A sequence of case stories to be introduced at this yr’s Annual Assembly of The European Affiliation for the Research of Diabetes (EASD), Madrid (9-13 Sept), describe how a expertise giving insulin doses knowledgeable by an insulin pump algorithm helped three adults with sort 1 diabetes higher handle their blood sugars enabling them to steer extra lively lives, and even run marathons.
The AID system incorporates a complicated hybrid closed loop algorithm that automates the supply of each basal and correction bolus insulin each 5 minutes primarily based on sensor glucose values.
It’s nice to see advances in diabetes expertise come to fruition and ship such enhancements to individuals’s lives. This expertise is sport altering, permitting extra individuals with diabetes to have safer, more healthy, extra lively lives.”
Dr. Maria Onetto, lead writer from Pontificia Universidad Católica Chile, Santiago, Chile
In T1D, an individual’s blood glucose stage turns into too excessive (hyperglycaemia) as a result of there isn’t a, manufacturing of insulin by the pancreas. Blood glucose ranges can solely be regulated by giving insulin to forestall hyperglycaemia.
If T1D shouldn’t be effectively managed, individuals are at elevated threat of long-term issues of hyperglycaemia, together with microvascular harm reminiscent of eye, kidney or nerve harm, coronary heart illness or stroke.
“Regardless of higher techniques for monitoring blood sugars and delivering insulin, sustaining glucose ranges in goal vary throughout cardio coaching and athletic competitors is very tough,” defined Dr Onetto. “The usage of automated insulin supply expertise is rising, however train continues to be a problem for people with T1D, who can nonetheless battle to achieve the really helpful blood sugar targets.”
Though there are some printed suggestions of learn how to alter insulin supply and carbohydrate consumption for train, there are few stories of real-world examples of individuals with T1D utilizing automated insulin supply techniques throughout intensive train or competitors.
The expertise often called Advance-Hybrid Closed-Loop consists of an algorithm on an insulin pump which communicates with the standard steady glucose monitoring. The actual-time glucose monitoring system adjusts insulin doses each 5 minutes based on blood sugar ranges, that means that it constantly responds to the persistent adjustments in blood sugar ranges.
The affected person delivers boluses for meals and snacks by getting into the whole grams of carbohydrates they’re consuming. The algorithm targets a glucose stage chosen by the consumer, which could be adjusted to be 100, 110 or 120 mg/dL. The affected person also can set a brief sensor glucose goal (Temp Goal) of 150 mg/dL for conditions the place hypoglycaemia threat could also be elevated, reminiscent of throughout train. When the Temp Goal is on, auto-bolus corrections are disabled.Â
To evaluate blood sugar management throughout the marathons, the researchers measured: time in vary (TIR) that exhibits the proportion of time an individual spends inside a goal glucose vary (3.9 to 10 mmol/litre); time under vary (TBR; under 70 mg/dL or 3.9 mmol/litre) goal to lower than 4% of the time; and time above vary (TAR) when blood glucose ranges exceed 180 mg/dL.
50-year-old man with T1D for 22 years ran Tokyo marathon in round 3.5 hours
The primary report particulars a 50-year-old man who had been residing with T1D for 22 years earlier than he ran the Tokyo Marathon in March 2023 in 3 hours and 34 minutes.
Thirty days earlier than the race his time within the goal glucose vary (TIR 70-180 mg/dL ) was 89%, time above vary (TAR>180 mg/dL) was 9%, time under vary (TBR<70 mg/dL) was 1%, and HbA1c (common blood sugar over the past 8 to 12 weeks) was 6.9%.
To be able to forestall hypoglycaemia, on the morning of the marathon he lowered his breakfast insulin dose by 25% and the insulin dose utilized to the pre-race snack was additionally lowered by 50% to higher handle blood sugar ranges.
He consumed glucose gels, the first supply of carbohydrates throughout the race, at a charge of 0.39 g/kg/hour, with 102g consumed general.
Throughout the race, the person maintained wonderful glycaemic management, spending 96% of the marathon throughout the appropriate glucose vary, simply 4% under vary, and no time above the goal vary. He achieved a median blood glucose of 107mg/dl-;effectively under the imply glucose of lower than 154 mg/dl really helpful in adults (see desk in summary).
40-year-old man with T1D for 4 years ran Santiago marathon in beneath 5 hours
The second report is of a 40-year-old man who had been residing with T1D for the previous 4 years. He took half within the Santiago (Chile) marathon in Might 2023, finishing the race in 4 hours and 56 minutes.
Earlier than the marathon (30 days), his time within the goal glucose vary was 76%, time above vary was 9%, time under vary was 3%, and HbA1c was 6.7%.
The day of the race, he didn’t decrease his breakfast insulin dose, however he lowered the insulin dose utilized to the pre-race snack by 100%. Throughout the marathon, the person consumed glucose gels at a charge of 0.42 g/kg/hour, with 120g consumed in complete.
The person spent 100% of the marathon throughout the appropriate glucose vary with a median blood glucose of 110mg/dl, underscoring the aptitude of the glucose monitoring system to reply in actual time (see desk in summary).
34-year-old girl with T1D for 27 years ran Paris marathon in beneath 4 hours
The third report describes a 34-year-old girl who had been residing with T1D for 27 years earlier than she accomplished the Paris Marathon in April 2023 in 3 hours and 56 minutes.
Thirty days earlier than the marathon, her time within the goal glucose vary was 83%, time above vary was 15%, time under vary was 1%, and her HbA1c was 6.6%.
On the morning of the marathon, she didn’t decrease her breakfast insulin dose, however she lowered the insulin dose utilized to her pre-race snack by 83%.
Throughout the marathon, she consumed glucose gels at a charge of 0.5 g/kg/hour, with 115g consumed in complete. She spent the entire marathon effectively above the goal glucose vary, with a median blood glucose of 271mg/dl-;effectively above the imply glucose of lower than 154 mg/dl really helpful in adults.
As Dr Onetto defined: “It’s seemingly that the girl remained hyperglycaemic all through the race for plenty of causes. She could have eaten too many carbs earlier than the race with out insulin, however she additionally did not deactivate the momentary sensor glucose goal (temp goal) as a result of she hadn’t realized that disconnecting it could re-enable the auto-correction boluses.”
She added, “We hope these case research present insights for healthcare professionals who help athletes with sort 1 diabetes utilizing automated insulin supply techniques throughout intense bodily actions. Underscoring the significance of specialised schooling, planning, and customized approaches, this analysis emphasizes the substantial alternatives that automated insulin supply expertise gives to people with sort 1 diabetes, enabling them to steer lively lives.”
