Randomized trial of a dual‐hormone artificial pancreas with dosing adjustment during exercise compared with no adjustment and sensor‐augmented pump therapy
Open accessAbstract
Aims: To test whether adjusting insulin and glucagon in response to exercise within a dual‐hormone artificial pancreas ( AP ) reduces exercise‐related hypoglycaemia. Materials and methods: In random order, 21 adults with type 1 diabetes ( T1D ) underwent three 22‐hour experimental sessions: AP with exercise dosing adjustment ( APX ); AP with no exercise dosing adjustment ( APN ); and sensor‐augmented pump ( SAP ) therapy. After an overnight stay and 2 hours after breakfast, participants exercised for 45 minutes at 60% of their maximum heart rate, with no snack given before exercise. During APX , insulin was decreased and glucagon was increased at exercise onset, while during SAP therapy, subjects could adjust dosing before exercise. The two primary outcomes were percentage of time spent in hypoglycaemia (<3.9 mmol/ L ) and percentage of time spent in euglycaemia (3.9‐10 mmol/ L ) from the start of exercise to the end of the study. Results: The mean (95% confidence interval) times spent in hypoglycaemia (<3.9 mmol/ L ) after the start of exercise were 0.3% (−0.1, 0.7) for APX , 3.1% (0.8, 5.3) for APN , and 0.8% (0.1, 1.4) for SAP therapy. There was an absolute difference of 2.8% less time spent in hypoglycaemia for APX versus APN (p = .001) and 0.5% less time spent in hypoglycaemia for APX versus SAP therapy (p = .16). Mean time spent in euglycaemia was similar across the different sessions. Conclusions: Adjusting insulin and glucagon delivery at exercise onset within a dual‐hormone AP significantly reduces hypoglycaemia compared with no adjustment and performs similarly to SAP therapy when insulin is adjusted before exercise.
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Activity monitors can be used in conjunction with on-body continuous glucose monitors, an insulin pump and a control algorithm to adjust insulin delivery, and perhaps glucagon delivery in real time.
“In theory, activity monitors can be used in conjunction with on-body continuous glucose monitors, an insulin pump and a control algorithm to adjust insulin delivery, and perhaps glucagon delivery in real time [5,6].”
From Accuracy of Wrist-Worn Activity Monitors During Common Daily Physical Activities and Types of Structured Exercise: Evaluation Study (2018) · cites this paper as [5]
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Self-citation
- Authors
- Jacobs, P. G., El Youssef, J., Reddy, R., Resalat, N., Branigan, D., Condon, J., Preiser, N., Ramsey, K., Jones, M., Edwards, C., Kuehl, K., Leitschuh, J., Rajhbeharrysingh, U., & Castle, J. R.
- Affiliations
- Oregon Health & Science University (US)
- Department of Medicine, Division of Endocrinology, Harold Schnitzer Diabetes Health Center Oregon Health and Science University Portland
- Corresponding author
- Jacobs, P. G.
- Venue
- Diabetes, Obesity and Metabolism
- Publisher
- Wiley
- Published
- 2016-08-15
- Volume
- 18
- Issue
- 11
- Pages
- 1110-1119
- ISSN
- 1462-8902 (ISSN-L)
- 1463-1326
- PMC
- PMC5056819
- OpenAlex
- W2463876450
- Cited by
- 116
- References
- 23
- Citations by year
- 2026: 1 · 2025: 8 · 2024: 4 · 2023: 7 · 2022: 11 · 2021: 11 · 2020: 16 · 2019: 25 · 2018: 20 · 2017: 10 · 2016: 3
- FWCI
- 19.41
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Diabetes Obesity and Metabolism (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- Oregon Clinical and Translational Research Institute (UL1TR000128)
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Treatment and Management
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Education
- Keywords
- type 1 diabetes, exercise-induced hypoglycaemia, sensor-augmented pump therapy, continuous glucose monitoring
- MeSH terms
- Adolescent, Adult, Blood Glucose, Diabetes Mellitus, Type 1, Dose-Response Relationship, Drug, Female, Glucagon, Humans, Hypoglycemia, Hypoglycemic Agents, Insulin, Insulin Infusion Systems, Male, Middle Aged, Biosensing Techniques, Exercise, Cross-Over Studies, Pancreas, Artificial, Young Adult
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