Institut de recherches cliniques de Montréal, Montréal, QC, Canada.
Département de Nutrition, Faculté de Médecine, Université de Montréal, Montréal, QC, Canada.
Front Endocrinol (Lausanne). 2022 Sep 27;13:953879. doi: 10.3389/fendo.2022.953879. eCollection 2022.
Studies investigating strategies to limit the risk of nocturnal hypoglycemia associated with physical activity (PA) are scarce and have been conducted in standardized, controlled conditions in people with type 1 diabetes (T1D). This study sought to investigate the effect of daily PA level on nocturnal glucose management in free-living conditions while taking into consideration reported mitigation strategies to limit the risk of nocturnal hyoglycemia in people with T1D.
Data from 25 adults (10 males, 15 females, HbA: 7.6 ± 0.8%), 20-60 years old, living with T1D, were collected. One week of continuous glucose monitoring and PA (assessed using an accelerometer) were collected in free-living conditions. Nocturnal glucose values (midnight-6:00 am) following an active day "ACT" and a less active day "L-ACT" were analyzed to assess the time spent within the different glycemic target zones (<3.9 mmol/L; 3.9 - 10.0 mmol/L and >10.0 mmol/L) between conditions. Self-reported data about mitigation strategies applied to reduce the risk of nocturnal hypoglycemia was also analyzed.
Only 44% of participants reported applying a carbohydrate- or insulin-based strategy to limit the risk of nocturnal hypoglycemia on ACT day. Nocturnal hypoglycemia occurrences were comparable on ACT night versus on L-ACT night. Additional post-meal carbohydrate intake was higher on evenings following ACT (27.7 ± 15.6 g, ACT vs. 19.5 ± 11.0 g, L-ACT; P=0.045), but was frequently associated with an insulin bolus (70% of participants). Nocturnal hypoglycemia the night following ACT occurred mostly in people who administrated an additional insulin bolus before midnight (3 out of 5 participants with nocturnal hypoglycemia).
Although people with T1D seem to be aware of the increased risk of nocturnal hypoglycemia associated with PA, the risk associated with additional insulin boluses may not be as clear. Most participants did not report using compensation strategies to reduce the risk of PA related late-onset hypoglycemia which may be because they did not consider habitual PA as something requiring treatment adjustments.
研究限制与体力活动（PA）相关的夜间低血糖风险的策略的研究很少，并且已经在 1 型糖尿病（T1D）患者的标准化、对照条件下进行。本研究旨在调查在考虑到报告的减轻 T1D 患者夜间低血糖风险的缓解策略的情况下，自由生活条件下日常 PA 水平对夜间血糖管理的影响。
收集了 25 名年龄在 20-60 岁之间、患有 T1D 的成年人（男性 10 名，女性 15 名，HbA：7.6±0.8%）的连续葡萄糖监测和 PA（使用加速度计评估）数据。在自由生活条件下采集了一周的夜间葡萄糖值（午夜至早上 6:00），并在活跃日“ACT”和不太活跃日“L-ACT”后分析，以评估不同血糖目标范围内的时间（<3.9mmol/L；3.9-10.0mmol/L 和>10.0mmol/L）。还分析了关于减轻夜间低血糖风险的缓解策略的自我报告数据。
仅 44%的参与者报告在 ACT 日应用碳水化合物或胰岛素策略来限制夜间低血糖的风险。ACT 夜间和 L-ACT 夜间发生夜间低血糖的情况相当。ACT 后晚上的额外餐后碳水化合物摄入较高（27.7±15.6g，ACT 与 19.5±11.0g，L-ACT；P=0.045），但经常与胰岛素推注相关（70%的参与者）。ACT 后的夜间低血糖发生在午夜前额外给予胰岛素推注的人（5 名夜间低血糖患者中有 3 名）。
尽管 T1D 患者似乎意识到与 PA 相关的夜间低血糖风险增加，但与额外胰岛素推注相关的风险可能并不明显。大多数参与者没有报告使用补偿策略来降低与 PA 相关的迟发性低血糖的风险，这可能是因为他们不认为习惯性 PA 需要调整治疗。
