OBJECTIVE: Our aim in this study was to assess attitudes toward exercise and quality of life (QoL) in adults with type 1 diabetes (T1D) with and without insulin resistance (IR). METHODS: We pooled baseline pretreatment data from a subset of individuals with T1D from 2 randomized controlled trials. Estimated glucose disposal rate (eGDR), a validated surrogate marker of IR, was calculated using an established formula to classify individuals according to IR status with a cutpoint of <6 mg/kg/min for the determination of IR. Self-reported barriers to exercise were obtained using a validated questionnaire, the Barriers to Physical Activity in T1D (BAPAD-1). In addition, QoL was determined using the 36-item Short Form (SF-36) questionnaire. Differences between dichotomized variables were assessed using the independent t test, Mann-Whitney U test, or Fisher exact test. Linear regression was employed to explore the association of eGDR with BAPAD-1 and QoL scores, with sequential adjustment for potential confounders. RESULTS: Of the 85 individuals included in our study, 39 were classified as having IR. The mean BAPAD-1 total score was higher for individuals with IR (IR: 3.87±0.61; non-IR: 2.83±0.55; p<0.001). The highest exercise barrier scores for individuals with IR were risk of hypoglycemia (5.67±1.26) and risk of hyperglycemia (5.23±1.20), whereas the highest scoring exercise barrier scores for non-IR individuals were not diabetes-related, with low level of fitness (3.91±1.26) and physical health status, excluding diabetes (3.67±1.48), ranked highest. QoL scores were comparable between groups (p>0.05). CONCLUSIONS: Risk of hypoglycemia was the greatest barrier to exercise in individuals with T1D with IR, whereas non-diabetes-related barriers to exercise were more salient in individuals with T1D without IR.
- Klíčová slova
- activité physique, attitudes envers l’exercice, attitudes toward exercise, diabète de type 1, insulin resistance, physical activity, quality of life, qualité de vie, résistance à l’insuline, type 1 diabetes,
- MeSH
- cvičení MeSH
- diabetes mellitus 1. typu * MeSH
- dospělí MeSH
- glukosa MeSH
- hypoglykemie * epidemiologie prevence a kontrola MeSH
- inzulinová rezistence * MeSH
- kvalita života MeSH
- lidé MeSH
- Check Tag
- dospělí MeSH
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- Názvy látek
- glukosa MeSH
Nonsevere hypoglycemia in people with diabetes is usually treated with rapid-acting carbohydrate, of which glucose is the most suitable form. A quantity of 15 g is recommended and repeated after 15 min if hypoglycemia persists. This recommendation has not changed for several years despite the introduction of continuous glucose monitoring, newer and more flexible insulin regimens and improved insulin delivery. The present review has examined published studies that have explored how effectively defined amounts of carbohydrate treat nonsevere hypoglycemia in adults with insulin-treated diabetes. For most nonsevere episodes of hypoglycemia, the optimal treatment is 15 to 20 g of oral glucose. However, this dose may not be appropriate with many current insulins and insulin pump therapy, where doses of glucose may have to be individualized, based on body weight or type of insulin delivery system. Current guidelines on hypoglycemia treatment for newer glucose-lowering therapies may require re-evaluation.
OBJECTIVES: Circulating insulin concentrations mediate vascular-inflammatory and prothrombotic factors. However, it is unknown whether interindividual differences in circulating insulin levels are associated with different inflammatory and prothrombotic profiles in type 1 diabetes (T1D). We applied an unsupervised machine-learning approach to determine whether interindividual differences in rapid-acting insulin levels associate with parameters of vascular health in patients with T1D. METHODS: We re-analyzed baseline pretreatment meal-tolerance test data from 2 randomized controlled trials in which 32 patients consumed a mixed-macronutrient meal and self-administered a single dose of rapid-acting insulin individualized by carbohydrate counting. Postprandial serum insulin, tumour necrosis factor (TNF)-alpha, plasma fibrinogen, human tissue factor (HTF) activity and plasminogen activator inhibitor-1 (PAI-1) were measured. Two-step clustering categorized individuals based on shared clinical characteristics. For analyses, insulin pharmacokinetic summary statistics were normalized, allowing standardized intraindividual comparisons. RESULTS: Despite standardization of insulin dose, individuals exhibited marked interpersonal variability in peak insulin concentrations (48.63%), time to peak (64.95%) and insulin incremental area under the curve (60.34%). Two clusters were computed: cluster 1 (n=14), representing increased serum insulin concentrations; and cluster 2 (n=18), representing reduced serum insulin concentrations (cluster 1: 389.50±177.10 pmol/L/IU h-1; cluster 2: 164.29±41.91 pmol/L/IU h-1; p<0.001). Cluster 2 was characterized by increased levels of fibrinogen, PAI-1, TNF-alpha and HTF activity; higher glycated hemoglobin; increased body mass index; lower estimated glucose disposal rate (increased insulin resistance); older age; and longer diabetes duration (p<0.05 for all analyses). CONCLUSIONS: Reduced serum insulin concentrations are associated with insulin resistance and a prothrombotic milieu in individuals with T1D, and therefore may be a marker of adverse vascular outcome.
- Klíčová slova
- apprentissage automatique, diabète de type 1, insulin pharmacokinetics, interpersonal variability, machine learning, pharmacocinétique de l’insuline, type 1 diabetes, variabilité interpersonnelle,
- MeSH
- diabetes mellitus 1. typu * komplikace MeSH
- fibrinogen terapeutické užití MeSH
- hypoglykemika farmakologie terapeutické užití MeSH
- inhibitor aktivátoru plazminogenu 1 terapeutické užití MeSH
- injekce subkutánní MeSH
- inzulin terapeutické užití MeSH
- inzulinová rezistence * MeSH
- krátkodobě působící inzuliny terapeutické užití MeSH
- krevní glukóza analýza MeSH
- lidé MeSH
- postprandiální období MeSH
- strojové učení MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- Názvy látek
- fibrinogen MeSH
- hypoglykemika MeSH
- inhibitor aktivátoru plazminogenu 1 MeSH
- inzulin MeSH
- krátkodobě působící inzuliny MeSH
- krevní glukóza MeSH
- MeSH
- diabetes mellitus 2. typu * MeSH
- hypoglykemie MeSH
- hypoglykemika MeSH
- inzulin * MeSH
- krevní glukóza MeSH
- lidé MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- dopisy MeSH
- komentáře MeSH
- Názvy látek
- hypoglykemika MeSH
- inzulin * MeSH
- krevní glukóza MeSH
