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Randomized Controlled Trial
. 2023 Apr 1;46(4):704-713.
doi: 10.2337/dc22-1721.

Examining the Acute Glycemic Effects of Different Types of Structured Exercise Sessions in Type 1 Diabetes in a Real-World Setting: The Type 1 Diabetes and Exercise Initiative (T1DEXI)

Michael C Riddell  1 , Zoey Li  2 , Robin L Gal  2 , Peter Calhoun  2 , Peter G Jacobs  3 , Mark A Clements  4 , Corby K Martin  5 , Francis J Doyle Iii  6 , Susana R Patton  7 , Jessica R Castle  8 , Melanie B Gillingham  9 , Roy W Beck  2 , Michael R Rickels  10 ; T1DEXI Study Group
Collaborators, Affiliations
Randomized Controlled Trial

Examining the Acute Glycemic Effects of Different Types of Structured Exercise Sessions in Type 1 Diabetes in a Real-World Setting: The Type 1 Diabetes and Exercise Initiative (T1DEXI)

Michael C Riddell et al. Diabetes Care. .

Abstract

Objective: 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.

Research design and methods: 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.

Results: 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).

Conclusions: 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.

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Conflict of interest statement

Duality of Interest. M.C.R. reports consulting fees from the Jaeb Center for Health Research, Eli Lilly, Zealand Pharma, and Zucara Therapeutics; speaker fees from Sanofi Diabetes, Eli Lilly, Dexcom Canada, and Novo Nordisk; and stock options from Supersapiens and Zucara Therapeutics. P.G.J. reports grants from the National Institutes of Health, The Leona M. and Harry B. Charitable Trust, the Juvenile Diabetes Research Foundation, Dexcom, and the Oregon Health & Science University Foundation; consultancy fees from the Clinical Data Interchange Standards Consortium; U.S. patents 62/352939, 63/269094, 62/944287, 8810388, 9480418, 8317700, 61/570382, 8810388, 7976466, and 6558321; and stock options from Pacific Diabetes Technologies, outside the submitted work. M.A.C. is chief medical officer of Glooko, Inc., and reports grants or contracts from Dexcom, Abbott Diabetes Care, the National Institutes of Health, the Juvenile Diabetes Research Foundation, the Emily Rosebud Foundation, Eli Lilly, Tolerion, and Garmin. S.R.P. reports grants from The Leona M. and Harry B. Helmsley Charitable Trust, the National Institutes of Health, and the Jaeb Center for Health Research and an honorarium from the American Diabetes Association, outside the submitted work. J.R.C. reports grants from the Juvenile Diabetes Research Foundation, the National Institutes of Health, Dexcom, and Medtronic and consultancy fees from Novo Nordisk, Insulet, and Zealand Pharma, outside the submitted work. R.W.B. reports consulting fees, paid to institution, from Insulet, Bigfoot Biomedical, vTv Therapeutics, and Eli Lilly; grant support and supplies, provided to institution, from Tandem and Dexcom; and supplies from Ascenia and Roche. M.R.R. reports consultancy fees from Zealand Pharma.

Figures

None
Graphical abstract
Figure 1
Figure 1
Boxplots of change in glucose during study exercise by exercise type and insulin modality (N = 2,756 exercise sessions from 497 participants). Black lines in the middle of colored boxes represent medians; solid black dots in the middle of boxes represent means. Whiskers outside of the colored boxes represent the 10th and 90th percentiles. The number above each box indicates the number of exercise sessions.
Figure 2
Figure 2
N = 398 participants. A: Scatterplot of participant-level exercise versus sedentary day percent time 70–180 mg/dL. B: Boxplots of day-level percent time in range 70–180 mg/dL on exercise versus sedentary days. Black lines in the middle of colored boxes represent medians; solid black dots in the middle of boxes represent means. Whiskers outside of the colored boxes represent the 10th and 90th percentiles. The number above each box indicates the number of days. C: Cumulative distribution of participant-level percent time 70–180 mg/dL on exercise versus sedentary days.
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References

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