评估胰岛素类型(超快速胰岛素与快速胰岛素)和运动时间对 1 型糖尿病患者餐后运动诱发低血糖风险的影响:随机对照试验。

IF 8.4 1区 医学 Q1 ENDOCRINOLOGY & METABOLISM
Diabetologia Pub Date : 2024-11-01 Epub Date: 2024-07-29 DOI:10.1007/s00125-024-06234-0
Joséphine Molveau, Étienne Myette-Côté, Sémah Tagougui, Nadine Taleb, Roxane St-Amand, Corinne Suppère, Valérie Bourdeau, Elsa Heyman, Rémi Rabasa-Lhoret
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引用次数: 0

摘要

目的/假设:1 型糖尿病患者餐前胰岛素类型、运动时间与餐后运动诱发低血糖风险之间的关系尚不清楚。我们旨在评估运动时间(餐后 60 分钟 vs 餐后 120 分钟)和不同胰岛素类型(天冬胰岛素 vs 超快速天冬胰岛素)对低血糖风险的影响:这是一项四向交叉随机试验,包括 40 名每日多次注射的 1 型糖尿病患者(平均 HbA1c 56 mmol/mol [7.4%])。参与者从蒙特利尔临床研究所招募,在早餐后(餐后 60 分钟 [EX60min] 或 120 分钟 [EX120min])进行 60 分钟的自行车运动(V˙O 2 峰值的 60%),胰岛素剂量为平时的 50%(天冬胰岛素或超快速天冬胰岛素)。资格标准包括年龄≥18 岁,临床诊断为 1 型糖尿病至少 1 年,HbA1c ≤80 mmol/mol (9.5%)。参试者使用按顺序编号的不透明密封信封进行分配。参与者的组别分配均不公开,每位参与者都有一个唯一的识别号码,以确保匿名性。主要结果是运动开始和最低点之间血糖水平的变化:结果:在运动开始前,EX60min 与 EX120min 的高血糖时间较短(时间 >10.0 mmol/l:56.6% [1.2-100%] vs 78.0% [52.7-97.9%];p结论/解释:EX60min减弱了早餐后运动前血糖的升高,与运动中血糖降低幅度较小有关。超快速阿斯巴甜可使运动中的血糖降低幅度更小,可能与运动后低血糖症的减少有关:试验注册:ClinicalTrials.gov NCT03659799 资助:本研究由诺和诺德加拿大公司资助。
本文章由计算机程序翻译,如有差异,请以英文原文为准。

Assessing the influence of insulin type (ultra-rapid vs rapid insulin) and exercise timing on postprandial exercise-induced hypoglycaemia risk in individuals with type 1 diabetes: a randomised controlled trial.

Assessing the influence of insulin type (ultra-rapid vs rapid insulin) and exercise timing on postprandial exercise-induced hypoglycaemia risk in individuals with type 1 diabetes: a randomised controlled trial.

Aims/hypothesis: The relationship between pre-meal insulin type, exercise timing and the risk of postprandial exercise-induced hypoglycaemia in people living with type 1 diabetes is unknown. We aimed to evaluate the effects of exercise timing (60 vs 120 min post meal) and different insulin types (aspart vs ultra-rapid aspart) on hypoglycaemic risk.

Methods: This was a four-way crossover randomised trial including 40 individuals with type 1 diabetes using multiple daily injections (mean HbA1c 56 mmol/mol [7.4%]). Participants, who were recruited from the Montreal Clinical Research Institute, undertook 60 min cycling sessions (60% of V ˙ O 2 peak ) after breakfast (60 min [EX60min] or 120 min [EX120min] post meal) with 50% of their usual insulin dose (aspart or ultra-rapid aspart). Eligibility criteria included age ≥18 years old, clinical diagnosis of type 1 diabetes for at least 1 year and HbA1c ≤80 mmol/mol (9.5%). Participants were allocated using sequentially numbered, opaque sealed envelopes. Participants were masked to their group assignment, and each participant was allocated a unique identification number to ensure anonymisation. The primary outcome was change in blood glucose levels between exercise onset and nadir.

Results: Prior to exercise onset, time spent in hyperglycaemia was lower for EX60min vs EX120min (time >10.0 mmol/l: 56.6% [1.2-100%] vs 78.0% [52.7-97.9%]; p<0.001). The glucose reduction between exercise onset and nadir was less pronounced with EX60min vs EX120min (-3.8±2.7 vs -4.7±2.5 mmol/l; p<0.001). A similar number of hypoglycaemic events occurred during both exercise timings. Blood glucose between exercise onset and nadir decreased less with ultra-rapid aspart compared with aspart (-4.1±2.3 vs -4.4±2.8 mmol/l; p=0.037). While a similar number of hypoglycaemic events during exercise were observed, less post-exercise hypoglycaemia occurred with ultra-rapid aspart (n=0, 0%, vs n=15, 38%; p=0.003). No interactions between insulin types and exercise timings were found.

Conclusions/interpretation: EX60min blunted the pre-exercise glucose increase following breakfast and was associated with a smaller glucose reduction during exercise. Ultra-rapid aspart led to a smaller blood glucose reduction during exercise and might be associated with diminished post-exercise hypoglycaemia.

Trial registration: ClinicalTrials.gov NCT03659799 FUNDING: This study was funded by Novo Nordisk Canada.

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来源期刊
Diabetologia
Diabetologia 医学-内分泌学与代谢
CiteScore
18.10
自引率
2.40%
发文量
193
审稿时长
1 months
期刊介绍: Diabetologia, the authoritative journal dedicated to diabetes research, holds high visibility through society membership, libraries, and social media. As the official journal of the European Association for the Study of Diabetes, it is ranked in the top quartile of the 2019 JCR Impact Factors in the Endocrinology & Metabolism category. The journal boasts dedicated and expert editorial teams committed to supporting authors throughout the peer review process.
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