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Is Better Understanding of Management Strategies for Adults With Type 1 Diabetes Associated With a Lower Risk of Developing Hypoglycemia During and After Physical Activity?

Published:March 05, 2022DOI:https://doi.org/10.1016/j.jcjd.2022.02.009

      Abstract

      Background

      We aim to determine how knowledge and type 1 diabetes (T1D) management strategies are associated with hypoglycemic risk for physical activity (PA)-induced hypoglycemia among people with T1D (PWT1D).

      Methods

      One hundred thirty-seven physically active adults with T1D completed diabetes management, PA habits and PA-associated hypoglycemia questionnaire.

      Results

      PA-associated hypoglycemia (during PA, within 1 hour of PA and overnight after PA) was reported by 49% to 61% of respondents, with 18% indicating that they felt inadequately equipped to perform regular PA safely. For during PA, more hypoglycemia was reported by PWT1D with more knowledge of hypoglycemia prevention strategies and those using continuous subcutaneous insulin infusion (CSII) vs multiple injections, those with decreasing basal rate 30 to 60 minutes before PA vs no adjustment before PA, and those taking snacks for unplanned PA vs no snacking. For within 1 hour after PA, more hypoglycemia was reported by PWT1D less knowledgeable about insulin pharmacokinetics and those practicing pre- vs post-dinner PA. For overnight after PA, more hypoglycemia was reported by PWT1D with shorter diabetes duration; CSII users having greater understanding of exercise-induced glucose fluctuations; those reporting reducing nocturnal insulin infusion rates vs no adjustment at night; those engaged in PA for at least 31 minutes; and those engaged in moderate and vigorous PA (vs light PA) as well as regularly performing interval training vs nonregular practice. Glycated hemoglobin and use of continuous glucose monitoring were not associated with any timing of reported PA-associated hypoglycemia.

      Conclusions

      PA-associated hypoglycemia is common among PWT1D. Greater knowledge of PA and T1D management is not associated with less PA-associated hypoglycemia. Diabetes management confidence could encourage higher tolerance for hypoglycemic risk.

      Résumé

      Introduction

      Notre objectif était de déterminer la façon dont les connaissances et les stratégies en matière de prise en charge du diabète de type 1 (DT1) sont associées au risque d’hypoglycémie induite par l’activité physique (AP) chez les personnes vivant avec le diabète de type 1 (PDT1).

      Méthodes

      Cent trente-sept PDT1 adultes physiquement actifs ont rempli un questionnaire sur la prise en charge du diabète, les habitudes en matière d’AP et l’hypoglycémie associée à l’AP.

      Résultats

      De 49 % à 61 % des répondants ont signalé avoir subi un épisode d’hypoglycémie associée à l’AP (durant l’AP, dans l’heure suivant l’AP et dans la nuit suivant l’AP), et 18 % ont indiqué qu’ils se sentaient inadéquatement outillés pour faire en toute sécurité une AP régulière. Pour ce qui est de durant l’AP, les PDT1 qui avaient plus de connaissances sur les stratégies de prévention de l’hypoglycémie et ceux qui utilisaient la perfusion sous-cutanée continue d’insuline (PSCI) vs les injections multiples, ceux qui avaient une diminution du débit basal de 30 à 60 minutes avant l’AP vs ne faisaient aucun ajustement avant l’AP et ceux qui prenaient des collations avant l’AP non planifiée vs qui n’en prenaient pas ont déclaré plus d’épisodes d’hypoglycémie. Pour ce qui est de l’heure suivant l’AP, les PDT1 qui avaient moins de connaissances sur la pharmacocinétique de l’insuline et ceux qui pratiquaient l’AP avant vs après le souper ont déclaré plus d’épisodes d’hypoglycémie. Pour ce qui est de la nuit suivant l’AP, les patients qui avaient le diabète depuis moins longtemps, les utilisateurs de PSCI qui avaient une meilleure compréhension des fluctuations glycémiques induites par l’exercice, ceux qui déclaraient une réduction des débits de perfusion d’insuline durant la nuit vs ne déclaraient aucun ajustement la nuit, ceux qui pratiquaient au moins 31 minutes d’AP et ceux qui pratiquaient l'AP d'intensité moyenne et élevée (vs AP légère) ainsi que ceux qui faisaient des entraînements par intervalles régulièrement vs n’avaient pas une pratique régulière ont déclaré plus d’épisodes d’hypoglycémie. L’hémoglobine glyquée et l’utilisation de la surveillance de la glycémie en continu n’étaient associées à aucun moment d’hypoglycémie associée à l’AP déclarée.

      Conclusions

      L’hypoglycémie associée à l’AP est fréquente chez les PDT1. De meilleures connaissances de l’AP et de la prise en charge du DT1 ne sont pas associées à de moins nombreux épisodes d’hypoglycémie associée à l’AP. La confiance en la prise en charge du diabète pourrait favoriser une plus grande tolérance au risque d’hypoglycémie.

      Keywords

      Mots clés

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      References

        • McGibbon A.
        • Adams L.
        • Ingersoll K.
        • Kader T.
        • Tugwell B.
        Glycemic management in adults with type 1 diabetes.
        Can J Diabetes. 2018; 42: 80-87
        • Sigal R.J.
        • Armstrong M.J.
        • Colby P.
        • et al.
        Physical activity and diabetes.
        Can J Diabetes. 2013; 37: 40-44
        • Ducat L.
        • Philipson L.H.
        • Anderson B.J.
        The mental health comorbidities of diabetes.
        JAMA. 2014; 312: 691-692
        • Sharma A.
        • Madaan V.
        • Petty F.D.
        Exercise for mental health.
        Prim Care Companion J Clin Psychiatry. 2006; 8: 106
        • Colberg S.R.
        • Sigal R.J.
        • Yardley J.E.
        • et al.
        Physical activity/exercise and diabetes: A position statement of the American Diabetes Association.
        Diabetes Care. 2016; 39: 2065-2079
        • Bohn B.
        • Herbst A.
        • Pfeifer M.
        • et al.
        Impact of physical activity on glycemic control and prevalence of cardiovascular risk factors in adults with type 1 diabetes: A cross-sectional multicenter study of 18,028 patients.
        Diabetes Care. 2015; 38: 1536-1543
        • Lascar N.
        • Kennedy A.
        • Hancock B.
        • et al.
        Attitudes and barriers to exercise in adults with type 1 diabetes (T1DM) and how best to address them: A qualitative study.
        PLoS One. 2014; 9e108019
        • Brazeau A.S.
        • Rabasa-Lhoret R.
        • Strychar I.
        • Mircescu H.
        Barriers to physical activity among patients with type 1 diabetes.
        Diabetes Care. 2008; 31: 2108-2109
        • Moser O.
        • Riddell M.C.
        • Eckstein M.L.
        • et al.
        Glucose management for exercise using continuous glucose monitoring (CGM) and intermittently scanned CGM (isCGM) systems in type 1 diabetes: position statement of the European Association for the Study of Diabetes (EASD) and of the International Society for Pediatric and Adolescent Diabetes (ISPAD) endorsed by JDRF and supported by the American Diabetes Association (ADA).
        Diabetologia. 2020; 63: 2501-2520
        • Riddell M.C.
        • Gallen I.W.
        • Smart C.E.
        • et al.
        Exercise management in type 1 diabetes: A consensus statement.
        Lancet Diabetes Endocrinol. 2017; 5: 377-390
        • Molveau J.
        • Rabasa-Lhoret R.
        • Taleb N.
        • et al.
        Minimizing the risk of exercise-induced glucose fluctuations in people living with type 1 diabetes using continuous subcutaneous insulin infusion: An overview of strategies.
        Can J Diabetes. 2021; 45: 666-676
        • Deichmann J.
        • Bachmann S.
        • Burckhardt M.A.
        • Szinnai G.
        • Kaltenbach H.M.
        Simulation-based evaluation of treatment adjustment to exercise in type 1 diabetes.
        Front Endocrinol. 2021; 12723812
        • Jensen T.E.
        • Richter E.A.
        Regulation of glucose and glycogen metabolism during and after exercise.
        J Physiol. 2012; 590: 1069-1076
        • Ploug T.
        • Galbo H.
        • Richter E.A.
        Increased muscle glucose uptake during contractions: No need for insulin.
        Am J Physiol Endocrinol Metab. 1984; 247: E726-E731
        • Pinsker J.E.
        • Kraus A.
        • Gianferante D.
        • et al.
        Techniques for exercise preparation and management in adults with type 1 diabetes.
        Can J Diabetes. 2016; 40: 503-508
        • Sigal R.J.
        • Armstrong M.J.
        • Colby P.
        • et al.
        Physical activity and diabetes.
        Can J Diabetes. 2013; 37: S40-S44
        • Brazeau A.S.
        • Leroux C.
        • Mircescu H.
        • Rabasa-Lhoret R.
        Physical activity level and body composition among adults with type 1 diabetes.
        Diabet Med. 2012; 29: e402-e408
        • Yardley J.E.
        • Iscoe K.E.
        • Sigal R.J.
        • Kenny G.P.
        • Perkins B.A.
        • Riddell M.C.
        Insulin pump therapy is associated with less post-exercise hyperglycemia than multiple daily injections: An observational study of physically active type 1 diabetes patients.
        Diabetes Technol Ther. 2013; 15: 84-88
        • Dyck R.A.
        • Kleinman N.J.
        • Funk D.R.
        • Yeung R.O.
        • Senior P.
        • Yardley J.E.
        We can work (it) out together: Type 1 diabetes boot cAMP for adult patients and providers improves exercise self-efficacy.
        Can J Diabetes. 2018; 42: 619-625
        • Giorda C.B.
        • Ozzello A.
        • Gentile S.
        • et al.
        Incidence and risk factors for severe and symptomatic hypoglycemia in type 1 diabetes. Results of the HYPOS-1 study.
        Acta Diabetol. 2015; 52: 845-853
        • Allen C.
        • LeCaire T.
        • Palta M.
        • Daniels K.
        • Meredith M.
        • D’Alessio D.J.
        Risk factors for frequent and severe hypoglycemia in type 1 diabetes.
        Diabetes Care. 2001; 24: 1878
        • Desjardins K.
        • Brazeau A.S.
        • Strychar I.
        • Leroux C.
        • Gingras V.
        • Rabasa-Lhoret R.
        Association between post-dinner dietary intakes and nocturnal hypoglycemic risk in adult patients with type 1 diabetes.
        Diabetes Res Clin Pract. 2014; 106: 420-427
        • Franc S.
        • Daoudi A.
        • Pochat A.
        • et al.
        Insulin-based strategies to prevent hypoglycaemia during and after exercise in adult patients with type 1 diabetes on pump therapy: The DIABRASPORT randomized study.
        Diabetes Obes Metab. 2015; 17: 1150-1157
        • Guelfi K.J.
        • Ratnam N.
        • Smythe G.A.
        • Jones T.W.
        • Fournier P.A.
        Effect of intermittent high-intensity compared with continuous moderate exercise on glucose production and utilization in individuals with type 1 diabetes.
        Am J Physiol Endocrinol Metab. 2007; 292: E865-E870
        • Campbell M.D.
        • West D.
        • Bain S.C.
        • et al.
        Simulated games activity vs continuous running exercise: a novel comparison of the glycemic and metabolic responses in T1DM patients.
        Scand J Med Sci Sports. 2015; 25: 216-222
        • Iscoe K.E.
        • Riddell M.C.
        Continuous moderate-intensity exercise with or without intermittent high-intensity work: Effects on acute and late glycaemia in athletes with Type 1 diabetes mellitus.
        Diabet Med. 2011; 28: 824-832
        • Maran A.
        • Pavan P.
        • Bonsembiante B.
        • et al.
        Continuous glucose monitoring reveals delayed nocturnal hypoglycemia after intermittent high-intensity exercise in nontrained patients with type 1 diabetes.
        Diabetes Technol Ther. 2010; 12: 763-768
        • Rempel M.
        • Yardley J.E.
        • MacIntosh A.
        • et al.
        Vigorous intervals and hypoglycemia in type 1 diabetes: a randomized cross over trial.
        Sci Rep. 2018; 8: 1-9
        • Al Khalifah R.A.
        • Suppère C.
        • Haidar A.
        • Rabasa-Lhoret R.
        • Ladouceur M.
        • Legault L.
        Association of aerobic fitness level with exercise-induced hypoglycaemia in Type 1 diabetes.
        Diabet Med. 2016; 33: 1686-1690
        • Yardley J.E.
        • Kenny G.P.
        • Perkins B.A.
        • et al.
        Resistance versus aerobic exercise: Acute effects on glycemia in type 1 diabetes.
        Diabetes Care. 2013; 36: 537-542
        • Teich T.
        • Riddell M.C.
        The enhancement of muscle insulin sensitivity after exercise: A Rac1-independent handoff to some other player?.
        Endocrinology. 2016; 157: 2999-3001
        • Burr J.F.
        • Shephard R.J.
        • Riddell M.C.
        Physical activity in type 1 diabetes mellitus: Assessing risks for physical activity clearance and prescription.
        Can Fam Physician. 2012; 58: 533-535
        • Brazeau A.S.
        • Gingras S.
        • Leroux C.
        • et al.
        A pilot program for physical exercise promotion in adults with type 1 diabetes: The PEP-1 program.
        Appl Physiol Nutr Metab. 2014; 39: 465-471
        • Vicente P.
        • Reis E.
        Using questionnaire design to fight nonresponse bias in web surveys.
        Soc Sci Comput Rev. 2010; 28: 251-267
        • Tagougui S.
        • Taleb N.
        • Legault L.
        • et al.
        A single-blind, randomised, crossover study to reduce hypoglycaemia risk during postprandial exercise with closed-loop insulin delivery in adults with type 1 diabetes: Announced (with or without bolus reduction) vs unannounced exercise strategies.
        Diabetologia. 2020; 63: 2282-2291