A collection of case reviews to be offered on the Annual Assembly of The European Affiliation for the Examine of Diabetes (EASD), held in Madrid (9–13 Sept), describe how a expertise giving insulin doses knowledgeable by an insulin pump algorithm helped three adults with kind 1 diabetes higher handle their blood sugars, enabling them to steer extra lively lives, and even run marathons.
The AID system accommodates a complicated hybrid closed loop algorithm that automates the supply of each basal and correction bolus insulin each 5 minutes based mostly on sensor glucose values.
“It’s nice to see advances in diabetes expertise come to fruition and ship such enhancements to folks’s lives,” mentioned lead creator Dr. Maria Onetto from Pontificia Universidad Católica Chile, Santiago, Chile. “This expertise is recreation altering, permitting extra folks with diabetes to have safer, more healthy, extra lively lives.”
In T1D, an individual’s blood glucose stage turns into too excessive (hyperglycemia) as a result of there isn’t any manufacturing of insulin by the pancreas. Blood glucose ranges can solely be regulated by giving insulin to stop hyperglycemia.
If T1D just isn’t properly managed, individuals are at elevated danger of long-term issues of hyperglycemia, together with microvascular injury reminiscent of eye, kidney or nerve injury, coronary heart illness or stroke.
“Regardless of higher programs for monitoring blood sugars and delivering insulin, sustaining glucose ranges in goal vary throughout cardio coaching and athletic competitors is very troublesome,” 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 wrestle to succeed in the advisable blood sugar targets.”
Though there are some revealed suggestions on the best way to modify insulin supply and carbohydrate consumption for train, there are few reviews of real-world examples of individuals with T1D utilizing automated insulin supply programs 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 in response to blood sugar ranges, that means that it repeatedly responds to the persistent modifications in blood sugar ranges.
The affected person delivers boluses for meals and snacks by coming into the entire grams of carbohydrates they’re consuming. The algorithm targets a glucose stage chosen by the consumer, which may be adjusted to be 100, 110 or 120 mg/dL. The affected person may also set a brief sensor glucose goal (Temp Goal) of 150 mg/dL for conditions the place hypoglycemia danger could also be elevated, reminiscent of throughout train. When the Temp Goal is on, auto-bolus corrections are disabled.
To evaluate blood sugar management in the course of the marathons, the researchers measured: time in vary (TIR) that reveals the share of time an individual spends inside a goal glucose vary (3.9 to 10 mmol/liter); time under vary (TBR; under 70 mg/dL or 3.9 mmol/liter) 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 the Tokyo marathon in round 3.5 hours
The primary report particulars a 50-year-old man who had been dwelling with T1D for 22 years earlier than he ran the Tokyo Marathon in March 2023 in three 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 eight to 12 weeks) was 6.9%.
With the intention to forestall hypoglycemia, on the morning of the marathon he decreased his breakfast insulin dose by 25% and the insulin dose utilized to the pre-race snack was additionally decreased by 50% to higher handle blood sugar ranges.
He consumed glucose gels, the first supply of carbohydrates in the course of the race, at a fee of 0.39 g/kg/hour, with 102g consumed general.
In the course of the race, the person maintained glorious glycemic management, spending 96% of the marathon inside the appropriate glucose vary, simply 4% under vary, and no time above the goal vary. He achieved a mean blood glucose of 107mg/dl—properly under the imply glucose of lower than 154 mg/dl advisable in adults.
40-year-old man with T1D for 4 years ran the Santiago marathon in beneath 5 hours
The second report is of a 40-year-old man who had been dwelling 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 decreased the insulin dose utilized to the pre-race snack by 100%. In the course of the marathon, the person consumed glucose gels at a fee of 0.42 g/kg/hour, with 120g consumed in whole.
The person spent 100% of the marathon inside the appropriate glucose vary with a mean blood glucose of 110mg/dl, underscoring the potential of the glucose monitoring system to reply in actual time (see desk in summary).
34-year-old girl with T1D for 27 years ran the Paris marathon in beneath 4 hours
The third report describes a 34-year-old girl who had been dwelling with T1D for 27 years earlier than she accomplished the Paris Marathon in April 2023 in three 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 decreased the insulin dose utilized to her pre-race snack by 83%.
In the course of the marathon, she consumed glucose gels at a fee of 0.5 g/kg/hour, with 115g consumed in whole. She spent the entire marathon properly above the goal glucose vary, with a mean blood glucose of 271mg/dl—properly above the imply glucose of lower than 154 mg/dl advisable in adults.
As Dr. Onetto defined, “It’s possible that the lady remained hyperglycemic all through the race for a lot of causes. She might 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 will re-enable the auto-correction boluses.”
She added, “We hope these case research present insights for well being care professionals who help athletes with kind 1 diabetes utilizing automated insulin supply programs 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 presents to people with kind 1 diabetes, enabling them to steer lively lives.”
