabetes], [type 2 diabetes], [physical activity] [physical exercise]. RESULTS 17 recommendations were defined by the members. For this review, it was considered different Evidence Levels, as well as different Classes of Recommendations. As to Evidence Levels, the following levels were contemplated: Level A) More than one randomized clinical trial or a randomized clinical trial meta-analysis with low heterogeneity. Level B) Meta analysis with observational studies, one randomized clinical trial, sizeable observational studies and sub-groups analysis. Level C) Small non-randomized studies, cross-sectional studies, case control studies, guidelines or experts' opinions. In respect to Recommendation Classes, the following criteria were adopted: I. "Recommended": Meaning there was a consent of more than 90% of the panel; IIa. "Must be considered": meaning there is a general preference of the panel which 70-90% agrees; IIb. "Can be considered". 50-70% agrees; III Not recommended: There is a consensus that the intervention should not be performed. CONCLUSION Physical exercise aids on the glycemic control of type 2 diabetes individuals while also decreasing cardiovascular risk in individuals with type 1 and 2 diabetes. Individuals diagnosed with diabetes should perform combined aerobic and resistance exercises in order to manage the disease. In addition, exercises focusing on flexibility and balance should be specially addressed on elderly individuals. Diabetes individuals using insulin as therapeutic treatment should properly monitor glycemia levels before, during and after exercise sessions to minimize health incidents, such as hypoglycemia.
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Affiliation(s)
- William Valadares Campos Pereira
- Research Group on Physical Exercise and Non-Transmissible Chronic Diseases from the Physical Education School of the University of Pernambuco (UPE), Recife, Brazil
| | - Denise Maria Martins Vancea
- Research Group on Physical Exercise and Non-Transmissible Chronic Diseases from the Physical Education School of the University of Pernambuco (UPE), Recife, Brazil
- Physical Education School of the University of Pernambuco (UPE), Avenida Agamenon Magalhães, S/N-Santo Amaro, Recife,, PE CEP 50100-010 Brazil
| | - Ricardo de Andrade Oliveira
- Department of Obesity and Associated Diseases of the Brazilian Obesity Association (ABESO), Board of Directors of the Rio de Janeiro Society of Exercise Medicine and Sports, Rio de Janeiro, Brazil
| | | | | | - Wellington S. Silva Júnior
- Endocrinology Discipline, Department of Medicine I, Faculty of Medicine, Center of Biological Sciences, Federal University of Maranhão (UFMA), Praça Gonçalves Dias, 21, Centro, São Luís, MA CEP 65020-240 Brazil
| | | | | | - Marcello Casaccia Bertoluci
- Internal Medicine Department, Federal University of Rio Grande do Sul (UFRGS), Ramiro Barcelos, 2350 Building 12, 4th Floor, Porto Alegre, RS Brazil
- Endocrinology Division, Hospital de Clínicas de Porto Alegre (HCPA), Ramiro Barcelos, 2350 Building 12, 4th Floor, Porto Alegre, RS Brazil
| | - Roberto Luis Zagury
- Luiz Capriglione State Institute of Diabetes and Endocrinology (IEDE), Rio de Janeiro, Brazil
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Grau-Del Valle C, Marco-Expósito JF, Bosch-Sierra N, Zaragoza-Villena B, Solá E, Montoya-Castilla I, Morillas C, Bañuls C. Effect of perceived stress, concern about hypoglycaemia and level of knowledge of management of the disease on glycaemic control in type 1 diabetes mellitus. J Clin Nurs 2023; 32:264-272. [PMID: 35224806 DOI: 10.1111/jocn.16270] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Revised: 11/10/2021] [Accepted: 01/10/2022] [Indexed: 12/14/2022]
Abstract
AIMS AND OBJECTIVES To evaluate perceived stress, concern about hypoglycaemia and the level of knowledge of management of the disease in patients with type 1 diabetes mellitus and their relationship with glycaemic control, gender and age. BACKGROUND Perceived stress and concern about hypoglycaemia are significant obstacles to achieving adequate glycaemic control in patients with type 1 diabetes mellitus, and notably influence management of the disease itself. MATERIAL AND METHODS A cross-sectional study was carried out in 193 adult patients with type 1 diabetes mellitus. Study quality was scored using the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) checklist for cohort studies. Glycaemic control was evaluated by number and type of hypoglycaemic event and glycosylated haemoglobin. Questionnaires about hypoglycaemia concern (HFS II), perceived stress (PSS), unrecognised hypoglycaemia (Clarke Test) and level of knowledge of the disease were completed. RESULTS Perceived stress was significantly associated with glycosylated haemoglobin (p < 0.001) and concern about hypoglycaemia (p < 0.037). With respect to level of knowledge, we observed that an advanced level was associated with lower glycosylated haemoglobin (p < 0.001), number (p < 0.001) and type (p < 0.001) of hypoglycaemic episode, and less perceived stress (p = 0.006). In addition, age was negatively correlated with perceived stress (p < 0.030) and positively correlated with the number of unrecognised hypoglycaemic episodes (p < 0.002), which was associated, in turn, with a higher number of daily glycaemia tests (p < 0.037) and concern about hypoglycaemia (p < 0.006). CONCLUSION In type 1 diabetes mellitus, perceived stress can negatively influence glycaemic control and concern about hypoglycaemia, and level of knowledge about the condition has a bearing on glycosylated haemoglobin levels, perceived stress and number and type of hypoglycaemic events. In addition, higher age is associated with more frequent unrecognised hypoglycaemic events. RELEVANCE TO CLINICAL PRACTICE It is essential to identify and address the psychological needs of patients with type 1 diabetes mellitus with the aim of achieving an adequate management of the disease itself and generating a change in future intervention strategies.
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Affiliation(s)
- Carmen Grau-Del Valle
- Department of Endocrinology and Nutrition, University Hospital Doctor Peset- Foundation for the Promotion of Health and Biomedical Research in the Valencian Region (FISABIO), Valencia, Spain
| | - José Francisco Marco-Expósito
- Department of Endocrinology and Nutrition, University Hospital Doctor Peset- Foundation for the Promotion of Health and Biomedical Research in the Valencian Region (FISABIO), Valencia, Spain
| | - Neus Bosch-Sierra
- Department of Endocrinology and Nutrition, University Hospital Doctor Peset- Foundation for the Promotion of Health and Biomedical Research in the Valencian Region (FISABIO), Valencia, Spain
| | - Begoña Zaragoza-Villena
- Department of Endocrinology and Nutrition, University Hospital Doctor Peset- Foundation for the Promotion of Health and Biomedical Research in the Valencian Region (FISABIO), Valencia, Spain
| | - Eva Solá
- Department of Endocrinology and Nutrition, University Hospital Doctor Peset- Foundation for the Promotion of Health and Biomedical Research in the Valencian Region (FISABIO), Valencia, Spain.,Departament of Medicine, University of Valencia, Valencia, Spain
| | | | - Carlos Morillas
- Department of Endocrinology and Nutrition, University Hospital Doctor Peset- Foundation for the Promotion of Health and Biomedical Research in the Valencian Region (FISABIO), Valencia, Spain.,Departament of Medicine, University of Valencia, Valencia, Spain
| | - Celia Bañuls
- Department of Endocrinology and Nutrition, University Hospital Doctor Peset- Foundation for the Promotion of Health and Biomedical Research in the Valencian Region (FISABIO), Valencia, Spain
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Yardley JE. Reassessing the evidence: prandial state dictates glycaemic responses to exercise in individuals with type 1 diabetes to a greater extent than intensity. Diabetologia 2022; 65:1994-1999. [PMID: 35978179 DOI: 10.1007/s00125-022-05781-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Accepted: 07/04/2022] [Indexed: 01/11/2023]
Abstract
Recent guidelines suggest that adding anaerobic (high intensity or resistance) activity to an exercise session can prevent blood glucose declines that occur during aerobic exercise in individuals with type 1 diabetes. This theory evolved from earlier study data showing that sustained, anaerobic activity (high intensity cycling) increases blood glucose levels in these participants. However, studies involving protocols where anaerobic (high intensity interval) and aerobic exercise are combined have extremely variable glycaemic outcomes, as do resistance exercise studies. Scrutinising earlier studies will reveal that, in addition to high intensity activity (intervals or weight lifting), these protocols had another common feature: participants were performing exercise after an overnight fast. Based on these findings, and data from recent exercise studies, it can be argued that participant prandial state may be a more dominant factor than exercise intensity where glycaemic changes in individuals with type 1 diabetes are concerned. As such, a reassessment of study outcomes and an update to exercise recommendations for those with type 1 diabetes may be warranted.
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Affiliation(s)
- Jane E Yardley
- Augustana Faculty, University of Alberta, Camrose, AB, Canada.
- Physical Activity and Diabetes Laboratory, Alberta Diabetes Institute, Edmonton, AB, Canada.
- Women and Children's Health Research Institute, Edmonton, AB, Canada.
- Faculty of Kinesiology, Sport and Recreation, University of Alberta, Edmonton, AB, Canada.
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Eckstein ML, Aberer F, Dobler FJR, Aziz F, Heise T, Sourij H, Moser O. Association of HbA1c with VO(2max) in Individuals with Type 1 Diabetes: A Systematic Review and Meta-Analysis. Metabolites 2022; 12. [PMID: 36355100 DOI: 10.3390/metabo12111017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2022] [Revised: 10/12/2022] [Accepted: 10/20/2022] [Indexed: 11/17/2022] Open
Abstract
The aim of this systematic review and meta-analysis was to evaluate the association between glycemic control (HbA1c) and functional capacity (VO2max) in individuals with type 1 diabetes (T1DM). A systematic literature search was conducted in EMBASE, PubMed, Cochrane Central Register of Controlled Trials, and ISI Web of Knowledge for publications from January 1950 until July 2020. Randomized and observational controlled trials with a minimum number of three participants were included if cardio-pulmonary exercise tests to determine VO2max and HbA1c measurement has been performed. Pooled mean values were estimated for VO2max and HbA1c and weighted Pearson correlation and meta-regression were performed to assess the association between these parameters. We included 187 studies with a total of 3278 individuals with T1DM. The pooled mean HbA1c value was 8.1% (95%CI; 7.9−8.3%), and relative VO2max was 38.5 mL/min/kg (37.3−39.6). The pooled mean VO2max was significantly lower (36.9 vs. 40.7, p = 0.001) in studies reporting a mean HbA1c > 7.5% compared to studies with a mean HbA1c ≤ 7.5%. Weighted Pearson correlation coefficient was r = −0.19 (p < 0.001) between VO2max and HbA1c. Meta-regression adjusted for age and sex showed a significant decrease of −0.94 mL/min/kg in VO2max per HbA1c increase of 1% (p = 0.024). In conclusion, we were able to determine a statistically significant correlation between HbA1c and VO2max in individuals with T1DM. However, as the correlation was only weak, the association of HbA1c and VO2max might not be of clinical relevance in individuals with T1DM.
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Wang L, Zhang H, Xu T, Zhang J, Liu Y, Qu Y. Effects of cheerleading practice on advanced glycation end products, areal bone mineral density, and physical fitness in female adolescents. Front Physiol 2022; 13:954672. [PMID: 36160858 PMCID: PMC9494030 DOI: 10.3389/fphys.2022.954672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Accepted: 08/08/2022] [Indexed: 11/13/2022] Open
Abstract
Background: Exercise has been widely reported to promote bone health, but it is unknown whether is associated with a reduction in advanced glycosylation end products (AGEs). This study aimed to investigate the effects of 14 weeks of cheerleading exercise on areal bone mineral density (aBMD) and AGEs. Methods: In this study, 46 female teenagers (age, 19.52 ± 1.21 years; body mass index, 20.15 ± 2.47 kg/m2) were randomly divided into a cheerleading group (CHE, n = 21) and a control group (CON, n = 25). The CHE group was subjected to cheerleading practice twice a week for 14 weeks; the CON group maintained their daily routine. Dual-energy X-ray absorptiometry was used to measure aBMD, and autofluorescence (AF) values were used to reflect AGEs. Physical fitness testing all-in-one machines are used to test body composition, cardiorespiratory fitness, muscle fitness and flexibility. A mixed ANOVA model was used to examine the effect of the intervention on each outcome. A multiple mediation model with covariates for physical activity and eating behaviors was performed to explore the mediators between cheerleading exercise and aBMD. Results: After 14 weeks of cheerleading practice, 1) aBMD increased significantly in both groups with significantly higher increases in the CHE group (p < 0.05). 2) AGEs significantly decreased in the CHE group (−2.7%), but not in the CON group (p > 0.05). 3) Vertical jumps and sit-ups significantly increased in the CHE group (p < 0.05), but not in the CON group (p > 0.05). 4) ΔAF values was significantly negatively correlated with Δ aBMD (r = −0.302, p < 0.05). 5) ΔAF values mediated the effect of exercise on the aBMD (indirect effect: 0.0032, 95% CI 0.0002–0.0079). Conclusion: Cheerleading practice improved aBMD and physical fitness and reduced AGEs accumulation in female adolescents. The effect of exercise on aBMD was partially mediated by AGEs.
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22
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Bronczek GA, Soares GM, Marmentini C, Boschero AC, Costa-Júnior JM. Resistance Training Improves Beta Cell Glucose Sensing and Survival in Diabetic Models. Int J Mol Sci 2022; 23:ijms23169427. [PMID: 36012692 PMCID: PMC9409046 DOI: 10.3390/ijms23169427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Revised: 08/15/2022] [Accepted: 08/16/2022] [Indexed: 11/16/2022] Open
Abstract
Resistance training increases insulin secretion and beta cell function in healthy mice. Here, we explored the effects of resistance training on beta cell glucose sensing and survival by using in vitro and in vivo diabetic models. A pancreatic beta cell line (INS-1E), incubated with serum from trained mice, displayed increased insulin secretion, which could be linked with increased expression of glucose transporter 2 (GLUT2) and glucokinase (GCK). When cells were exposed to pro-inflammatory cytokines (in vitro type 1 diabetes), trained serum preserved both insulin secretion and GCK expression, reduced expression of proteins related to apoptotic pathways, and also protected cells from cytokine-induced apoptosis. Using 8-week-old C57BL/6 mice, turned diabetic by multiple low doses of streptozotocin, we observed that resistance training increased muscle mass and fat deposition, reduced fasting and fed glycemia, and improved glucose tolerance. These findings may be explained by the increased fasting and fed insulinemia, along with increased beta cell mass and beta cell number per islet, observed in diabetic-trained mice compared to diabetic sedentary mice. In conclusion, we believe that resistance training stimulates the release of humoral factors which can turn beta cells more resistant to harmful conditions and improve their response to a glucose stimulus.
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Affiliation(s)
- Gabriela Alves Bronczek
- Obesity and Comorbidities Research Center, Institute of Biology, University of Campinas (UNICAMP), Campinas 13083-864, Brazil
| | - Gabriela Moreira Soares
- Obesity and Comorbidities Research Center, Institute of Biology, University of Campinas (UNICAMP), Campinas 13083-864, Brazil
| | - Carine Marmentini
- Obesity and Comorbidities Research Center, Institute of Biology, University of Campinas (UNICAMP), Campinas 13083-864, Brazil
| | - Antonio Carlos Boschero
- Obesity and Comorbidities Research Center, Institute of Biology, University of Campinas (UNICAMP), Campinas 13083-864, Brazil
| | - José Maria Costa-Júnior
- Obesity and Comorbidities Research Center, Institute of Biology, University of Campinas (UNICAMP), Campinas 13083-864, Brazil
- Center for Diabetes Research, Division of Endocrinology, Erasmus Hospital, Universite Libre de Bruxelles (ULB), 1070 Brussels, Belgium
- Correspondence: ; Tel.: +32-455-11-02-04
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Sarria-Santamera A, Alexeyeva Z, Yen Chan M, Ortega MA, Asunsolo-del-Barco A, Navarro-García C. Direct and Indirect Costs Related to Physical Activity Levels in Patients with Diabetes Mellitus in Spain: A Cross-Sectional Study. Healthcare (Basel) 2022; 10:healthcare10040752. [PMID: 35455929 PMCID: PMC9027157 DOI: 10.3390/healthcare10040752] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Revised: 04/11/2022] [Accepted: 04/15/2022] [Indexed: 02/01/2023] Open
Abstract
Diabetes mellitus (DM) is a global public health concern. DM is importantly linked to the modern lifestyle. Lifestyle-based interventions currently represent a critical preventive and therapeutic approach for patients with DM. Increasing physical activity has proven multiple benefits to prevent this condition; however, there is still room for further progress in this field, especially in terms of the effect of exercise in patients with already established DM. This study intends to examine the economic relationship between physical activity and direct/indirect costs in patients with DM. We analyze a national representative sample (n = 1496) of the general population of Spain, using available data from the National Health Survey of 2017 (NHS 2017). Our results show that 63.7% of the sample engaged in some degree of physical activity, being more frequent in men (67.5%), younger individuals (80.0%), and those with higher educational levels (69.7%). Conversely, lower levels of physical activity were associated with female sex, older subjects, and various comorbidities. Our study estimates that 2151 € per (51% in direct costs) patient may be saved if a minimum level of physical activity is implemented, primarily, due to a decrease in indirect costs (absenteeism and presenteeism). This study shows that physical activity will bring notable savings in terms of direct and indirect costs in patients with DM, particularly in some vulnerable groups.
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Affiliation(s)
- Antonio Sarria-Santamera
- Department of Medicine, Nazarbayev University School of Medicine, Nur-Sultan 010000, Kazakhstan; (Z.A.); (M.Y.C.)
- Correspondence:
| | - Zhanna Alexeyeva
- Department of Medicine, Nazarbayev University School of Medicine, Nur-Sultan 010000, Kazakhstan; (Z.A.); (M.Y.C.)
| | - Mei Yen Chan
- Department of Medicine, Nazarbayev University School of Medicine, Nur-Sultan 010000, Kazakhstan; (Z.A.); (M.Y.C.)
| | - Miguel A. Ortega
- Department of Medicine and Medical Specialities, Faculty of Medicine and Health Sciences, University of Alcalá, 28801 Alcala de Henares, Spain;
- Ramón y Cajal Institute of Sanitary Research (IRYCIS), 28034 Madrid, Spain;
| | - Angel Asunsolo-del-Barco
- Ramón y Cajal Institute of Sanitary Research (IRYCIS), 28034 Madrid, Spain;
- Department of Surgery, Medical and Social Sciences, Faculty of Medicine and Health Sciences, University of Alcalá, 28801 Alcala de Henares, Spain
| | - Carlos Navarro-García
- Faculty of Health and Sports Sciences, Universidad Alfonso X, Villanueva de la Cañada, 28691 Madrid, Spain;
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Wake AD. Protective effects of physical activity against health risks associated with type 1 diabetes: “Health benefits outweigh the risks”. World J Diabetes 2022; 13:161-184. [PMID: 35432757 PMCID: PMC8984568 DOI: 10.4239/wjd.v13.i3.161] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2021] [Revised: 12/08/2021] [Accepted: 02/20/2022] [Indexed: 02/06/2023] Open
Abstract
The magnitude of diabetes mellitus (DM) has increased in recent decades, where the number of cases and the proportion of the disease have been gradually increasing over the past few decades. The chronic complications of DM affect many organ systems and account for the majority of morbidity and mortality associated with the disease. The prevalence of type 1 DM (T1DM) is increasing globally, and it has a very significant burden on countries and at an individual level. T1DM is a chronic illness that requires ongoing medical care and patient self-management to prevent complications. This study aims to discuss the health benefits of physical activity (PA) in T1DM patients. The present review article was performed following a comprehensive literature search. The search was conducted using the following electronic databases: “Cochrane Library”, Web of Science, PubMed, HINARI, EMBASE, Google for grey literature, Scopus, African journals Online, and Google Scholar for articles published up to June 21, 2021. The present review focused on the effects of PA on many outcomes such as blood glucose (BG) control, physical fitness, endothelial function, insulin sensitivity, well-being, the body defense system, blood lipid profile, insulin resistance, cardiovascular diseases (CVDs), insulin requirements, blood pressure (BP), and mortality. It was found that many studies recommended the use of PA for the effective management of T1DM. PA is a component of comprehensive lifestyle modifications, which is a significant approach for the management of T1DM. It provides several health benefits, such as improving BG control, physical fitness, endothelial function, insulin sensitivity, well-being, and the body defense system. Besides this, it reduces the blood lipid profile, insulin resistance, CVDs, insulin requirements, BP, and mortality. Overall, PA has significant and essential protective effects against the health risks associated with T1DM. Even though PA has several health benefits for patients with T1DM, these patients are not well engaged in PA due to barriers such as a fear of exercise-induced hypoglycemia in particular. However, several effective strategies have been identified to control exercise-induced hypoglycemia in these patients. Finally, the present review concludes that PA should be recommended for the management of patients with T1DM due to its significant health benefits and protective effects against associated health risks. It also provides suggestions for the future direction of research in this field.
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Affiliation(s)
- Addisu Dabi Wake
- Department of Nursing, College of Health Sciences, Arsi University, Asella 193/4, Ethiopia
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25
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Flotyńska J, Jaz K, Cieluch A, Grzelka-Woźniak A, Kaczmarek A, Pypeć A, Ciepłucha W, Nowicka A, Zozulińska-Ziółkiewicz D, Uruska A. Association between physical activity before diagnosis and the presence of clinical remission in type 1 diabetes - InlipoDiab1 study. Diabetes Metab Res Rev 2022; 38:e3510. [PMID: 34729892 DOI: 10.1002/dmrr.3510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Accepted: 10/25/2021] [Indexed: 11/11/2022]
Abstract
AIM To investigate whether physical activity is associated with the occurrence of remission in adults with type 1 diabetes. METHODS Ninety nine adult participants with newly diagnosed type 1 diabetes were enroled into a prospective, observational study. The participants were advised to exercise 2-3 times a week with moderate intensity for a one-year period. Physical activity was assessed by a self-administrated questionnaire on every fourth visit. We counted the months in which participants fulfiled a partial-remission criteria: HbA1c < 6.5%, C-peptide > 0.5 ng/ml, and daily dose of insulin <0.3 U/kg/day. We assigned the participants to two groups: MORE EFFORT and LESS EFFORT, depending on the median value of physical activity in the studied population. RESULTS The occurrence of the remission achieved statistical significance at 6th month with a greater prevalence in MORE EFFORT group (55% vs. 35% p = 0.047). In multivariate logistic regression analysis for the occurrence of remission at 12th month, physical activity before the diagnosis was the only variable that influences the occurrence of the remission (adjusted odds ratios = 3.32 [95% confidence intervals 1.25-8.80]; p = 0.02). CONCLUSION In adults with newly diagnosed type 1 diabetes physical activity before the diagnosis is associated with higher occurrence of remission.
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Affiliation(s)
- Justyna Flotyńska
- Department of Internal Medicine and Diabetology, Raszeja Hospital, Poznan, Poland
| | - Kamila Jaz
- Department of Internal Medicine and Diabetology, Raszeja Hospital, Poznan, Poland
| | - Aleksandra Cieluch
- Department of Internal Medicine and Diabetology, Raszeja Hospital, Poznan, Poland
| | | | - Anita Kaczmarek
- Department of Internal Medicine and Diabetology, Raszeja Hospital, Poznan, Poland
| | - Aleksandra Pypeć
- Department of Internal Medicine and Diabetology, Raszeja Hospital, Poznan, Poland
| | - Wiktoria Ciepłucha
- Department of Internal Medicine and Diabetology, Raszeja Hospital, Poznan, Poland
| | - Aleksandra Nowicka
- Department of Internal Medicine and Diabetology, Raszeja Hospital, Poznan, Poland
| | | | - Aleksandra Uruska
- Department of Internal Medicine and Diabetology, Raszeja Hospital, Poznan, Poland
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Ghanemi A, Yoshioka M, St-Amand J. Exercise, Diet and Sleeping as Regenerative Medicine Adjuvants: Obesity and Ageing as Illustrations. Medicines (Basel) 2022; 9:medicines9010007. [PMID: 35049940 PMCID: PMC8778846 DOI: 10.3390/medicines9010007] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Revised: 01/11/2022] [Accepted: 01/13/2022] [Indexed: 12/21/2022]
Abstract
Regenerative medicine uses the biological and medical knowledge on how the cells and tissue regenerate and evolve in order to develop novel therapies. Health conditions such as ageing, obesity and cancer lead to an impaired regeneration ability. Exercise, diet choices and sleeping pattern have significant impacts on regeneration biology via diverse pathways including reducing the inflammatory and oxidative components. Thus, exercise, diet and sleeping management can be optimized towards therapeutic applications in regenerative medicine. It could allow to prevent degeneration, optimize the biological regeneration and also provide adjuvants for regenerative medicine.
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Affiliation(s)
- Abdelaziz Ghanemi
- Functional Genomics Laboratory, Endocrinology and Nephrology Axis, CHU de Québec-Université Laval Research Center, Québec, QC G1V 4G2, Canada; (A.G.); (M.Y.)
- Department of Molecular Medicine, Faculty of Medicine, Laval University, Québec, QC G1V 0A6, Canada
| | - Mayumi Yoshioka
- Functional Genomics Laboratory, Endocrinology and Nephrology Axis, CHU de Québec-Université Laval Research Center, Québec, QC G1V 4G2, Canada; (A.G.); (M.Y.)
| | - Jonny St-Amand
- Functional Genomics Laboratory, Endocrinology and Nephrology Axis, CHU de Québec-Université Laval Research Center, Québec, QC G1V 4G2, Canada; (A.G.); (M.Y.)
- Department of Molecular Medicine, Faculty of Medicine, Laval University, Québec, QC G1V 0A6, Canada
- Correspondence: ; Tel.: +1-418-654-2296
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Mosquera-Lopez C, Jacobs PG. Incorporating Glucose Variability into Glucose Forecasting Accuracy Assessment Using the New Glucose Variability Impact Index and the Prediction Consistency Index: An LSTM Case Example. J Diabetes Sci Technol 2022; 16:7-18. [PMID: 34490793 PMCID: PMC8875041 DOI: 10.1177/19322968211042621] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND In this work, we developed glucose forecasting algorithms trained and evaluated on a large dataset of free-living people with type 1 diabetes (T1D) using closed-loop (CL) and sensor-augmented pump (SAP) therapies; and we demonstrate how glucose variability impacts accuracy. We introduce the glucose variability impact index (GVII) and the glucose prediction consistency index (GPCI) to assess the accuracy of prediction algorithms. METHODS A long-short-term-memory (LSTM) neural network was designed to predict glucose up to 60 minutes in the future using continuous glucose measurements and insulin data collected from 175 people with T1D (41,318 days) and evaluated on 75 people (11,333 days) from the Tidepool Big Data Donation Dataset. LSTM was compared with two naïve forecasting algorithms as well as Ridge linear regression and a random forest using root-mean-square error (RMSE). Parkes error grid quantified clinical accuracy. Regression analysis was used to derive the GVII and GPCI. RESULTS The LSTM had highest accuracy and best GVII and GPCI. RMSE for CL was 19.8 ± 3.2 and 33.2 ± 5.4 mg/dL for 30- and 60-minute prediction horizons, respectively. RMSE for SAP was 19.6 ± 3.8 and 33.1 ± 7.3 mg/dL for 30- and 60-minute prediction horizons, respectively; 99.6% and 97.6% of predictions were within zones A+B of the Parkes error grid at 30- and 60-minute prediction horizons, respectively. Glucose variability was strongly correlated with RMSE (R≥0.64, P < 0.001); GVII and GPCI demonstrated a means to compare algorithms across datasets with different glucose variability. CONCLUSIONS The LSTM model was accurate on a large real-world free-living dataset. Glucose variability should be considered when assessing prediction accuracy using indices such as GVII and GPCI.
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Affiliation(s)
- Clara Mosquera-Lopez
- Artificial Intelligence for Medical Systems (AIMS) Lab, Department of Biomedical Engineering, Oregon Health & Science University, Portland, OR, USA
- Clara Mosquera-Lopez, PhD, 3303 SW Bond Avenue, Portland, OR 97239, USA.
| | - Peter G. Jacobs
- Artificial Intelligence for Medical Systems (AIMS) Lab, Department of Biomedical Engineering, Oregon Health & Science University, Portland, OR, USA
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Hamasaki H. What can hand grip strength tell us about type 2 diabetes?: mortality, morbidities and risk of diabetes. Expert Rev Endocrinol Metab 2021; 16:237-250. [PMID: 34402694 DOI: 10.1080/17446651.2021.1967743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Accepted: 08/02/2021] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Hand grip strength (HGS) has been determined as a simple and cost effective method for evaluating overall skeletal muscle strength and quality. It has been used in numerous clinical studies to examine the association between skeletal muscle and type 2 diabetes (T2D). Previous studies have shown that HGS is significantly associated with mortality and cardiovascular disease (CVD) in patients with T2D. As the prevalence of T2D has seen a steady increase globally, HGS measurement can be useful and essential in managing T2D. AREAS COVERED This narrative review summarizes the current evidence regarding the association between HGS and T2D. HGS has been considered a useful tool for identifying risks for T2D, CVD, and mortality and evaluating skeletal muscle strength and quality. OPINION HGS should be measured in all patients with T2D together with height, weight, and waist circumference. However, there is yet no standard method used in measuring for HGS. T2D patients with a low HGS can engage in resistance training more effectively with appropriate advice based on HGS. Future studies clarifying the genetic association between skeletal muscle and T2D are needed to provide individualized exercise therapy.
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Wang W, Huang M, Wang J. THE EFFECT OF PHYSICAL EXERCISE ON BLOOD SUGAR CONTROL IN DIABETIC PATIENTS. REV BRAS MED ESPORTE 2021. [DOI: 10.1590/1517-8692202127032021_0103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
ABSTRACT Introduction Diabetes is a metabolic disease characterized by hyperglycemia. It is a metabolic syndrome in which blood sugar levels increase due to defects in insulin secretion or impaired function, or even both defects. Object To understand the effect of diabetic patients in controlling blood sugar through physical exercise, the paper analyzes the correlation between the exercise status and physiological indicators of diabetic patients in our hospital. Methods We randomly selected 41 diabetic patients and monitored their exercise. At the same time, we check the physiological indicators of the patients after the exercise is completed and analyze the control of blood sugar by sports. Results After healthy physical exercise, the blood sugar level of diabetic patients tended to stabilize, and the glycosylated hemoglobin level decreased. The blood sugar levels of patients who did not participate in healthy physical exercises were not stable, and their glycosylated hemoglobin levels did not improve. Conclusion Healthy sports is a simple, easy, safe and effective adjuvant therapy for the prevention and treatment of diabetes, and it is worthy of clinical promotion. Level of evidence II; Therapeutic studies - investigation of treatment results.
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Hassabi M, Esteghamati A, Halabchi F, Abedi-Yekta AH, Mahdaviani B, Hassanmirzaie B, Hosseinpanah F, Valizadeh M. Iranian National Clinical Practice Guideline for Exercise in Patients with Diabetes. Int J Endocrinol Metab 2021; 19:e109021. [PMID: 34567134 PMCID: PMC8453655 DOI: 10.5812/ijem.109021] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Revised: 02/04/2021] [Accepted: 04/10/2021] [Indexed: 11/23/2022] Open
Abstract
CONTEXT Growing evidence highlights the importance of physical activity as a critical element for the prevention and control of diabetes. However, there is no clinical practice guideline focusing on the different aspects of exercise in patients with diabetes, especially for the Iranian population. OBJECTIVE We aimed to prepare and adopt a clinical practice guideline to provide well-defined, simple, and concise responses to certain questions related to physical activity and exercise in all patients with diabetes, including type 1, 2, and gestational diabetes mellitus (GDM). EVIDENCE ACQUISITION A multidisciplinary team of experts in various fields (sports medicine specialists, endocrinologists, and cardiologists) developed the guideline. This group did the task in four stages: (1) identifying and refining the subject area using 17 clinical questions; (2) appraising evidence through a systematic review of the literature; (3) extracting recommendations from evidence and grading them as A, B, C, or D based on the quality, quantity, and consistency of existing evidence; and (4) subjecting the guideline to external review and finally selecting the recommendations with high scores of appropriateness and agreement. The final version was evaluated and approved by the National Deputy for Curative Affairs - Ministry of Health and Medical Education and has also been endorsed by the Iran Endocrine Society (IES) and Iranian Association of Sports and Exercise Medicine (IASEM). RESULTS The guideline consists of 52 recommendations addressing 17 important questions concerning different aspects of exercise prescription in Iranian patients with diabetes. CONCLUSIONS The guideline provides evidence-based information that may help physicians to prescribe exercise for Iranian patients with diabetes safely and effectively.
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Affiliation(s)
- Mohammad Hassabi
- Department of Sports and Exercise Medicine, Taleghani Hospital Research Development Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Alireza Esteghamati
- Endocrinology and Metabolism Research Center (EMRC), Vali-Asr Hospital, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Farzin Halabchi
- Department of Sports and Exercise Medicine, Imam Khomeini Complex Hospital, Tehran University of Medical Sciences, Tehran, Iran
- Corresponding Author: Department of Sports and Exercise Medicine, Imam Khomeini Complex Hospital, Tehran University of Medical Sciences, Tehran, Iran.
| | - Amir Hosein Abedi-Yekta
- Department of Sports and Exercise Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Behnaz Mahdaviani
- Department of Sports and Exercise Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Bahar Hassanmirzaie
- Sports Medicine Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Farhad Hosseinpanah
- Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Majid Valizadeh
- Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Särnblad S, Ponsot E, Leprêtre PM, Kadi F. Acute effects of aerobic continuous, intermittent, and resistance exercise on glycemia in adolescents males with type 1 diabetes. Pediatr Diabetes 2021; 22:610-617. [PMID: 33650298 DOI: 10.1111/pedi.13194] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Revised: 01/22/2021] [Accepted: 02/05/2021] [Indexed: 12/28/2022] Open
Abstract
OBJECTIVE Increased levels of physical activity is often associated with reduced HbA1c in individuals with diabetes. However, the effect on glycemic control differs between different programs of exercise. The aim of this study was to compare the acute effects on glycemia of resistance and two aerobic continuous and intermittent exercise bouts in adolescent males with type 1 diabetes. RESEARCH DESIGN AND METHODS Eight active males with type 1 diabetes (17.5 ± 0.8 years, BMI: 20.8 ± 2.2 kg/m2 , HbA1c: 7.2 ± 0.5% [54.9 ± 5.3 mmol/mol]) performed four experimental sessions-nonexercise (control), resistance exercise (RE) and two isocaloric continuous (CE) and intermittent (IE) cycling exercise trials-in a randomized order. Each session consisted of 45 min of exercise (except for the control modality) and 60 min of passive recovery. Venous blood was drawn for assessment of plasma glucose (PG). A two-way repeated-measures ANOVA was used for statistical comparisons. RESULTS A significant time-to-exercise interaction effect on PG was detected. PG significantly decreased during IE (-5.1 ± 1.6 mmol/L) and CE (-5.4 ± 1.8 mmol/L) but not during RE (-1.0 ± 1.4 mmol/L, ns). Additionally, decreases in PG after IE and CE were sustained throughout the recovery period. CONCLUSIONS While intermittent and continuous aerobic exercises are associated with a lowering of glycemia in male adolescents with type 1 diabetes, glycemia remained stable without significant alterations after resistance exercise. These findings hold important implications related to clinical exercise advice and disease management in adolescents with type 1 diabetes.
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Affiliation(s)
- Stefan Särnblad
- Department of Pediatrics, School of Medical Sciences, Örebro University, Örebro, SE, Sweden
| | - Elodie Ponsot
- School of Health Sciences, Örebro University, Örebro, SE, Sweden
| | - Pierre-Marie Leprêtre
- School of Health Sciences, Örebro University, Örebro, SE, Sweden.,Faculty of Sport Sciences, University of Picardie Jules Verne, Amiens, France.,Cardiovascular Rehabilitation Unit, Hospital center of Corbie, Corbie, France
| | - Fawzi Kadi
- School of Health Sciences, Örebro University, Örebro, SE, Sweden
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32
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Riddell MC, Li Z, Beck RW, Gal RL, Jacobs PG, Castle JR, Gillingham MB, Clements M, Patton SR, Dassau E, Doyle III FJ, Martin CK, Calhoun P, Rickels MR. More Time in Glucose Range During Exercise Days than Sedentary Days in Adults Living with Type 1 Diabetes. Diabetes Technol Ther 2021; 23:376-383. [PMID: 33259257 PMCID: PMC8080930 DOI: 10.1089/dia.2020.0495] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Objective: This study analysis was designed to examine the 24-h effects of exercise on glycemic control as measured by continuous glucose monitoring (CGM). Methods: Individuals with type 1 diabetes (ages: 15-68 years; hemoglobin A1c: 7.5% ± 1.5% [mean ± standard deviation (SD)]) were randomly assigned to complete twice-weekly aerobic, high-intensity interval, or resistance-based exercise sessions in addition to their personal exercise sessions for a period of 4 weeks. Exercise was tracked with wearables and glucose concentrations assessed using CGM. An exercise day was defined as a 24-h period after the end of exercise, while a sedentary day was defined as any 24-h period with no recorded exercise ≥10 min long. Sedentary days start at least 24 h after the end of exercise. Results: Mean glucose was lower (150 ± 45 vs. 166 ± 49 mg/dL, P = 0.01), % time in range [70-180 mg/dL] higher (62% ± 23% vs. 56% ± 25%, P = 0.03), % time >180 mg/dL lower (28% ± 23% vs. 37% ± 26%, P = 0.01), and % time <70 mg/dL higher (9.3% ± 11.0% vs. 7.1% ± 9.1%, P = 0.04) on exercise days compared with sedentary days. Glucose variability and % time <54 mg/dL did not differ significantly between exercise and sedentary days. No significant differences in glucose control by exercise type were observed. Conclusion: Participants had lower 24-h mean glucose levels and a greater time in range on exercise days compared with sedentary days, with mode of exercise affecting glycemia similarly. In summary, this study offers data supporting frequency of exercise as a method of facilitating glucose control but does not suggest an effect for mode of exercise.
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Affiliation(s)
- Michael C. Riddell
- School of Kinesiology and Health Science, York University, Toronto, Canada
- Address correspondence to, Michael C. Riddell, PhD, School of Kinesiology and Health Science, York University, 4700 Keele Street, Toronto M3J1P3, Ontario, Canada
| | - Zoey Li
- Jaeb Center for Health Research, Tampa, Florida, USA
| | - Roy W. Beck
- Jaeb Center for Health Research, Tampa, Florida, USA
| | - Robin L. Gal
- Jaeb Center for Health Research, Tampa, Florida, USA
| | | | | | | | - Mark Clements
- Children's Mercy Hospital, Kansas City, Missouri, USA
| | - Susana R. Patton
- Center for Healthcare Delivery Science, Nemours Children's Specialty Clinic, Jacksonville, Florida, USA
| | - Eyal Dassau
- Harvard John A. Paulson School of Engineering and Applied Sciences, Harvard University, Cambridge, Massachusetts, USA
| | - Francis J. Doyle III
- Harvard John A. Paulson School of Engineering and Applied Sciences, Harvard University, Cambridge, Massachusetts, USA
| | - Corby K. Martin
- Pennington Biomedical Research Center, Louisiana State University, Baton Rouge, Louisiana, USA
| | - Peter Calhoun
- Jaeb Center for Health Research, Tampa, Florida, USA
| | - Michael R. Rickels
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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33
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Bronczek GA, Soares GM, de Barros JF, Vettorazzi JF, Kurauti MA, Marconato-Júnior E, Zangerolamo L, Marmentini C, Boschero AC, Costa-Júnior JM. Resistance exercise training improves glucose homeostasis by enhancing insulin secretion in C57BL/6 mice. Sci Rep 2021; 11:8574. [PMID: 33883630 DOI: 10.1038/s41598-021-88105-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Accepted: 04/06/2021] [Indexed: 01/14/2023] Open
Abstract
Resistance exercise exerts beneficial effects on glycemic control, which could be mediated by exercise-induced humoral factors released in the bloodstream. Here, we used C57Bl/6 healthy mice, submitted to resistance exercise training for 10 weeks. Trained mice presented higher muscle weight and maximum voluntary carrying capacity, combined with reduced body weight gain and fat deposition. Resistance training improved glucose tolerance and reduced glycemia, with no alterations in insulin sensitivity. In addition, trained mice displayed higher insulinemia in fed state, associated with increased glucose-stimulated insulin secretion. Islets from trained mice showed reduced expression of genes related to endoplasmic reticulum (ER) stress, associated with increased expression of Ins2. INS-1E beta-cells incubated with serum from trained mice displayed similar pattern of insulin secretion and gene expression than isolated islets from trained mice. When exposed to CPA (an ER stress inducer), the serum from trained mice partially preserved the secretory function of INS-1E cells, and prevented CPA-induced apoptosis. These data suggest that resistance training, in healthy mice, improves glucose homeostasis by enhancing insulin secretion, which could be driven, at least in part, by humoral factors.
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34
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Molveau J, Rabasa-Lhoret R, Taleb N, Heyman E, Myette-Côté É, Suppère C, Berthoin S, Tagougui S. Minimizing the Risk of Exercise-Induced Glucose Fluctuations in People Living With Type 1 Diabetes Using Continuous Subcutaneous Insulin Infusion: An Overview of Strategies. Can J Diabetes 2021; 45:666-676. [PMID: 33744123 DOI: 10.1016/j.jcjd.2021.01.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Revised: 01/11/2021] [Accepted: 01/11/2021] [Indexed: 12/16/2022]
Abstract
Physical activity (PA) is important for individuals living with type 1 diabetes (T1D) due to its various health benefits. Nonetheless, maintaining adequate glycemic control around PA remains a challenge for many individuals living with T1D because of the difficulty in properly managing circulating insulin levels around PA. Although the most common problem is increased incidence of hypoglycemia during and after most types of PA, hyperglycemia can also occur. Accordingly, a large proportion of people living with T1D are sedentary partly due to the fear of PA-associated hypoglycemia. Continuous subcutaneous insulin infusion (CSII) offers a higher precision and flexibility to adjust insulin basal rates and boluses according to the individual's specific needs around PA practice. Indeed, for physically active patients with T1D, CSII can be a preferred option to facilitate glucose regulation. To our knowledge, there are no guidelines to manage exercise-induced hypoglycemia during PA, specifically for individuals living with T1D and using CSII. In this review, we highlight the current state of knowledge on exercise-related glucose variations, especially hypoglycemic risk and its underlying physiology. We also detail the current recommendations for insulin modulations according to the different PA modalities (type, intensity, duration, frequency) in individuals living with T1D using CSII.
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Affiliation(s)
- Joséphine Molveau
- Institut de recherches cliniques de Montréal, Montréal, Québec, Canada; Département de Nutrition, Faculté de Médicine, Université de Montréal, Montreal, Québec, Canada
| | - Rémi Rabasa-Lhoret
- Institut de recherches cliniques de Montréal, Montréal, Québec, Canada; Département de Nutrition, Faculté de Médicine, Université de Montréal, Montreal, Québec, Canada; Département des Sciences Biomédicales, Faculté de Médicine, Université de Montréal, Montreal, Québec, Canada; Division of Endocrinology, McGill University, Montreal, Québec, Canada; Endocrinology Division, Montreal Diabetes Research Center, Montreal, Québec, Canada
| | - Nadine Taleb
- Institut de recherches cliniques de Montréal, Montréal, Québec, Canada; Département des Sciences Biomédicales, Faculté de Médicine, Université de Montréal, Montreal, Québec, Canada
| | - Elsa Heyman
- Université Lille, Unité de Recherche Pluridisciplinaire Sport Santé Société, Lille, France; Université Artois, Artois, France; Université Littoral Côte d'Opale, Dunkerque, France
| | - Étienne Myette-Côté
- Institut de recherches cliniques de Montréal, Montréal, Québec, Canada; Department of Medicine, McGill University, Montreal, Québec, Canada
| | - Corinne Suppère
- Institut de recherches cliniques de Montréal, Montréal, Québec, Canada
| | - Serge Berthoin
- Université Lille, Unité de Recherche Pluridisciplinaire Sport Santé Société, Lille, France; Université Artois, Artois, France; Université Littoral Côte d'Opale, Dunkerque, France
| | - Sémah Tagougui
- Institut de recherches cliniques de Montréal, Montréal, Québec, Canada; Département de Nutrition, Faculté de Médicine, Université de Montréal, Montreal, Québec, Canada; Université Lille, Unité de Recherche Pluridisciplinaire Sport Santé Société, Lille, France; Université Artois, Artois, France; Université Littoral Côte d'Opale, Dunkerque, France.
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35
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Myśliwiec A, Skalska M, Michalak A, Chrzanowski J, Szmigiero-Kawko M, Lejk A, Jastrzębska J, Radzimiński Ł, López-Sánchez GF, Gawrecki A, Jastrzębski Z. Responses to Low- and High-Intensity Exercise in Adolescents with Type 1 Diabetes in Relation to Their Level of VO 2 Max. Int J Environ Res Public Health 2021; 18:E692. [PMID: 33467392 DOI: 10.3390/ijerph18020692] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Revised: 12/31/2020] [Accepted: 01/09/2021] [Indexed: 12/20/2022]
Abstract
The purpose of this study was to investigate the influence of maximal oxygen uptake (VO2 max) on the glycemic changes during low and high intensity exercises in young type 1 diabetic patients. Twenty boys (age: 14.3 ± 1.6 years; height: 171.0 ± 11.3 cm; weight; 59.5 ± 12.8 kg) were divided into low-fit group (LFG, n = 10) and high-fit group (HFG, n = 10). According to the experimental design, participants performed three physical efforts (VO2 max test, mixed aerobic-anaerobic effort and aerobic effort) on the cycloergometer, during which real-time glycemia was measured. Mixed aerobic-anaerobic exercise demanded significantly smaller carbohydrate supplementation (0.2 ± 0.2 g/kg during exercise) than the aerobic test session (0.4 ± 0.3 g/kg during exercise). Moreover, patients with higher VO2 max had lower tendency for glycemic changes during the aerobic effort. The results of the current study suggest that young type 1 diabetic patients should perform different intensity activities using continuous glycemic monitoring system to avoid acute and chronic complications of the disease.
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36
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Muñoz Fabra E, Díez JL, Bondia J, Laguna Sanz AJ. A Comprehensive Review of Continuous Glucose Monitoring Accuracy during Exercise Periods. Sensors (Basel) 2021; 21:E479. [PMID: 33445438 DOI: 10.3390/s21020479] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Revised: 12/29/2020] [Accepted: 01/05/2021] [Indexed: 12/15/2022]
Abstract
Continuous Glucose Monitoring (CGM) has been a springboard of new diabetes management technologies such as integrated sensor-pump systems, the artificial pancreas, and more recently, smart pens. It also allows patients to make better informed decisions compared to a few measurements per day from a glucometer. However, CGM accuracy is reportedly affected during exercise periods, which can impact the effectiveness of CGM-based treatments. In this review, several studies that used CGM during exercise periods are scrutinized. An extensive literature review of clinical trials including exercise and CGM in type 1 diabetes was conducted. The gathered data were critically analysed, especially the Mean Absolute Relative Difference (MARD), as the main metric of glucose accuracy. Most papers did not provide accuracy metrics that differentiated between exercise and rest (non-exercise) periods, which hindered comparative data analysis. Nevertheless, the statistic results confirmed that CGM during exercise periods is less accurate.
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37
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Sangha GS, Goergen CJ, Prior SJ, Ranadive SM, Clyne AM. Preclinical techniques to investigate exercise training in vascular pathophysiology. Am J Physiol Heart Circ Physiol 2021; 320:H1566-H1600. [PMID: 33385323 PMCID: PMC8260379 DOI: 10.1152/ajpheart.00719.2020] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Atherosclerosis is a dynamic process starting with endothelial dysfunction and inflammation and eventually leading to life-threatening arterial plaques. Exercise generally improves endothelial function in a dose-dependent manner by altering hemodynamics, specifically by increased arterial pressure, pulsatility, and shear stress. However, athletes who regularly participate in high-intensity training can develop arterial plaques, suggesting alternative mechanisms through which excessive exercise promotes vascular disease. Understanding the mechanisms that drive atherosclerosis in sedentary versus exercise states may lead to novel rehabilitative methods aimed at improving exercise compliance and physical activity. Preclinical tools, including in vitro cell assays, in vivo animal models, and in silico computational methods, broaden our capabilities to study the mechanisms through which exercise impacts atherogenesis, from molecular maladaptation to vascular remodeling. Here, we describe how preclinical research tools have and can be used to study exercise effects on atherosclerosis. We then propose how advanced bioengineering techniques can be used to address gaps in our current understanding of vascular pathophysiology, including integrating in vitro, in vivo, and in silico studies across multiple tissue systems and size scales. Improving our understanding of the antiatherogenic exercise effects will enable engaging, targeted, and individualized exercise recommendations to promote cardiovascular health rather than treating cardiovascular disease that results from a sedentary lifestyle.
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Affiliation(s)
- Gurneet S Sangha
- Fischell Department of Bioengineering, University of Maryland, College Park, Maryland
| | - Craig J Goergen
- Weldon School of Biomedical Engineering, Purdue University, West Lafayette, Indiana.,Purdue University Center for Cancer Research, Purdue University, West Lafayette, Indiana
| | - Steven J Prior
- Department of Kinesiology, University of Maryland School of Public Health, College Park, Maryland.,Baltimore Veterans Affairs Geriatric Research, Education, and Clinical Center, Baltimore, Maryland
| | - Sushant M Ranadive
- Department of Kinesiology, University of Maryland School of Public Health, College Park, Maryland
| | - Alisa M Clyne
- Fischell Department of Bioengineering, University of Maryland, College Park, Maryland
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38
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Zhu X, Zhao L, Chen J, Lin C, Lv F, Hu S, Cai X, Zhang L, Ji L. The Effect of Physical Activity on Glycemic Variability in Patients With Diabetes: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Front Endocrinol (Lausanne) 2021; 12:767152. [PMID: 34867812 PMCID: PMC8635769 DOI: 10.3389/fendo.2021.767152] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Accepted: 10/28/2021] [Indexed: 01/03/2023] Open
Abstract
PURPOSE The effect of physical activity on glycemic variability remains controversial. This meta-analysis aimed to assess the overall effect of physical activity treatment on glycemic variability in patients with diabetes. METHODS PubMed/MEDLINE, Embase, and Cochrane databases were searched for clinical trials that conducted in patients with type 1 diabetes mellitus and type 2 diabetes mellitus with reports of the mean amplitude of glycemic excursion (MAGE), time in range (TIR), time above range (TAR), or time below range (TBR). Eligible trials were analyzed by fixed-effect model, random effect model, and meta-regression analysis accordingly. RESULTS In total, thirteen trials were included. Compared with the control group, physical activity intervention was significantly associated with increased TIR (WMDs, 4.17%; 95% CI, 1.11 to 7.23%, P<0.01), decreased MAGE (WMDs, -0.68 mmol/L; 95% CI, -1.01 to -0.36 mmol/L, P<0.01) and decreased TAR (WMDs, -3.54%; 95% CI, -5.21 to -1.88%, P<0.01) in patients with diabetes, but showed insignificant effects on TBR. Patients with higher baseline BMI levels was associated with a greater decrease in MAGE (β=-0.392, 95% CI: -0.710, -0.074), and patients with lower baseline HbA1c levels was associated with a greater increase in TBR during physical activities (β=-0.903, 95% CI: -1.550, -0.255). CONCLUSION Physical activity was associated with significantly decreased glycemic variability in patients with diabetes. Patients with higher BMI might benefit more from physical activity therapy in terms of a lower MAGE. Hypoglycemia associated with physical activity treatment still warranted caution, especially in patients with intensive glycemic control. SYSTEMATIC REVIEW REGISTRATION PROSPERO [CRD42021259807].
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Affiliation(s)
- Xingyun Zhu
- Department of Endocrinology and Metabolism, Peking University People’s Hospital, Beijing, China
| | - Lina Zhao
- Department of Endocrinology and Metabolism, Langfang Traditional Chinese Medicine (TCM) Hospital, Hebei, China
| | - Jing Chen
- Department of Endocrinology and Metabolism, Peking University People’s Hospital, Beijing, China
| | - Chu Lin
- Department of Endocrinology and Metabolism, Peking University People’s Hospital, Beijing, China
| | - Fang Lv
- Department of Endocrinology and Metabolism, Peking University People’s Hospital, Beijing, China
| | - Suiyuan Hu
- Department of Endocrinology and Metabolism, Peking University People’s Hospital, Beijing, China
| | - Xiaoling Cai
- Department of Endocrinology and Metabolism, Peking University People’s Hospital, Beijing, China
- *Correspondence: Xiaoling Cai, ; Li Zhang, ; Linong Ji,
| | - Li Zhang
- China Institute of Sport Science, Beijing, China
- *Correspondence: Xiaoling Cai, ; Li Zhang, ; Linong Ji,
| | - Linong Ji
- Department of Endocrinology and Metabolism, Peking University People’s Hospital, Beijing, China
- *Correspondence: Xiaoling Cai, ; Li Zhang, ; Linong Ji,
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Buckley JP, Riddell M, Mellor D, Bracken RM, Ross MK, LaGerche A, Poirier P. Acute glycaemic management before, during and after exercise for cardiac rehabilitation participants with diabetes mellitus: a joint statement of the British and Canadian Associations of Cardiovascular Prevention and Rehabilitation, the International Council for Cardiovascular Prevention and Rehabilitation and the British Association of Sport and Exercise Sciences. Br J Sports Med 2020; 55:bjsports-2020-102446. [PMID: 33361136 DOI: 10.1136/bjsports-2020-102446] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/19/2020] [Indexed: 12/12/2022]
Abstract
Type 1 (T1) and type 2 (T2) diabetes mellitus (DM) are significant precursors and comorbidities to cardiovascular disease and prevalence of both types is still rising globally. Currently,~25% of participants (and rising) attending cardiac rehabilitation in Europe, North America and Australia have been reported to have DM (>90% have T2DM). While there is some debate over whether improving glycaemic control in those with heart disease can independently improve future cardiovascular health-related outcomes, for the individual patient whose blood glucose is well controlled, it can aid the exercise programme in being more efficacious. Good glycaemic management not only helps to mitigate the risk of acute glycaemic events during exercising, it also aids in achieving the requisite physiological and psycho-social aims of the exercise component of cardiac rehabilitation (CR). These benefits are strongly associated with effective behaviour change, including increased enjoyment, adherence and self-efficacy. It is known that CR participants with DM have lower uptake and adherence rates compared with those without DM. This expert statement provides CR practitioners with nine recommendations aimed to aid in the participant's improved blood glucose control before, during and after exercise so as to prevent the risk of glycaemic events that could mitigate their beneficial participation.
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Affiliation(s)
- John P Buckley
- Shrewsbury Centre for Active Living, University of Chester Faculty of Medicine and Life Sciences, Chester, Cheshire West and Chester, UK
- Institute of Sport Exercise and Health, University College London, London, UK
| | - Michael Riddell
- School of Kinesiology and Health Science, York University, Toronto, Ontario, Canada
- LMC Healthcare, Diabetes and Endocrinology, Toronto, Ontario, Canada
| | - Duane Mellor
- Aston Medical School, Aston University, Birmingham, West Midlands, UK
- Sport and Exercise Science, Swansea University College of Engineering, Swansea, Wales, UK
| | - Richard M Bracken
- Sport and Exercise Science, Swansea University College of Engineering, Swansea, Wales, UK
| | - Marie-Kristelle Ross
- Hotel-Dieu de Levis, Laval University Faculty of Medicine, Quebec city, Quebec, Canada
| | - Andre LaGerche
- Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia
- St Vincent's Hospital Melbourne Pty Ltd, Fitzroy, Victoria, Australia
| | - Paul Poirier
- Cardiology, Institut universitaire de cardiologie et de pneumologie de Québec, Quebec City, Quebec, Canada
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40
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Moser O, Riddell MC, Eckstein ML, Adolfsson P, Rabasa-Lhoret R, van den Boom L, Gillard P, Nørgaard K, Oliver NS, Zaharieva DP, Battelino T, de Beaufort C, Bergenstal RM, Buckingham B, Cengiz E, Deeb A, Heise T, Heller S, Kowalski AJ, Leelarathna L, Mathieu C, Stettler C, Tauschmann M, Thabit H, Wilmot EG, Sourij H, Smart CE, Jacobs PG, Bracken RM, Mader JK. Glucose management for exercise using continuous glucose monitoring (CGM) and intermittently scanned CGM (isCGM) systems in type 1 diabetes: position statement of the European Association for the Study of Diabetes (EASD) and of the International Society for Pediatric and Adolescent Diabetes (ISPAD) endorsed by JDRF and supported by the American Diabetes Association (ADA). Diabetologia 2020; 63:2501-2520. [PMID: 33047169 DOI: 10.1007/s00125-020-05263-9] [Citation(s) in RCA: 87] [Impact Index Per Article: 21.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Physical exercise is an important component in the management of type 1 diabetes across the lifespan. Yet, acute exercise increases the risk of dysglycaemia, and the direction of glycaemic excursions depends, to some extent, on the intensity and duration of the type of exercise. Understandably, fear of hypoglycaemia is one of the strongest barriers to incorporating exercise into daily life. Risk of hypoglycaemia during and after exercise can be lowered when insulin-dose adjustments are made and/or additional carbohydrates are consumed. Glycaemic management during exercise has been made easier with continuous glucose monitoring (CGM) and intermittently scanned continuous glucose monitoring (isCGM) systems; however, because of the complexity of CGM and isCGM systems, both individuals with type 1 diabetes and their healthcare professionals may struggle with the interpretation of given information to maximise the technological potential for effective use around exercise (i.e. before, during and after). This position statement highlights the recent advancements in CGM and isCGM technology, with a focus on the evidence base for their efficacy to sense glucose around exercise and adaptations in the use of these emerging tools, and updates the guidance for exercise in adults, children and adolescents with type 1 diabetes. Graphical abstract.
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Affiliation(s)
- Othmar Moser
- Division of Endocrinology and Diabetology, Department of Internal Medicine, Medical University of Graz, Auenbruggerplatz 2, 8036, Graz, Austria.
- Division of Exercise Physiology and Metabolism, Department of Sport Science, University of Bayreuth, Bayreuth, Germany.
| | - Michael C Riddell
- School of Kinesiology and Health Science, York University, Toronto, ON, Canada
| | - Max L Eckstein
- Division of Endocrinology and Diabetology, Department of Internal Medicine, Medical University of Graz, Auenbruggerplatz 2, 8036, Graz, Austria
| | - Peter Adolfsson
- Department of Pediatrics, The Hospital of Halland, Kungsbacka, Sweden
- Sahlgrenska Academy at University of Gothenburg, Institution of Clinical Sciences, Gothenburg, Sweden
| | - Rémi Rabasa-Lhoret
- Institut de Recherches Cliniques de Montréal, Montréal, QC, Canada
- Endocrinology Division Centre Hospitalier Universitaire de Montréal, Montréal, QC, Canada
- Nutrition Department, Faculty of Medicine, Université de Montréal, Montréal, QC, Canada
- Montreal Diabetes Research Centre, Montréal, QC, Canada
| | | | - Pieter Gillard
- Department of Endocrinology, University Hospitals Leuven, KU Leuven, Leuven, Belgium
| | - Kirsten Nørgaard
- Steno Diabetes Center Copenhagen, University of Copenhagen, Copenhagen, Denmark
| | - Nick S Oliver
- Department of Metabolism, Digestion and Reproduction, Faculty of Medicine, Imperial College, London, London, UK
| | - Dessi P Zaharieva
- Department of Pediatric Endocrinology and Diabetes, Stanford University School of Medicine, Stanford, CA, USA
| | - Tadej Battelino
- Department of Paediatric Endocrinology, Diabetes and Metabolic Diseases, UMC - University Children's Hospital, University Medical Centre Ljubljana, Ljubljana, Slovenia
- Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Carine de Beaufort
- Department of Pediatric Diabetes and Endocrinology, Centre Hospitalier Luxembourg, Luxembourg, Luxembourg
- Department of Pediatrics, Free University Brussels (VUB), Brussels, Belgium
| | | | - Bruce Buckingham
- Department of Pediatric Endocrinology and Diabetes, Stanford University School of Medicine, Stanford, CA, USA
| | - Eda Cengiz
- Department of Pediatrics, Yale School of Medicine, New Haven, CT, USA
- Bahçeşehir Üniversitesi, Istanbul, Turkey
| | - Asma Deeb
- Paediatric Endocrinology Division, Shaikh Shakhbout Medical City, Abu Dhabi, United Arab Emirates
| | | | - Simon Heller
- Department of Oncology & Metabolism, The Medical School, University of Sheffield, Sheffield, UK
- Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | | | - Lalantha Leelarathna
- Manchester Diabetes Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
- Division of Diabetes, Endocrinology and Gastroenterology, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Chantal Mathieu
- Department of Endocrinology, University Hospitals Leuven, KU Leuven, Leuven, Belgium
| | - Christoph Stettler
- Department of Diabetes, Endocrinology, Nutritional Medicine and Metabolism, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland
| | - Martin Tauschmann
- Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Vienna, Austria
| | - Hood Thabit
- Manchester Diabetes Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | - Emma G Wilmot
- Diabetes Department, Royal Derby Hospital, University Hospitals of Derby and Burton NHSFT, Derby, UK
- Faculty of Medicine & Health Sciences, University of Nottingham, Nottingham, UK
| | - Harald Sourij
- Division of Endocrinology and Diabetology, Department of Internal Medicine, Medical University of Graz, Auenbruggerplatz 2, 8036, Graz, Austria
| | - Carmel E Smart
- School of Health Sciences, University of Newcastle, Callaghan, NSW, Australia
- Department of Paediatric Diabetes and Endocrinology, John Hunter Children's Hospital, Newcastle, NSW, Australia
| | - Peter G Jacobs
- Department of Biomedical Engineering, Oregon Health & Science University, Portland, OR, USA
| | - Richard M Bracken
- Applied Sport, Technology, Exercise and Medicine Research Centre (A-STEM), College of Engineering, Swansea University, Swansea, UK
| | - Julia K Mader
- Division of Endocrinology and Diabetology, Department of Internal Medicine, Medical University of Graz, Auenbruggerplatz 2, 8036, Graz, Austria
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Moser O, Riddell MC, Eckstein ML, Adolfsson P, Rabasa‐Lhoret R, van den Boom L, Gillard P, Nørgaard K, Oliver NS, Zaharieva DP, Battelino T, de Beaufort C, Bergenstal RM, Buckingham B, Cengiz E, Deeb A, Heise T, Heller S, Kowalski AJ, Leelarathna L, Mathieu C, Stettler C, Tauschmann M, Thabit H, Wilmot EG, Sourij H, Smart CE, Jacobs PG, Bracken RM, Mader JK. Glucose management for exercise using continuous glucose monitoring (CGM) and intermittently scanned CGM (isCGM) systems in type 1 diabetes: position statement of the European Association for the Study of Diabetes (EASD) and of the International Society for Pediatric and Adolescent Diabetes (ISPAD) endorsed by JDRF and supported by the American Diabetes Association (ADA). Pediatr Diabetes 2020; 21:1375-1393. [PMID: 33047481 PMCID: PMC7702152 DOI: 10.1111/pedi.13105] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Physical exercise is an important component in the management of type 1 diabetes across the lifespan. Yet, acute exercise increases the risk of dysglycaemia, and the direction of glycaemic excursions depends, to some extent, on the intensity and duration of the type of exercise. Understandably, fear of hypoglycaemia is one of the strongest barriers to incorporating exercise into daily life. Risk of hypoglycaemia during and after exercise can be lowered when insulin-dose adjustments are made and/or additional carbohydrates are consumed. Glycaemic management during exercise has been made easier with continuous glucose monitoring (CGM) and intermittently scanned continuous glucose monitoring (isCGM) systems; however, because of the complexity of CGM and isCGM systems, both individuals with type 1 diabetes and their healthcare professionals may struggle with the interpretation of given information to maximise the technological potential for effective use around exercise (ie, before, during and after). This position statement highlights the recent advancements in CGM and isCGM technology, with a focus on the evidence base for their efficacy to sense glucose around exercise and adaptations in the use of these emerging tools, and updates the guidance for exercise in adults, children and adolescents with type 1 diabetes.
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Affiliation(s)
- Othmar Moser
- Division of Endocrinology and Diabetology, Department of Internal MedicineMedical University of GrazAustria
- Division of Exercise Physiology and Metabolism, Department of Sport Science, University of BayreuthBayreuthGermany
| | - Michael C. Riddell
- School of Kinesiology and Health ScienceYork UniversityTorontoOntarioCanada
| | - Max L. Eckstein
- Division of Endocrinology and Diabetology, Department of Internal MedicineMedical University of GrazAustria
| | - Peter Adolfsson
- Department of PediatricsThe Hospital of HallandKungsbackaSweden
- Sahlgrenska Academy at University of GothenburgInstitution of Clinical SciencesGothenburgSweden
| | - Rémi Rabasa‐Lhoret
- Institut de recherches Cliniques de MontréalMontréalQCCanada
- Endocrinology division Centre Hospitalier Universitaire de MontréalMontréalQCCanada
- Nutrition Department, Faculty of MedicineUniversité de MontréalMontréalQCCanada
- Montreal Diabetes Research CentreMontréalQCCanada
| | | | - Pieter Gillard
- Department of EndocrinologyUniversity Hospitals Leuven, KU LeuvenLeuvenBelgium
| | - Kirsten Nørgaard
- Steno Diabetes Center CopenhagenUniversity of CopenhagenCopenhagenDenmark
| | - Nick S. Oliver
- Department of Metabolism, Digestion and Reproduction, Faculty of MedicineImperial CollegeLondonLondonUK
| | - Dessi P. Zaharieva
- Department of Pediatric Endocrinology and DiabetesStanford University School of MedicineStanfordCaliforniaUSA
| | - Tadej Battelino
- Department of Paediatric Endocrinology, Diabetes and Metabolic Diseases, UMC ‐ University Children’s HospitalUniversity Medical Centre LjubljanaLjubljanaSlovenia
- Faculty of MedicineUniversity of LjubljanaLjubljanaSlovenia
| | - Carine de Beaufort
- Department of Pediatric Diabetes and EndocrinologyCentre Hospitalier LuxembourgLuxembourgLuxembourg
- Department of Pediatrics, Free University Brussels (VUB)BrusselsBelgium
| | | | - Bruce Buckingham
- Department of Pediatric Endocrinology and DiabetesStanford University School of MedicineStanfordCaliforniaUSA
| | - Eda Cengiz
- Department of Pediatrics, Yale School of MedicineNew HavenConnecticutUSA
- Bahçeşehir Üniversitesi, IstanbulTurkey
| | - Asma Deeb
- Paediatric Endocrinology DivisionShaikh Shakhbout Medical CityAbu DhabiUnited Arab Emirates
| | | | - Simon Heller
- Department of Oncology & Metabolism, The Medical SchoolUniversity of SheffieldSheffieldUK
- Sheffield Teaching Hospitals NHS Foundation Trust, SheffieldUK
| | | | - Lalantha Leelarathna
- Manchester Diabetes Centre, Manchester University NHS Foundation TrustManchester Academic Health Science CentreManchesterUK
- Division of Diabetes, Endocrinology and Gastroenterology, Faculty of Biology, Medicine and HealthUniversity of ManchesterManchesterUK
| | - Chantal Mathieu
- Department of EndocrinologyUniversity Hospitals Leuven, KU LeuvenLeuvenBelgium
| | - Christoph Stettler
- Department of Diabetes, Endocrinology, Nutritional Medicine and Metabolism, InselspitalBern University Hospital and University of BernBernSwitzerland
| | - Martin Tauschmann
- Department of Pediatrics and Adolescent MedicineMedical University of ViennaViennaAustria
| | - Hood Thabit
- Manchester Diabetes Centre, Manchester University NHS Foundation TrustManchester Academic Health Science CentreManchesterUK
| | - Emma G. Wilmot
- Diabetes Department, Royal Derby Hospital, University Hospitals of Derby and Burton NHSFTDerbyUK
- Faculty of Medicine & Health SciencesUniversity of NottinghamNottinghamUK
| | - Harald Sourij
- Division of Endocrinology and Diabetology, Department of Internal MedicineMedical University of GrazAustria
| | - Carmel E. Smart
- School of Health Sciences, University of NewcastleCallaghanNew South WalesAustralia
- Department of Paediatric Diabetes and EndocrinologyJohn Hunter Children’s HospitalNewcastleNew South WalesAustralia
| | - Peter G. Jacobs
- Department of Biomedical EngineeringOregon Health & Science UniversityPortlandOregonUSA
| | - Richard M. Bracken
- Applied Sport, Technology, Exercise and Medicine Research Centre (A‐STEM), College of EngineeringSwansea UniversitySwanseaUK
| | - Julia K. Mader
- Division of Endocrinology and Diabetology, Department of Internal MedicineMedical University of GrazAustria
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Mosquera-Lopez C, Dodier R, Tyler NS, Wilson LM, El Youssef J, Castle JR, Jacobs PG. Predicting and Preventing Nocturnal Hypoglycemia in Type 1 Diabetes Using Big Data Analytics and Decision Theoretic Analysis. Diabetes Technol Ther 2020; 22:801-811. [PMID: 32297795 PMCID: PMC7698985 DOI: 10.1089/dia.2019.0458] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Background: Despite new glucose sensing technologies, nocturnal hypoglycemia is still a problem for people with type 1 diabetes (T1D) as symptoms and sensor alarms may not be detected while sleeping. Accurately predicting nocturnal hypoglycemia before sleep may help minimize nighttime hypoglycemia. Methods: A support vector regression (SVR) model was trained to predict, before bedtime, the overnight minimum glucose and overnight nocturnal hypoglycemia for people with T1D. The algorithm was trained on continuous glucose measurements and insulin data collected from 124 people (22,804 valid nights of data) with T1D. The minimum glucose threshold for announcing nocturnal hypoglycemia risk was derived by applying a decision theoretic criterion to maximize expected net benefit. Accuracy was evaluated on a validation set from 10 people with T1D during a 4-week trial under free-living sensor-augmented insulin-pump therapy. The primary outcome measures were sensitivity and specificity of prediction, the correlation between predicted and actual minimum nocturnal glucose, and root-mean-square error. The impact of using the algorithm to prevent nocturnal hypoglycemia is shown in-silico. Results: The algorithm predicted 94.1% of nocturnal hypoglycemia events (<3.9 mmol/L, 95% confidence interval [CI], 71.3-99.9) with an area under the receiver operating characteristic curve of 0.86 (95% CI, 0.75-0.98). Correlation between actual and predicted minimum glucose was high (R = 0.71, P < 0.001). In-silico simulations showed that the algorithm could reduce nocturnal hypoglycemia by 77.0% (P = 0.006) without impacting time in target range (3.9-10 mmol/L). Conclusion: An SVR model trained on a big data set and optimized using decision theoretic criterion can accurately predict at bedtime if overnight nocturnal hypoglycemia will occur and may help reduce nocturnal hypoglycemia.
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Affiliation(s)
- Clara Mosquera-Lopez
- Artificial Intelligence for Medical Systems (AIMS) Lab, Department of Biomedical Engineering, Oregon Health & Science University, Portland, Oregon, USA
- Harold Schnitzer Diabetes Health Center, Oregon Health and Science University, Portland, Oregon, USA
- Clara Mosquera-Lopez, PhD, Artificial Intelligence for Medical Systems (AIMS) Lab, Department of Biomedical Engineering, Oregon Health & Science University, 3303 SW Bond Avenue, Portland, OR 97239, USA
| | - Robert Dodier
- Artificial Intelligence for Medical Systems (AIMS) Lab, Department of Biomedical Engineering, Oregon Health & Science University, Portland, Oregon, USA
- Harold Schnitzer Diabetes Health Center, Oregon Health and Science University, Portland, Oregon, USA
| | - Nichole S. Tyler
- Artificial Intelligence for Medical Systems (AIMS) Lab, Department of Biomedical Engineering, Oregon Health & Science University, Portland, Oregon, USA
- Harold Schnitzer Diabetes Health Center, Oregon Health and Science University, Portland, Oregon, USA
| | - Leah M. Wilson
- Artificial Intelligence for Medical Systems (AIMS) Lab, Department of Biomedical Engineering, Oregon Health & Science University, Portland, Oregon, USA
- Harold Schnitzer Diabetes Health Center, Oregon Health and Science University, Portland, Oregon, USA
| | - Joseph El Youssef
- Artificial Intelligence for Medical Systems (AIMS) Lab, Department of Biomedical Engineering, Oregon Health & Science University, Portland, Oregon, USA
- Harold Schnitzer Diabetes Health Center, Oregon Health and Science University, Portland, Oregon, USA
| | - Jessica R. Castle
- Artificial Intelligence for Medical Systems (AIMS) Lab, Department of Biomedical Engineering, Oregon Health & Science University, Portland, Oregon, USA
- Harold Schnitzer Diabetes Health Center, Oregon Health and Science University, Portland, Oregon, USA
| | - Peter G. Jacobs
- Artificial Intelligence for Medical Systems (AIMS) Lab, Department of Biomedical Engineering, Oregon Health & Science University, Portland, Oregon, USA
- Harold Schnitzer Diabetes Health Center, Oregon Health and Science University, Portland, Oregon, USA
- Address correspondence to: Peter G. Jacobs, PhD, Artificial Intelligence for Medical Systems (AIMS) Lab, Department of Biomedical Engineering, Oregon Health & Science University, 3303 SW Bond Avenue, Portland, OR 97239, USA
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Minnock D, Annibalini G, Le Roux CW, Contarelli S, Krause M, Saltarelli R, Valli G, Stocchi V, Barbieri E, De Vito G. Effects of acute aerobic, resistance and combined exercises on 24-h glucose variability and skeletal muscle signalling responses in type 1 diabetics. Eur J Appl Physiol 2020; 120:2677-2691. [PMID: 32909059 DOI: 10.1007/s00421-020-04491-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Accepted: 09/03/2020] [Indexed: 12/25/2022]
Abstract
PURPOSE To compare the effect of high-intensity aerobic (AER), resistance (RES), and combined (COMB: RES + AER) exercise, on interstitial glucose (IG) variability and skeletal muscle signalling pathways in type 1 diabetes (T1D). METHODS T1D participants (6 M/6F) wore a flash glucose monitoring system in four randomized sessions: one control (CONT), and one AER, RES and COMB (40 min each). Mean amplitude of glycemic excursions (MAGE), standard deviation (SD) and coefficient variation (CV) of IG were used to compare the 24 h post-exercise IG variability. Blood and muscle samples were collected to compare exercise-induced systemic and muscle signalling responses related to metabolic, growth and inflammatory adaptations. RESULTS Both RES and COMB decreased the 24 h MAGE compared to CONT; additionally, COMB decreased the 24 h SD and CV. In the 6-12 h post-exercise, all exercise modalities reduced the IG CV while SD decreased only after COMB. Both AER and COMB stimulated the PGC-1α mRNA expression and promoted the splicing of IGF-1Ea variant, while Akt and p38MAPK phosphorylation increased only after RES and COMB. Additionally, COMB enhanced eEF2 activation and RES increased myogenin and MRF4 mRNA expression. Blood lactate and glycerol levels and muscle IL-6, TNF-α, and MCP-1 mRNAs increased after all exercise sessions, while serum CK and LDH level did not change. CONCLUSION COMB is more effective in reducing IG fluctuations compared to single-mode AER or RES exercise. Moreover, COMB simultaneously activates muscle signalling pathways involved in substrate metabolism and anabolic adaptations, which can help to improve glycaemic control and maintain muscle health in T1D.
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Affiliation(s)
- Dean Minnock
- Institute for Sport and Health, School of Public Health, Physiotherapy and Sports Science, University College Dublin, Belfield, Dublin 4, Ireland.
| | - Giosuè Annibalini
- Department of Biomolecular Sciences, University of Urbino Carlo Bo, Urbino, Italy
| | - Carel W Le Roux
- Diabetes Complications Research Centre, Conway Institute, University College Dublin, Dublin, Ireland
| | - Serena Contarelli
- Department of Biomolecular Sciences, University of Urbino Carlo Bo, Urbino, Italy
| | - Mauricio Krause
- Laboratory of Inflammation, Metabolism, and Exercise Research (LAPIMEX) and Laboratory of Cellular Physiology, Department of Physiology, Institute of Basic Health Sciences, Federal University of Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Roberta Saltarelli
- Department of Biomolecular Sciences, University of Urbino Carlo Bo, Urbino, Italy
| | - Giacomo Valli
- Department of Biomolecular Sciences, University of Urbino Carlo Bo, Urbino, Italy
| | - Vilberto Stocchi
- Department of Biomolecular Sciences, University of Urbino Carlo Bo, Urbino, Italy
| | - Elena Barbieri
- Department of Biomolecular Sciences, University of Urbino Carlo Bo, Urbino, Italy.,Interuniversitary Institute of Myology (IIM) Perugia, Perugia, Italy
| | - Giuseppe De Vito
- Institute for Sport and Health, School of Public Health, Physiotherapy and Sports Science, University College Dublin, Belfield, Dublin 4, Ireland.,Department of Biomedical Sciences, University of Padova, Padova, Italy
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Romeres D, Olson K, Carter R, Cobelli C, Dalla Man C, Basu A, Basu R. Hyperglycemia But Not Hyperinsulinemia Is Favorable for Exercise in Type 1 Diabetes: A Pilot Study. Diabetes Care 2020; 43:2176-2182. [PMID: 32661106 PMCID: PMC7440891 DOI: 10.2337/dc20-0611] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Accepted: 06/09/2020] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To distinguish the effects of hyperglycemia and hyperinsulinemia on exercise-induced increases in Rd and endogenous glucose production (EGP) in type 1 diabetes. RESEARCH DESIGN AND METHODS We studied six participants without diabetes and six participants with type 1 diabetes on three visits in random order for the following: euglycemia, low insulin (EuLoI); euglycemia, high insulin (EuHiI); and hyperglycemia, low insulin (HyLoI). Glucose fluxes were measured using [6,6-2H2] glucose before, during, and after 60 min of exercise. RESULTS Rd increased (P < 0.01) with exercise within groups, while peak Rd during exercise was lower (P < 0.01) in participants with type 1 diabetes than participants without diabetes during all visits. In type 1 diabetes participants, EGP increased (P < 0.001) with exercise during EuLoI and HyLoI but not during EuHiI. This demonstrates that hyperinsulinemia, but not hyperglycemia, blunts the compensatory exercise-induced increase in EGP in type 1 diabetes. CONCLUSIONS The data from this pilot study indicate that 1) exercise-induced compensatory increase in EGP was inhibited in participants with type 1 diabetes with hyperinsulinemia but not with hyperglycemia; 2) in contrast, in participants without diabetes, exercise-induced increase in EGP was inhibited only during combined hyperinsulinemia and hyperglycemia. Taken together, these results suggest that low insulin coupled with euglycemia or modest hyperglycemia appear to be the most favorable milieu for type 1 diabetes during exercise.
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Affiliation(s)
- Davide Romeres
- Department of Information Engineering, University of Padova, Padova, Italy
| | - Karen Olson
- Division of Endocrinology, Center of Diabetes Technology, University of Virginia School of Medicine, Charlottesville, VA
| | - Rickey Carter
- Department of Health Sciences Research, Mayo Clinic, Jacksonville, FL
| | - Claudio Cobelli
- Department of Information Engineering, University of Padova, Padova, Italy
| | - Chiara Dalla Man
- Department of Information Engineering, University of Padova, Padova, Italy
| | - Ananda Basu
- Division of Endocrinology, Center of Diabetes Technology, University of Virginia School of Medicine, Charlottesville, VA
| | - Rita Basu
- Division of Endocrinology, Center of Diabetes Technology, University of Virginia School of Medicine, Charlottesville, VA
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Abstract
Treatments for type 1 diabetes have advanced significantly over recent years. There are now multiple hybrid closed-loop systems commercially available and additional systems are in development. Challenges remain, however. This review outlines the recent advances in closed-loop systems and outlines the remaining challenges, including post-prandial hyperglycemia and exercise-related dysglycemia.
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Affiliation(s)
- Melanie Jackson
- Division of Endocrinology, Harold Schnitzer Diabetes Health Center, Oregon Health & Science University, Portland, Oregon
| | - Jessica R. Castle
- Division of Endocrinology, Harold Schnitzer Diabetes Health Center, Oregon Health & Science University, Portland, Oregon
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Yang QQ, Shao D, Li J, Yang CL, Fan MH, Cao FL. Positive Association Between Serum Levels of High-Sensitivity C-Reactive Protein and Depression/Anxiety in Female, but Not Male, Patients With Type 2 Diabetes Mellitus. Biol Res Nurs 2019; 22:178-187. [PMID: 31867989 DOI: 10.1177/1099800419894641] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Purpose: Patients with Type 2 diabetes (T2D) have increased risk of depression and anxiety. Evidence suggests that a heightened inflammatory state may contribute to this association. Females experience more depression and higher inflammation levels than males. This study compared associations of serum high-sensitivity C-reactive protein (hs-CRP) levels with symptoms of depression and anxiety between men and women with Type 2 diabetes mellitus (T2DM). Method: Cross-sectional data including demographic and disease characteristics, symptoms of depression and anxiety, clinical data, and laboratory values were collected from 392 patients with T2DM recruited from a general hospital in Shandong Province, China. We evaluated associations between serum hs-CRP level and symptoms of depression and anxiety in males and females separately using multiple linear regressions and χ2 tests for trend. Results: Sex moderated the association between serum hs-CRP level and symptoms of depression ( B = .112 [ SE = 0.049]; p = .022) and anxiety ( B = .137 [ SE = 0.053]; p = .011). Among females, hs-CRP level was positively associated with depression ( B = .034, 95% confidence interval [CI] = [.006, .061]; p = .016, false discovery rate [FDR]-adjusted p = .020) and anxiety ( B = .041, 95% CI [.011, .071], p = .007, FDR-adjusted p = .007). Positive trends indicated a higher prevalence of clinically significant symptoms of depression and anxiety in higher serum hs-CRP categories in females. No associations were found in males. Conclusion: Findings demonstrate that associations between serum hs-CRP level and symptoms of depression and anxiety in patients with T2D are sex-specific, with only females demonstrating a significant positive association.
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Affiliation(s)
- Qian-Qian Yang
- School of Nursing, Shandong University, Shandong, People’s Republic of China
| | - Di Shao
- School of Health Care Management, Shandong University, Shandong, People’s Republic of China
| | - Jie Li
- School of Public Health, Shandong University, Shandong, People’s Republic of China
| | - Chun-Ling Yang
- Nursing Department, Liaocheng People’s Hospital, Shandong, People's Republic of China
| | - Min-Hua Fan
- Endocrinology Department, Liaocheng People’s Hospital, Shandong, People's Republic of China
| | - Feng-Lin Cao
- School of Nursing, Shandong University, Shandong, People’s Republic of China
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Hohendorff J, Ucieklak D, Skupien J, Matejko B, Di Giacomo A, Malecki MT, Klupa T. Risk factors of hypoglycaemia in type 1 diabetes individuals during intensive sport exercise-Data from the SPORTGIVECHANCE event. Int J Clin Pract 2019; 73:e13411. [PMID: 31456268 DOI: 10.1111/ijcp.13411] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Revised: 07/23/2019] [Accepted: 08/23/2019] [Indexed: 11/29/2022] Open
Abstract
AIMS Fear of hypoglycaemia seems to be one of the strongest barrier to physical activity for individuals with type 1 diabetes mellitus (T1DM).The aim of the study was to describe clinical characteristics of participants with T1DM in the intense sporting event of runs and bike rides"SPORTGIVECHANCE-Diabetic runners and cyclists for more sport for all in Europe", and investigate factors associated with self-reported hypoglycaemia episodes during the competition, in particular the use of continuous and flash glucose monitoring systems (CGM/FGM). METHODS The sporting event took place in Spoleto, Italy from 30 August 2018 to 2 September 2018. An online survey was distributed among 150 participants with diabetes. Only T1DM patients were invited to complete the survey that included questions on baseline clinical characteristics as well as glucose control and meal related issues during the competition. Logistic regression was used to determine factors associated with reported hypoglycaemia. RESULTS There were 35 T1DM individuals who completed the questionnaire: eight subjects were continuous glucose monitoring system (CGM) users, 10 used flash glucose monitoring systems (FGM), while the others performed self-measured blood glucose measurements (SMBG) on glucose meters. Mild hypoglycaemia episodes during the competition were reported by four CGM/FGM users and six non-users (OR: 0.73, CI: 0.34-1.53). No severe hypoglycaemic episode was reported. Body mass index (BMI) (OR: 1.47, CI: 1.01-2.13) and subjectively very hard or maximal intensity of the competition (OR: 4.90, CI: 1.51-15.89) were associated with a higher risk of hypoglycaemia. CONCLUSIONS Data obtained from the self-selected sample of T1DM patients suggests that T1DM individuals can participate in intense sport competitions with moderate risk of mild hypoglycaemia regardless of CGM/FGM or SMBG use.
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Affiliation(s)
- Jerzy Hohendorff
- Department of Metabolic Diseases, Jagiellonian University Medical College, Krakow, Poland
- Department of Metabolic Diseases, University Hospital in Krakow, Krakow, Poland
| | - Damian Ucieklak
- Department of Metabolic Diseases, Jagiellonian University Medical College, Krakow, Poland
- Department of Metabolic Diseases, University Hospital in Krakow, Krakow, Poland
| | - Jan Skupien
- Department of Metabolic Diseases, Jagiellonian University Medical College, Krakow, Poland
- Department of Metabolic Diseases, University Hospital in Krakow, Krakow, Poland
| | - Bartlomiej Matejko
- Department of Metabolic Diseases, Jagiellonian University Medical College, Krakow, Poland
- Department of Metabolic Diseases, University Hospital in Krakow, Krakow, Poland
| | | | - Maciej T Malecki
- Department of Metabolic Diseases, Jagiellonian University Medical College, Krakow, Poland
- Department of Metabolic Diseases, University Hospital in Krakow, Krakow, Poland
| | - Tomasz Klupa
- Department of Metabolic Diseases, Jagiellonian University Medical College, Krakow, Poland
- Department of Metabolic Diseases, University Hospital in Krakow, Krakow, Poland
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Resalat N, Hilts W, Youssef JE, Tyler N, Castle JR, Jacobs PG. Adaptive Control of an Artificial Pancreas Using Model Identification, Adaptive Postprandial Insulin Delivery, and Heart Rate and Accelerometry as Control Inputs. J Diabetes Sci Technol 2019; 13:1044-1053. [PMID: 31595784 PMCID: PMC6835177 DOI: 10.1177/1932296819881467] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND People with type 1 diabetes (T1D) have varying sensitivities to insulin and also varying responses to meals and exercise. We introduce a new adaptive run-to-run model predictive control (MPC) algorithm that can be used to help people with T1D better manage their glucose levels using an artificial pancreas (AP). The algorithm adapts to individuals' different insulin sensitivities, glycemic response to meals, and adjustment during exercise as a continuous input during free-living conditions. METHODS A new insulin sensitivity adaptation (ISA) algorithm is presented that updates each patient's insulin sensitivity during nonmeal periods to reduce the error between the actual glucose levels and the process model. We further demonstrate how an adaptive learning postprandial hypoglycemia prevention algorithm (ALPHA) presented in the previous work can complement the ISA algorithm, and the algorithm can adapt in several days. We further show that if physical activity is incorporated as a continuous input (heart rate and accelerometry), performance is improved. The contribution of this work is the description of the ISA algorithm and the evaluation of how ISA, ALPHA, and incorporation of exercise metrics as a continuous input can impact glycemic control. RESULTS Incorporating ALPHA, ISA, and physical activity into the MPC improved glycemic outcome measures. The adaptive learning postprandial hypoglycemia prevention algorithm combined with ISA significantly reduced time spent in hypoglycemia by 71.7% and the total number of rescue carbs by 67.8% to 0.37% events/day/patient. Insulin sensitivity adaptation significantly reduced model-actual mismatch by 12.2% compared to an AP without ISA. Incorporating physical activity as a continuous input modestly improved time in the range 70 to 180 mg/dL during high physical activity days from 84.4% to 84.9% and reduced the percentage time in hypoglycemia by 23.8% from 2.1% to 1.6%. CONCLUSION Adapting postprandial insulin delivery, insulin sensitivity, and adapting to physical exercise in an MPC-based AP systems can improve glycemic outcomes.
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Affiliation(s)
- Navid Resalat
- Artificial Intelligence for Medical Systems (AIMS) Lab, Department of Biomedical Engineering, Oregon Health & Science University, Portland, OR, USA
| | - Wade Hilts
- Artificial Intelligence for Medical Systems (AIMS) Lab, Department of Biomedical Engineering, Oregon Health & Science University, Portland, OR, USA
| | - Joseph El Youssef
- Artificial Intelligence for Medical Systems (AIMS) Lab, Department of Biomedical Engineering, Oregon Health & Science University, Portland, OR, USA
- Department of Medicine, Division of Endocrinology, Harold Schnitzer Diabetes Health Center Oregon Health & Science University, Portland, OR, USA
| | - Nichole Tyler
- Artificial Intelligence for Medical Systems (AIMS) Lab, Department of Biomedical Engineering, Oregon Health & Science University, Portland, OR, USA
| | - Jessica R. Castle
- Department of Medicine, Division of Endocrinology, Harold Schnitzer Diabetes Health Center Oregon Health & Science University, Portland, OR, USA
| | - Peter G. Jacobs
- Artificial Intelligence for Medical Systems (AIMS) Lab, Department of Biomedical Engineering, Oregon Health & Science University, Portland, OR, USA
- Peter G. Jacobs, PhD, Department of Biomedical Engineering, Oregon Health & Science University, 3303 SW Bond Ave, Mailstop: 13B, Portland, OR 97239, USA.
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McCarthy O, Moser O, Eckstein ML, Deere R, Bain SC, Pitt J, Bracken RM. Resistance Isn't Futile: The Physiological Basis of the Health Effects of Resistance Exercise in Individuals With Type 1 Diabetes. Front Endocrinol (Lausanne) 2019; 10:507. [PMID: 31428047 PMCID: PMC6688119 DOI: 10.3389/fendo.2019.00507] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2018] [Accepted: 07/11/2019] [Indexed: 12/12/2022] Open
Abstract
The importance of regular exercise for glucose management in individuals with type 1 diabetes is magnified by its acknowledgment as a key adjunct to insulin therapy by several governmental, charitable, and healthcare organisations. However, although actively encouraged, exercise participation rates remain low, with glycaemic disturbances and poor cardiorespiratory fitness cited as barriers to long-term involvement. These fears are perhaps exacerbated by uncertainty in how different forms of exercise can considerably alter several acute and chronic physiological outcomes in those with type 1 diabetes. Thus, understanding the bodily responses to specific forms of exercise is important for the provision of practical guidelines that aim to overcome these exercise barriers. Currently, the majority of existing exercise research in type 1 diabetes has focused on moderate intensity continuous protocols with less work exploring predominately non-oxidative exercise modalities like resistance exercise. This is surprising, considering the known neuro-muscular, osteopathic, metabolic, and vascular benefits associated with resistance exercise in the wider population. Considering that individuals with type 1 diabetes have an elevated susceptibility for complications within these physiological systems, the wider health benefits associated with resistance exercise may help alleviate the prevalence and/or magnitude of pathological manifestation in this population group. This review outlines the health benefits of resistance exercise with reference to evidence in aiding some of the common complications associated with individuals with type 1 diabetes.
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Affiliation(s)
- Olivia McCarthy
- Applied Sport, Technology, Exercise and Medicine Research Centre (A-STEM), College of Engineering, Swansea University, Swansea, United Kingdom
- Diabetes Research Group, Medical School, Swansea University, Swansea, United Kingdom
- *Correspondence: Olivia McCarthy
| | - Othmar Moser
- Applied Sport, Technology, Exercise and Medicine Research Centre (A-STEM), College of Engineering, Swansea University, Swansea, United Kingdom
- Cardiovascular Diabetology Research Group, Division of Endocrinology and Diabetology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Max L. Eckstein
- Applied Sport, Technology, Exercise and Medicine Research Centre (A-STEM), College of Engineering, Swansea University, Swansea, United Kingdom
- Cardiovascular Diabetology Research Group, Division of Endocrinology and Diabetology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Rachel Deere
- Applied Sport, Technology, Exercise and Medicine Research Centre (A-STEM), College of Engineering, Swansea University, Swansea, United Kingdom
- Diabetes Research Group, Medical School, Swansea University, Swansea, United Kingdom
| | - Steve C. Bain
- Diabetes Research Group, Medical School, Swansea University, Swansea, United Kingdom
| | - Jason Pitt
- Applied Sport, Technology, Exercise and Medicine Research Centre (A-STEM), College of Engineering, Swansea University, Swansea, United Kingdom
| | - Richard M. Bracken
- Applied Sport, Technology, Exercise and Medicine Research Centre (A-STEM), College of Engineering, Swansea University, Swansea, United Kingdom
- Diabetes Research Group, Medical School, Swansea University, Swansea, United Kingdom
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