Comparing Two Treatment Approaches for Patients with Type 1 Diabetes During Aerobic Exercise: a Randomised, Crossover Study

Background In a randomised, counterbalanced, crossover design, eight men with type 1 diabetes (T1D; mean ± SD age, 27.6 ± 11.4 years) reduced insulin (INS) by 50% of their normal dose or consumed carbohydrates equivalent to 1 g of carbohydrate per kilogramme of their body weight without the usual insulin bolus (CARBS) over two sessions, held a week apart. Each session included standardised meals, a 45-min treadmill walk at 7.24 km h−1 and a 6-min walk test (6MWT). Rate of perceived exertion (RPE), blood glucose, ketone and lactate measures were taken before, during and immediately after the aerobic exercise. The distance covered in metres and the predicted VO2 max (mL kg−1 min−1) were also calculated for the 6MWT. Results Participants completing the INS intervention spent more time in normoglycaemia (242 ± 135 min vs 88 ± 132 min; P < 0.01) and less time in hyperglycaemia (41 ± 95 min vs 154 ± 125 min; P = 0.01) as compared to the CARBS intervention. Mild hypoglycaemia occurred in two participants during INS and no participants during CARBS. Furthermore, there was no significant difference for blood lactate, ketone, RPE, distance covered and predicted VO2 max between interventions. Conclusion Based on this pilot study, INS intervention appears to be the best approach for maintaining blood glucose levels in those with T1D during aerobic exercise, though this does need evaluation in other groups, including women, children and those with suboptimal glycaemic control. Trial Registration Australian New Zealand Clinical Trial Registry, ACTRN12619001397101p. Registered 09 September 2019.

Comparing two treatment approaches for patients with type 1 diabetes during aerobic exercise: a randomised, crossover study

In a randomised, counterbalanced, crossover design, eight men with type 1 diabetes (T1D; mean ± SD age: 27.6 ± 11.4 years) reduced insulin (INS) by 50% of their normal dose or consumed carbohydrates equivalent to 1 g of carbohydrate/kg of their body weight without the usual insulin bolus (CARBS) over two sessions, held a week apart. Each session included standardised meals, a 45-minute treadmill-walk at 7.24 km.h-1 and a six-minute walk test (6MWT). Rate of perceived exertion (RPE), blood glucose, blood ketone and blood lactate measures were taken before, during and immediately after the aerobic exercise. The distance covered in metres and the predicted VO2 max (mL⋅kg−1⋅min−1) were also calculated for the 6MWT. Participants completing the INS intervention spent more time in normoglycaemia (242 ± 135 min vs 88 ± 132 min; P < 0.01) and less time in hyperglycaemia (41 ± 95 min vs 154 ± 125 min; P = 0.01) as compared to the CARBS intervention. Mild hypoglycaemia occurred in two participants during INS and no participants during CARBS. Furthermore, there was no significant difference for blood lactate, ketone, RPE, distance covered and predicted VO2 max between interventions. Based on this pilot study, INS intervention appears to be the best approach for maintaining blood glucose levels in those with T1D during aerobic exercise, though this does need evaluating in other groups, including women, children and those with sub-optimal glycaemic control. Trial registration: ACTRN12619001397101p. Registered 09 September 2019, http://anzctr.org.au/Trial/Registration/TrialReview.aspx?id=378264

Glucose response to low-dose glucagon for insulin-induced mild hypoglycaemia after 12 weeks of high versus low carbohydrate diet. A pilot study

ObjectiveTo compare the glucose response to low-dose glucagon after high carbohydrate diet (HCD) versus low carbohydrate diet (LCD).MethodsIndividuals with insulin pump-treated type 1 diabetes went through 12 weeks of HCD (>250 g/day) and 12 weeks of LCD (<100 g/day) in random order and separated by 12 weeks. At end of each diet, mild hypoglycaemia was induced in the fasting state by a subcutaneous insulin bolus. When plasma glucose (PG) reached 3.9 mmol/L, 100 µg glucagon was given subcutaneously.ResultsFour of six participants completed both study visits while the remaining two only completed the study visit following LCD. They were 37 (28-52) years old (median (IQR)), had BMI 25.0 (24.5-25.2) kg/m2, and HbA1c 57 (55-59) mmol/mol or 7.4 (7.2-7.5) %. Daily carbohydrate intake was 95 (86-97) g during LCD and 254 (184-259) g during HCD. Compared with HCD, LCD had a significantly lower area under the PG curve from 0-120 min (521 (394-617) vs 663 (546-746) mmol/l x min, p=0.045) and insignificant lower incremental PG peak after the glucagon bolus (1.5 (0.6-3.2) vs 3.0 (2.2-4.2) mmol/L, p=0.317).ConclusionIn conclusion, the glucose response to low-dose glucagon was reduced after 12 weeks of LCD compared with HCD.

Comparing Two Treatment Approaches for Patients with Type 1 Diabetes During Aerobic Exercise: A Randomised, Crossover Study

In a randomised, counterbalanced, crossover design, eight men with type 1 diabetes (T1D; mean ± SD age: 27.6 ± 11.4 years) reduced insulin (INS) or consumed carbohydrates without the usual insulin bolus (CARBS) over two sessions, held a week apart. Each session included standardised meals, a 45-minute treadmill-walk at 7.24 km.h-1 and a six-minute walk test (6MWT). Rate of perceived exertion (RPE), blood glucose, blood ketone and blood lactate measures were taken before, during and immediately after the aerobic exercise. The distance covered and the predicted VO2 max were also calculated for the 6MWT. Participants completing the INS intervention spent more time in normoglycaemia (P < 0.01) and less time in hyperglycaemia (P = 0.01) as compared to the CARBS intervention. Mild hypoglycaemia occurred in two participants during INS and no participants during CARBS. Furthermore, there was no significant difference for blood lactate, ketone, RPE, distance covered and predicted VO2 max between interventions. Six of the eight participants felt that their performance was better during INS, with all six (including the two participants that experienced mild hypoglycaemia) indicating that they would prefer to use this strategy for management of glycaemic during exercise in the future. Based on this pilot study, INS intervention appears to be the best approach for maintaining blood glucose levels in those with T1D during aerobic exercise, though this does need evaluating in other groups, including women, children and those with sub-optimal glycaemic control.Trial registration: ACTRN12619001397101p. Registered 09 September 2019, http://anzctr.org.au/Trial/Registration/TrialReview.aspx?id=378264

Hypoglycaemia, Abnormal Lipids, and Cardiovascular Disease among Chinese with Type 2 Diabetes

We recruited a group of 6713 consecutive Chinese patients with T2D but normal renal and liver function who were admitted to one of 81 top tertiary care hospitals in China. Mild hypoglycaemia was defined as having symptomatic hypoglycaemia in one month before hospitalization. Severe hypoglycaemia was defined as having hypoglycaemia that needed assistance from other people in three months before hospitalization. Prior cardiovascular disease (CVD) was defined as having coronary heart disease, stroke, or peripheral arterial disease. Of 6713 patients, 80 and 304 had severe and mild hypoglycaemia episodes, respectively, and 561 had CVD. Patients with severe and mild hypoglycaemia episodes were more likely to have prior CVD (32.5% versus 16.5% versus 7.7%,P<0.0001). Both mild and severe hypoglycaemia were associated with increased risk of CVD (adjusted odds ratios (ORs): 2.64, 95% CI: 1.85–3.76 for mild hypoglycaemia; 6.59, 95% CI: 3.79–11.45 for sever hypoglycaemia) than those patients free of hypoglycaemia. Further adjustment for lipid profile did not change these two ORs. In the same way, the ORs of lipid profile for CVD were similar before and after adjustment for hypoglycaemia. We concluded that hypoglycaemia and lipid profile were independently associated with increased risk of CVD.