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

L.C.A. Drenthen; M. Ajie; E.J. Abbink; L. Rodwell; D.H.J. Thijssen; C.J. Tack; B.E. de Galan

doi:10.1007/s00125-023-05893-9

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

L.C.A. Drenthen^*, M. Ajie, E.J. Abbink, L. Rodwell, D.H.J. Thijssen, C.J. Tack, B.E. de Galan

^*Corresponding author for this work

Research output: Contribution to journal › Article › Academic › peer-review

Abstract

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 t1/2, 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.

Original language	English
Pages (from-to)	1035-1044
Number of pages	10
Journal	Diabetologia
Volume	66
Issue number	6
Early online date	1 Mar 2023
DOIs	https://doi.org/10.1007/s00125-023-05893-9
Publication status	Published - Jun 2023

Keywords

Dose adjustment
Exercise
Hypoglycaemia
Insulin treatment
Type 1 diabetes mellitus
NOCTURNAL HYPOGLYCEMIA
IMPAIRED AWARENESS
PHYSICAL-ACTIVITY
GLARGINE
POSTEXERCISE
ADOLESCENTS
FREQUENCY

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Cite this

@article{4402020438de4bd3be4a9b8008757608,

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

abstract = "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 t1/2, 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.",

keywords = "Dose adjustment, Exercise, Hypoglycaemia, Insulin treatment, Type 1 diabetes mellitus, NOCTURNAL HYPOGLYCEMIA, IMPAIRED AWARENESS, PHYSICAL-ACTIVITY, GLARGINE, POSTEXERCISE, ADOLESCENTS, FREQUENCY",

author = "L.C.A. Drenthen and M. Ajie and E.J. Abbink and L. Rodwell and D.H.J. Thijssen and C.J. Tack and {de Galan}, B.E.",

note = "Funding Information: The authors thank all volunteers for their participation. The authors also express their gratitude to B. Kersten and E. Bakker from the Department of Physiology, Radboud University Medical Center, Nijmegen, the Netherlands, for assistance during the exercise tests and with analysing activity tracker data, respectively. The authors also thank T. van Herwaarden from the Department of Laboratory Medicine, Radboud University Medical Center, Nijmegen, the Netherlands, for assistance with determining the analyses methods for the laboratory measurements. They received no financial support for their participation. Some of these data were presented in abstract form at the Annual Dutch Diabetes Research Meeting (ADDRM) in 2022 and at the 58th EASD Annual Meeting in 2022. BEdG is associate editor for Diabetologia , but was not involved in the handling of the manuscript during the editorial process. The authors declare that there are no other relationships or activities that might bias, or be perceived to bias, their work. EJA, CJT and BEdG designed the study. LCAD recruited the participants, performed the experiments, collected the data, analysed the data and wrote the first version of the manuscript. LCAD, MA and LR performed the statistical analyses. All authors discussed the results and implications, commented on the manuscript at all stages and approved the final version of the manuscript. The guarantor (BEdG) accepts full responsibility for the work and conduct of the study, has access to the data and controlled the decision to publish. Publisher Copyright: {\textcopyright} 2023, The Author(s).",

year = "2023",

month = jun,

doi = "10.1007/s00125-023-05893-9",

language = "English",

volume = "66",

pages = "1035--1044",

journal = "Diabetologia",

issn = "0012-186X",

publisher = "Springer, Cham",

number = "6",

}

TY - JOUR

T1 - No insulin degludec dose adjustment required after aerobic exercise for people with type 1 diabetes: the ADREM study

AU - Drenthen, L.C.A.

AU - Ajie, M.

AU - Abbink, E.J.

AU - Rodwell, L.

AU - Thijssen, D.H.J.

AU - Tack, C.J.

AU - de Galan, B.E.

N1 - Funding Information: The authors thank all volunteers for their participation. The authors also express their gratitude to B. Kersten and E. Bakker from the Department of Physiology, Radboud University Medical Center, Nijmegen, the Netherlands, for assistance during the exercise tests and with analysing activity tracker data, respectively. The authors also thank T. van Herwaarden from the Department of Laboratory Medicine, Radboud University Medical Center, Nijmegen, the Netherlands, for assistance with determining the analyses methods for the laboratory measurements. They received no financial support for their participation. Some of these data were presented in abstract form at the Annual Dutch Diabetes Research Meeting (ADDRM) in 2022 and at the 58th EASD Annual Meeting in 2022. BEdG is associate editor for Diabetologia , but was not involved in the handling of the manuscript during the editorial process. The authors declare that there are no other relationships or activities that might bias, or be perceived to bias, their work. EJA, CJT and BEdG designed the study. LCAD recruited the participants, performed the experiments, collected the data, analysed the data and wrote the first version of the manuscript. LCAD, MA and LR performed the statistical analyses. All authors discussed the results and implications, commented on the manuscript at all stages and approved the final version of the manuscript. The guarantor (BEdG) accepts full responsibility for the work and conduct of the study, has access to the data and controlled the decision to publish. Publisher Copyright: © 2023, The Author(s).

PY - 2023/6

Y1 - 2023/6

N2 - 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 t1/2, 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.

AB - 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 t1/2, 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.

KW - Dose adjustment

KW - Exercise

KW - Hypoglycaemia

KW - Insulin treatment

KW - Type 1 diabetes mellitus

KW - NOCTURNAL HYPOGLYCEMIA

KW - IMPAIRED AWARENESS

KW - PHYSICAL-ACTIVITY

KW - GLARGINE

KW - POSTEXERCISE

KW - ADOLESCENTS

KW - FREQUENCY

U2 - 10.1007/s00125-023-05893-9

DO - 10.1007/s00125-023-05893-9

M3 - Article

C2 - 36879098

SN - 0012-186X

VL - 66

SP - 1035

EP - 1044

JO - Diabetologia

JF - Diabetologia

IS - 6

ER -