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Published Online: 1 June 2017

Closed-Loop Insulin Delivery for Adults with Type 1 Diabetes Undertaking High-Intensity Interval Exercise Versus Moderate-Intensity Exercise: A Randomized, Crossover Study

Publication: Diabetes Technology & Therapeutics
Volume 19, Issue Number 6

Abstract

Background: We aimed to compare closed-loop glucose control for people with type 1 diabetes undertaking high-intensity interval exercise (HIIE) versus moderate-intensity exercise (MIE).
Methods: Adults with type 1 diabetes established on insulin pumps undertook HIIE and MIE stages in random order during automated insulin delivery via a closed-loop system (Medtronic). Frequent venous sampling for glucose, lactate, ketones, insulin, catecholamines, cortisol, growth hormone, and glucagon levels was performed. The primary outcome was plasma glucose <4.0 mmol/L for ≥15 min, from exercise commencement to 120 min postexercise. Secondary outcomes included continuous glucose monitoring and biochemical parameters.
Results: Twelve adults (age mean ± standard deviation 40 ± 13 years) were recruited; all completed the study. Plasma glucose of one participant fell to 3.4 mmol/L following MIE completion; no glucose levels were <4.0 mmol/L for HIIE (primary outcome). There were no glucose excursions >15.0 mmol/L for either stage. Mean (±standard error) plasma glucose did not differ between stages pre-exercise; was higher during exercise in HIIE than MIE (11.3 ± 0.5 mmol/L vs. 9.7 ± 0.6 mmol/L, respectively; P < 0.001); and remained higher until 60 min postexercise. There were no differences in circulating free insulin before, during, or postexercise. During HIIE compared with MIE, there were greater increases in lactate (P < 0.001), catecholamines (all P < 0.05), and cortisol (P < 0.001). Ketones increased more with HIIE than MIE postexercise (P = 0.031).
Conclusions: Preliminary findings suggest that closed-loop glucose control is safe for people undertaking HIIE and MIE. However, the management of the postexercise rise in ketones secondary to counter-regulatory hormone-induced insulin resistance observed with HIIE may represent a challenge for closed-loop systems.

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Published In

cover image Diabetes Technology & Therapeutics
Diabetes Technology & Therapeutics
Volume 19Issue Number 6June 2017
Pages: 340 - 348
PubMed: 28574723

History

Published ahead of print: 2 June 2017
Published in print: June 2017
Published online: 1 June 2017

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Authors

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Dilshani C. Jayawardene*
Department of Endocrinology & Diabetes, St Vincent's Hospital Melbourne, Melbourne, Australia.
Sybil A. McAuley*
Department of Endocrinology & Diabetes, St Vincent's Hospital Melbourne, Melbourne, Australia.
University of Melbourne Department of Medicine, St. Vincent's Hospital, Melbourne, Australia.
Jodie C. Horsburgh
University of Melbourne Department of Medicine, St. Vincent's Hospital, Melbourne, Australia.
André La Gerche
Department of Sports Cardiology, Baker Heart and Diabetes Institute, Melbourne, Australia.
Department of Cardiology, St Vincent's Hospital Melbourne, Melbourne, Australia.
Alicia J. Jenkins
Department of Endocrinology & Diabetes, St Vincent's Hospital Melbourne, Melbourne, Australia.
University of Melbourne Department of Medicine, St. Vincent's Hospital, Melbourne, Australia.
NHMRC Clinical Trials Centre, University of Sydney, Sydney, Australia.
Glenn M. Ward
Department of Endocrinology & Diabetes, St Vincent's Hospital Melbourne, Melbourne, Australia.
Department of Pathology, University of Melbourne, Melbourne, Australia.
Richard J. MacIsaac
Department of Endocrinology & Diabetes, St Vincent's Hospital Melbourne, Melbourne, Australia.
University of Melbourne Department of Medicine, St. Vincent's Hospital, Melbourne, Australia.
Timothy J. Roberts
University of Melbourne Department of Medicine, St. Vincent's Hospital, Melbourne, Australia.
Department of Cardiology, St Vincent's Hospital Melbourne, Melbourne, Australia.
Benyamin Grosman
Medtronic Diabetes, Northridge, California.
Natalie Kurtz
Medtronic Diabetes, Northridge, California.
Anirban Roy
Medtronic Diabetes, Northridge, California.
David N. O'Neal
Department of Endocrinology & Diabetes, St Vincent's Hospital Melbourne, Melbourne, Australia.
University of Melbourne Department of Medicine, St. Vincent's Hospital, Melbourne, Australia.

Notes

*
Equal first author.
Prior Presentation: Part of this work was presented at the 9th International Conference on Advanced Technologies & Treatments for Diabetes, Milan, Italy, February 2016.
Address correspondence to:David N. O'Neal, MD, FRACPUniversity of Melbourne Department of MedicineSt. Vincent's Hospital29 Regent StreetFitzroy, Melbourne, VIC 3065Australia
E-mail: [email protected]

Authors' Contributions

D.C.J. contributed to study design, participant recruitment, protocol implementation, data collection, and data analysis. S.A.M. and D.N.O. conceived the study and were involved in all aspects of the study. J.C.H. contributed to study design, participant recruitment, protocol implementation, and data collection. A.L.G. and T.J.R. contributed to study design, protocol implementation, and interpretation of data. A.J.J. contributed to study design and protocol implementation. G.M.W. contributed to data analysis. R.J.M. contributed to protocol implementation. A.R., B.G., and N.K. provided technical support. All authors were involved in drafting the article (D.C.J., S.A.M., D.N.O.) or revising it critically for important intellectual content (J.C.H., A.L.G., A.J.J., G.M.W., R.J.M., T.J.R., A.R., B.G., N.K.). All authors approved the final article version. D.C.J. and D.N.O. are the guarantors of this work.

Author Disclosure Statement

S.A.M. has received travel support from Novo Nordisk. A.J.J. is on an advisory board for Medtronic and has received honoraria from Medtronic. R.J.M. has received research funding and travel support from Novo Nordisk. A.R., B.G., N.K. are employees of Medtronic. D.N.O. has been on advisory boards, received honoraria and research support from Novo Nordisk and Medtronic. All other authors declare that there is no duality of interest associated with their contribution to this article.

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