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No insulin degludec dose adjustment required after aerobic exercise for people with type 1 diabetes: the ADREM study

Drenthen, LCA, Ajie, M, Abbink, EJ, Rodwell, L, Thijssen, DHJ, Tack, CJ and de Galan, BE (2023) No insulin degludec dose adjustment required after aerobic exercise for people with type 1 diabetes: the ADREM study. Diabetologia, 66 (6). pp. 1035-1044. ISSN 0012-186X

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Aims/hypothesis: It is generally recommended to reduce basal insulin doses after exercise to reduce the risk of post-exercise nocturnal hypoglycaemia. Based on its long t½, it is unknown whether such adjustments are required or beneficial for insulin degludec. Methods: The ADREM study (Adjustment of insulin Degludec to Reduce post-Exercise (nocturnal) hypoglycaeMia in people with diabetes) was a randomised controlled, crossover study in which we compared 40% dose reduction (D40), or postponement and 20% dose reduction (D20-P), with no dose adjustment (CON) in adults with type 1 diabetes at elevated risk of hypoglycaemia, who performed a 45 min aerobic exercise test in the afternoon. All participants wore blinded continuous glucose monitors for 6 days, measuring the incidence of (nocturnal) hypoglycaemia and subsequent glucose profiles. Results: We recruited 18 participants (six women, age 38 ± 13 years, HbA1c 56 ± 8 mmol/mol [7.3 ± 0.8%], mean ± SD). Time below range (i.e. glucose <3.9 mmol/l) the night after the exercise test was generally low and occurrence did not differ between the treatment regimens. During the subsequent whole day, time below range was lower for D40 compared with CON (median [IQR], 0 [0–23] vs 18 [0–55] min, p=0.043), without differences in the number of hypoglycaemic events. Time above range (i.e. glucose >10 mmol/l) was greater for D20-P vs CON (mean ± SEM, 584 ± 81 vs 364 ± 66 min, p=0.001) and D40 (385 ± 72 min, p=0.003). Conclusions/interpretation: Post-exercise adjustment of degludec does not mitigate the risk of subsequent nocturnal hypoglycaemia in people with type 1 diabetes. Although reducing degludec reduced next-day time below range, this did not translate into fewer hypoglycaemic events, while postponing degludec should be avoided because of increased time above range. Altogether, these data do not support degludec dose adjustment after a single exercise bout. Trial registration: EudraCT number 2019-004222-22 Funding: The study was funded by an unrestricted grant from Novo Nordisk, Denmark. Graphical abstract: [Figure not available: see fulltext.]

Item Type: Article
Uncontrolled Keywords: Humans; Diabetes Mellitus, Type 1; Hypoglycemia; Blood Glucose; Hypoglycemic Agents; Exercise; Cross-Over Studies; Adult; Middle Aged; Female; Male; Insulin Glargine; Dose adjustment; Exercise; Hypoglycaemia; Insulin treatment; Type 1 diabetes mellitus; Adult; Female; Humans; Middle Aged; Blood Glucose; Cross-Over Studies; Diabetes Mellitus, Type 1; Exercise; Hypoglycemia; Hypoglycemic Agents; Insulin Glargine; Male; 1103 Clinical Sciences; 1114 Paediatrics and Reproductive Medicine; 1117 Public Health and Health Services; Endocrinology & Metabolism
Subjects: Q Science > QP Physiology
R Medicine > RC Internal medicine > RC1200 Sports Medicine
Divisions: Sport & Exercise Sciences
Publisher: Springer Science and Business Media LLC
SWORD Depositor: A Symplectic
Date Deposited: 21 Jul 2023 11:08
Last Modified: 21 Jul 2023 11:15
DOI or ID number: 10.1007/s00125-023-05893-9
URI: https://researchonline.ljmu.ac.uk/id/eprint/20473
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