Abstract
Continuous glucose monitoring (CGM) plays an important role in treatment decisions for patients with type 1 diabetes under conventional or closed-loop therapy. Physical activity represents a great challenge for diabetes management as well as for CGM systems. In this work, the accuracy of CGM in the context of exercise is addressed. Six adults performed aerobic and anaerobic exercise sessions and used two Medtronic Paradigm Enlite-2 sensors under closed-loop therapy. CGM readings were compared with plasma glucose during different periods: one hour before exercise, during exercise, and four hours after the end of exercise. In aerobic sessions, the median absolute relative difference (MARD) increased from 9.5% before the beginning of exercise to 16.5% during exercise (p < 0.001), and then decreased to 9.3% in the first hour after the end of exercise (p < 0.001). For the anaerobic sessions, the MARD before exercise was 15.5% and increased without statistical significance to 16.8% during exercise realisation (p = 0.993), and then decreased to 12.7% in the first hour after the cessation of anaerobic activities (p = 0.095). Results indicate that CGM might present lower accuracy during aerobic exercise, but return to regular operation a few hours after exercise cessation. No significant impact for anaerobic exercise was found.
Highlights
Continuous glucose monitoring (CGM) is associated with improvement in glycaemic control in patients with type 1 diabetes (T1D), reducing glycated haemoglobin (HBA1C ) percentage without increasing the occurrence of hypoglycaemic episodes [1,2,3]
Regular physical activity (PA) is recommended for patients with T1D to improve overall health conditions [4], diabetes management in front of exercise is not a trivial task and monitoring glucose levels before, during, and after physical activity is fundamental to maintaining plasma glucose (PG) levels in euglycaemic ranges during and after exercise [5]
The results showed a degradation of accuracy caused by the onset of aerobic exercise
Summary
Continuous glucose monitoring (CGM) is associated with improvement in glycaemic control in patients with type 1 diabetes (T1D), reducing glycated haemoglobin (HBA1C ) percentage without increasing the occurrence of hypoglycaemic episodes [1,2,3]. Using a minimally invasive sensor inserted in the subcutaneous tissue, patients can follow their readings in real-time, allowing them to make changes in their therapy to improve glycaemic variability and metabolic control safely. CGM data allows physicians to visualise individualised glycaemic traces along consecutive days, and improve patients’ insulin treatment. Artificial pancreas systems ( referred to as closed-loop systems) rely on CGM readings to automatically calculate at every sampling time the necessary insulin dose to keep patients’ PG levels in safe ranges [6]. In 2017, the first artificial pancreas system hit the market in United States, still requiring patient intervention at mealtimes [7]
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