Muscle Health Research Centre, York University, Toronto, Canada.
Jaeb Center for Health Research, Tampa, FL.
Diabetes Care. 2023 Apr 1;46(4):704-713. doi: 10.2337/dc22-1721.
Maintenance of glycemic control during and after exercise remains a major challenge 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.
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 (multiple daily injection [MDI] users) using a custom smart phone application and provided pump (pump users), heart rate, and continuous glucose monitoring data.
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), interval (n = 165), or resistance (n = 170) exercise were analyzed. The mean (± SD) change in glucose during assigned exercise was -18 ± 39, -14 ± 32, and -9 ± 36 mg/dL for aerobic, 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).
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 improvement in glucose time in range but may have slightly increased time below range.
1 型糖尿病患者在运动期间和运动后维持血糖控制仍然是一个主要挑战。运动对血糖的反应可能因运动类型（有氧运动、间歇运动或抗阻运动）而异，运动类型对运动后血糖控制的影响尚不清楚。
1 型糖尿病运动倡议（T1DEXI）是一项在家中进行运动的真实研究。成年参与者被随机分配在 4 周内完成 6 次结构化的有氧运动、间歇运动或抗阻运动。参与者使用定制的智能手机应用程序报告研究和非研究运动、饮食摄入和胰岛素剂量（多次注射[MDI]使用者），并提供泵（泵使用者）、心率和连续血糖监测数据。
共分析了 497 名 1 型糖尿病成人（平均年龄 ± SD 37 ± 14 岁；平均 HbA1c ± SD 6.6 ± 0.8% [49 ± 8.7 mmol/mol]），分为结构化有氧运动（n = 162）、间歇运动（n = 165）或抗阻运动（n = 170）。指定运动期间血糖的平均（± SD）变化分别为-18 ± 39、-14 ± 32 和-9 ± 36 mg/dL，有氧运动、间歇运动和抗阻运动之间差异有统计学意义（P < 0.001），闭环、标准泵和 MDI 使用者也有类似的结果。与无运动日相比，研究运动后 24 小时内范围内（70-180 mg/dL [3.9-10.0 mmol/L]）的时间更高（平均 ± SD 76 ± 20% vs. 70 ± 23%；P < 0.001）。
无论胰岛素输送方式如何，1 型糖尿病成人进行有氧运动时血糖水平下降最大，其次是间歇运动和抗阻运动。即使在血糖控制良好的 1 型糖尿病成人中，进行结构化运动课程的日子也有助于血糖时间在范围内的显著改善，但可能会略微增加血糖水平低于范围的时间。
