ECSS Paris 2023: OP-MH30
INTRODUCTION: Type 2 diabetes (T2D) is a leading contributor to premature death and disability worldwide. While structured exercise is a critical component of T2D care and prevention, the health effects of incidental physical activity, such as commuting, domestic, or occupational activity are less understood. Therefore, this study aimed to determine the association between device-measured incidental physical activity and T2D incidence in adults. METHODS: We were able to study the effects of incidental physical activity by restricting analyses to consenting UK Biobank accelerometry sub-study participants who self-reported not engaging in any structured exercise (including sports, gyms, and fitness classes). Participants were excluded if, at baseline, they had prevalent T2D, were undergoing exogenous insulin therapy, or were diagnosed with T2D within 12 months of follow-up. Device-captured incidental physical activity duration was quantified in minutes/day and intensities were categorised into light, moderate, and vigorous (LIPA, MIPA and VIPA) using a validated two-stage machine learning-based intensity and posture classification schema. Additional analyses were conducted by stratifying participants into two groups based on whether they met the moderate-to-vigorous physical activity (MVPA) guidelines. T2D diagnosis was obtained from multiple data sources, including self-reports, primary care records, and hospital inpatient records. The reference group included participants who did not engage in MIPA or VIPA. RESULTS: The analysis included 23,100 non-exercisers, 748 of whom developed T2D over a 7.9-year follow-up period. MIPA and VIPA, but not LIPA, exhibited near-linear inverse associations with T2D risk. Compared to undertaking no MIPA or VIPA, the median 2.8 minutes of VIPA was associated with a hazard ratio (HR) of 0.57 (95%CI: 0.47 to 0.69) and the median 24.2 minutes of MIPA was associated with a HR of 0.53 (95%CI 0.41 to 0.69). Participants who met or did not meet the MVPA guidelines displayed strong inverse associations between VIPA and T2D (HR 0.64, 95%CI: 0.47 to 0.86 and HR 0.67, 95%CI: 0.52 to 0.88, respectively). However, the dose-response curve was steeper among those who did not meet the physical activity guidelines, and required less time for the same risk reduction (4.02 min/day and 1.43 min/day, respectively). CONCLUSION: The results of this study demonstrate the importance of incidental MVPA within the context of T2D prevention by showing that even small amounts may be associated with a stark reduction in T2D incidence. These findings support public health recommendations that any MVPA is better than none, especially among individuals who do not meet current physical activity recommendations.
Read CV Angelo SabagECSS Paris 2023: OP-MH30
INTRODUCTION: Exercise-induced hypoglycemia remains a significant challenge for individuals with type 1 diabetes (T1D), even with advanced technology such as automated insulin delivery (AID) systems. A key contributor to hypoglycemia risk in T1D is an impaired glucagon response. In T1D the glucagon response to protein ingestion (unlike exercise or hypoglycemia) remains intact, and ingestion of rapidly digestible protein (such a whey protein), which has potent glycemic action may represent a novel strategy to mitigate exercise-induced hypoglycemia in T1D. METHODS: An ongoing multi-stage, block-randomized, crossover study is being conducted in adults with T1D using the Medtronic 780G AID system. After a cardiopulmonary exercise test, all participants completed two 60-minute moderate-intensity (50% VO2max) exercise sessions, as well as two 60-minute seated rest sessions in the afternoon. Each session was performed 4 h post a standardized meal with a temporary glucose target set 2 h prior to the session to minimize insulin on board, and 10g fast-acting carbohydrate was given 10min pre-exercise if sensor glucose was <7.0mmol/L. Each session included consumption of either 0.5g/kg body weight of whey protein with water (rest-protein and exercise-protein) or water only (rest-control and exercise-control) 30 minutes before exercise/rest. Blood samples were taken pre-ingestion (-30min), exercise/rest commencement (0min), 30, 60 and 90min for plasma glucagon quantification. Continuous glucose monitoring (CGM) was used to collect interstitial glucose readings every 5min throughout. RESULTS: Preliminary data is available from five adults with T1D (5 male, mean; HbA1c 6.8%, age 58.6 yrs, body mass 80kg, BMI 26kg/m2, VO2max, 36.3) who completed all exercise sessions (n=2 completed both rest sessions). The mean ± SD protein dose was 40 ± 4g. Fast-acting carbohydrate was supplemented pre-exercise for CGM glucose <7.0mmol/L once (n=1 exercise-control, n=0 exercise-protein). The average change in CGM glucose from start to end of exercise (i.e. 0-60min) was lower for protein ingestion (-0.40 ± 1.04 mmol/L, mean ± SD, n=5) vs control (-2.94 ± 1.87 mmol/L, mean ± SD, n=5). For both rest-control and exercise-control conditions, the average peak change in glucagon (n=2) was negligible (0.96-fold versus 0.95-fold, respectively). The average peak change in glucagon (n=2) was similar for both the rest-protein and exercise-protein conditions (4.01-fold versus 3.15-fold, respectively). CONCLUSION: Preliminary data indicates that whey protein promotes glucagon secretion equally at rest and during exercise and does not appear to work synergistically. Importantly, whey protein represents a novel strategy to mitigate dropping glucose during exercise in people with T1D, is readily available and could be easily translated into current exercise guidelines and clinical practice for people with T1D wishing to exercise.
Read CV Declan HennessyECSS Paris 2023: OP-MH30
INTRODUCTION: Optimal glycemic control (GC) is essential in people with type 1 diabetes (T1D) for long-term health. In fact, GC is associated with the prevention of diabetes complications. Evidence underlines that health benefits are potentiate by a regular practice of physical exercise (PE). Specifically, PE improves the metabolic profile contributing to blood glucose management and reducing daily insulin requirements. Dealing with daily PE implies for people with T1D several practical issues because of its duration, intensity and typology impact in a different way on the glycemic trend. However, it remains unclear the relationship between a stable GC and physical performance (PP) in this population. METHODS: 59 adults (24F/35M; aged (95% C.I.; 40.189, 46.794)) with type 1 diabetes participated in the study. The data collection consisted of a series of clinical metrics and PP tests. Performance tests evaluate aerobic, strength and flexibility parameters. They were assessed through the Six-Minute Walking Test (6MWT), Yo-Yo Intermittent Recovery Test (Yo-Yo IR), Standing Broad Jump (SBJ), Handgrip Strength Test (HG) and Sit-and-Reach (SaR). HbA1c values were obtained from medical records while Time in Range (TIR), Time Above Range (TAR), Time Below Range (TBR), Coefficient of Variation (CV) and Glucose Monitor Index (GMI) were tracked by a continuous glucose monitor. A linear regression analyses adjusted by sex, age and insulin therapy was conducted to determine the relationship between clinical and motor variable. RESULTS: Results indicated that there were no significant association between 6MWT and Yo-Yo IR with HbA1c (6MWT: β= -0.228, p=0.177; Yo-Yo IR: β=-0.223, p=0.460), TIR (6MWT: β=0.337,p=0.050; Yo-Yo IR: β= -0.012,p=0.968) and CV (6MWT: β=-0.387, p=0.011; Yo-Yo IR: β=0.017, p=0.948). Similarly, no relationships were observed for the SBJ, SaR and HG tests with these metabolic parameters (all p>0.05). Also TAR and TBR values showed no significant association with all performance tests (all p>0.05). CONCLUSION: These findings highlighted the concept that better GC is not associated with higher PP levels. Since there is an absence of a significant correlation between PE measure and optimal glycemic management, we can affirm that multiple factors such as insulin therapy, diet strategies and supplementation influence GC in people with T1D. Therefore, these results indicated that a multidisciplinary approach is necessary in this field.
Read CV Agnese PirazziECSS Paris 2023: OP-MH30