A Roy-Fleming1, N Taleb2, V Messier3, C Suppère3, C Cameli3, S Elbekri3, M R Smaoui4, M Ladouceur5, L Legault6, R Rabasa-Lhoret7. 1. Institut de recherches cliniques de Montréal, 110, avenue des Pins Ouest, Montréal, Québec, Canada; Nutrition department, faculty of medicine, universite de Montréal, 1204-2405, chemin de la Côte-Sainte-Catherine, Montréal, Québec H3T 1A8, Canada. 2. Institut de recherches cliniques de Montréal, 110, avenue des Pins Ouest, Montréal, Québec, Canada; Division of biomedical sciences, faculty of medicine, université de Montréal, C.P.6128 Succ. Centre-Ville, Montréal, Québec H3C 3J7, Canada. 3. Institut de recherches cliniques de Montréal, 110, avenue des Pins Ouest, Montréal, Québec, Canada. 4. School of computer science, McGill university, Montreal, Québec, Canada. 5. School of public health, social and preventive medicine department, université de Montréal, C.P.6128 Succ. Centre-Ville, Montréal, Québec, H3C 3J7, Canada. 6. Institut de recherches cliniques de Montréal, 110, avenue des Pins Ouest, Montréal, Québec, Canada; Montreal children's hospital, McGill university health centre, 1001 Boul Décarie, Montreal, Québec H4A 3J1, Canada. 7. Institut de recherches cliniques de Montréal, 110, avenue des Pins Ouest, Montréal, Québec, Canada; Nutrition department, faculty of medicine, universite de Montréal, 1204-2405, chemin de la Côte-Sainte-Catherine, Montréal, Québec H3T 1A8, Canada; Centre de recherche du centre hospitalier de l'université de Montréal (CRCHUM), R-900 Saint-Denis, Montreal, Québec H2X 0A9, Canada; Montreal diabetes research centre, R-900 Saint-Denis, Montreal, Québec H2X 0A9, Canada. Electronic address: remi.rabasa-lhoret@ircm.qc.ca.
Abstract
AIMS: To compare the efficacy of three timings to decrease basal insulin infusion rate to reduce exercise-induced hypoglycaemia in patients with type 1 diabetes (T1D) using pump therapy. METHODS: A single-blinded, randomized, 3-way crossover study in 22 adults that had T1D > 1 year and using insulin pump > 3 months (age, 40 ± 15 years; HbA1c, 56.3 ± 10.2 mmol/mol). Participants practiced three 45-min exercise sessions (ergocyle) at 60% VO2peak 3 hours after lunch comparing an 80% reduction of basal insulin applied 40 minutes before (T-40), 20 minutes before (T-20) or at exercise onset (T0). RESULTS:No significant difference was observed for percentage of time spent < 4.0 mmol/L (T-40: 16 ± 25%; T-20: 26 ± 27%; T0: 24 ± 29%) (main outcome) and time spent in target range 4.0-10.0 mmol/L (T-40: 63 ± 37%; T-20: 66 ± 25%; T0: 65 ± 31%). With T-40 strategy, although not significant, starting blood glucose (BG) was higher (T-40: 8.6 ± 3.6 mmol/L; T-20: 7.4 ± 2.5 mmol/L ; T0: 7.4 ± 2.7 mmol/L), fewer patients needed extra carbohydrates consumption prior to exercise for BG < 5.0 mmol/L (T-40: n = 3; T-20: n = 5; T0: n = 6) as well as during exercise for BG < 3.3 mmol/L [T-40: n = 6 (27%); T-20: n = 12 (55%); T0: n = 11 (50%)] while time to first hypoglycaemic episode was delayed (T-40: 28 ± 14 min; T-20: 24 ± 10 min; T0: 22 ± 11 min). CONCLUSION:Decreasing basal insulin infusion rate by 80% up to 40 minutes before exercise onset is insufficient to reduce exercise-induced hypoglycaemia.
RCT Entities:
AIMS: To compare the efficacy of three timings to decrease basal insulin infusion rate to reduce exercise-induced hypoglycaemia in patients with type 1 diabetes (T1D) using pump therapy. METHODS: A single-blinded, randomized, 3-way crossover study in 22 adults that had T1D > 1 year and using insulin pump > 3 months (age, 40 ± 15 years; HbA1c, 56.3 ± 10.2 mmol/mol). Participants practiced three 45-min exercise sessions (ergocyle) at 60% VO2peak 3 hours after lunch comparing an 80% reduction of basal insulin applied 40 minutes before (T-40), 20 minutes before (T-20) or at exercise onset (T0). RESULTS: No significant difference was observed for percentage of time spent < 4.0 mmol/L (T-40: 16 ± 25%; T-20: 26 ± 27%; T0: 24 ± 29%) (main outcome) and time spent in target range 4.0-10.0 mmol/L (T-40: 63 ± 37%; T-20: 66 ± 25%; T0: 65 ± 31%). With T-40 strategy, although not significant, starting blood glucose (BG) was higher (T-40: 8.6 ± 3.6 mmol/L; T-20: 7.4 ± 2.5 mmol/L ; T0: 7.4 ± 2.7 mmol/L), fewer patients needed extra carbohydrates consumption prior to exercise for BG < 5.0 mmol/L (T-40: n = 3; T-20: n = 5; T0: n = 6) as well as during exercise for BG < 3.3 mmol/L [T-40: n = 6 (27%); T-20: n = 12 (55%); T0: n = 11 (50%)] while time to first hypoglycaemic episode was delayed (T-40: 28 ± 14 min; T-20: 24 ± 10 min; T0: 22 ± 11 min). CONCLUSION: Decreasing basal insulin infusion rate by 80% up to 40 minutes before exercise onset is insufficient to reduce exercise-induced hypoglycaemia.