Abstract
AimThis pilot study aimed to investigate whether a 4‐week programme of intermittent high‐intensity training (HIT) will improve counterregulatory responses and improve hypoglycaemia awareness in adults with type 1 diabetes who have been exposed to recurrent hypoglycaemia.MethodsAdults with type 1 diabetes who have been exposed to recurrent hypoglycaemia will be recruited from NHS Tayside, Scotland. All participants have a 4‐week run‐in period to optimize glycaemic control and to receive instruction in hypoglycaemia avoidance using insulin dose adjustment and real‐time continuous glucose monitoring (CGM). Following this, they will undergo a baseline 90‐minute hyperinsulinaemic hypoglycaemic clamp to assess symptomatic, cognitive and hormonal counterregulatory responses. Subsequently, participants will be randomized in a parallel‐group design to either undergo a 4‐week intervention with HIT or to no exercise with both groups using CGM throughout and receiving additional advice on hypoglycaemia avoidance. Participants in the HIT arm of the trial will be instructed to exercise 3 times a week on a cycle ergometer and asked to achieve ≥ 90% max heart rate during each period of exercise. On completion of the intervention period, all subjects then undergo a second matched hyperinsulinaemic hypoglycaemic clamp study.DiscussionThis pilot study will determine whether high‐intensity exercise may offer a novel approach to restore hypoglycaemic awareness in type 1 diabetes (International Standard Randomised Controlled Trials No: ISRCTN15373978).
Highlights
Impaired awareness of hypoglycaemia (IAH) is defined as ‘a diminished ability to perceive the onset of acute hypoglycaemia’.1 IAH affects 20%-25% of all people with type 1 diabetes, and of concern, the incidence of IAH has not changed in the last 2-3 decades despite the introduction of insulin analogues and improved insulin delivery systems.[2]
Aim: This pilot study aimed to investigate whether a 4-week programme of intermittent high-intensity training (HIT) will improve counterregulatory responses and improve hypoglycaemia awareness in adults with type 1 diabetes who have been exposed to recurrent hypoglycaemia
20%-30% of all people with type 1 diabetes have impaired awareness of hypoglycaemia,[2] a condition that negatively impacts on their quality of life and that is associated with significant morbidity
Summary
Impaired awareness of hypoglycaemia (IAH) is defined as ‘a diminished ability to perceive the onset of acute hypoglycaemia’.1 IAH affects 20%-25% of all people with type 1 diabetes, and of concern, the incidence of IAH has not changed in the last 2-3 decades despite the introduction of insulin analogues and improved insulin delivery systems.[2]. IAH affects 20%-25% of all people with type 1 diabetes, and of concern, the incidence of IAH has not changed in the last 2-3 decades despite the introduction of insulin analogues and improved insulin delivery systems.[2] In people with type 1 diabetes, IAH increases the risk of Endocrinol Diab Metab. The underlying mechanisms that lead to the development of IAH are unclear; it has been well established in multiple studies in people with and without type 1 diabetes that IAH can develop by inducing one or more episodes of experimentally induced hypoglycaemia.[4] In addition, the greater the frequency of incidence exposure to hypoglycaemia, the greater the degree of suppression of symptomatic and hormonal counterregulatory responses (CRR), a process that can be reversed through strict hypoglycaemia avoidance.[5,6,7]
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