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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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Methods: This was a three-period, randomized, crossover trial involving 10 adults with T1D (hemoglobin A1C; HbA1c: 8.3%&#x2009;&#xB1;&#x2009;0.6% [67&#x2009;&#xB1;&#x2009;6&#x2009;mmol/mol]) using an AID system (MiniMed 780G; Medtronic USA). Participants performed 45&#x2009;min of moderate intensity continuous exercise 90&#x2009;min after consuming a carbohydrate-based meal using three strategies: (1) a 100% dose of bolus insulin with exercise announcement immediately at exercise onset &#x201C;spontaneous exercise&#x201D; (SE) or a 25% reduced dose of bolus insulin with exercise announcement either (2) 90&#x2009;min (AE90) or (3) 45&#x2009;min (AE45) before exercise. Venous-derived plasma glucose (PG) taken in 5 and 15&#x2009;min intervals over a 3&#x2009;h collection period was stratified into the percentage of time spent below (TBR [&lt;3.9&#x2009;mmol/L]), time in range (TIR [3.9&#x2013;10&#x2009;mmol/L]), and time above range (TAR [ &gt; 10&#x2009;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&#x2009;&#xB1;&#x2009;22.2, AE90: 1.1&#x2009;&#xB1;&#x2009;1.9, AE45: 7.8%&#x2009;&#xB1;&#x2009;10.3%, P&#x2009;=&#x2009;0.029). Hypoglycemia during exercise occurred in four participants in SE but one in both AE90 and AE45 (&#xAB53;2 [2]&#x2009;=&#x2009;3.600, P&#x2009;=&#x2009;0.165). In the 1&#x2009;h postexercise period, AE90 was associated with higher TIR (SE: 43.8&#x2009;&#xB1;&#x2009;49.6, AE90: 97.9&#x2009;&#xB1;&#x2009;5.9, AE45: 66.7%&#x2009;&#xB1;&#x2009;34.5%, P&#x2009;=&#x2009;0.033), lower TBR (SE: 56.3&#x2009;&#xB1;&#x2009;49.6, AE90: 2.1&#x2009;&#xB1;&#x2009;5.9, AE45: 29.2%&#x2009;&#xB1;&#x2009;36.5%, P&#x2009;=&#x2009;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&#x2009;min before commencing the activity may be most effective in minimizing dysglycemia. 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spelling 2025-01-02T12:51:15.7969323 v2 63844 2023-07-10 Automated Insulin Delivery Around Exercise in Adults with Type 1 Diabetes: A Pilot Randomized Controlled Study 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 2023-07-10 EAAS 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). Journal Article Diabetes Technology & Therapeutics 25 7 476 484 Mary Ann Liebert Inc 1520-9156 1557-8593 Exercise, Type 1 diabetes, Automated insulin delivery system, Artificial pancreas 31 7 2023 2023-07-31 10.1089/dia.2023.0009 COLLEGE NANME Engineering and Applied Sciences School COLLEGE CODE EAAS Swansea University 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). 2025-01-02T12:51:15.7969323 2023-07-10T09:39:03.0248070 Faculty of Science and Engineering School of Engineering and Applied Sciences - Sport and Exercise Sciences Olivia McCarthy 1 Merete B. Christensen 2 Kasper Birch Kristensen 3 Signe Schmidt 0000-0002-6968-6675 4 Ajenthen G. Ranjan 5 Steve Bain 0000-0001-8519-4964 6 Richard Bracken 0000-0002-6986-6449 7 Kirsten Nørgaard 8 63844__28065__aab23d343b914d8dbd5dcf65b8779937.pdf 63844.pdf 2023-07-10T13:23:13.4365571 Output 341230 application/pdf Accepted Manuscript true © 2023, Mary Ann Liebert, Inc., publishers. true eng
title Automated Insulin Delivery Around Exercise in Adults with Type 1 Diabetes: A Pilot Randomized Controlled Study
spellingShingle Automated Insulin Delivery Around Exercise in Adults with Type 1 Diabetes: A Pilot Randomized Controlled Study
Olivia McCarthy
Steve Bain
Richard Bracken
title_short Automated Insulin Delivery Around Exercise in Adults with Type 1 Diabetes: A Pilot Randomized Controlled Study
title_full Automated Insulin Delivery Around Exercise in Adults with Type 1 Diabetes: A Pilot Randomized Controlled Study
title_fullStr Automated Insulin Delivery Around Exercise in Adults with Type 1 Diabetes: A Pilot Randomized Controlled Study
title_full_unstemmed Automated Insulin Delivery Around Exercise in Adults with Type 1 Diabetes: A Pilot Randomized Controlled Study
title_sort Automated Insulin Delivery Around Exercise in Adults with Type 1 Diabetes: A Pilot Randomized Controlled Study
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
Merete B. Christensen
Kasper Birch Kristensen
Signe Schmidt
Ajenthen G. Ranjan
Steve Bain
Richard Bracken
Kirsten Nørgaard
format Journal article
container_title Diabetes Technology & Therapeutics
container_volume 25
container_issue 7
container_start_page 476
publishDate 2023
institution Swansea University
issn 1520-9156
1557-8593
doi_str_mv 10.1089/dia.2023.0009
publisher Mary Ann Liebert Inc
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 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).
published_date 2023-07-31T05:24:13Z
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