Type 1 diabetes: Dealing with physical activity

Franc, Sylvia; Dardari, D.; Biedzinski, M.; Requeda, E.; Canipel, L.; Hochberg, G.; Boucherie, B.; Charpentier, G.

doi:10.1016/j.diabet.2012.03.009

Cited by 10 publications

(7 citation statements)

References 8 publications

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“…Self-efficacy (following a healthy eating plan, choosing healthy foods, exercise, confidence in ability to control DM as reported by patients), and self-management 8,12,19,20 …”

Section: Discussionmentioning

confidence: 99%

“…These studies were published between January 2010 and August 2015, and they evaluated a total of 8 mobile medical app products: Blue Star 8,9 Diabeo, 10–12 Diabetes Diary, 13 DID, 14,15 Accu-Chek Aviva Expert, 16,17 Diabetes Insulin Guidance Systems, 18 FreeStyle InsulLinx, 19,20 and Telcare. 21 Six apps (Dexcom Share, Glooko, Accu-Chek Connect, Dario, Livongo, and Telcare) have received FDA clearance for use but do not have studies on efficacy and safety in peer-reviewed literature.…”

Section: Introductionmentioning

confidence: 99%

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Evidence-based Mobile Medical Applications in Diabetes

Drincic

Prahalad

Greenwood

et al. 2016

Endocrinology and Metabolism Clinics of North America

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“…Self-efficacy (following a healthy eating plan, choosing healthy foods, exercise, confidence in ability to control DM as reported by patients), and self-management 8,12,19,20 …”

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Evidence-based Mobile Medical Applications in Diabetes

Drincic

Prahalad

Greenwood

et al. 2016

Endocrinology and Metabolism Clinics of North America

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“…At present, several authors consider that reducing the premeal bolus dose, in most instances by 50%, might be more effective than reducing BR in preventing hypoglycaemic events for exercises soon after a meal. We previously showed that reducing prandial insulin for the meal closest to exercise by 30 or 50% according to exercise intensity [moderate or intense], lowered hypoglycaemic risk to the same level as at rest in patients under continuous subcutaneous insulin infusion or MDI . In a randomized prospective study in patients on MDI, Rabasa‐Lhoret et al also showed that, for short‐lasting postprandial activities of moderate intensity, 50% prandial insulin reduction brought BG back to its starting level, thereby considerably reducing hypoglycaemic risk.…”

Section: Discussionmentioning

confidence: 99%

Insulin‐based strategies to prevent hypoglycaemia during and after exercise in adult patients with type 1 diabetes on pump therapy: the DIABRASPORT randomized study

Franc

Daoudi

Pochat

et al. 2015

Diabetes Obesity Metabolism

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AimsTo validate strategies to prevent exercise‐induced hypoglycaemia via insulin‐dose adjustment in adult patients with type 1 diabetes (T1D) on pump therapy.MethodsA total of 20 patients randomly performed four 30‐min late post‐lunch (3 h after lunch) exercise sessions and a rest session: two moderate sessions [50% maximum oxygen consumption (VO2max)] with 50 or 80% basal rate (BR) reduction during exercise + 2 h and two intense sessions (75% VO2max) with 80% BR reduction or with their pump stopped. Two additional early post‐lunch sessions (90 min after lunch) were analysed to compare hypoglycaemia incidence for BR reduction versus bolus reduction.ResultsIn all, 100 late post‐lunch sessions were analysed. Regardless of exercise type and BR reduction, no more hypoglycaemic events occurred in the period until the next morning than occurred after the rest sessions. In the afternoon, no more hypoglycaemic events occurred with 80% BR reduction/moderate exercise or with pump discontinuation/intense exercise than for the rest session, whereas more hypoglycaemic events occurred with 50% BR reduction/moderate exercise and 80% BR reduction/intense exercise. After early post‐lunch exercise (n = 37), a trend towards fewer hypoglycaemic episodes was observed with bolus reduction versus BR reduction (p = 0.07). Mean blood glucose fell by ∼3.3 mmol/l after 30 min of exercise, irrespective of dose reduction, remaining stable until the next morning with no rebound hyperglycaemia.ConclusionIn adults with T1D, to limit the hypoglycaemic risk associated with 30 min of exercise 3 h after lunch, without carbohydrate supplements, the best options seem to be to reduce BR by 80% or to stop the pump for moderate or intense exercise, or for moderate exercise 90 min after lunch, to reduce the prandial bolus rather than the BR.

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“…The algorithms used to calculate 'units per portion' and 'compensation levels' have been adapted from the studies by Howorka et al [16] and clinically validated [17]. The very simple algorithms used for adjustment to unscheduled physical activity were created by our team and clinically validated [18]. All values can be modified and adapted to individual patients by the treating doctor.…”

Section: Fourth Level: Decision-support Systemsmentioning

confidence: 99%

Devices to Support Treatment Decisions in Type 1 Diabetes: The Diabeo System

Franc¹,

Charpentier²

2014

Frontiers in Diabetes

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Blood glucose control in type 1 diabetes has improved considerably since the DCCT due to general diffusion of 'physiological' basal-prandial therapeutic schedules, generalization of therapeutic educational programs, functional insulin therapy, insulin analogues, and insulin pumps. However, glycated hemoglobin (HbA 1c ) averages 8% within various studies, which is still unsatisfactory. The creation of new technological tools could lead to new levels of success, as attested by the Diabeo system. This system comprises three programs. The first program automatically calculates basal and prandial insulin doses while taking account of blood glucose levels, carbohydrate intake, and physical activity, and is equipped with algorithms that allow automatic adjustment based on the results obtained. The entire system must first of all be configured by the doctor according to the patient's characteristics, and then it has to be downloaded to a smartphone from a secure website. All of the patient's results and data are then made available for consultation at all times by authorized caregivers, enabling remote monitoring to be performed. The second program analyzes the results and automatically generates coaching messages for the patient and messages for the caregiver in the event of underuse, unsatisfactory results, or inadequate operation of the system. The caregiver may then intervene in a timely fashion via a telephone consultation or modification of the patient's treatment profile. The third program optimizes the doctor's available time by delegating tasks and allowing action to be undertaken by a specialized telemedicine nurse working in conjunction with the responsible diabetologist. An initial version of the system, comprising only the first of these three programs, resulted in a mean reduction in HbA 1c of 0.9% at 6 months versus the control group in a population of patients with chronic glycemic control problems and treated with multiple injections or insulin pump. Analysis of individual patient data shows that the most compliant patients derived the greatest benefit from the dose calculation function, while less compliant patients benefited considerably from the telemonitoring function, which allowed short but repeated consultations at opportune moments. A large-scale national study is currently being initiated in France to confirm these favorable metabolic results at 1 year and to assess the medicoeconomic impact of this system after 2 years of use. Ultimately, the results may lead to granting of reimbursable status for the Diabeo system by the French national social security authorities, followed by widespread use of the system in France and international availability.

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Type 1 diabetes: Dealing with physical activity

Cited by 10 publications

References 8 publications

Evidence-based Mobile Medical Applications in Diabetes

Evidence-based Mobile Medical Applications in Diabetes

Insulin‐based strategies to prevent hypoglycaemia during and after exercise in adult patients with type 1 diabetes on pump therapy: the DIABRASPORT randomized study

Devices to Support Treatment Decisions in Type 1 Diabetes: The Diabeo System

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