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Associations between daily step count classifications and continuous glucose monitoring metrics in adults with type 1 diabetes: analysis of the Type 1 Diabetes Exercise Initiative (T1DEXI) cohort

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Abstract

Aims/hypothesis

Adults with type 1 diabetes should perform daily physical activity to help maintain health and fitness, but the influence of daily step counts on continuous glucose monitoring (CGM) metrics are unclear. This analysis used the Type 1 Diabetes Exercise Initiative (T1DEXI) dataset to investigate the effect of daily step count on CGM-based metrics.

Methods

In a 4 week free-living observational study of adults with type 1 diabetes, with available CGM and step count data, we categorised participants into three groups—below (<7000), meeting (7000–10,000) or exceeding (>10,000) the daily step count goal—to determine if step count category influenced CGM metrics, including per cent time in range (TIR: 3.9–10.0 mmol/l), time below range (TBR: <3.9 mmol/l) and time above range (TAR: >10.0 mmol/l).

Results

A total of 464 adults with type 1 diabetes (mean±SD age 37±14 years; HbA1c 48.8±8.1 mmol/mol [6.6±0.7%]; 73% female; 45% hybrid closed-loop system, 38% standard insulin pump, 17% multiple daily insulin injections) were included in the study. Between-participant analyses showed that individuals who exceeded the mean daily step count goal over the 4 week period had a similar TIR (75±14%) to those meeting (74±14%) or below (75±16%) the step count goal (p>0.05). In the within-participant comparisons, TIR was higher on days when the step count goal was exceeded or met (both 75±15%) than on days below the step count goal (73±16%; both p<0.001). The TBR was also higher when individuals exceeded the step count goals (3.1%±3.2%) than on days when they met or were below step count goals (difference in means −0.3% [p=0.006] and −0.4% [p=0.001], respectively). The total daily insulin dose was lower on days when step count goals were exceeded (0.52±0.18 U/kg; p<0.001) or were met (0.53±0.18 U/kg; p<0.001) than on days when step counts were below the current recommendation (0.55±0.18 U/kg). Step count had a larger effect on CGM-based metrics in participants with a baseline HbA1c ≥53 mmol/mol (≥7.0%).

Conclusions/interpretation

Our results suggest that, compared with days with low step counts, days with higher step counts are associated with slight increases in both TIR and TBR, along with small reductions in total daily insulin requirements, in adults living with type 1 diabetes.

Data availability

The data that support the findings reported here are available on the Vivli Platform (ID: T1-DEXI; https://doi.org/10.25934/PR00008428).

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Abbreviations

7000–10,000:

7–10K

bpm:

Beats per minute

CGM:

Continuous glucose monitoring

HCL:

Hybrid closed-loop

MDI:

Multiple daily insulin injections

TAR:

Time above range (>10.0 mmol/l)

TBR:

Time below range (<3.9 mmol/l)

TIR:

Time in range (3.9–10.0 mmol/l)

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Authors and Affiliations

  1. School of Kinesiology and Health Science, York University, Toronto, ON, Canada

    Lauren V. Turner & Michael C. Riddell

  2. Jaeb Center for Health Research, Tampa, FL, USA

    Martin Chase Marak, Robin L. Gal, Peter Calhoun, Zoey Li & Roy W. Beck

  3. Department of Biomedical Engineering, Oregon Health & Science University, Portland, OR, USA

    Peter G. Jacobs

  4. Children’s Mercy Hospital, Kansas City, MO, USA

    Mark A. Clements

  5. Pennington Biomedical Research Center, Louisiana State University, Baton Rouge, LA, USA

    Corby K. Martin

  6. Harvard John A. Paulson School of Engineering and Applied Sciences, Harvard University, Cambridge, MA, USA

    Francis J. Doyle III

  7. Nemours Children’s Health, Jacksonville, FL, USA

    Susana R. Patton

  8. Harold Schnitzer Diabetes Health Center, Oregon Health & Science University, Portland, OR, USA

    Jessica R. Castle

  9. Department of Molecular and Medical Genetics, Oregon Health & Science University, Portland, OR, USA

    Melanie B. Gillingham

  10. Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA

    Michael R. Rickels

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  1. Lauren V. Turner
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for the T1DEXI Study Group

Corresponding author

Correspondence to Michael C. Riddell.

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Acknowledgements

We would like to thank the T1DEXI study participants for taking the time to participate in this study.

Data availability

The data that support the findings reported here are available on the Vivli Platform Repository (ID: T1-DEXI; dataset name: Type 1 Diabetes EXercise Initiative (T1DEXI): The Effect of Exercise on Glycemic Control in Type 1 Diabetes Study; https://doi.org/https://doi.org/10.25934/PR00008428). The data package can be requested at https://doi.org/https://doi.org/10.25934/PR00008428.1.

Funding

This study was supported by The Leona M. and Harry B. Helmsley Charitable Trust. Verily (South San Francisco, CA) provided the Study Watch at no cost. Dexcom provided continuous glucose monitors at a discounted rate. CKM’s institution (Pennington Biomedical Research Center) is supported by a NORC Center grant (P30 DK072476) entitled ‘Nutrition and Metabolic Health Through the Lifespan’, sponsored by the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), and by grant U54 GM104940 from the National Institute of General Medical Sciences, which funds the Louisiana Clinical and Translational Science Center. The content is solely the responsibility of the authors and does not necessarily represent the official views of the Leona M. and Harry B. Helmsley Charitable Trust.

Authors’ relationships and activities

PGJ reports receiving grants from the National Institutes of Health, The Leona M. and Harry B. Charitable Trust, JDRF, Dexcom and the Oregon Health and Science University Foundation and consultancy fees from the Clinical Data Interchange Standards Consortium (CDISC); US patents 62/352,939, 63/269,094, 62/944,287, 8810388, 9,480,418, 8,317,700, 61/570382, 8,810,388, 7,976,466 and 6,558,321; and stock options from Pacific Diabetes Technologies, outside the submitted work. MAC is Chief Medical Officer of Glooko and has received grants or contracts from Dexcom, Abbott Diabetes Care, the National Institutes of Health, JDRF, the Emily Rosebud Foundation, Eli Lilly, Tolerion and Garmin. SRP reports receiving grants from The Leona M. and Harry B. Helmsley Charitable Trust, the National Institutes of Health and the Jaeb Center for Health Research, and honorarium from the ADA, outside the submitted work. JRC reports receiving grants from JDRF, the National Institutes of Health, Dexcom and Medtronic, and consultancy fees from Novo Nordisk, Insulet and Zealand, outside the submitted work. RWB reports receiving consulting fees, paid to his institution, from Insulet, Bigfoot Biomedical, vTv Therapeutics and Eli Lilly; grant support and supplies, provided to his institution, from Tandem and Dexcom; and supplies from Ascensia and Roche. MRR reports consultancy fees from Zealand Pharma. MCR reports receiving consulting fees from the Jaeb Center for Health Research, Eli Lilly, Zealand Pharma and Zucara Therapeutics; speaker fees from Sanofi Diabetes, Eli Lilly, Dexcom Canada and Novo Nordisk; and stock options from Supersapiens and Zucara Therapeutics. LVT, MCM, RLG, PC, ZL, CKM, FJD and MBG declare that there are no relationships or activities that might bias, or be perceived to bias, their work.

Contribution statement

RLG, PGJ, MAC, CKM, FJD, SRP, JRC, MBG, MRR and MCR contributed to the conception or design of the T1DEXI study. RLG, PGJ and MAC contributed to the acquisition of data. LVT, MCM, PC and ZL contributed to the data analysis. LVT, MCM, RLG, PC, ZL, RWB, MRR and MCR contributed to interpretation of the data. LVT and MCR drafted the manuscript. All authors reviewed the work critically for important intellectual content and approved the final version submitted for publication. MCR is the guarantor of this work and, as such, had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

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Turner, L.V., Marak, M.C., Gal, R.L. et al. Associations between daily step count classifications and continuous glucose monitoring metrics in adults with type 1 diabetes: analysis of the Type 1 Diabetes Exercise Initiative (T1DEXI) cohort. Diabetologia (2024). https://doi.org/10.1007/s00125-024-06127-2

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