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22-05-2020 | Diabetes | News | Article

Hybrid insulin regimen may address type 1 diabetes exercise issues

Author:
Eleanor McDermid

medwireNews: A proof-of-concept study indicates that taking some basal insulin as a single injection of degludec improves glucose control during and after exercise in people with type 1 diabetes who prefer to remove their insulin pump while exercising.

“Exercise dysglycaemia remains a considerable challenge for physically active individuals living with type 1 diabetes,” say Ronnie Aronson (LMC Diabetes & Endocrinology, Toronto, Ontario, Canada) and co-researchers.

They used a randomized crossover trial to test combining an insulin pump with a long-acting insulin after the approach “anecdotally gained attention on social media.”

The team studied 24 physically active people with type 1 diabetes, aged an average of 34.8 years, who routinely used an insulin pump. The participants completed two 5-week study phases in a randomly assigned order. These comprised 1 week of insulin optimization followed by 4 weeks of data collection, which included at least five high-intensity and three moderate-intensity exercise sessions with the insulin pump removed, with the first of each session being supervised in the clinic.

During one phase, all the participants’ basal insulin needs were met by the pump. Continuous glucose monitoring for a 6-hour period from the start of their supervised moderate-intensity exercise session showed they spent an average of 143 minutes or 40% of the time within the target blood glucose range of 4–10 mmol/L (70–180 mg/dL).

But during the other phase, when half of their insulin was delivered via a daily morning degludec injection and the other half by the pump, the corresponding figures were a significantly improved 230 minutes and 64%. This was down to a significant 87-minute reduction in the time spent in hyperglycemia, with no difference seen for hypoglycemia.

The participants had a 4.6 mmol/L (82.9 mg/dL) rise in blood glucose between the start of exercise and 30 minutes after its end when using insulin pumps alone; this rise was just 0.8 mmol/L (14.5 mg/dL) on the hybrid insulin regimen.

The results were similar for the supervised high-intensity session, the researchers report in The Lancet Diabetes & Endocrinology.

“Improved post-exercise glycaemic control can often be offset by an increase in delayed hypoglycaemia, which can occur overnight (nocturnal hypoglycaemia),” they write.

But this was not the case when using degludec plus a pump. Indeed, time in hypoglycemia during the overnight period immediately following exercise was nonsignificantly reduced with this regimen relative to the pump alone.

Findings for at-home exercise periods were consistent with those undertaken in the clinic, and overall glycemic control was “identical” with the two insulin regimens, say Aronson et al.

Fifteen (68%) of the participants felt the hybrid insulin regimen was “somewhat” or “very” useful for facilitating exercise, and only 18% found the additional injection to be somewhat or very bothersome. Ten (45%) participants said they were somewhat or very likely to continue with the hybrid approach.

“These findings suggest that people with type 1 diabetes have additional options to help maintain, or even improve, glycaemic control while living an active life,” say the researchers.

They add: “A larger randomised control study is warranted to assess whether this hybrid approach could present a viable clinical strategy for active individuals with type 1 diabetes who routinely exercise with their insulin pump removed.”

medwireNews is an independent medical news service provided by Springer Healthcare. © 2020 Springer Healthcare part of the Springer Nature Group

Lancet Diabetes Endo 2020; 8: 511–523

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