Acute hyperglycaemia does not have a consistent adverse effect on exercise performance in recreationally active young people with type 1 diabetes: a randomised crossover in-clinic study

Abstract

Aims/hypothesis

In individuals with type 1 diabetes, chronic hyperglycaemia impairs aerobic fitness. However, the effect of acute marked hyperglycaemia on aerobic fitness is unclear, and the impact of insulin level has not been examined. In this study, we explored if acute hyperglycaemia with higher or low insulin levels affects \( \dot{V}{\mathrm{O}}_{2\mathrm{peak}} \) and other exercise performance indicators in individuals with type 1 diabetes.

Methods

Eligible participants were aged 14 to 30 years, with complication-free, type 1 diabetes and HbA1c ≤ 75 mmol/mol (≤9%). Participants exercised in a clinical laboratory under three clamp (constant insulin, variable glucose infusion) conditions: euglycaemia (5 mmol/l) with 20 mU [m2 BSA]−1 min−1 insulin (where BSA is body surface area) (Eu20); hyperglycaemia (17 mmol/l) with 20 mU [m2 BSA]−1 min−1 insulin (Hyper20); and hyperglycaemia (17 mmol/l) with mU [5 m2 BSA]−1 min−1 insulin (Hyper5) on separate days. Participants and the single testing assessor were blinded to condition, with participants allocated to randomised testing condition sequences as they were consecutively recruited. Standardised testing (in order) conducted on each of the three study days included: triplicate 6 second sprint cycling, grip strength, single leg static balance, vertical jump and modified Star Excursion Balance Test, ten simple and choice reaction times and one cycle ergometer \( \dot{V}{\mathrm{O}}_{2\mathrm{peak}} \) test. The difference between conditions in the aforementioned testing measures was analysed, with the primary outcome being the difference in \( \dot{V}{\mathrm{O}}_{2\mathrm{peak}} \).

Results

Twelve recreationally active individuals with type 1 diabetes (8 male, mean ± SD 17.9 ± 3.9 years, HbA1c 61 ± 11 mmol/mol [7.7 ± 1.0%], 7 ± 3 h exercise/week) were analysed. Compared with Eu20, \( \dot{V}{\mathrm{O}}_{2\mathrm{peak}} \) was lower in Hyper20 (difference 0.17 l/min [95% CI 0.31, 0.04; p = 0.02] 6.6% of mean Eu20 level), but Hyper5 was not different (p = 0.39). Compared with Eu20, sprint cycling peak power was not different in Hyper20 (p = 0.20), but was higher in Hyper5 (64 W [95% CI 13, 115; p = 0.02] 13.1%). Hyper20 reaction times were not different (simple: p = 0.12) but Hyper5 reaction times were slower (simple: 11 milliseconds [95% CI 1, 22; p = 0.04] 4.7%) than Eu20. No differences between Eu20 and either hyperglycaemic condition were observed for the other testing measures (p > 0.05).

Conclusions/interpretation

Acute marked hyperglycaemia in the higher but not low insulin state impaired \( \dot{V}{\mathrm{O}}_{2\mathrm{peak}} \) but to a small extent. Acute hyperglycaemia had an insulin-dependent effect on sprint cycling absolute power output and reaction time but with differing directionality (positive for sprint cycling and negative for reaction time) and no effect on the other indicators of exercise performance examined. We find that acute hyperglycaemia is not consistently adverse and does not impair overall exercise performance to an extent clinically relevant for recreationally active individuals with type 1 diabetes.

Funding

This research was funded by Diabetes Research Western Australia and Australasian Paediatric Endocrine Group grants.

Graphical abstract

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Data availability

The datasets generated during the study are available from the corresponding author on reasonable request.

Abbreviations

BGL:

Blood glucose level

BSA:

Body surface area

CMJ:

Countermovement jump

GIR:

Glucose infusion rate

SEBT:

Star Excursion Balance Test

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Acknowledgements

The authors thank the study participants for their involvement and research nurses and research assistants for their help conducting the study.

Authors’ relationships and activities

The authors declare that there are no relationships or activities that might bias, or be perceived to bias, their work.

Funding

This research was funded by Diabetes Research Western Australia and Australasian Paediatric Endocrine Group grants. The research team was supported by the National Health and Medical Research Council and the JDRF Australia by way of Centre for Research Excellence funding and by JDRF Australia, as the recipient of the Australian Research Council Special Research Initiative for Type 1 Juvenile Diabetes. The study funders were not involved in the design of the study; the collection, analysis and interpretation of data; writing the report; and did not impose any restrictions regarding the publication of the report.

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Authors

Contributions

KMR, SA, PA, TWJ, PAF and EAD contributed to study conception, design, protocol and data interpretation. KMR was the principal investigator of this study and was responsible for participant recruitment, conduct of participant sessions/data acquisition, data management and interpretation and drafting of the manuscript. SA conducted exercise/reaction time testing (data acquisition) and assisted with data management and interpretation and drafting of the manuscript. GJS determined statistical methods, performed data analysis, assisted in data interpretation and drafting of the manuscript. NB and BL provided equipment,recommendations for study design, assistance with data interpretation and drafting of the manuscript related to static balance and vertical CMJ testing. All authors had full access to the study data, reviewed and revised where necessary the final manuscript and were responsible for the final decision to submit the manuscript. All authors read and approved the final manuscript. KMR is the guarantor of this work and takes responsibility for the integrity of the data and accuracy of the data analysis.

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Correspondence to Karen M. Rothacker.

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Rothacker, K.M., Armstrong, S., Smith, G.J. et al. Acute hyperglycaemia does not have a consistent adverse effect on exercise performance in recreationally active young people with type 1 diabetes: a randomised crossover in-clinic study. Diabetologia (2021). https://doi.org/10.1007/s00125-021-05465-9

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Keywords

  • Balance
  • Clamp
  • Exercise
  • Hyperglycaemia
  • Muscle power
  • Performance
  • Reaction time
  • Strength
  • Type 1 diabetes
  • \( \dot{V}{\mathrm{O}}_{2\mathrm{peak}} \)