Examining the Acute Glycemic Effects of Different Types of Structured Exercise Sessions in Type 1 Diabetes in a Real-World Setting: The Type 1 Diabetes and Exercise Initiative (T1DEXI)

Michael C. Riddell; Zoey Li; Robin L. Gal; Peter Calhoun; Peter G. Jacobs; Mark A. Clements; Corby K. Martin; Francis J. Doyle; Susana R. Patton; Jessica R. Castle; Melanie B. Gillingham; Roy W. Beck; Michael R. Rickels

doi:10.2337/dc22-1721

Examining the Acute Glycemic Effects of Different Types of Structured Exercise Sessions in Type 1 Diabetes in a Real-World Setting: The Type 1 Diabetes and Exercise Initiative (T1DEXI)

Michael C. Riddell
, Zoey Li
, Robin L. Gal
, Peter Calhoun
, Peter G. Jacobs
, Mark A. Clements
, Corby K. Martin
, Francis J. Doyle
, Susana R. Patton
, Jessica R. Castle
, Melanie B. Gillingham
, Roy W. Beck
, Michael R. Rickels

York University Toronto
Jaeb Center for Health Research
Department of Biomedical Engineering
Children's Mercy Hospitals and Clinics
LSU Pennington Biomedical Research Center
Harvard University
Alfred I. duPont Hospital for Children
Oregon Health and Science University
University of Pennsylvania

Research output: Contribution to journal › Article › peer-review

135 Scopus citations

Abstract

OBJECTIVE Maintenance of glycemic control during and after exercise remains a major chal-lenge for individuals with type 1 diabetes. Glycemic responses to exercise may differ by exercise type (aerobic, interval, or resistance), and the effect of activity type on glycemic control after exercise remains unclear. RESEARCH DESIGN AND METHODS The Type 1 Diabetes Exercise Initiative (T1DEXI) was a real-world study of at-home exercise. Adult participants were randomly assigned to complete six structured aerobic, interval, or resistance exercise sessions over 4 weeks. Participants self-reported study and nonstudy exercise, food intake, and insulin dosing (multi-ple daily injection [MDI] users) using a custom smart phone application and provided pump (pump users), heart rate, and continuous glucose monitoring data. RESULTS A total of 497 adults with type 1 diabetes (mean age ± SD 37 ± 14 years; mean HbA_1c ± SD 6.6 ± 0.8% [49 ± 8.7 mmol/mol]) assigned to structured aerobic (n = 162), interva(n = 165), or resistance (n = 170) exercise were analyzed. The mean (± SD) change in glucose during assigned exercise was 218 ± 39, 214 ± 32, and 29 ± 36 mg/dL for aer-obic, interval, and resistance, respectively (P < 0.001), with similar results for closed-loop, standard pump, and MDI users. Time in range 70–180 mg/dL (3.9–10.0 mmol/L) was higher during the 24 h after study exercise when compared with days without exercise (mean ± SD 76 ± 20% vs. 70 ± 23%; P < 0.001). CONCLUSIONS Adults with type 1 diabetes experienced the largest drop in glucose level with aerobic exercise, followed by interval and resistance exercise, regardless of insulin delivery modality. Even in adults with well-controlled type 1 diabetes, days with structured exercise sessions contributed to clinically meaningful improve-ment in glucose time in range but may have slightly increased time below range.

Original language	English
Pages (from-to)	704-713
Number of pages	10
Journal	Diabetes Care
Volume	46
Issue number	4
DOIs	https://doi.org/10.2337/dc22-1721
State	Published - 1 Apr 2023
Externally published	Yes

Keywords

Adult
Blood Glucose
Blood Glucose Self-Monitoring/methods
Diabetes Mellitus, Type 1/drug therapy
Exercise/physiology
Humans
Hypoglycemia
Hypoglycemic Agents/therapeutic use
Insulin
Insulin Infusion Systems
Insulin, Regular, Human/therapeutic use

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10.2337/dc22-1721

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Riddell, M. C., Li, Z., Gal, R. L., Calhoun, P., Jacobs, P. G., Clements, M. A., Martin, C. K., Doyle, F. J., Patton, S. R., Castle, J. R., Gillingham, M. B., Beck, R. W., & Rickels, M. R. (2023). Examining the Acute Glycemic Effects of Different Types of Structured Exercise Sessions in Type 1 Diabetes in a Real-World Setting: The Type 1 Diabetes and Exercise Initiative (T1DEXI). Diabetes Care, 46(4), 704-713. https://doi.org/10.2337/dc22-1721

@article{6c13c58a1fe94625b04185cba0d0463c,

title = "Examining the Acute Glycemic Effects of Different Types of Structured Exercise Sessions in Type 1 Diabetes in a Real-World Setting: The Type 1 Diabetes and Exercise Initiative (T1DEXI)",

abstract = "OBJECTIVE Maintenance of glycemic control during and after exercise remains a major chal-lenge for individuals with type 1 diabetes. Glycemic responses to exercise may differ by exercise type (aerobic, interval, or resistance), and the effect of activity type on glycemic control after exercise remains unclear. RESEARCH DESIGN AND METHODS The Type 1 Diabetes Exercise Initiative (T1DEXI) was a real-world study of at-home exercise. Adult participants were randomly assigned to complete six structured aerobic, interval, or resistance exercise sessions over 4 weeks. Participants self-reported study and nonstudy exercise, food intake, and insulin dosing (multi-ple daily injection [MDI] users) using a custom smart phone application and provided pump (pump users), heart rate, and continuous glucose monitoring data. RESULTS A total of 497 adults with type 1 diabetes (mean age ± SD 37 ± 14 years; mean HbA1c ± SD 6.6 ± 0.8\% [49 ± 8.7 mmol/mol]) assigned to structured aerobic (n = 162), interva(n = 165), or resistance (n = 170) exercise were analyzed. The mean (± SD) change in glucose during assigned exercise was 218 ± 39, 214 ± 32, and 29 ± 36 mg/dL for aer-obic, interval, and resistance, respectively (P < 0.001), with similar results for closed-loop, standard pump, and MDI users. Time in range 70{\textendash}180 mg/dL (3.9{\textendash}10.0 mmol/L) was higher during the 24 h after study exercise when compared with days without exercise (mean ± SD 76 ± 20\% vs. 70 ± 23\%; P < 0.001). CONCLUSIONS Adults with type 1 diabetes experienced the largest drop in glucose level with aerobic exercise, followed by interval and resistance exercise, regardless of insulin delivery modality. Even in adults with well-controlled type 1 diabetes, days with structured exercise sessions contributed to clinically meaningful improve-ment in glucose time in range but may have slightly increased time below range.",

keywords = "Adult, Blood Glucose, Blood Glucose Self-Monitoring/methods, Diabetes Mellitus, Type 1/drug therapy, Exercise/physiology, Humans, Hypoglycemia, Hypoglycemic Agents/therapeutic use, Insulin, Insulin Infusion Systems, Insulin, Regular, Human/therapeutic use",

author = "Riddell, \{Michael C.\} and Zoey Li and Gal, \{Robin L.\} and Peter Calhoun and Jacobs, \{Peter G.\} and Clements, \{Mark A.\} and Martin, \{Corby K.\} and Doyle, \{Francis J.\} and Patton, \{Susana R.\} and Castle, \{Jessica R.\} and Gillingham, \{Melanie B.\} and Beck, \{Roy W.\} and Rickels, \{Michael R.\}",

note = "{\textcopyright} 2023 by the American Diabetes Association.",

year = "2023",

month = apr,

day = "1",

doi = "10.2337/dc22-1721",

language = "English",

volume = "46",

pages = "704--713",

journal = "Diabetes Care",

issn = "0149-5992",

publisher = "American Diabetes Association Inc.",

number = "4",

}

Riddell, MC, Li, Z, Gal, RL, Calhoun, P, Jacobs, PG, Clements, MA, Martin, CK, Doyle, FJ, Patton, SR, Castle, JR, Gillingham, MB, Beck, RW & Rickels, MR 2023, 'Examining the Acute Glycemic Effects of Different Types of Structured Exercise Sessions in Type 1 Diabetes in a Real-World Setting: The Type 1 Diabetes and Exercise Initiative (T1DEXI)', Diabetes Care, vol. 46, no. 4, pp. 704-713. https://doi.org/10.2337/dc22-1721

TY - JOUR

T1 - Examining the Acute Glycemic Effects of Different Types of Structured Exercise Sessions in Type 1 Diabetes in a Real-World Setting

T2 - The Type 1 Diabetes and Exercise Initiative (T1DEXI)

AU - Riddell, Michael C.

AU - Li, Zoey

AU - Gal, Robin L.

AU - Calhoun, Peter

AU - Jacobs, Peter G.

AU - Clements, Mark A.

AU - Martin, Corby K.

AU - Doyle, Francis J.

AU - Patton, Susana R.

AU - Castle, Jessica R.

AU - Gillingham, Melanie B.

AU - Beck, Roy W.

AU - Rickels, Michael R.

PY - 2023/4/1

Y1 - 2023/4/1

N2 - OBJECTIVE Maintenance of glycemic control during and after exercise remains a major chal-lenge for individuals with type 1 diabetes. Glycemic responses to exercise may differ by exercise type (aerobic, interval, or resistance), and the effect of activity type on glycemic control after exercise remains unclear. RESEARCH DESIGN AND METHODS The Type 1 Diabetes Exercise Initiative (T1DEXI) was a real-world study of at-home exercise. Adult participants were randomly assigned to complete six structured aerobic, interval, or resistance exercise sessions over 4 weeks. Participants self-reported study and nonstudy exercise, food intake, and insulin dosing (multi-ple daily injection [MDI] users) using a custom smart phone application and provided pump (pump users), heart rate, and continuous glucose monitoring data. RESULTS A total of 497 adults with type 1 diabetes (mean age ± SD 37 ± 14 years; mean HbA1c ± SD 6.6 ± 0.8% [49 ± 8.7 mmol/mol]) assigned to structured aerobic (n = 162), interva(n = 165), or resistance (n = 170) exercise were analyzed. The mean (± SD) change in glucose during assigned exercise was 218 ± 39, 214 ± 32, and 29 ± 36 mg/dL for aer-obic, interval, and resistance, respectively (P < 0.001), with similar results for closed-loop, standard pump, and MDI users. Time in range 70–180 mg/dL (3.9–10.0 mmol/L) was higher during the 24 h after study exercise when compared with days without exercise (mean ± SD 76 ± 20% vs. 70 ± 23%; P < 0.001). CONCLUSIONS Adults with type 1 diabetes experienced the largest drop in glucose level with aerobic exercise, followed by interval and resistance exercise, regardless of insulin delivery modality. Even in adults with well-controlled type 1 diabetes, days with structured exercise sessions contributed to clinically meaningful improve-ment in glucose time in range but may have slightly increased time below range.

AB - OBJECTIVE Maintenance of glycemic control during and after exercise remains a major chal-lenge for individuals with type 1 diabetes. Glycemic responses to exercise may differ by exercise type (aerobic, interval, or resistance), and the effect of activity type on glycemic control after exercise remains unclear. RESEARCH DESIGN AND METHODS The Type 1 Diabetes Exercise Initiative (T1DEXI) was a real-world study of at-home exercise. Adult participants were randomly assigned to complete six structured aerobic, interval, or resistance exercise sessions over 4 weeks. Participants self-reported study and nonstudy exercise, food intake, and insulin dosing (multi-ple daily injection [MDI] users) using a custom smart phone application and provided pump (pump users), heart rate, and continuous glucose monitoring data. RESULTS A total of 497 adults with type 1 diabetes (mean age ± SD 37 ± 14 years; mean HbA1c ± SD 6.6 ± 0.8% [49 ± 8.7 mmol/mol]) assigned to structured aerobic (n = 162), interva(n = 165), or resistance (n = 170) exercise were analyzed. The mean (± SD) change in glucose during assigned exercise was 218 ± 39, 214 ± 32, and 29 ± 36 mg/dL for aer-obic, interval, and resistance, respectively (P < 0.001), with similar results for closed-loop, standard pump, and MDI users. Time in range 70–180 mg/dL (3.9–10.0 mmol/L) was higher during the 24 h after study exercise when compared with days without exercise (mean ± SD 76 ± 20% vs. 70 ± 23%; P < 0.001). CONCLUSIONS Adults with type 1 diabetes experienced the largest drop in glucose level with aerobic exercise, followed by interval and resistance exercise, regardless of insulin delivery modality. Even in adults with well-controlled type 1 diabetes, days with structured exercise sessions contributed to clinically meaningful improve-ment in glucose time in range but may have slightly increased time below range.

KW - Adult

KW - Blood Glucose

KW - Blood Glucose Self-Monitoring/methods

KW - Diabetes Mellitus, Type 1/drug therapy

KW - Exercise/physiology

KW - Humans

KW - Hypoglycemia

KW - Hypoglycemic Agents/therapeutic use

KW - Insulin

KW - Insulin Infusion Systems

KW - Insulin, Regular, Human/therapeutic use

UR - https://www.scopus.com/pages/publications/85151043719

U2 - 10.2337/dc22-1721

DO - 10.2337/dc22-1721

M3 - Article

C2 - 36795053

AN - SCOPUS:85151043719

SN - 0149-5992

VL - 46

SP - 704

EP - 713

JO - Diabetes Care

JF - Diabetes Care

IS - 4

ER -

Examining the Acute Glycemic Effects of Different Types of Structured Exercise Sessions in Type 1 Diabetes in a Real-World Setting: The Type 1 Diabetes and Exercise Initiative (T1DEXI)

Abstract

Keywords

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