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A single load of fructose attenuates the risk of exercise-induced hypoglycaemia in adults with type 1 diabetes on ultra-long-acting basal insulin - a randomised, open-label, crossover proof-of-principle study

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posted on 26.06.2020 by Christophe Kosinski, David Herzig, Céline Isabelle Laesser, Christos Nakas, Andreas Melmer, Andreas Vogt, Bruno Vogt, Markus Laimer, Lia Bally, Christoph Stettler
Objective

While the adjustment of insulin is an established strategy to reduce the risk of exercise-associated hypoglycaemia for individuals with type 1 diabetes, it is not easily feasible for those treated with ultra-long acting basal insulin. The present study determined whether pre-exercise intake of fructose attenuates the risk of exercise-induced hypoglycaemia in individuals with type 1 diabetes using insulin degludec.

Research design and method

Fourteen male adults with type 1 diabetes completed two 60min aerobic cycling sessions with or without prior intake (30min) of 20g of fructose, in a randomised two-period crossover design. Exercise was performed in the morning in a fasted state without prior insulin reduction, and after 48h of standardised diet. The primary outcome was time to hypoglycaemia (plasma glucose ≤3.9mmol/L) during exercise.

Results

Intake of fructose resulted in one hypoglycaemic event at 60min compared to six hypoglycaemic events at 27.5±9.4min of exercise in the control condition, translating into a risk reduction of 87.8% (hazard ratio 0.12 [95% CI 0.02; 0.66]; p=0.015). Mean plasma glucose during exercise was 7.3±1.4mmol/L with fructose and 5.5±1.1mmol/L during control (p<0.001). Lactate levels were higher at rest in the 30min following fructose intake (p<0.001) but were not significantly different from control during exercise (p=0.32). Substrate oxidation during exercise did not significantly differ between the conditions (p=0.73 for carbohydrate and p=0.48 for fat oxidation). Fructose was well tolerated.

Conclusions

Pre-exercise intake of fructose is an easily feasible, effective and well-tolerated strategy to alleviate the risk of exercise-induced hypoglycaemia whilst avoiding hyperglycaemia in individuals with type 1 diabetes on ultra-long acting insulin.

Funding

This was an Investigator Initiated Clinical Study supported by the ISS (Investigator Sponsored Studies) program of Novo Nordisk A/S, Denmark, and the UDEM Research Fund.

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