Dilshani C Jayawardene1, Sybil A McAuley1,2, Jodie C Horsburgh2, André La Gerche3,4, Alicia J Jenkins1,2,5, Glenn M Ward1,6, Richard J MacIsaac1,2, Timothy J Roberts2,4, Benyamin Grosman7, Natalie Kurtz7, Anirban Roy7, David N O'Neal1,2. 1. 1 Department of Endocrinology & Diabetes, St Vincent's Hospital Melbourne , Melbourne, Australia . 2. 2 University of Melbourne Department of Medicine, St. Vincent's Hospital, Melbourne, Australia . 3. 3 Department of Sports Cardiology, Baker Heart and Diabetes Institute , Melbourne, Australia . 4. 4 Department of Cardiology, St Vincent's Hospital Melbourne , Melbourne, Australia . 5. 5 NHMRC Clinical Trials Centre, University of Sydney , Sydney, Australia . 6. 6 Department of Pathology, University of Melbourne , Melbourne, Australia . 7. 7 Medtronic Diabetes , Northridge, California.
Abstract
BACKGROUND: We aimed to compare closed-loop glucose control for people with type 1 diabetes undertaking high-intensity interval exercise (HIIE) versus moderate-intensity exercise (MIE). METHODS:Adults with type 1 diabetes established on insulin pumps undertook HIIE and MIE stages in random order during automated insulin delivery via a closed-loop system (Medtronic). Frequent venous sampling for glucose, lactate, ketones, insulin, catecholamines, cortisol, growth hormone, and glucagon levels was performed. The primary outcome was plasma glucose <4.0 mmol/L for ≥15 min, from exercise commencement to 120 min postexercise. Secondary outcomes included continuous glucose monitoring and biochemical parameters. RESULTS:Twelve adults (age mean ± standard deviation 40 ± 13 years) were recruited; all completed the study. Plasma glucose of one participant fell to 3.4 mmol/L following MIE completion; no glucose levels were <4.0 mmol/L for HIIE (primary outcome). There were no glucose excursions >15.0 mmol/L for either stage. Mean (±standard error) plasma glucose did not differ between stages pre-exercise; was higher during exercise in HIIE than MIE (11.3 ± 0.5 mmol/L vs. 9.7 ± 0.6 mmol/L, respectively; P < 0.001); and remained higher until 60 min postexercise. There were no differences in circulating free insulin before, during, or postexercise. During HIIE compared with MIE, there were greater increases in lactate (P < 0.001), catecholamines (all P < 0.05), and cortisol (P < 0.001). Ketones increased more with HIIE than MIE postexercise (P = 0.031). CONCLUSIONS: Preliminary findings suggest that closed-loop glucose control is safe for people undertaking HIIE and MIE. However, the management of the postexercise rise in ketones secondary to counter-regulatory hormone-induced insulin resistance observed with HIIE may represent a challenge for closed-loop systems.
RCT Entities:
BACKGROUND: We aimed to compare closed-loop glucose control for people with type 1 diabetes undertaking high-intensity interval exercise (HIIE) versus moderate-intensity exercise (MIE). METHODS: Adults with type 1 diabetes established on insulin pumps undertook HIIE and MIE stages in random order during automated insulin delivery via a closed-loop system (Medtronic). Frequent venous sampling for glucose, lactate, ketones, insulin, catecholamines, cortisol, growth hormone, and glucagon levels was performed. The primary outcome was plasma glucose <4.0 mmol/L for ≥15 min, from exercise commencement to 120 min postexercise. Secondary outcomes included continuous glucose monitoring and biochemical parameters. RESULTS: Twelve adults (age mean ± standard deviation 40 ± 13 years) were recruited; all completed the study. Plasma glucose of one participant fell to 3.4 mmol/L following MIE completion; no glucose levels were <4.0 mmol/L for HIIE (primary outcome). There were no glucose excursions >15.0 mmol/L for either stage. Mean (±standard error) plasma glucose did not differ between stages pre-exercise; was higher during exercise in HIIE than MIE (11.3 ± 0.5 mmol/L vs. 9.7 ± 0.6 mmol/L, respectively; P < 0.001); and remained higher until 60 min postexercise. There were no differences in circulating free insulin before, during, or postexercise. During HIIE compared with MIE, there were greater increases in lactate (P < 0.001), catecholamines (all P < 0.05), and cortisol (P < 0.001). Ketones increased more with HIIE than MIE postexercise (P = 0.031). CONCLUSIONS: Preliminary findings suggest that closed-loop glucose control is safe for people undertaking HIIE and MIE. However, the management of the postexercise rise in ketones secondary to counter-regulatory hormone-induced insulin resistance observed with HIIE may represent a challenge for closed-loop systems.
Authors: Gabriela de Oliveira Teles; Carini Silva da Silva; Vinicius Ramos Rezende; Ana Cristina Silva Rebelo Journal: Int J Environ Res Public Health Date: 2022-06-09 Impact factor: 4.614
Authors: Sybil A McAuley; Martin I de Bock; Vijaya Sundararajan; Melissa H Lee; Barbora Paldus; Geoff R Ambler; Leon A Bach; Morton G Burt; Fergus J Cameron; Philip M Clarke; Neale D Cohen; Peter G Colman; Elizabeth A Davis; Jan M Fairchild; Christel Hendrieckx; D Jane Holmes-Walker; Jodie C Horsburgh; Alicia J Jenkins; Joey Kaye; Anthony C Keech; Bruce R King; Kavita Kumareswaran; Richard J MacIsaac; Roland W McCallum; Jennifer A Nicholas; Catriona Sims; Jane Speight; Stephen N Stranks; Steven Trawley; Glenn M Ward; Sara Vogrin; Timothy W Jones; David N O'Neal Journal: BMJ Open Date: 2018-06-09 Impact factor: 2.692