Vancouver - World Diabetes Congress
Vancouver - World Diabetes Congress
pd303  Poster Discussion
Improving patient engagement for better outcomes

01-Dec-2015 13:00 14:00
 
 
Title: 0674-PD
An on-line support tool that reduces exercise-related hypoglycemia in type 1 diabetes
 
Co-authors
A.K. Piotrowicz1, M.J. McGill1, J. Overland1, L. Molyneaux1, S.M. Twigg1.
1University of Sydney and Royal Prince Alfred Hospital, Sydney Medical School and Diabetes Centre Department of Endocrinology, Sydney, Australia.

 

Background

Stabilizing glycaemia around exercise is often a challenge in type 1 diabetes.

Aim

We undertook a randomized controlled trial (RCT) of an online exercise tool (ExT1D) to test if it attenuates hypoglycemia especially that related to exercise.

Method

Adults with T1DM (n=32), exercising ≥60min/week, were studied by baseline continuous glucose monitoring system (CGMS) iPro2 for ~6days. They were then randomized to ExT1D (Intervention) for 6 weeks or usual care (Control), followed by CGMS. Subsequently, in a partial cross-over, Controls accessed ExT1D for 6 weeks, then had a third CGMS. Exercise-related hypoglycemia was pre-defined as CGMS readings <4.0 mM within 24 hours of commencing exercise.

Results

Baseline clinical characteristics were: 50%M, 35.8±9.5 years (mean±SD), duration 12.3±9.9 years, BMI 24.2±2.6 kg/m2, median HbA1c 7.1%(ICR 6.4-7.7) and fructosamine 347μM(297-438). RCT data showed median exercise-related hypoglycemia number, episode duration, and total duration, were reduced after using ExT1D, each by ≥40% (NS) (Table). Compared with their own baseline, significant longitudinal reductions were seen in exercise-related hypoglycemia number (by 43%), in total hypoglycemia duration (by 71%), and also in combined (exercise and non-exercise related) hypoglycemia duration (by 25%). In contrast fructosamine and HbA1c were unchanged (not shown).

TableExercise-related Hypoglycemia
Median (ICR)
Combined Hypoglycemia (Exercise-related and non-exercise-related) Median (ICR)
Study groupHypoglycemia Number Hypoglycemia Duration (min)per episode Hypoglycemia Duration (min)Hypoglycemia Number Hypoglycemia Duration (min) per episode Hypoglycemia Duration (min)
Control RCT n=154.0 (1.0-5.0) 58.3 (10.0-87.5) 225.0(10.0-700.0) 6.0 (3.0-13.0)45.0 (23.3-64.6)270.0(70.0-810.0)
Intervention RCT n=172.0 (1.0-5.5)*p=0.6 30.0 (5.0-54.4)*p=0.2 45.0 (5.0-265.0)*p=0.3 5.0 (1.5-8.0)*p=0.5 45.0 (20.0-61.7)*p=0.6160.0 (42.5-545)*p=0.3
Base-line longitudinal n=323.5 (0.0-7.8)57.5 (0.0-83.1)210.0 (0.0-680.0)5.5 (1.3-12.8)44.4 (11.3-85.5)272.0(16.3-881.3)
Intervention longitudinal n=322.0 (1.0-5.0)27.5 (5.0-63.1)60.0 (5.0-270.0) 5.5 (2.0-8.5)47.3 (20.0-69.8)205.0(53.8-568.8)
Wilcoxon signed-rank test, paired, 1 tailp=0.044p=0.078p=0.015p=0.050p=0.378 p=0.044

*Mann Whitney U 2 tailed, unpaired for control vs intervention

Discussion

This study shows ExT1D can especially improve exercise-related hypoglycemia and thus aid adults with type 1 diabetes to exercise more safely.

 
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