Morrison Dale, Zaharieva Dessi P, Lee Melissa H, Paldus Barbora, Vogrin Sara, Grosman Benyamin, Roy Anirban, Kurtz Natalie, O'Neal David Norman
Department of Medicine, University of Melbourne, Melbourne, Australia.
Division of Endocrinology, Department of Pediatrics, School of Medicine, Stanford University, Stanford, California, USA.
Diabetes Technol Ther. 2022 Feb;24(2):93-101. doi: 10.1089/dia.2021.0221. Epub 2021 Oct 8.
This study compared glucose control with fast-acting insulin aspart (FiAsp) versus insulin aspart following moderate-intensity exercise (MIE) and high-intensity exercise (HIE) using a second-generation closed-loop (CL) system in people with type 1 diabetes. This randomized crossover study compared FiAsp versus insulin aspart over four sessions during MIE and HIE with CL insulin delivery by the MiniMed™ Advanced hybrid CL system. Participants were randomly assigned FiAsp and insulin aspart each for 6 weeks and within each period performed, in random order, 40 min MIE (∼50% VOmax) and HIE (6 × 2 min ∼80% VOmax; 5 min recovery). The primary outcome was continuous glucose monitoring (CGM) time in range (TIR, 3.9-10.0 mM) for 24 h following exercise. Sixteen adults (9 male; age 48 [37, 57] years; hemoglobin A1c (HbA1c) 7.0 [6.4, 7.2] %; duration diabetes 30 [17, 41] years) were recruited. In the 24 h postexercise, median TIR was >81%, time in hypoglycemia (<3.9 mM) was <4%, and time in hyperglycemia (>10 mM) was <17% for both exercise conditions and insulin formations, with no significant differences between insulins ( > 0.05). In the 2 h postexercise and overnight, the TIR approached 100% for all conditions. There were no differences in TIR during and 24 h after MIE or HIE when comparing insulin aspart with FiAsp delivered by a second-generation CL system. Insulin formulations with an offset in action greater than FiAsp are needed to provide a meaningful improvement in CL glucose control with exercise. Clinical Trial Registration number: ACTRN12619000469112.
本研究使用第二代闭环（CL）系统，比较了1型糖尿病患者在中等强度运动（MIE）和高强度运动（HIE）后，使用门冬胰岛素类似物（FiAsp）与门冬胰岛素进行血糖控制的情况。这项随机交叉研究在MIE和HIE期间，通过美敦力™高级混合CL系统进行CL胰岛素输注，比较了四个疗程中FiAsp与门冬胰岛素的效果。参与者被随机分配接受FiAsp和门冬胰岛素治疗，各为期6周，在每个阶段内，以随机顺序进行40分钟的MIE（约50%最大摄氧量）和HIE（6×2分钟，约80%最大摄氧量；5分钟恢复时间）。主要结局指标是运动后24小时的连续血糖监测（CGM）处于目标范围内的时间（TIR，3.9 - 10.0毫摩尔/升）。招募了16名成年人（9名男性；年龄48[37, 57]岁；糖化血红蛋白（HbA1c）7.0[6.4, 7.2]%；糖尿病病程30[17, 41]年）。在运动后的24小时内，两种运动条件和胰岛素制剂的TIR中位数均>81%，低血糖时间（<3.9毫摩尔/升）<4%，高血糖时间（>10毫摩尔/升）<17%，两种胰岛素之间无显著差异（P>0.05）。在运动后2小时和夜间，所有条件下的TIR均接近100%。比较第二代CL系统输注的门冬胰岛素与FiAsp时，MIE或HIE期间及之后24小时的TIR没有差异。需要作用延迟大于FiAsp的胰岛素制剂，才能在运动时的CL血糖控制方面实现有意义的改善。临床试验注册号：ACTRN12619000469112。
