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Quantifying the Acute Changes in Glucose with Exercise in Type 1 Diabetes: A Systematic Review and Meta-Analysis

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Abstract

Background

The acute impact of different types of physical activity on glycemic control in type 1 diabetes has not been well quantified.

Objectives

Our objective was to estimate the rate of change (RoC) in glucose concentration induced acutely during the performance of structured exercise and at recovery in subjects with type 1 diabetes.

Methods

We searched for original articles in the PubMed, MEDLINE, Scopus, and Cochrane databases. Search terms included type 1 diabetes, blood glucose, physical activity, and exercise. Eligible studies (randomized controlled trials and non-randomized experiments) encompassed controlled physical activity sessions (continuous moderate [CONT], intermittent high intensity [IHE], resistance [RESIST], and/or a resting reference [REST]) and reported excursions in glucose concentration during exercise and after its cessation. Data were extracted by graph digitization to compute two RoC measures from population profiles: RoCE during exercise and RoCR in recovery.

Results

Ten eligible studies were found from 540 publications. Meta-analyses of exercise modalities versus rest yielded the following: RoCE −4.43 mmol/L h−1 (p < 0.00001, 95 % confidence interval [CI] −6.06 to −2.79) and RoCR +0.70 mmol/L h−1 (p = 0.46, 95 % CI −1.14 to +2.54) for CONT vs. REST; RoCE −5.25 mmol/L·h−1 (p < 0.00001, 95 % CI −7.02 to −3.48) and RoCR +0.72 mmol/L h−1 (p = 0.71, 95 % CI −3.10 to +4.54) for IHE vs. REST; RoCE −2.61 mmol/L h−1 (p = 0.30, 95 % CI −7.55 to +2.34) and RoCR −0.02 mmol/L h−1 (p = 1.00, 95 % CI −7.58 to +7.53) for RESIST vs. REST.

Conclusions

Novel RoC magnitudes RoCE, RoCR reflected rapid decays of glycemia during CONT exercise and gradual recoveries immediately afterwards. RESIST showed more constrained decays, whereas discrepancies were found for IHE.

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Acknowledgments

The authors would like to thank the reviewers for their comments, which led to a substantial improvement of our work. In particular, their identification of the study by Yardley et al. [28] is of special note. This work was partly supported by a doctoral research Grant from the Technical University of Madrid, by a fellowship from the Spanish Ministry of Education, and by the ‘APRIORI’ Project (FIS PS09/01318) from the Spanish Ministry of Science and Innovation. Funders were not involved in the research or its publication. The authors declare that there is no conflict of interest that could be perceived as prejudicing the impartiality of the review reported.

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Correspondence to Fernando García-García.

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40279_2015_302_MOESM1_ESM.tiff

Figure S1. Funnel plots depicting standard errors (SE) versus mean differences (MD) for studies in the meta-analysis. Panels (a) and (b) show outcomes for RoC E and RoC R , respectively, in the case of studies comparing CONT versus REST periods. Panels (c) and (d): outcomes for RoC E and RoC R , respectively, in IHE versus REST studies. Panels (e), (f): RoC E , RoC R in RESIST vs REST. Panels (g), (h): RoC E , RoC R in IHE vs CONT. Panels (i), (j): RoC E , RoC R in RESIST vs CONT. All axes are in units [mmol/L·h–1]. SE = standard error, MD = mean difference, RoC E  = glycaemia rate-of-change during exercise, RoC R  = glycaemia rate-of-change at recovery, CONT = continuous physical activity, IHE = intermittent high-intensity exercise, RESIST = resistance exercise, REST = resting control period. (TIFF 382 kb)

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García-García, F., Kumareswaran, K., Hovorka, R. et al. Quantifying the Acute Changes in Glucose with Exercise in Type 1 Diabetes: A Systematic Review and Meta-Analysis. Sports Med 45, 587–599 (2015). https://doi.org/10.1007/s40279-015-0302-2

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