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Automated Insulin Delivery Around Exercise in Adults with Type 1 Diabetes: A Pilot Randomized Controlled Study

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

Diabetes Technology & Therapeutics, Volume: 25, Issue: 7, Pages: 476 - 484

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

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DOI (Published version): 10.1089/dia.2023.0009

Abstract

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, randomized, crossover trial involving 10 adults with T1D (hemoglobin A1C; HbA1c: 8.3% ± 0.6% [67 ± 6 mmol/mol]) using an AID system (...

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Published in: Diabetes Technology & Therapeutics
ISSN: 1520-9156 1557-8593
Published: Mary Ann Liebert Inc 2023
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URI: https://cronfa.swan.ac.uk/Record/cronfa63844
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Abstract: 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, randomized, crossover trial involving 10 adults with T1D (hemoglobin A1C; HbA1c: 8.3% ± 0.6% [67 ± 6 mmol/mol]) using an AID system (MiniMed 780G; Medtronic USA). Participants performed 45 min of moderate intensity continuous exercise 90 min after consuming a carbohydrate-based meal using three strategies: (1) 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 (2) 90 min (AE90) or (3) 45 min (AE45) before exercise. Venous-derived plasma glucose (PG) taken in 5 and 15 min intervals over a 3 h collection period was stratified into the percentage of time spent below (TBR [<3.9 mmol/L]), time in range (TIR [3.9–10 mmol/L]), and time above range (TAR [ > 10 mmol/L]). In instances of hypoglycemia, 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). Hypoglycemia during exercise occurred in four participants in SE but one in both AE90 and AE45 (ꭓ2 [2] = 3.600, P = 0.165). In the 1 h postexercise 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 postprandial exercise, a strategy involving both bolus insulin dose reduction and exercise announcement 90 min before commencing the activity may be most effective in minimizing dysglycemia. The study was registered as a clinical trial (Clinical Trials Register; NCT05134025).
Keywords: Exercise, Type 1 diabetes, Automated insulin delivery system, Artificial pancreas
College: Faculty of Science and Engineering
Funders: The authors would like to thank the Diabetesforeningen (Denmark) for their financial contributions to the project as well as BENEO GmbH (Mannhein, Germany) for supplying the pre-exercise carbohydrate source used in this research (PalatinoseTM).
Issue: 7
Start Page: 476
End Page: 484

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