Efficacy of Continuous Real-Time Blood Glucose Monitoring During and After Prolonged High-Intensity Cycling Exercise: Spinning with a Continuous Glucose Monitoring System

Iscoe, Katherine E.; Campbell, Jonathan E.; Jamnik, Veronica; Perkins, Bruce A.; Riddell, Michael C.

doi:10.1089/dia.2006.8.627

Cited by 94 publications

(79 citation statements)

References 23 publications

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“…26 During moderate-intensity exercise lag times of up to 20 min were observed with the Guardian Ò REAL-Time (Medtronic MiniMed), 14 compared with only 8-12 min at rest for the next-generation EnliteÔ sensor (Medtronic MiniMed). 27 The DexCom Ò (San Diego, CA) and FreeStyle Navigator CGM devices report similar lag times (6 and 13 min, respectively) under sedentary conditions.…”

Section: Discussionmentioning

confidence: 99%

“…[10][11][12][13][14][15] The study was carried out in a carefully controlled clinical research facility setting, over a 22.5-h duration, thus providing numerous paired glucose values for analysis. We used plasma glucose measured by the YSI 2300 STAT Plus analyzer as the reference standard, unlike other studies that used capillary glucose.…”

Section: Discussionmentioning

confidence: 99%

“…Accuracy, as measured by the median relative absolute difference (RAD) between paired sensor and reference glucose values in time, ranges from 11% to 14% under resting conditions. 8,9 There is limited objective evidence on performance of CGMs during physical activity, [10][11][12][13][14][15] in particular none using current-generation sensors. There are no studies evaluating CGM use in pregnant women during exercise.…”

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confidence: 99%

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Accuracy of Continuous Glucose Monitoring During Exercise in Type 1 Diabetes Pregnancy

Kumareswaran

Elleri²,

Allen³

et al. 2013

Diabetes Technology & Therapeutics

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Background: Performance of continuous glucose monitors (CGMs) may be lower when glucose levels are changing rapidly, such as occurs during physical activity. Our aim was to evaluate accuracy of a current-generation CGM during moderateintensity exercise in type 1 diabetes (T1D) pregnancy. Subjects and Methods: As part of a study of 24-h closed-loop insulin delivery in 12 women with T1D (disease duration, 17.6 years; glycosylated hemoglobin, 6.4%) during pregnancy (gestation, 21 weeks), we evaluated the Freestyle Navigator Ò sensor (Abbott Diabetes Care, Alameda, CA) during afternoon (15:00-18:00 h) and morning (09:30-12:30 h) exercise (55 min of brisk walking on a treadmill followed by a 2-h recovery), compared with sedentary conditions (18:00-09:00 h). Plasma (reference) glucose, measured at regular 15-30-min intervals with the YSI Ltd. (Fleet, United Kingdom) model YSI 2300 analyzer, was used to assess CGM performance. Results: Sensor accuracy, as indicated by the larger relative absolute difference (RAD) between paired sensor and reference glucose values, was lower during exercise compared with rest (median RAD, 11.8% vs. 18.4%; P < 0.001). These differences remained significant when correcting for plasma glucose relative rate of change (P < 0.001). Analysis by glucose range showed lower accuracy during hypoglycemia for both sedentary (median RAD, 24.4%) and exercise (median RAD, 32.1%) conditions. Using Clarke error grid analysis, 96% of CGM values were clinically safe under resting conditions compared with only 87% during exercise. Conclusions: Compared with sedentary conditions, accuracy of the Freestyle Navigator CGM was lower during moderateintensity exercise in pregnant women with T1D. This difference was particularly marked in hypoglycemia and could not be solely explained by the glucose rate of change associated with physical activity.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

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Accuracy of Continuous Glucose Monitoring During Exercise in Type 1 Diabetes Pregnancy

Kumareswaran

Elleri²,

Allen³

et al. 2013

Diabetes Technology & Therapeutics

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“…For example, hypoglycemia during just one 75-min intermittent exercise session occurred in 86% of children starting the exercise with normal glucose levels (Tansey et al 2006). In studies of adults with type 1 diabetes who had continuous glucose monitoring, nearly all active persons were shown to develop exercise-associated hypoglycemia within 12-24 h of recovery (Iscoe et al 2006(Iscoe et al , 2008 . In a multicentered study of 50 youth with type 1 diabetes, postexercise hypoglycemia occurred in 26% of subjects after just 1 typical exercise bout, compared with only 6% in the same children after a sedentary day (Tsalikian et al 2005).…”

Section: Risks Of Exercise In Type 1 Diabetesmentioning

confidence: 99%

Evidence-based risk assessment and recommendations for physical activity clearance: diabetes mellitus and related comorbidities¹This paper is one of a selection of papers published in this Special Issue, entitled Evidence-based risk assessment and recommendations for physical activity clearance, and has undergone the Journal’s usual peer review process.

Riddell

Burr

2011

Appl. Physiol. Nutr. Metab.

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Physical activity (PA) is one of the most powerful treatment options for persons with prediabetes or diabetes. However, some elevation in risk occurs with increased PA, at least initially, and certain precautions need to be made to lower these risks, particularly if these persons are unaccustomed to exercise. We conducted a standardized search of all adverse events associated with increased PA in persons with prediabetes or diabetes (type 1 or type 2) and provided evidencebased guidelines on PA screening in these apparently high-risk individuals. A systematic literature review was performed of all studies reporting on adverse events in persons with prediabetes or diabetes. Studies included were from all designs (retrospective and prospective including randomized controlled trials) and were assessed according to evaluation criteria adapted by a consensus panel. A total of 47 studies, involving >8000 individuals, were deemed eligible. A number of these studies identified a range of mild to severe acute risks with exercise (musculoskeletal injury, hypoglycemia, foot ulceration, proliferative retinopathy, hypotension, sudden death) but the overall prevalence was low. Based on several randomized controlled trials and prospective studies in which prescribed exercise was performed at a wide range of intensities, it appears that increased PA is a relatively safe procedure with no evidence of a loss of life. Based on our assessment of the available literature, we provide a new PA risk algorithm for persons with prediabetes and diabetes and comment on the role of the patient, the qualified exercise professional, and the patient's physician in the risk screening process.Key words: exercise, diabetes mellitus, prediabetes, adverse events, Par-Q.Résumé : L'activité physique (PA) est un des meilleurs traitements à l'intention des personnes prédiabétiques et diabéti-ques. Toutefois, avec l'intensification de la pratique de l'activité physique vient une augmentation du risque, du moins au début, et il est donc indiqué de prendre des précautions pour diminuer ce risque particulièrement chez les personnes non accoutumées à l'effort physique. Nous avons réalisé une recherche systématique de tous les événements indésirables se présen-tant avec l'intensification de la PA chez des personnes prédiabétiques et diabétiques (type 1 et type 2) et nous présentons des directives basées sur des données probantes pour le dépistage des patients apparemment à haut risque en matière de PA. On effectue une analyse documentaire systématique de toutes les études présentant des événements indésirables s'étant manifestés chez des personnes prédiabétiques et diabétiques. Les études incluent tous les devis expérimentaux (rétrospectifs et prospectifs y compris les essais cliniques aléatoires (RCTs)); on évalue ces études en fonction des critères adaptés par consensus d'experts. Au total, 47 études comprenant plus de 8000 personnes sont retenues. Un certain nombre d'études identifient des risques associés à PA allant de faibles à graves (blessu...

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“…9,10 Exercise has also been shown to mask hypoglycemic symptoms, facilitating repeated exposure to unrecognized hypoglycemia and potentially causing hypoglycemia-associated autonomic failure 7 with all its negative consequences. 11,12 Recent closed-loop control artificial pancreas (AP) studies have shown reduction in the risk for hypoglycemia in T1DM subjects, increase of the time in near-normoglycemia (70-180 mg/dL), and reduction in average glucose level, both in the hospital and in home-like settings, with and without exercise. [13][14][15][16][17][18][19][20][21][22] However, although overnight hypoglycemia can be reduced severalfold, preventing hypoglycemia during and immediately after exercise remains a hurdle, likely due to the inherent delay of the glycemic response to exercise coupled with delays due to subcutaneously injected insulin.…”

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confidence: 99%

Adding Heart Rate Signal to a Control-to-Range Artificial Pancreas System Improves the Protection Against Hypoglycemia During Exercise in Type 1 Diabetes

Breton

Brown²,

Karvetski³

et al. 2014

Diabetes Technology & Therapeutics

113

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Background: We present a clinical trial establishing the feasibility of a control-to-range (CTR) closed-loop system informed by heart rate (HR) and assess the effect of HR information added to CTR on the risk for hypoglycemia during and after exercise. Subjects and Methods: Twelve subjects with type 1 diabetes (five men, seven women; weight, 68.9 -3.1 kg; age, 38 -3.3 years; glycated hemoglobin, 6.9 -0.2%) participated in a randomized crossover clinical trial comparing CTR versus CTR + HR in two 26-h admissions, each including 30 min of mild exercise. The CTR algorithm was implemented in the DiAs portable artificial pancreas platform based on an Android Ò (Google, Mountainview, CA) smartphone. We assessed blood glucose (BG) decline during exercise, the Low BG Index (LBGI) (a measure of hypoglycemic risk), number of hypoglycemic episodes (BG < 70 mg/dL) and overall glucose control (percentage time within the target range 70 mg/dL £ BG £ 180 mg/dL). Results: Using HR to inform the CTR algorithm reduced significantly the BG decline during exercise (P = 0.022), indicated marginally lower LBGI (P = 0.3) and fewer hypoglycemic events during exercise (none vs. two events; P = 0.16), and resulted in overall higher percentage time within the target range (81% vs. 75%; P = 0.2). LBGI and average BG remained unchanged overall, during recovery, and overnight. Conclusions: HR-informed closed-loop control can be implemented in a portable artificial pancreas. Although closed loop has been shown to reduce hypoglycemia, adding HR signal may further limit the risk for hypoglycemia during and immediately after exercise. The most prominent effect of adding HR information is reduced BG decline during exercise, without deterioration of overall glycemic control.

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Efficacy of Continuous Real-Time Blood Glucose Monitoring During and After Prolonged High-Intensity Cycling Exercise: Spinning with a Continuous Glucose Monitoring System

Cited by 94 publications

References 23 publications

Accuracy of Continuous Glucose Monitoring During Exercise in Type 1 Diabetes Pregnancy

Accuracy of Continuous Glucose Monitoring During Exercise in Type 1 Diabetes Pregnancy

Adding Heart Rate Signal to a Control-to-Range Artificial Pancreas System Improves the Protection Against Hypoglycemia During Exercise in Type 1 Diabetes

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