Continuous Glucose Monitoring at High Altitude—Effects on Glucose Homeostasis

Hill, Neil; Deighton, Kevin; Matu, Jamie; Misra, Shivani; Oliver, Nick; Newman, C. W.; Mellor, Adrian; O’Hara, John; Woods, David R.

doi:10.1249/mss.0000000000001624

Cited by 21 publications

(15 citation statements)

References 37 publications

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“…40 Another study performed in an Andean population reported a lower waist circumference at a higher elevation; an adjusted inverse association between geographical elevation and obesity that varied by sex was also found. 21 Furthermore, lower fasting glucose and better glucose tolerance were associated with a high elevation, 33,[41][42][43] and lower prevalence 22,44 and incidence 23,24,45 of overweight or obesity were also found in residents at high elevation.…”

Section: Discussionmentioning

confidence: 95%

<p>Low Elevation and Physical Inactivity are Associated with a Higher Prevalence of Metabolic Syndrome in Ecuadorian Adults: A National Cross-Sectional Study</p>

Juca¹,

Cho²,

Joung³

2020

DMSO

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Background: Elevation and health-related lifestyles have been associated with the development of metabolic syndrome (MetS). However, such associations have not been investigated extensively in a global context. The present study aimed to determine the associations among elevation of residence, health-related lifestyles, and the risk of MetS in an Ecuadorian adult population. Subjects and Methods: This cross-sectional study was conducted utilizing secondary data from the 2012 Ecuador National Health and Nutrition Survey (ENSANUT-ECU). A total of 6024 adults (1964 men and 4060 women) 20 to 60 years old were included in the study. Elevation was obtained by georeferencing techniques and categorized into low (0-2000 masl) and high (>2001 masl). Dietary intake was measured using a 24-hour recall and healthrelated lifestyle via risk and physical activity standardized questionnaire. MetS was defined on the basis of the National Cholesterol Education Program Adult Treatment Panel III and the Latin American Diabetes Association criteria. Multiple logistic regression analyses were used to examine whether elevation of residence and health-related lifestyles can increase the risk of MetS. Results: Residing at low elevation increased prevalence of MetS in men (1.37; 95% CI, 1.05-1.76) and elevated fasting glucose in both men (1.80; 95% CI, 1.32-2.46) and women (1.55; 95% CI, 1.24-1.93) after adjusting for confounders. Additionally, a lack of physical activity was identified as an important factor that raises the risk of increased waist circumference in both men (2.05; 95% CI, 1.22-3.45) and women (1.38; 95% CI, 1.05-1.83) living at low elevation. Conclusion: Our findings suggest that low elevation of residence and physical inactivity are associated with a higher prevalence of MetS in Ecuadorian adults.

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Section: Discussionmentioning

confidence: 95%

<p>Low Elevation and Physical Inactivity are Associated with a Higher Prevalence of Metabolic Syndrome in Ecuadorian Adults: A National Cross-Sectional Study</p>

Juca¹,

Cho²,

Joung³

2020

DMSO

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“…61 Although there is conflicting evidence on glycemic control at altitudes between 1500 m (4,920 ft) and 4000 m (13,120 ft), 36 several studies have observed increased insulin requirements above 4000 m (13,120 ft) in those with type 1 diabetes. 35,36 Relative hyperglycemia 62 and insulin resistance at extremely high altitudes in people without diabetes have been reported as well. 36,63,64 It is unclear whether this observed insulin resistance is a result of acute mountain sickness or exposure to hypobaric hypoxia.…”

Section: Change In Insulin Requirementsmentioning

confidence: 86%

Wilderness Medical Society Clinical Practice Guidelines for Diabetes Management

VanBaak

Nally

Finigan³

et al. 2019

Wilderness & Environmental Medicine

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The Wilderness Medical Society convened an expert panel in 2018 to develop a set of evidence-based guidelines for the treatment of type 1 and 2 diabetes, as well as the recognition, prevention, and treatment of complications of diabetes in wilderness athletes. We present a review of the classifications, pathophysiology, and evidence-based guidelines for planning and preventive measures, as well as best practice recommendations for both routine and urgent therapeutic management of diabetes and glycemic complications. These recommendations are graded based on the quality of supporting evidence and balance between the benefits and risks or burdens for each recommendation.

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“…The observed diabetes management inertia contributing to hyperglycemia among our patients could be potentially explained by the perceived exertion, which increased together with the altitude reached. It was also postulated that the stress response to high altitude dominates exercise-enhanced insulin sensitivity, resulting in relative hyperglycemia [ 19 ]. Of interest, the rise in glucose concentration could not be fully explained by the rise in lactate concentration alone, as the positive correlation was found only for day 2.…”

Section: Discussionmentioning

confidence: 99%

Physiological Characteristics of Type 1 Diabetes Patients during High Mountain Trekking

Matejko

Gawrecki

Wróbel

et al. 2020

Journal of Diabetes Research

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In this study, the aim was to provide observational data from an ascent to the summit of Mount Damavand (5670 meters above sea level (m.a.s.l), Iran) by a group of people with type 1 diabetes (T1DM), with a focus on their physiological characteristics. After a 3-day expedition, 18 T1DM patients, all treated with personal insulin pumps, successfully climbed Mount Damavand. Information was collected on their physiological and dietary behaviors, as well as medical parameters, such as carbohydrate consumption, glucose patterns, insulin dosing, and the number of hypo- and hyperglycemic episodes during this time frame. The participants consumed significantly less carbohydrates on day 3 compared to day 1 (16.4 vs. 23.1 carbohydrate units; p=0.037). Despite this, a gradual rise in the mean daily glucose concentration as measured with a glucometer was observed. Interestingly, the patients did not fully respond to higher insulin delivery as there was no significant difference in mean daily insulin dose during the expedition. There were more hyperglycemic episodes (≥180 mg/dL) per patient on day 3 vs. day 1 (p<0.05) and more severe hyperglycemic episodes (>250 mg/dL) per patient on days 2 (p<0.05) and 3 (p<0.05) vs. day 1. In summary, high mountain trekking is feasible for T1DM patients with good glycemic control and no chronic complications. However, some changes in dietary preferences and an observable rise in glucose levels may occur. This requires an adequate therapeutic response.

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Continuous Glucose Monitoring at High Altitude—Effects on Glucose Homeostasis

Cited by 21 publications

References 37 publications

<p>Low Elevation and Physical Inactivity are Associated with a Higher Prevalence of Metabolic Syndrome in Ecuadorian Adults: A National Cross-Sectional Study</p>

<p>Low Elevation and Physical Inactivity are Associated with a Higher Prevalence of Metabolic Syndrome in Ecuadorian Adults: A National Cross-Sectional Study</p>

Wilderness Medical Society Clinical Practice Guidelines for Diabetes Management

Physiological Characteristics of Type 1 Diabetes Patients during High Mountain Trekking

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