A single-blind, randomised, crossover study to reduce hypoglycaemia risk during postprandial exercise with closed-loop i
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ARTICLE
A single-blind, randomised, crossover study to reduce hypoglycaemia risk during postprandial exercise with closed-loop insulin delivery in adults with type 1 diabetes: announced (with or without bolus reduction) vs unannounced exercise strategies Sémah Tagougui 1,2,3 & Nadine Taleb 1,4 & Laurent Legault 1,5 & Corinne Suppère 1 & Virginie Messier 1 Inès Boukabous 1 & Azadeh Shohoudi 6 & Martin Ladouceur 7 & Rémi Rabasa-Lhoret 1,2,8,9
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Received: 14 April 2020 / Accepted: 15 June 2020 # Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Aims/hypothesis For individuals living with type 1 diabetes, closed-loop insulin delivery improves glycaemic control. Nonetheless, maintenance of glycaemic control during exercise while a prandial insulin bolus remains active is a challenge even to closed-loop systems. We investigated the effect of exercise announcement on the efficacy of a closed-loop system, to reduce hypoglycaemia during postprandial exercise. Methods A single-blind randomised, crossover open-label trial was carried out to compare three strategies applied to a closed-loop system at mealtime in preparation for exercise taken 90 min after eating at a research testing centre: (1) announced exercise to the closed-loop system (increases target glucose levels) in addition to a 33% reduction in meal bolus (A-RB); (2) announced exercise to the closed-loop system and a full meal bolus (A-FB); (3) unannounced exercise and a full meal bolus (U-FB). Participants performed ˙ 2peak 90 min after eating breakfast. The investigators were not blinded to the interventions. However, the 60 min of exercise at 60% VO participants were blinded to the sensor glucose readings and to the insulin infusion rates throughout the intervention visits. Results The trial was completed by 37 adults with type 1 diabetes, all using insulin pumps: mean±SD, 40.0 ± 15.0 years of age, HbA1c 57.1 ± 10.8 mmol/mol (7.3 ± 1.0%). Reported results were based on plasma glucose values. During exercise and the following 1 h recovery period, time spent in hypoglycaemia (10 mmol/l) by 21% (p = 0.001). No side effects were reported during the applied strategies. Sémah Tagougui and Nadine Taleb contributed equally to this work. Electronic supplementary material The online version of this article (https://doi.org/10.1007/s00125-020-05244-y) contains peer-reviewed but unedited supplementary material, which is available to authorised users. * Rémi Rabasa-Lhoret [email protected] 1
Montreal Clinical Research Institute (IRCM), 110 Pine Ave W, Montreal, QC H2W 1R7, Canada
2
Department of Nutrition, Université de Montréal, Montreal, QC, Canada
3
Université de Lille, Université d’Artois, Université du Littoral Côte d’Opale, ULR 7369 – URePSSS – Unité de Recherche Pluridisciplinaire Sport, Santé, Société (URePSSS), Lille, France
4
Department of Biomedical Sciences, Université de Montréal, Montréal, QC, Canada
5
Montreal Children’s Hospital, McGill University Health Centre (MUHC), Montreal, QC, Canada
6
Montreal Heart Institut
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