All patients said that insulin pump therapy helped them manage their exercise-related diabetes.
Older patients with type 1 diabetes (T1D) appear to benefit from insulin pumps and continuous glucose monitoring (CGM) when exercising, according to a new report.
The study, based on the experiences of 30 adults aged 60 or older, confirms the technology’s benefits, as well as counters concerns that age may be a barrier to adopting new diabetes management techniques.
Writing in the magazine Acta DiabetologyCorresponding author Sybil A. McCauley, PhD, from the University of Melbourne, and co-authors explained that the guidelines recommend older adults do 120 to 150 minutes of T1D exercise each week, including moderate-intensity aerobic activities and resistance training.
However, McCauley and colleagues said exercise can be challenging for this population, not only because of age-related physical limitations, but also because exercise brings with it greater glucose variability and risk of hypoglycemia.
The researchers wanted to better understand the exercise habits of older adults with T1D, and the effect of insulin pump therapy on their self-management practices.
They turned to a list of people who had participated in a previous trial of closed-loop insulin therapy, and identified 30 people who had been diagnosed with T1D for at least ten years and who had been using insulin pumps. In addition to obtaining clinical characteristics and health history, the researchers also asked patients to complete surveys related to disease self-management, confidence, goals, and exercise habits.
The patients in the study tended to be active; They exercised an average of 4 days a week for an average of 60 minutes.
All participants had experience using real-time CGM, and 25 of them were currently using real-time CGM systems. About half (17 patients) were using a first-generation closed-loop system with automated basal insulin delivery, McCauley and colleagues said.
When asked about their perceptions of exercise and its effect on glucose levels, 21 patients said glucose management affected their exercise participation, and 3 patients said concerns about hypoglycemia limited exercise levels.
“Twenty-four participants (80%) always had their glucose levels checked before exercise,” the investigators said. Five participants (17%) routinely ate snacks before bed to avoid exercise-related hypoglycemia overnight; however, 4 of these participants routinely administered an insulin shot with these snacks.
Globally 30 patients agreed that their insulin pumps improved their diabetes self-management when it came to exercise, but two patients felt that continuous monitoring of diabetes negatively affected their management of exercise-related diabetes because they ended up needing additional blood glucose testing To calibrate continuous glucose monitoring. devices or check for low glucose alerts.
17 participants used closed-loop systems, and most (11) said the devices helped.
“The other six felt that closed-loop therapy did not confer the glucose benefits associated with exercise; the described burdens included suffering from hypoglycemia despite use of a temporal higher glucose target, delayed insulin adjustment, and higher confidence in personally adjusting insulin doses compared to the closed-loop algorithm.”
When asked where they obtained information about how to manage their diabetes during exercise, the most common response was personal experience, followed by consultation with diabetes educators and endocrinologists.
The authors include a number of caveats. They noted that while the study participants were very active, half of the participants said the leisurely walk was their most strenuous activity, even though that did not meet the exercise intensity recommendations for this group of patients. Additionally, while most patients were careful to check their glucose levels before exercise, most did not follow other strategies to avoid exercise-related glucose problems.
However, McCauley and colleagues said the data suggest that tools like insulin pumps and CGMs can make an important difference in exercise rates among older adults.
“Our observations suggest that the increased use of techniques for older adults with T1D may help reduce barriers to exercise through safer and better exercise-related glucose management,” they wrote.
However, they also cautioned that patients who are less healthy or who have significant comorbidities may encounter barriers to exercise that will not be fully improved by these devices.
Chakrabarti A, Muhammad Alipur A, Sandra Segaran TR, et al. Exercise habits and glucose management among older adults with type 1 diabetes using insulin pumps. Acta Diabetol. Published online March 1, 2022. doi: 10.1007/s00592-022-01858-3