Stabilizing glycaemia around exercise is often a challenge in type 1 diabetes.
We undertook a randomized controlled trial (RCT) of an online exercise tool (ExT1D) to test if it attenuates hypoglycemia especially that related to exercise.
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.
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).
|Table||Exercise-related Hypoglycemia |
|Combined Hypoglycemia (Exercise-related and non-exercise-related) Median (ICR)|
|Study group||Hypoglycemia Number ||Hypoglycemia Duration (min)per episode ||Hypoglycemia Duration (min)||Hypoglycemia Number ||Hypoglycemia Duration (min) per episode ||Hypoglycemia Duration (min)|
|Control RCT n=15||4.0 (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=17||2.0 (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=0.6||160.0 (42.5-545)*p=0.3|
|Base-line longitudinal n=32||3.5 (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=32||2.0 (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 tail||p=0.044||p=0.078||p=0.015||p=0.050||p=0.378 ||p=0.044|
*Mann Whitney U 2 tailed, unpaired for control vs intervention
This study shows ExT1D can especially improve exercise-related hypoglycemia and thus aid adults with type 1 diabetes to exercise more safely.