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Metabolic and physiological responses to graded exercise testing in individuals with type 1 diabetes using insulin pump therapy

Olivia McCarthy, Kasper Birch Kristensen, Merete Bechmann Christensen, Signe Schmidt Orcid Logo, Ajenthen G. Ranjan Orcid Logo, Chloe Nicholas, Steve Bain Orcid Logo, Kirsten Nørgaard, Richard Bracken Orcid Logo

Diabetes, Obesity and Metabolism, Volume: 25, Issue: 3

Swansea University Authors: Olivia McCarthy, Steve Bain Orcid Logo, Richard Bracken Orcid Logo

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DOI (Published version): 10.1111/dom.14938

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Aims1) To profile acute glycaemic dynamics during graded exercise testing (GXT) and 2) explore the influence of glycaemic indicators on the physiological responses to GXT in adults with T1D using insulin pump therapy.MethodsThis was a retrospective analysis of pooled data from four clinical trials w...

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Published in: Diabetes, Obesity and Metabolism
ISSN: 1462-8902 1463-1326
Published: Wiley 2023
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Data was obtained from 45 adults with type 1 diabetes using insulin pumps ([30 females], HbA1c: 59.5±0.5 mmol.mol-1 [7.6±1.0 %], age: 49.7±13.0 years, diabetes duration: 31.2±13.5 years, V̇O2peak: 29.5±8.0 mL.min-1.kg-1). Integrated cardiopulmonary variables were collected continuously via spiroergometry. Plasma glucose (PG) was obtained every three minutes during GXT as well as the point of volitional exhaustion. Data were assessed via general linear modelling techniques with age and gender adjustment. Significance was accepted at P ≤0.05.ResultsDespite increasing duration and intensity, PG concentrations remained similar to rest values (8.8±2.3 mmol.L-1) throughout exercise (p=0.419) with an overall change of +0.3±1.1 mmol.L-1. Starting glycaemia bore no influence on subsequent GXT responses. Per 1% increment in HbA1c there was an associated decrease in V̇O2peak of 3.8 mL.min-1.kg-1 (p&lt;0.001) and powerpeak of 0.33 watts.kg-1 (p&lt;0.001) concomitant with attenuations in indices of peripheral oxygen extraction ([O2 pulse] -1.2 mL.beat-1, p=0.023).ConclusionIn adults with long-standing type 1 diabetes using insulin pump therapy, circulating glucose remains stable during a graded incremental cycle test to volitional exhaustion. Glycaemic indicators are inversely associated with aerobic rate, oxygen economy and mechanical output across the exercise intensity spectrum. 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spelling v2 62161 2022-12-12 Metabolic and physiological responses to graded exercise testing in individuals with type 1 diabetes using insulin pump therapy 4fea3e19b39712dea1d051d317614572 Olivia McCarthy Olivia McCarthy true false 5399f4c6e6a70f3608a084ddb938511a 0000-0001-8519-4964 Steve Bain Steve Bain true false f5da81cd18adfdedb2ccb845bddc12f7 0000-0002-6986-6449 Richard Bracken Richard Bracken true false 2022-12-12 STSC Aims1) To profile acute glycaemic dynamics during graded exercise testing (GXT) and 2) explore the influence of glycaemic indicators on the physiological responses to GXT in adults with T1D using insulin pump therapy.MethodsThis was a retrospective analysis of pooled data from four clinical trials with identical GXT protocols. Data was obtained from 45 adults with type 1 diabetes using insulin pumps ([30 females], HbA1c: 59.5±0.5 mmol.mol-1 [7.6±1.0 %], age: 49.7±13.0 years, diabetes duration: 31.2±13.5 years, V̇O2peak: 29.5±8.0 mL.min-1.kg-1). Integrated cardiopulmonary variables were collected continuously via spiroergometry. Plasma glucose (PG) was obtained every three minutes during GXT as well as the point of volitional exhaustion. Data were assessed via general linear modelling techniques with age and gender adjustment. Significance was accepted at P ≤0.05.ResultsDespite increasing duration and intensity, PG concentrations remained similar to rest values (8.8±2.3 mmol.L-1) throughout exercise (p=0.419) with an overall change of +0.3±1.1 mmol.L-1. Starting glycaemia bore no influence on subsequent GXT responses. Per 1% increment in HbA1c there was an associated decrease in V̇O2peak of 3.8 mL.min-1.kg-1 (p<0.001) and powerpeak of 0.33 watts.kg-1 (p<0.001) concomitant with attenuations in indices of peripheral oxygen extraction ([O2 pulse] -1.2 mL.beat-1, p=0.023).ConclusionIn adults with long-standing type 1 diabetes using insulin pump therapy, circulating glucose remains stable during a graded incremental cycle test to volitional exhaustion. Glycaemic indicators are inversely associated with aerobic rate, oxygen economy and mechanical output across the exercise intensity spectrum. An appreciation of these nexuses may help guide appropriate decision making for optimal exercise management strategies. Journal Article Diabetes, Obesity and Metabolism 25 3 Wiley 1462-8902 1463-1326 Type 1 diabetes, exercise, cardiopulmonary exercise testing, insulin pump therapy, graded exercise testing, plasma glucose 3 1 2023 2023-01-03 10.1111/dom.14938 COLLEGE NANME Sport and Exercise Sciences COLLEGE CODE STSC Swansea University SU Library paid the OA fee (TA Institutional Deal) 2023-06-12T17:00:04.3155379 2022-12-12T15:04:51.9431527 Faculty of Science and Engineering School of Engineering and Applied Sciences - Sport and Exercise Sciences Olivia McCarthy 1 Kasper Birch Kristensen 2 Merete Bechmann Christensen 3 Signe Schmidt 0000-0002-6968-6675 4 Ajenthen G. Ranjan 0000-0002-2253-6071 5 Chloe Nicholas 6 Steve Bain 0000-0001-8519-4964 7 Kirsten Nørgaard 8 Richard Bracken 0000-0002-6986-6449 9 62161__26266__75a2d644cdac4edaa7c842bafd083595.pdf 62161.pdf 2023-01-12T09:45:05.5787340 Output 1124139 application/pdf Version of Record true This is an open access article under the terms of the Creative Commons Attribution NonCommercial-NoDerivs License true eng http://creativecommons.org/licenses/by-nc-nd/4.0/
title Metabolic and physiological responses to graded exercise testing in individuals with type 1 diabetes using insulin pump therapy
spellingShingle Metabolic and physiological responses to graded exercise testing in individuals with type 1 diabetes using insulin pump therapy
Olivia McCarthy
Steve Bain
Richard Bracken
title_short Metabolic and physiological responses to graded exercise testing in individuals with type 1 diabetes using insulin pump therapy
title_full Metabolic and physiological responses to graded exercise testing in individuals with type 1 diabetes using insulin pump therapy
title_fullStr Metabolic and physiological responses to graded exercise testing in individuals with type 1 diabetes using insulin pump therapy
title_full_unstemmed Metabolic and physiological responses to graded exercise testing in individuals with type 1 diabetes using insulin pump therapy
title_sort Metabolic and physiological responses to graded exercise testing in individuals with type 1 diabetes using insulin pump therapy
author_id_str_mv 4fea3e19b39712dea1d051d317614572
5399f4c6e6a70f3608a084ddb938511a
f5da81cd18adfdedb2ccb845bddc12f7
author_id_fullname_str_mv 4fea3e19b39712dea1d051d317614572_***_Olivia McCarthy
5399f4c6e6a70f3608a084ddb938511a_***_Steve Bain
f5da81cd18adfdedb2ccb845bddc12f7_***_Richard Bracken
author Olivia McCarthy
Steve Bain
Richard Bracken
author2 Olivia McCarthy
Kasper Birch Kristensen
Merete Bechmann Christensen
Signe Schmidt
Ajenthen G. Ranjan
Chloe Nicholas
Steve Bain
Kirsten Nørgaard
Richard Bracken
format Journal article
container_title Diabetes, Obesity and Metabolism
container_volume 25
container_issue 3
publishDate 2023
institution Swansea University
issn 1462-8902
1463-1326
doi_str_mv 10.1111/dom.14938
publisher Wiley
college_str Faculty of Science and Engineering
hierarchytype
hierarchy_top_id facultyofscienceandengineering
hierarchy_top_title Faculty of Science and Engineering
hierarchy_parent_id facultyofscienceandengineering
hierarchy_parent_title Faculty of Science and Engineering
department_str School of Engineering and Applied Sciences - Sport and Exercise Sciences{{{_:::_}}}Faculty of Science and Engineering{{{_:::_}}}School of Engineering and Applied Sciences - Sport and Exercise Sciences
document_store_str 1
active_str 0
description Aims1) To profile acute glycaemic dynamics during graded exercise testing (GXT) and 2) explore the influence of glycaemic indicators on the physiological responses to GXT in adults with T1D using insulin pump therapy.MethodsThis was a retrospective analysis of pooled data from four clinical trials with identical GXT protocols. Data was obtained from 45 adults with type 1 diabetes using insulin pumps ([30 females], HbA1c: 59.5±0.5 mmol.mol-1 [7.6±1.0 %], age: 49.7±13.0 years, diabetes duration: 31.2±13.5 years, V̇O2peak: 29.5±8.0 mL.min-1.kg-1). Integrated cardiopulmonary variables were collected continuously via spiroergometry. Plasma glucose (PG) was obtained every three minutes during GXT as well as the point of volitional exhaustion. Data were assessed via general linear modelling techniques with age and gender adjustment. Significance was accepted at P ≤0.05.ResultsDespite increasing duration and intensity, PG concentrations remained similar to rest values (8.8±2.3 mmol.L-1) throughout exercise (p=0.419) with an overall change of +0.3±1.1 mmol.L-1. Starting glycaemia bore no influence on subsequent GXT responses. Per 1% increment in HbA1c there was an associated decrease in V̇O2peak of 3.8 mL.min-1.kg-1 (p<0.001) and powerpeak of 0.33 watts.kg-1 (p<0.001) concomitant with attenuations in indices of peripheral oxygen extraction ([O2 pulse] -1.2 mL.beat-1, p=0.023).ConclusionIn adults with long-standing type 1 diabetes using insulin pump therapy, circulating glucose remains stable during a graded incremental cycle test to volitional exhaustion. Glycaemic indicators are inversely associated with aerobic rate, oxygen economy and mechanical output across the exercise intensity spectrum. An appreciation of these nexuses may help guide appropriate decision making for optimal exercise management strategies.
published_date 2023-01-03T17:00:02Z
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score 11.016235

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