Faculty of Medicine and Health Sciences, Ghent University, Ghent 9000, Belgium.
Fonds Wetenschappelijk Onderzoek (FWO) Flanders, Brussel 1000, Belgium.
J Clin Endocrinol Metab. 2024 Jul 12;109(8):2039-2052. doi: 10.1210/clinem/dgae079.
The precise glycemic impact and clinical relevance of postprandial exercise in type 1 diabetes (T1D) has not been clarified yet.
This work aimed to examine acute, subacute, and late effects of postprandial exercise on blood glucose (BG).
A randomized, controlled trial comprised 4 laboratory visits, with 24-hour follow-up at home. Participants included adults with T1D (n = 8), aged 44 ± 13 years, with body mass index of 24 ± 2.1. Intervention included 30 minutes of rest (CONTROL), walking (WALK), moderate-intensity (MOD), or intermittent high-intensity (IHE) exercise performed 60 minutes after a standardized meal. Main outcome measures included BG change during exercise/control (acute), and secondary outcomes included the subacute (≤2 h after) and late glycemic effects (≤24 h after).
Exercise reduced postprandial glucose (PPG) excursion compared to CONTROL, with a consistent BG decline in all patients for all modalities (mean declines -45 ± 24, -71 ± 39, and -35 ± 21 mg/dL, during WALK, MOD, and IHE, respectively (P < .001). For this decline, clinical superiority was demonstrated separately for each exercise modality vs CONTROL. Noninferiority of WALK vs MOD was not demonstrated, noninferiority of WALK vs IHE was demonstrated, and equivalence of IHE vs MOD was not demonstrated. Hypoglycemia did not occur during exercise. BG increased in the hour after exercise (more than after CONTROL; P < .001). More than half of participants showed hyperglycemia after exercise necessitating insulin correction. There were more nocturnal hypoglycemic events after exercise vs CONTROL (P < .05).
Postprandial exercise of all modalities is effective, safe, and feasible if necessary precautions are taken (ie, prandial insulin reductions), as exercise lowered maximal PPG excursion and caused a consistent and clinically relevant BG decline during exercise while there was no hypoglycemia during or shortly after exercise. However, there seem to be 2 remaining challenges: subacute postexercise hyperglycemia and nocturnal hypoglycemia.
1 型糖尿病（T1D）患者餐后运动的血糖影响及其临床意义尚不清楚。
本研究旨在探讨餐后运动对血糖（BG）的急性、亚急性和延迟影响。
一项随机对照试验包括 4 次实验室访视，并在家中进行 24 小时随访。参与者包括 8 名年龄 44 ± 13 岁、体重指数 24 ± 2.1 的 T1D 成年人。干预措施包括休息 30 分钟（对照）、散步（步行）、中等强度（MOD）或间歇性高强度（IHE）运动，在标准化餐后 60 分钟进行。主要观察指标包括运动/对照期间的 BG 变化（急性），次要观察指标包括亚急性（≤2 小时后）和延迟血糖效应（≤24 小时后）。
与对照相比，运动降低了餐后血糖（PPG）波动，所有患者在所有模式下均出现一致的血糖下降（分别下降-45 ± 24、-71 ± 39 和-35 ± 21mg/dL，步行、MOD 和 IHE 时）（P <.001）。对于这种下降，每种运动方式相对于对照均显示出临床优越性。步行与 MOD 之间的非劣效性未得到证实，步行与 IHE 之间的非劣效性得到证实，IHE 与 MOD 之间的等效性未得到证实。运动期间未发生低血糖。运动后 1 小时内血糖升高（高于对照；P <.001）。超过一半的参与者在运动后出现高血糖，需要胰岛素校正。与对照相比，运动后夜间低血糖事件更多（P <.05）。
如果采取必要的预防措施（即减少餐前胰岛素），所有运动方式的餐后运动都是有效、安全和可行的，因为运动降低了最大 PPG 波动，并在运动期间导致了一致且具有临床意义的血糖下降，而运动期间或运动后不久没有发生低血糖。然而，似乎还存在 2 个挑战：运动后亚急性高血糖和夜间低血糖。
