TY - JOUR
TI - Avoiding hypoglycemia: The use of insulin pump combined with continuous glucose monitor in type 1 diabetes crossing a Rocky Gorge
AU - Thomakos, P.
AU - Vazeou, A.
AU - Sakkas, D.
AU - Panagopoulos, G.
AU - Anifantakis, K.
AU - Smyrnaki, P.
AU - Arvanitaki, T.
AU - Kyrlaki, E.
AU - Kefalogiannis, N.
AU - Mamoulakis, D.
AU - Pappas, A.
AU - Mitrakou, A.
JO - QJM-MONTHLY JOURNAL OF THE ASSOCIATION OF PHYSICIANS
PY - 2018
VL - 111
TODO - 9
SP - 629-633
PB - Oxford University Press
SN - null
TODO - 10.1093/qjmed/hcy136
TODO - glucose;  insulin;  antidiabetic agent;  glycosylated hemoglobin;  insulin, adult;  area under the curve;  Article;  body mass;  clinical article;  controlled study;  disease duration;  female;  glucose blood level;  human;  hyperglycemia;  hypoglycemia;  insulin dependent diabetes mellitus;  insulin infusion;  male;  nocturnal hypoglycemia;  observational study;  physical activity;  priority journal;  prospective study;  adolescent;  analysis;  blood glucose monitoring;  devices;  drug administration;  exercise;  Greece;  hypoglycemia;  insulin dependent diabetes mellitus;  insulin infusion;  multivariate analysis;  statistical model;  young adult, Adolescent;  Adult;  Blood Glucose;  Blood Glucose Self-Monitoring;  Diabetes Mellitus, Type 1;  Drug Administration Schedule;  Exercise;  Female;  Glycated Hemoglobin A;  Greece;  Humans;  Hypoglycemia;  Hypoglycemic Agents;  Insulin;  Insulin Infusion Systems;  Linear Models;  Male;  Multivariate Analysis;  Prospective Studies;  Young Adult
TODO - Background: Continuous subcutaneous insulin infusion (CSII) and continuous glucose monitoring systems (CGMS) have been proven very effective in diabetes management. Aim: This study evaluated the usefulness of these devices during prolonged, intense physical activity in an uncontrolled natural environment away from the clinical research center. Design: Non-randomized, prospective and observational study. Methods: During the summer, 38 participants with type 1 diabetes crossed the Samaria gorge, the second largest gorge in Europe (17 km). Twenty subjects on CSII combined with real-time CGMS and 18 on multiple daily injections (MDI) combined with professional (retrospective) CGMS participated in the program. All participants were unsupervised during the event. Results: All 38 participants managed to reach the destination point safely. There were no episodes of severe hypoglycemia. The duration of the exercise (mean 6SD) was 6.4 6 1.3 h. The CSII group exhibited significantly lower hypoglycemic episodes during exercise (0.1 6 0.3 vs. 0.4 6 0.6; P ¼ 0.047) as well as lower AUC below 70 mg/dl compared with the MDI, during the 24 h (0.61 6 0.78 vs. 1.84 6 1.55; P ¼ 0.007). Individuals on CSII were significantly less likely to develop a hypoglycemic episode during exercise (P ¼ 0.038). Exercise induced nocturnal hypoglycemia was not prevented effectively in neither group. Conclusions: CSII combined with CGMS is effective in controlling blood glucose levels in type 1 diabetics who perform prolonged strenuous exercise. The use of insulin pump technology in regions with hot Mediterranean climates is safe and can provide protection against exercise-induced hypoglycemia. Development of precise instructions for T1DM who occasionally get involved in exercise activities, requires further studies. © The Author(s) 2018. Published by Oxford University Press on behalf of the Association of Physicians. All rights reserved.
ER -