Impact of pre- and post-exercise strategies on hypoglycemic risk for two modalities of aerobic exercise among adults and adolescents living with type 1 diabetes using continuous subcutaneous insulin infusion: a randomized controlled trial - 08/12/24

Doi : 10.1016/j.diabet.2024.101599

Joséphine Molveau ^1,^2,⁵, Étienne Myette-Côté ^1,⁶, Capucine Guédet ^1,^3,⁵, Sémah Tagougui ^1,^2,⁵, Roxane St-Amand ¹, Corinne Suppère ¹, Elsa Heyman ^5,⁷, Virginie Messier ¹, Valérie Boudreau ¹, Laurent Legault ⁸, Rémi Rabasa-Lhoret ^1,^2,^4,^⁎
¹ Institut de recherches cliniques de Montréal, Canada
² Département de Nutrition, Faculté de Médecine, Université de Montréal, Canada
³ Département de Kinésiologie, Faculté de Médecine, Université de Montréal, Canada
⁴ Endocrinology Division and Montreal Diabetes Research Center, Canada
⁵ Univ. Lille, Univ. Artois, Univ. Littoral Côte d'Opale, ULR 7369 - URePSSS - Unité de Recherche Pluridisciplinaire Sport Santé Société, France
⁶ Department of Applied Human Sciences, Faculty of Science, University of Prince Edward Island, Canada
⁷ Institut Universitaire de France, Paris, France
⁸ Montreal Children's Hospital, McGill University Health Centre, Canada

^⁎Correspondance: Pr. Rémi Rabasa-Lhoret

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Highlights

•	In adults and adolescents with type 1 diabetes (T1D) using continuous subcutaneous insulin infusion, continuous moderate-intensity exercise resulted in a greater decrease in blood glucose during exercise compared to intermittent high-intensity exercise without increasing hypoglycemia risk.
•	A larger (-80%) pre-exercise basal rate reduction (BRR) did not significantly reduce hypoglycemia risk during exercise compared to a smaller BRR (-40%).
•	Post-exercise strategies involving either a 20% BRR with reduced dinner bolus or carbohydrate snacks produced comparable glucose profiles, offering flexibility for personalized hypoglycemia management.
•	This study fills a significant gap in understanding exercise-induced hypoglycemia and offers evidence-based guidance for managing exercise in both adults and adolescents with T1D.

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Abstract

Objective

We investigated strategies to mitigate hypoglycemic risk during and after different aerobic exercises in people with type 1 diabetes (pwT1D) using continuous subcutaneous insulin infusion.

Research design and methods

Thirty-seven pwT1D (21 adults, 16 adolescents; HbA1c = 7.5 ± 1.0%) participated in two post-absorptive (4-h post-meal) exercise sessions (60-min continuous moderate intensity [CONT] vs. intermittent [INT]). Pre-exercise basal rate reduction (BRR) was either 40% or 80%, 90 min before exercise. Post-exercise, participants undertook either a 20% BRR for 10 hours with 20% reduced dinner bolus (INS) or a 45g post-exercise carbohydrate (CHO) snack with a 50% insulin bolus, and a 30g bedtime CHO snack without bolus (snack).

Results

While a similar number of hypoglycemic events (31 vs. 28) were observed between exercise modalities, CONT led to a greater decrease in blood glucose during exercise compared to INT (-3.1 ± 2.3, CONT vs. -2.7 ± 2.2 mmol/l, INT, P = 0.005). Changes in blood glucose during exercise (-3.0 ± 2.4, 40%BRR vs. -2.8 ± 2.1 mmol/l, 80%BRR, P = 0.076) and the number of hypoglycemic events (35 vs. 24) were similar between 40% and 80%BRR. Time in hyperglycemia was lower with INS compared to snack in the first 30min after exercise, but no differences were observed for late recovery period or nighttime.

Conclusion

Compared to INT, CONT led to greater blood glucose decline without increasing hypoglycemia risk. A larger pre-exercise BRR did not further reduce hypoglycemia risk during exercise. Post-exercise INS and snack strategies led to comparable glucose profiles in pwT1D.

Le texte complet de cet article est disponible en PDF.