Applying technologies to simplify strategies for exercise in type 1 diabetes.

IF 8.4 1区 医学 Q1 ENDOCRINOLOGY & METABOLISM Diabetologia Pub Date : 2024-10-01 Epub Date: 2024-08-15 DOI:10.1007/s00125-024-06229-x
Bruce A Perkins, Lauren V Turner, Michael C Riddell
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Abstract

Challenges and fears related to managing glucose levels around planned and spontaneous exercise affect outcomes and quality of life in people living with type 1 diabetes. Advances in technology, including continuous glucose monitoring, open-loop insulin pump therapy and hybrid closed-loop (HCL) systems for exercise management in type 1 diabetes, address some of these challenges. In this review, three research or clinical experts, each living with type 1 diabetes, leverage published literature and clinical and personal experiences to translate research findings into simplified, patient-centred strategies. With an understanding of limitations in insulin pharmacokinetics, variable intra-individual responses to aerobic and anaerobic exercise, and the features of the technologies, six steps are proposed to guide clinicians in efficiently communicating simplified actions more effectively to individuals with type 1 diabetes. Fundamentally, the six steps centre on two aspects. First, regardless of insulin therapy type, and especially needed for spontaneous exercise, we provide an estimate of glucose disposal into active muscle meant to be consumed as extra carbohydrates for exercise ('ExCarbs'; a common example is 0.5 g/kg body mass per hour for adults and 1.0 g/kg body mass per hour for youth). Second, for planned exercise using open-loop pump therapy or HCL systems, we additionally recommend pre-emptive basal insulin reduction or using HCL exercise modes initiated 90 min (1-2 h) before the start of exercise until the end of exercise. Modifications for aerobic- and anaerobic-type exercise are discussed. The burden of pre-emptive basal insulin reductions and consumption of ExCarbs are the limitations of HCL systems, which may be overcome by future innovations but are unquestionably required for currently available systems.

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应用技术简化 1 型糖尿病患者的运动策略。
1 型糖尿病患者在计划运动和自发运动过程中管理血糖水平所面临的挑战和恐惧影响着他们的治疗效果和生活质量。技术的进步,包括用于 1 型糖尿病患者运动管理的连续血糖监测、开环胰岛素泵疗法和混合闭环 (HCL) 系统,解决了其中的一些难题。在本综述中,三位研究或临床专家(均为 1 型糖尿病患者)利用已发表的文献以及临床和个人经验,将研究成果转化为以患者为中心的简化策略。在了解了胰岛素药代动力学的局限性、个体内部对有氧和无氧运动的不同反应以及各种技术的特点后,我们提出了六个步骤,以指导临床医生更有效地向 1 型糖尿病患者传达简化行动。从根本上讲,这六个步骤集中在两个方面。首先,无论胰岛素治疗的类型如何,尤其是自发运动时,我们都会提供一个估计值,说明运动时需要额外摄入的碳水化合物("ExCarbs";常见的例子是成人每小时每公斤体重 0.5 克,青少年每小时每公斤体重 1.0 克)中的葡萄糖排出量。其次,对于使用开环泵疗法或 HCL 系统的计划运动,我们还建议在运动开始前 90 分钟(1-2 小时)至运动结束前,预先减少基础胰岛素或使用 HCL 运动模式。我们还讨论了有氧运动和无氧运动的改进措施。预先降低基础胰岛素和消耗 ExCarbs 是 HCL 系统的局限性,未来的创新可能会克服这些局限性,但目前可用的系统无疑需要这些局限性。
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来源期刊
Diabetologia
Diabetologia 医学-内分泌学与代谢
CiteScore
18.10
自引率
2.40%
发文量
193
审稿时长
1 months
期刊介绍: Diabetologia, the authoritative journal dedicated to diabetes research, holds high visibility through society membership, libraries, and social media. As the official journal of the European Association for the Study of Diabetes, it is ranked in the top quartile of the 2019 JCR Impact Factors in the Endocrinology & Metabolism category. The journal boasts dedicated and expert editorial teams committed to supporting authors throughout the peer review process.
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