Reduction in insulin degludec dosing for multiple exercise sessions improves time spent in euglycaemia in people with type 1 diabetes: A randomized crossover trial

Moser, Othmar; Eckstein, Max L.; Mueller, Alexander; Birnbaumer, Philipp; Aberer, Felix; Koehler, Gerd; Sourij, Caren; Kojzar, Harald; Holler, Peter; Simi, Helmut; Pferschy, Peter N.; Dietz, Pavel; Bracken, Richard M.; Hofmann, Peter; Sourij, Harald

doi:10.1111/dom.13534

Cited by 22 publications

(34 citation statements)

References 31 publications

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“…After reaching maximum volitional exhaustion, participants performed an active cool‐down for 3 minutes at 20 W, followed by a 3‐minute passive cool‐down period without pedalling. Maximum volitional exhaustion was defined by one of the following parameters: a lactate concentration greater than10 mmol/L; a respiratory exchange ratio (RER) greater than 1.1; a plateau in oxygen uptake (VO 2 ); or inability to maintain a pedalling cadence of more than 50 rpm (rpm) for 5 seconds . During CPX testing, respiration measurement (METAMAX 3B; Cortex Biophysik GmbH, Leipzig, Germany), heart rate measurement (S410, Polar Electro, Kmpele, Finland) and electrocardiogram measurement (eMotion Faros 180°, Bittium Biosignals Ltd, Oulu, Finland) were ongoing.…”

Section: Methodsmentioning

confidence: 99%

Performance of the Freestyle Libre flash glucose monitoring (flash GM) system in individuals with type 1 diabetes: A secondary outcome analysis of a randomized crossover trial

Moser

Eckstein

McCarthy

et al. 2019

Diabetes Obesity Metabolism

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Aims The efficacy of flash glucose monitoring (flash GM) systems has been demonstrated by improvements in glycaemia; however, during high rates of glucose flux, the performance of continuous glucose monitoring systems was impaired, as detailed in previous studies. This study aimed to determine the performance of the flash GM system during daily‐life glycaemic challenges such as carbohydrate‐rich meals, bolus insulin‐induced glycaemic disturbances and acute physical exercise in individuals with type 1 diabetes. Materials and methods This study comprised four randomized trial visits with alternating pre‐ and post‐exercise bolus insulin doses. Throughout the four 14‐hour inpatient phases, 19 participants received three carbohydrate‐rich meals and performed moderate‐intensity exercise. Venous blood glucose and capillary blood glucose during exercise was compared to interstitial glucose concentrations. Flash GM accuracy was assessed by median absolute relative difference (MARD) (interquartile range [IQR]) using the Bland–Altman method and Clark error grid, as well as according to guidelines for integrated CGM approvals (Class II–510(K)). Results The overall MARD (IQR) during inpatient phases was 14.3% (6.9%–22.8%), during hypoglycaemia (≤3.9 mmol/L) was 31.6% (16.2%–46.8%), during euglycaemia (4.0 mmol/L − 9.9 mmol/L) was 16.0% (8.5%–24.0%) and during hyperglycaemia (≥10 mmol/L) was 9.4% (5.1%–15.7%). Overall Bland–Altman analysis showed a bias (95% LoA) of 1.26 mmol/L (−1.67 to 4.19 mmol/L). The overall MARD during acute exercise was 29.8% (17.5%–39.8%), during hypoglycaemia was 45.1% (35.2%–51.1%), during euglycaemia was 30.7% (18.7%–39.2%) and during hyperglycaemia was 16.3% (10.0%–22.8%). Conclusion Flash GM interstitial glucose readings were not sufficiently accurate within the hypoglycaemic range and during acute exercise and require confirmatory blood glucose measurements.

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Section: Methodsmentioning

confidence: 99%

Performance of the Freestyle Libre flash glucose monitoring (flash GM) system in individuals with type 1 diabetes: A secondary outcome analysis of a randomized crossover trial

Moser

Eckstein

McCarthy

et al. 2019

Diabetes Obesity Metabolism

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“…The results for the primary outcome, time spent in prespecified glycaemic ranges, were recently published [6]. The results for the primary outcome, time spent in prespecified glycaemic ranges, were recently published [6].…”

Section: Participants and Methodsmentioning

confidence: 99%

“…Details of the inclusion and exclusion criteria have been described previously [6]. Four women and six men were included in this trial.…”

Section: Participant Characteristicsmentioning

confidence: 99%

“…Moderate exercise intensity was set at the midpoint between the first and the second lactate turn points, corresponding to 63 AE 7% of VO 2max [6]. If any sensor was due to expire during the course of the trial, the participants were told to change the sensor at least 2 days before the first exercise session to ensure sensor accuracy.…”

Section: Trial Visitsmentioning

confidence: 99%

“…The primary outcome of this study was published in Moser et al [6]. This study was supported by an unrestricted grant from Novo Nordisk, Austria (DRKS.de; DRKS00013477).…”

Section: Acknowledgementsmentioning

confidence: 99%

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Impact of physical exercise on sensor performance of the FreeStyle Libre intermittently viewed continuous glucose monitoring system in people with Type 1 diabetes: a randomized crossover trial

et al. 2019

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Aims To evaluate the sensor performance of the FreeStyle Libre intermittently viewed continuous glucose monitoring system using reference blood glucose levels during moderate-intensity exercise while on either full or reduced basal insulin dose in people with Type 1 diabetes. Methods Ten participants with Type 1 diabetes [four women, mean AE SD age 31.4 AE 9.0 years, BMI 25.5AE3.8 kg/m 2 , HbA 1c 55AE7 mmol/mol (7.2AE0.6%)] exercised on a cycle ergometer for 55 min at a moderate intensity for 5 consecutive days at the clinical research facility, while receiving either their usual or a 75% basal insulin dose. After a 4-week washout period, participants performed the second exercise period having switched to the alternative basal insulin dose. During exercise, reference capillary blood glucose values were analysed using the fully enzymatic-amperometric method and compared with the interstitial glucose values obtained. Intermittently viewed continuous glucose monitoring accuracy was analysed according to median (interquartile range) absolute relative difference, and Clarke error grid and Bland-Altman analysis for overall glucose levels during exercise, stratified by glycaemic range and basal insulin dosing scheme (P<0.05).Results A total of 845 glucose values were available during exercise to evaluate intermittently viewed continuous glucose monitoring sensor performance. The median (interquartile range) absolute relative difference between the reference values and those obtained by the sensor across the glycaemic range overall was 22 (13.9-29.7)%, and was 36.3 (24.2-45.2)% during hypoglycaemia, 22.8 (14.6-30.6)% during euglycaemia and 15.4 (9-21)% during hyperglycaemia. Usual basal insulin dose was associated with a worse sensor performance during exercise compared with the reduced (75%) basal insulin dose [median (interquartile range) absolute relative difference: 23.7 (17.2-30.7)% vs 20.5 (12-28.1)%; P<0.001).Conclusions The intermittently viewed continuous glucose monitoring sensor showed diminished accuracy during exercise. Absolute glucose readings derived from the sensor should be used cautiously and need confirmation by additional finger-prick blood glucose measurements.

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The competitive athlete with type 1 diabetes

et al. 2020

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Regular exercise is important for health, fitness and longevity in people living with type 1 diabetes, and many individuals seek to train and compete while living with the condition. Muscle, liver and glycogen metabolism can be normal in athletes with diabetes with good overall glucose management, and exercise performance can be facilitated by modifications to insulin dose and nutrition. However, maintaining normal glucose levels during training, travel and competition can be a major challenge for athletes living with type 1 diabetes. Some athletes have low-to-moderate levels of carbohydrate intake during training and rest days but tend to benefit, from both a glucose and performance perspective, from high rates of carbohydrate feeding during longdistance events. This review highlights the unique metabolic responses to various types of exercise in athletes living with type 1 diabetes.

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Reduction in insulin degludec dosing for multiple exercise sessions improves time spent in euglycaemia in people with type 1 diabetes: A randomized crossover trial

Abstract: A 25% reduction in usual IDeg dose around regular exercise led to more time spent in euglycaemia, with small effects on time spent in hypo- and hyperglycaemia.

Cited by 22 publications

References 31 publications

Performance of the Freestyle Libre flash glucose monitoring (flash GM) system in individuals with type 1 diabetes: A secondary outcome analysis of a randomized crossover trial

Performance of the Freestyle Libre flash glucose monitoring (flash GM) system in individuals with type 1 diabetes: A secondary outcome analysis of a randomized crossover trial

Impact of physical exercise on sensor performance of the FreeStyle Libre intermittently viewed continuous glucose monitoring system in people with Type 1 diabetes: a randomized crossover trial

The competitive athlete with type 1 diabetes

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