February 05, 2021
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Valli does not report any relevant financial information.
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Exercise modalities have different effects on long-term glycemic response in adults with type 1 diabetes, and study data suggests that aerobic exercise may be the best approach to reducing the risk of delayed hypoglycemic events.
Giacomo Valli
“The result was quite unexpected as the results of studies with a shorter follow-up time – up to 3 to 6 hours – identified aerobic exercise as the worst approach to controlling blood sugar immediately after exercise.” Giacomo Valli, a graduate student in the Neuromuscular Physiology Laboratory, Department of Biomedical Sciences at the University of Padua, Italy, said Healio. “But here we have shown that aerobic exercise is the best approach over the long term – 24 hours after training.”
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Valli and colleagues performed a systemic review and meta-analysis of studies evaluating the delayed effect of exercise on blood sugar control in adults with type 1 diabetes. The quantitative studies were found through a literature search of studies published on PubMed, SPORTDiscus and Embase from January 2000 to September 2019. Only studies with a follow-up time of up to 6 hours were included. The study population had to be free of complications, disease, pregnancy, or any health condition other than type 1 diabetes. All participants were physically active and had good blood sugar control.
The researchers analyzed 12 studies with a total of 145 participants. In studies that compared participants with endurance training and participants with intermittent training, the intermittent group had a lower interstitial glucose level after training compared to endurance trainers (mean difference -0.77 mmol / L; 95% CI -1.19 to -0.36). . Intermittent athletes also spent extended periods of time on hypoglycemia. There was no significant difference in the time spent on hyperglycemia or the proportion of participants who experienced hypoglycemic events.
One of the studies included in the intermittent training group was based on a circuit training protocol and resulted in less time being spent on hypoglycemia than in other studies with other intermittent training groups.
“Preliminary results suggest that circuit training protocols may provide a better outcome than endurance,” the researchers wrote.
One study in the Systemic Review reported that those who did aerobic exercise in the morning had half the hypoglycemic events compared to those who did exercise in the afternoon. Morning exercisers also had better blood sugar control the following day.
“With this in mind, exercise is encouraged in the morning, while more alertness is required when exercising in the afternoon,” the researchers wrote. “This conclusion is twofold, as if people with diabetes know that certain behavior increases their risk of hypoglycemia. Along with the length of time it is more likely, they could employ strategies to prevent it.”
Another study showed that fast-acting athletes protected by insulin reduction were protected from hypoglycemia for up to 8 hours after endurance training, but not later in recovery. Based on literature from other studies that used varying orders of magnitude of fast-acting insulin reduction, the researchers wrote that a 50% reduction in the usual insulin dose may result in better blood sugar control.
Valli said that new research with a good study design comparing different exercise types is needed to produce stronger results. The new studies proposed by the researchers should include a common threshold for defining hypoglycemia, a sedentary control cohort, time of day of exercise, and data on the number of participants with hypoglycemia and the duration of hypoglycemic episodes.
“Determining the safest approach to exercise is fundamental to preventing or reducing the occurrence of delayed hypoglycemia during the night, when people are unaware of their glucose levels and are at greater risk,” Valli said.
For more informations:
Giacomo Valli can be reached at giacomo.valli@phd.unipd.it.
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