Oregon Health and Science University, Portland, OR, USA.
Jaeb Center for Health Research, Tampa, FL, USA.
Diabetes Res Clin Pract. 2024 Nov;217:111874. doi: 10.1016/j.diabres.2024.111874. Epub 2024 Sep 27.
Position statement guidelines should help people with type 1 diabetes (T1D) improve glucose outcomes during exercise.
In a 4-week observational study, continuous glucose, insulin, and nutrient data were collected from 561 adults with T1D. Glucose outcomes were calculated during exercise, post-exercise, and overnight, and were compared for sessions when participants used versus did not use exercise guidelines for open-loop (OL) and automated insulin delivery (AID) therapy.
Guidelines requiring behaviour modification were rarely used while guidelines not requiring modification were often used. The guideline recommending reduced meal insulin before exercise was associated with lower time <3.9 mmol/L during exercise (-2.2 %, P=0.02) for OL but not significant for AID (-1.4 %, P=0.27). Compared to exercise with low glucose (<3.9 mmol/L) in prior 24-hours, sessions without recent low glucose had lower time <3.9 mmol/L during exercise (-1.2 %, P<0.001). The AID guideline for no carbohydrates before exercise when CGM is flat, or increasing, was not associated with improved glycaemia.
Free-living datasets may be used to evaluate usage and benefit of position statement guidelines. Evidence suggests OL participants who reduced meal insulin prior to exercise and did not have low glucose in the prior 24 h had less time below range.
立场声明指南应该有助于 1 型糖尿病（T1D）患者在运动期间改善血糖结果。
在一项为期 4 周的观察性研究中，从 561 名 T1D 成年人中收集了连续血糖、胰岛素和营养数据。在运动期间、运动后和夜间计算血糖结果，并比较参与者使用和不使用开放-loop（OL）和自动化胰岛素输送（AID）治疗的运动指南时的结果。
需要行为改变的指南很少被使用，而不需要修改的指南经常被使用。建议在运动前减少餐时胰岛素的指南与 OL 治疗时运动期间血糖<3.9mmol/L 的时间减少（-2.2%，P=0.02）相关，但与 AID 治疗时无显著相关（-1.4%，P=0.27）。与 24 小时内血糖较低（<3.9mmol/L）的运动相比，没有近期低血糖的运动期间血糖<3.9mmol/L 的时间减少（-1.2%，P<0.001）。当 CGM 平坦或升高时，AID 指南建议在运动前不要摄入碳水化合物，这与改善血糖控制无关。
自由生活数据集可用于评估立场声明指南的使用和益处。有证据表明，在运动前减少餐时胰岛素且 24 小时内无低血糖的 OL 参与者，血糖低于目标范围的时间减少。
