Home » Exchange Case Study » Response to exercise in persons with Type 1 Diabetes

Response to exercise in persons with Type 1 Diabetes

Date of the exchange:
July 2019

Partners:
University of Newcastle
York University

“This research exchange visit was a small, but important, step in forging collaborative links with York University in the endeavour to improve health, wellbeing and quality of life for people with Type 1 Diabetes globally.”

Dr Sarah Valkenborghs, University of Newcastle

Initiatives in progress

The University of Newcastle and York University are collaborating on a multi-site trial to profile acute responses to exercise in persons with Type 1 Diabetes and inform development of a next-generation closed-loop system.

The first phase of this study is to record and mathematically model metabolic parameters, counter-regulatory hormones, kinetic and heart rate changes that occur with a session of (a) moderate-intensity exercise, (b) high-intensity interval exercise and (c) resistance exercise. This data will then be assessed to identify additional signals that could be integrated with current hybrid closed loop insulin pumps to enable them to recognise and respond to changing circumstances in real-time, without the user having to manually input information.

The visit to the York University site of the trial was a vital opportunity to ensure mutual consistency in methodology across sites and minimal discrepancies in the dataset. The visit was conducted in July-August 2019 to coincide with the commencement of data collection at the York site.

Prior to the first participant, the exercise physiology investigators (S Valkenborghs, M Riddell, and D Zaharieva) calibrated the implementation of the protocols including:

  • VO2max testing protocols (including workload increments, mixing chamber v. breath-by-breath analysis, etc.)
  • Tempo of contractions (and therefore time under tension, relative intensity, energy expenditure);
  • Weight increments, etc.

This exposed several variations in the interpretation and implementation of the global protocol that may have otherwise manifested due to often overlooked local factors at each site (e.g. variations in equipment, space, etc), but could have contributed to significant anomalies in the pooled dataset.

As well as then observing several participants from our collaborative research project, I also had the opportunity to observe data collection for several other Type 1 Diabetes exercise trials within the Riddell laboratory. It was very insightful to learn new techniques and considerations for monitoring physiological responses and adaptations to exercise in people with Type 1 Diabetes.

Current hybrid closed loop insulin pumps are not able to recognise and react to situations characterised by a rapid change in insulin and glucose requirements, in particular exercise, without prompts/input from the user (i.e. the Type 1 Diabetes patient). This usually happens retrospectively and makes exercise challenging to manage in individuals with Type 1 Diabetes. Unfortunately this is a major barrier to physical activity for these patients, and a major contributing factor to the high incidence (and costs) of hypokinetic diseases in this population. This research exchange visit was a small, but important, step in forging collaborative links with York University in the endeavour to improve health, wellbeing and quality of life for people with Type 1 Diabetes globally.

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