Association of aerobic fitness level with exercise-induced hypoglycaemia in Type 1 diabetes

Abstract BackgroundThe aim of this study was to examine a possible association of HbA1c, quality of life (QoL), fitness, and electrophysiological parameters in children with type 1 diabetes mellitus (T1DM).MethodsThe study population (n = 34) consisted of patients with T1DM (n = 17) and an age- and BMI-matched healthy control group (n = 17). HbA1c was obtained from patients with T1DM at time of diagnosis (T0), at 6 months (T6), at 12 months (T12), and at time of study inclusion (Tstudy). QoL was determined with a standardized questionnaire (KINDL-R). All children completed a 6-minute walk test (6MWT) to evaluate their fitness level. Electrodiagnostic studies established upper and lower limb motor and sensory nerve conduction velocities (NCV).ResultsHigher HbA1c (Tstudy) was associated with lower QoL showing in the subscales self-esteem, friends and school. Higher HbA1c (T6) and (T12) was associated with lower QoL in the subscale self-esteem. Based on various subscales, perceived problem areas differed significantly between children and their parents. No differences in fitness level and NCV were found between patients and controls except for a significantly slower median motor NCV in patients. HbA1c was not associated with NCVs at this early stage of disease.ConclusionsGood metabolic control reflected by adequate HbA1c values seems to be important for a good QoL in children with T1DM. Early HbA1c analysis serves as predictor for QoL during follow-up.Trial registration: Retrospectively registered

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In amateur athletes with type 1 diabetes, a 9-day period of cycling at moderate-to-vigorous intensity unexpectedly increased the time spent in hyperglycemia, which was associated with impairment in heart rate variability

10.2337/figshare.12517397.v1 ◽

2020 ◽

Author(s):

Elodie Lespagnol ◽

Olivia Bocock ◽

Joris Heyman ◽

François-Xavier Gamelin ◽

Serge Berthoin ◽

...

Keyword(s):

Heart Rate ◽

Heart Rate Variability ◽

Type 1 Diabetes ◽

Glycemic Variability ◽

Amateur Athletes ◽

Positive Effects ◽

Vigorous Intensity ◽

Exercise Induced ◽

The Impact

Objective In type 1 diabetes, autonomic dysfunction may occur early as a decrease in heart rate variability (HRV). In nondiabetic populations, the positive effects of exercise training on HRV are well documented. However, exercise in individuals with type 1 diabetes, particularly if strenuous and prolonged, can lead to sharp glycemic variations, which can negatively impact HRV. This study explores the impact of a 9-day cycling tour on HRV in this population, with a focus on exercise-induced glycemic excursions. Research Design and Methods Twenty amateur athletes with uncomplicated type 1 diabetes cycled 1500km. HRV and glycemic variability were measured by heart rate and continuous glucose monitoring. Linear mixed models were used to test the effects of exercise on HRV, considering concomitant glycemic excursions and subject characteristics as covariates. Results Nighttime HRV tended to decrease with the daily distance traveled. The more time the subjects spent in hyperglycemia, the lower the parasympathetic tone was. This result is striking given that hyperglycemic excursions progressively increased throughout the 9 days of the tour, and to a greater degree on the days a longer distance was traveled, while time spent in hypoglycemia surprisingly decreased. This phenomenon occurred despite no changes in insulin administration and a decrease in carbohydrate intake from snacks. Conclusions <a>In sports enthusiasts with type 1 diabetes</a>, multiday prolonged exercise at moderate-to-vigorous intensity worsened hyperglycemia with the latter being negatively associated with parasympathetic cardiac tone. Considering the putative deleterious consequences on cardiac risks, future work should focus on understanding and managing exercise-induced hyperglycemia.

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Reproducibility of Glucose Fluctuations Induced by Moderate Intensity Cycling Exercise in Persons with Type 1 Diabetes

Journal of Diabetes Research ◽

10.1155/2021/6640600 ◽

2021 ◽

Vol 2021 ◽

pp. 1-8

Author(s):

Gabriel Tafdrup Notkin ◽

Peter Lommer Kristensen ◽

Ulrik Pedersen-Bjergaard ◽

Andreas Kryger Jensen ◽

Stig Molsted

Keyword(s):

Heart Rate ◽

Type 1 Diabetes ◽

Moderate Intensity ◽

Blood Pressure Monitor ◽

Continuous Training ◽

Pressure Monitor ◽

Continuous Glucose Monitor ◽

Individual Level ◽

Exercise Induced

Aims. The purpose was to assess the reproducibility of glucose changes during three sessions of standardized moderate intensity continuous training of cycling on an individual level in people with type 1 diabetes. Methods. Twelve adults (six females) with type 1 diabetes performed three test sessions on an ergometer bicycle (30 min, 67% of predicted heart rate) on three different days. The participants were 36.5 (26.6-45.5) (median, IQR) years old, and their HbA1c was 65 ± 15 mmol/mol ( mean ± SD ). Two hours before the tests, the participants had a standard meal. Interstitial glucose (IG) and capillary glucose (CG) were measured using an iPro2 Medtronic continuous glucose monitor and the Bayer Contour XT-device, respectively. Prior to the test sessions, resting heart rate was measured using a digital blood pressure monitor to estimate the desired intensity of the exercise. Results. The average within-participant relationship between the average slope in glucose during sessions 2 and 1 was in IG -0.29 (95% CI -1.11; 0.58) and in CG -0.04 (-0.68; 0.77). Between sessions 3 and 2, IG is 0.18 (-0.27; 0.64) and in CG 0.13 (-0.25; 0.55). Between sessions 3 and 1, IG was 0.06 (-0.57; 0.71) and in CG 0.06 (-0.39; 0.52). The results indicate low reproducibility at participant levels and remained unchanged after adjustment for baseline glucose values. Conclusion. On an individual level, the glucose declines during three standardized sessions of PA were not associated with identical responses of the measured IG and CG levels. An overall anticipated decline of glucose concentrations was found in the moderate intensity cycling sessions. This highlights the importance of regular CG measurements during and after physical activity and awareness towards potential exercise-induced hypoglycemia in persons with type 1 diabetes.

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Effectiveness of a Predictive Algorithm in the Prevention of Exercise-Induced Hypoglycemia in Type 1 Diabetes

Diabetes Technology & Therapeutics ◽

10.1089/dia.2016.0141 ◽

2016 ◽

Vol 18 (9) ◽

pp. 543-550 ◽

Cited By ~ 26

Author(s):

Mary B. Abraham ◽

Raymond Davey ◽

Michael J. O'Grady ◽

Trang T. Ly ◽

Nirubasini Paramalingam ◽

...

Keyword(s):

Type 1 Diabetes ◽

Predictive Algorithm ◽

Exercise Induced

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Mini-Dose Glucagon as a Novel Approach to Prevent Exercise-Induced Hypoglycemia in Type 1 Diabetes

Diabetes Care ◽

10.2337/dc18-0051 ◽

2018 ◽

Vol 41 (9) ◽

pp. 1909-1916 ◽

Cited By ~ 24

Author(s):

Michael R. Rickels ◽

Stephanie N. DuBose ◽

Elena Toschi ◽

Roy W. Beck ◽

Alandra S. Verdejo ◽

...

Keyword(s):

Type 1 Diabetes ◽

Novel Approach ◽

Exercise Induced

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A Single Load of Fructose Attenuates the Risk of Exercise-Induced Hypoglycemia in Adults With Type 1 Diabetes on Ultra-Long-Acting Basal Insulin: A Randomized, Open-Label, Crossover Proof-of-Principle Study

Diabetes Care ◽

10.2337/dc19-2250 ◽

2020 ◽

Vol 43 (9) ◽

pp. 2010-2016

Author(s):

Christophe Kosinski ◽

David Herzig ◽

Céline Isabelle Laesser ◽

Christos T. Nakas ◽

Andreas Melmer ◽

...

Keyword(s):

Type 1 Diabetes ◽

Basal Insulin ◽

Open Label ◽

Exercise Induced ◽

Long Acting ◽

Proof Of Principle

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In amateur athletes with type 1 diabetes, a 9-day period of cycling at moderate-to-vigorous intensity unexpectedly increased the time spent in hyperglycemia, which was associated with impairment in heart rate variability

10.2337/figshare.12517397 ◽

2020 ◽

Author(s):

Elodie Lespagnol ◽

Olivia Bocock ◽

Joris Heyman ◽

François-Xavier Gamelin ◽

Serge Berthoin ◽

...

Keyword(s):

Heart Rate ◽

Heart Rate Variability ◽

Type 1 Diabetes ◽

Glycemic Variability ◽

Amateur Athletes ◽

Positive Effects ◽

Vigorous Intensity ◽

Exercise Induced ◽

The Impact

Objective In type 1 diabetes, autonomic dysfunction may occur early as a decrease in heart rate variability (HRV). In nondiabetic populations, the positive effects of exercise training on HRV are well documented. However, exercise in individuals with type 1 diabetes, particularly if strenuous and prolonged, can lead to sharp glycemic variations, which can negatively impact HRV. This study explores the impact of a 9-day cycling tour on HRV in this population, with a focus on exercise-induced glycemic excursions. Research Design and Methods Twenty amateur athletes with uncomplicated type 1 diabetes cycled 1500km. HRV and glycemic variability were measured by heart rate and continuous glucose monitoring. Linear mixed models were used to test the effects of exercise on HRV, considering concomitant glycemic excursions and subject characteristics as covariates. Results Nighttime HRV tended to decrease with the daily distance traveled. The more time the subjects spent in hyperglycemia, the lower the parasympathetic tone was. This result is striking given that hyperglycemic excursions progressively increased throughout the 9 days of the tour, and to a greater degree on the days a longer distance was traveled, while time spent in hypoglycemia surprisingly decreased. This phenomenon occurred despite no changes in insulin administration and a decrease in carbohydrate intake from snacks. Conclusions <a>In sports enthusiasts with type 1 diabetes</a>, multiday prolonged exercise at moderate-to-vigorous intensity worsened hyperglycemia with the latter being negatively associated with parasympathetic cardiac tone. Considering the putative deleterious consequences on cardiac risks, future work should focus on understanding and managing exercise-induced hyperglycemia.

Download Full-text