Glycemic responses to strenuous training in male professional cyclists with type 1 diabetes: a prospective observational study

• Type of Material: Article
• Authors: Olivia McCarthy, Swansea University; Max L. Eckstein, Medical University of Graz; Sam N. Scott, Liverpool John Moores University; Federico Y. Fontana, University of Verona; Mark P. Christiansen, Diablo Clinical Research Center; Christoph Stettler, University of Bern; Miles Fisher, University of Glasgow; Bruce Bode, Emory University; Michael C. Riddell, York University; Charlotte Hayes, Team Novo Nordisk; Peter L. Lagrou, Team Novo Nordisk; Phil Southerland, Team Novo Nordisk; Othmar Moser, Medical University of Graz; Richard M. Bracken, Swansea University
• Language: English
• Date: 2020-01-01
• Publisher: BMJ Publishing Group
• Publication Version: Final Published Version
• Copyright Statement: © Author(s) (or their employer(s)) 2020.
• License: Creative Commons Attribution-NonCommercial 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1136/bmjdrc-2020-001245
• Title of Journal or Parent Work: BMJ Open Diabetes Research & Care
• Volume: 8
• Issue: 1
• Grant/Funding Information: This study was funded by Novo Nordisk UK as part of an ISS.
• Keywords: Ultramarathon; Counterregulatory responses; exercise training; Race; CGM; Marathon; hypoglycemia; Science & Technology; exercise; Position; Life Sciences & Biomedicine; Men; Nutrition; Endocrinology & Metabolism; Exercise; Triathlon
• Research Categories: Health Sciences, Public Health; Health Sciences, Nutrition; Health Sciences, Medicine and Surgery

Abstract

Introduction: This prospective observational study sought to establish the glycemic, physiological and dietary demands of strenuous exercise training as part of a 9-day performance camp in a professional cycling team with type 1 diabetes (T1D). Research design and methods: Sixteen male professional cyclists with T1D on multiple daily injections (age: 27±4 years; duration of T1D: 11±5 years; body mass index: 22±2 kg/m 2; glycated hemoglobin: 7%±1% (50±6 mmol/mol); maximum rate of oxygen consumption: 73±4 mL/kg/min) performed road cycle sessions (50%-90% of the anaerobic threshold, duration 1-6 hours) over 9 consecutive days. Glycemic (Dexcom G6), nutrition and physiological data were collected throughout. Glycemic data were stratified into predefined glycemic ranges and mapped alongside exercise physiology and nutritional parameters, as well as split into daytime and night-time phases for comparative analysis. Data were assessed by means of analysis of variance and paired t-tests. A p value of ≤0.05 (two-tailed) was statistically significant. Results: Higher levels of antecedent hypoglycemia in the nocturnal hours were associated with greater time spent in next-day hypoglycemia overall (p=0.003) and during exercise (p=0.019). Occurrence of nocturnal hypoglycemia was associated with over three times the risk of next-day hypoglycemia (p<0.001) and a twofold risk of low glucose during cycling (p<0.001). Moreover, there was trend for a greater amount of time spent in mild hypoglycemia during the night compared with daytime hours (p=0.080). Conclusion: The higher prevalence of nocturnal hypoglycemia was associated with an increased risk of next-day hypoglycemia, which extended to cycle training sessions. These data highlight the potential need for additional prebed carbohydrates and/or insulin dose reduction strategies around exercise training in professional cyclists with T1D. Trial registration number DRKS00019923.