Automated insulin delivery around exercise in adults with type 1 diabetes: A pilot randomised controlled study

Aim: To assess the effectiveness of an automated insulin delivery (AID) system around exercise in adults with type 1 diabetes (T1D). Methods: This was a three-period, randomised, crossover trial involving ten adults with T1D (HbA1c: 8.3±0.6% [67±6 mmol/mol]) using an AID system (MiniMed 780G, Medtro...

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Veröffentlicht in:Diabetes technology & therapeutics 2023-07, Vol.25 (ja), p.476-484
Hauptverfasser: mccarthy, olivia mary, Christensen, Merete Bechmann, Kristensen, Kasper Birch, Schmidt, Signe, Ranjan, Ajenthen, Bain, Stephen, Bracken, Richard M, Nørgaard, Kirsten
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Sprache:eng
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Zusammenfassung:Aim: To assess the effectiveness of an automated insulin delivery (AID) system around exercise in adults with type 1 diabetes (T1D). Methods: This was a three-period, randomised, crossover trial involving ten adults with T1D (HbA1c: 8.3±0.6% [67±6 mmol/mol]) using an AID system (MiniMed 780G, Medtronic USA). Participants performed 45 minutes of moderate intensity continuous exercise 90 minutes after consuming a carbohydrate-based meal using three strategies: (i) a 100% dose of bolus insulin with exercise announcement immediately at exercise onset ‘spontaneous exercise’ (SE) or a 25% reduced dose of bolus insulin with exercise announcement either (ii) 90 minutes (AE90) or (iii) 45 minutes (AE45) before exercise. Venous-derived plasma glucose (PG) taken in 5- and 15-minute intervals over a 3-hour collection period was stratified into the percentage of time spent below (TBR [10 mmol/L]) target range. In instances of hypoglycaemia, PG data were carried forward for the remainder of the visit. Results: Overall TBR was greatest during SE (SE: 22.9±22.2, AE90: 1.1±1.9, AE45: 7.8±10.3%, p=0.029). Hypoglycaemia during exercise occurred in four participants in SE but one in both AE90 and AE45 (ꭓ2 [2] = 3.600, p=0.165). In the one-hour post-exercise period, AE90 was associated with higher TIR (SE: 43.8±49.6, AE90: 97.9±5.9, AE45: 66.7±34.5%, p=0.033), lower TBR (SE: 56.3±49.6, AE90: 2.1±5.9, AE45: 29.2±36.5%, p=0.041) with the greatest source of discrepancy observed relative to SE. Conclusion: In adults using an AID system and undertaking post-prandial exercise, a strategy involving both bolus insulin dose reduction and exercise announcement 90 minutes before commencing the activity may be most effective in minimising dysglycaemia
ISSN:1520-9156
1557-8593
DOI:10.1089/dia.2023.0009