1 Children's Diabetes Centre, Telethon Kids Institute, The University of Western Australia, Perth, Australia.
2 Department of Endocrinology and Diabetes, Perth Children's Hospital, Perth, Western Australia.
Diabetes Technol Ther. 2019 Jan;21(1):51-55. doi: 10.1089/dia.2018.0292.
Diabetes care during exercise frequently requires interruptions to activity and adds extra challenges particularly for young individuals with type 1 diabetes (T1D). This study investigated the use of a carbohydrate (CHO) intake algorithm based on continuous glucose monitoring (CGM) trends during physical activity. Children with T1D diagnosed for >1 year, ages 8-12 years, with a glycated hemoglobin of <10% were recruited into a randomized crossover study. They attended two similar mornings of fun-based physical activity and adhered to either a CHO intake algorithm based on CGM trends (intervention) or to standard exercise guidelines (consumption of 0.5 g CHO/kg/h when glucose <8 mmol/L) (control). Outcome measures included events such as exercise interruptions, CHO intake, and hypoglycemia events and percentage time spent in different sensor glucose ranges. Fourteen children completed the study. No episodes of significant hypoglycemia (sensor glucose level <3.0 mmol/L) occurred in either arm. Mean CHO intake was the same in both arms, 0.3 ± 0.2 g/kg/h. However, the intervention algorithm resulted in fewer CHO intake events per day: rate [95% confidence interval] 2.4 [1.6-2.3] versus 0.9 [0.4-1.5], P < 0.001, and exercise interruptions: 7.2 [5.9-8.8] versus 1.4 [0.8-2.1], P < 0.001, compared with control. There was no evidence of a difference in percentage time in range (3.9-10 mmol/L) and percentage time spent high between study arms. Both control and intervention protocols prevented significant hypoglycemia. Using a CHO intake algorithm based on CGM trends resulted in fewer CHO intake events and fewer interruptions to exercise. Use of this algorithm may reduce the burden of diabetes management with potential to facilitate activity in young people with T1D.
运动期间的糖尿病护理常常需要中断活动，这给 1 型糖尿病（T1D）患者带来了额外的挑战，尤其是年轻人。本研究调查了在体力活动期间使用基于连续血糖监测（CGM）趋势的碳水化合物（CHO）摄入算法。诊断为 T1D 超过 1 年、年龄为 8-12 岁、糖化血红蛋白<10%的儿童参加了一项随机交叉研究。他们参加了两次类似的以趣味为基础的体力活动，遵循基于 CGM 趋势的 CHO 摄入算法（干预组）或标准运动指南（当血糖<8mmol/L 时消耗 0.5g CHO/kg/h）（对照组）。主要观察指标包括运动中断、CHO 摄入、低血糖事件以及不同传感器血糖范围的时间百分比。14 名儿童完成了研究。在任何一组手臂中都没有发生明显的低血糖（传感器血糖水平<3.0mmol/L）事件。在两组中，CHO 的平均摄入量相同，均为 0.3±0.2g/kg/h。然而，干预算法导致每天的 CHO 摄入事件更少：发生率[95%置信区间]分别为 2.4[1.6-2.3]和 0.9[0.4-1.5]，P<0.001，运动中断率分别为 7.2[5.9-8.8]和 1.4[0.8-2.1]，P<0.001，与对照组相比。在范围内（3.9-10mmol/L）的时间百分比和高血糖时间百分比方面，两组之间没有差异的证据。对照组和干预组均未发生严重低血糖。使用基于 CGM 趋势的 CHO 摄入算法可减少 CHO 摄入事件和运动中断。使用该算法可能会减轻糖尿病管理的负担，并有可能促进 T1D 年轻人的活动。
