دورية أكاديمية
أعرض في EDS

High intensity interval training as a novel treatment for impaired awareness of hypoglycaemia in people with type 1 diabetes (HIT4HYPOS): a randomised parallel-group study.

التفاصيل البيبلوغرافية
العنوان: High intensity interval training as a novel treatment for impaired awareness of hypoglycaemia in people with type 1 diabetes (HIT4HYPOS): a randomised parallel-group study.
المؤلفون: Farrell CM; Division of Systems Medicine, School of Medicine, University of Dundee, Dundee, UK., McNeilly AD; Division of Systems Medicine, School of Medicine, University of Dundee, Dundee, UK., Hapca S; Computing Science and Mathematics, Faculty of Natural Sciences, University of Stirling, Stirling, UK., Fournier PA; University of Western Australia, Perth, WA, Australia., Jones TW; University of Western Australia, Perth, WA, Australia., Facchinetti A; Department of Information Engineering, University of Padova, Padova, Italy., Cappon G; Department of Information Engineering, University of Padova, Padova, Italy., West DJ; Population Health Sciences Institute, Faculty of Medical Science, Newcastle University, Newcastle upon Tyne, UK., McCrimmon RJ; Division of Systems Medicine, School of Medicine, University of Dundee, Dundee, UK. r.mccrimmon@dundee.ac.uk.
المصدر: Diabetologia [Diabetologia] 2024 Feb; Vol. 67 (2), pp. 392-402. Date of Electronic Publication: 2023 Nov 27.
نوع المنشور: Randomized Controlled Trial; Journal Article
اللغة: English
بيانات الدورية: Publisher: Springer Verlag Country of Publication: Germany NLM ID: 0006777 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1432-0428 (Electronic) Linking ISSN: 0012186X NLM ISO Abbreviation: Diabetologia Subsets: MEDLINE
أسماء مطبوعة: Original Publication: Berlin Springer Verlag
مواضيع طبية MeSH: Diabetes Mellitus, Type 1*/drug therapy , High-Intensity Interval Training* , Hypoglycemia*/drug therapy, Adult ; Male ; Humans ; Female ; Blood Glucose Self-Monitoring ; Glucagon ; Pilot Projects ; Blood Glucose/analysis ; Hypoglycemic Agents/therapeutic use ; Epinephrine
مستخلص: Aims/hypothesis: Impaired awareness of hypoglycaemia (IAH) in type 1 diabetes may develop through a process referred to as habituation. Consistent with this, a single bout of high intensity interval exercise as a novel stress stimulus improves counterregulatory responses (CRR) to next-day hypoglycaemia, referred to as dishabituation. This longitudinal pilot study investigated whether 4 weeks of high intensity interval training (HIIT) has sustained effects on counterregulatory and symptom responses to hypoglycaemia in adults with type 1 diabetes and IAH.
Methods: HIT4HYPOS was a single-centre, randomised, parallel-group study. Participants were identified using the Scottish Diabetes Research Network (SDRN) and from diabetes outpatient clinics in NHS Tayside, UK. The study took place at the Clinical Research Centre, Ninewells Hospital and Medical School, Dundee, UK. Participants were aged 18-55 years with type 1 diabetes of at least 5 years' duration and HbA 1c levels <75 mmol/mol (<9%). They had IAH confirmed by a Gold score ≥4, modified Clarke score ≥4 or Dose Adjustment For Normal Eating [DAFNE] hypoglycaemia awareness rating of 2 or 3, and/or evidence of recurrent hypoglycaemia on flash glucose monitoring. Participants were randomly allocated using a web-based system to either 4 weeks of real-time continuous glucose monitoring (RT-CGM) or RT-CGM+HIIT. Participants and investigators were not masked to group assignment. The HIIT programme was performed for 20 min on a stationary exercise bike three times a week. Hyperinsulinaemic-hypoglycaemic (2.5 mmol/l) clamp studies with assessment of symptoms, hormones and cognitive function were performed at baseline and after 4 weeks of the study intervention. The predefined primary outcome was the difference in hypoglycaemia-induced adrenaline (epinephrine) responses from baseline following RT-CGM or RT-CGM+HIIT.
Results: Eighteen participants (nine men and nine women) with type 1 diabetes (median [IQR] duration 27 [18.75-32] years) and IAH were included, with nine participants randomised to each group. Data from all study participants were included in the analysis. During the 4 week intervention there were no significant mean (SEM) differences between RT-CGM and RT-CGM+HIIT in exposure to level 1 (28 [7] vs 22 [4] episodes, p=0.45) or level 2 (9 [3] vs 4 [1] episodes, p=0.29) hypoglycaemia. The CGM-derived mean glucose level, SD of glucose and glucose management indicator (GMI) did not differ between groups. During the hyperinsulinaemic-hypoglycaemic clamp studies, mean (SEM) change from baseline was greater for the noradrenergic responses (RT-CGM vs RT-CGM+HIIT: -988 [447] vs 514 [732] pmol/l, p=0.02) but not the adrenergic responses (-298 [687] vs 1130 [747] pmol/l, p=0.11) in those participants who had undergone RT-CGM+HIIT. There was a benefit of RT-CGM+HIIT for mean (SEM) change from baseline in the glucagon CRR to hypoglycaemia (RT-CGM vs RT-CGM+HIIT: 1 [4] vs 16 [6] ng/l, p=0.01). Consistent with the hormone response, the mean (SEM) symptomatic response to hypoglycaemia (adjusted for baseline) was greater following RT-CGM+HIIT (RT-CGM vs RT-CGM+HIIT: -4 [2] vs 0 [2], p<0.05).
Conclusions/interpretation: In this pilot clinical trial in people with type 1 diabetes and IAH, we found continuing benefits of HIIT for overall hormonal and symptomatic CRR to subsequent hypoglycaemia. Our findings also suggest that HIIT may improve the glucagon response to insulin-induced hypoglycaemia.
Trial Registration: ISRCTN15373978.
Funding: Sir George Alberti Fellowship from Diabetes UK (CMF) and the Juvenile Diabetes Research Foundation.
(© 2023. The Author(s).)
References: Behav Res Methods. 2011 Mar;43(1):258-68. (PMID: 21287123)
Diabetes Care. 2015 Jun;38(6):1016-29. (PMID: 25998294)
Am J Physiol Endocrinol Metab. 2001 Jun;280(6):E908-17. (PMID: 11350772)
Endocrinol Diabetes Metab. 2020 Jul 21;4(1):e00166. (PMID: 33532608)
Diabetes. 1974 Feb;23(2):81-93. (PMID: 4811512)
Am J Physiol. 1979 Sep;237(3):E214-23. (PMID: 382871)
Diabetologia. 2020 Apr;63(4):853-863. (PMID: 31942669)
Diabetes Care. 1994 Jul;17(7):697-703. (PMID: 7924780)
Lancet. 1994 Jul 30;344(8918):283-7. (PMID: 7914259)
Diabetes. 2010 Oct;59(10):2333-9. (PMID: 20876723)
Diabetes Care. 2020 Oct;43(10):e142-e143. (PMID: 32820010)
Diabetes. 1992 Oct;41(10):1335-40. (PMID: 1397708)
Diabetes Care. 2012 Aug;35(8):1638-42. (PMID: 22619082)
Diabetes. 1991 Feb;40(2):223-6. (PMID: 1991573)
Science. 1973 Oct 12;182(4108):171-3. (PMID: 4581053)
Diabetologia. 1993 Aug;36(8):771-7. (PMID: 8405746)
Diabetes. 2017 Jun;66(6):1696-1702. (PMID: 28270522)
Diabet Med. 2017 Feb;34(2):148-155. (PMID: 27770582)
Diabetologia. 2021 Jun;64(6):1436-1441. (PMID: 33730186)
Diabetes Care. 1995 Apr;18(4):517-22. (PMID: 7497862)
Diabetes. 2006 Jun;55(6):1755-60. (PMID: 16731839)
Endocrinology. 1974 May;94(5):1254-8. (PMID: 4823508)
Psychol Rev. 1966 Jan;73(1):16-43. (PMID: 5324565)
Neurobiol Learn Mem. 2009 Sep;92(2):135-8. (PMID: 18854219)
Endocr Rev. 2007 Feb;28(1):84-116. (PMID: 17261637)
Lancet Diabetes Endocrinol. 2023 Jan;11(1):42-57. (PMID: 36493795)
Lancet. 2018 Apr 7;391(10128):1367-1377. (PMID: 29459019)
Diabet Med. 2008 Apr;25(4):501-4. (PMID: 18387080)
J Diabetes Sci Technol. 2023 Jan 5;:19322968221147570. (PMID: 36602030)
Diabetes Care. 2017 Dec;40(12):1631-1640. (PMID: 29162583)
Lancet Diabetes Endocrinol. 2017 May;5(5):377-390. (PMID: 28126459)
Diabetes. 2003 Jul;52(7):1761-9. (PMID: 12829644)
معلومات مُعتمدة: 17/0005591 United Kingdom DUK_ Diabetes UK
فهرسة مساهمة: Keywords: Behaviour; Counter-regulation; Diabetes; Exercise; Habituation; Hypoglycaemia; Impaired awareness
المشرفين على المادة: 9007-92-5 (Glucagon)
0 (Blood Glucose)
0 (Hypoglycemic Agents)
YKH834O4BH (Epinephrine)
تواريخ الأحداث: Date Created: 20231127 Date Completed: 20240116 Latest Revision: 20240118
رمز التحديث: 20240118
مُعرف محوري في PubMed: PMC10789679
DOI: 10.1007/s00125-023-06051-x
PMID: 38010533
قاعدة البيانات: MEDLINE
الوصف
تدمد:1432-0428
DOI:10.1007/s00125-023-06051-x