EASD 2022 | High-intensity exercise may be beneficial for people with poor awareness of hypoglycemia

Midwire: Results from the HIT4HYPOS trial suggest that a high-intensity exercise program may improve hormonal and symptomatic responses to hypoglycemia among people with type 1 diabetes and impaired awareness of hypoglycemia (IAH).

Summarizing the background of the study at the 58th Annual EASD Meeting in Stockholm, Sweden, Catriona Farrell (Ninewells Hospital, Dundee, UK), said that “the most important risk factor for IAH is prior exposure to hypoglycemia itself”, indicating this Habituation (ie, a decrease in response to a stimulus as a result of prolonged exposure) could be an appropriate target for intervention.

Farrell et al hypothesized that disability (that is, providing another stimulus to restore a habitual response) through a high-intensity exercise program could restore awareness of hypoglycemia in people with type 1 diabetes, and preliminary research from the team indicated that this hypothesis warrants further investigation. Evaluation .

The current study included 18 participants with a mean duration of type 1 diabetes of 27 years who had either IAH or evidence of recurrent hypoglycemia on flash or continuous glucose monitoring (CGM).

After a 4-week running period for insulin optimization, participants were randomly assigned to participate in a 4-week exercise program — consisting of three cycling sessions per week to reach an intensity corresponding to at least 90% of their peak heart rate — along with the real. Time (RT) CGM, or to receive rtCGM alone. They underwent a 90-minute hypoglycemic clamp at 2.5 mmol/L, with measurement of hormonal counterregulatory responses, before and after the intervention period.

After participating in the intervention, participants in the exercise group experienced significantly greater increases in glucagon levels during hypoglycemia than those in the control arm, Farrell said, with average increases of 16.2 versus 0.9 ng/L.

As for hormonal responses, the presenter said there was a “slight increase” in the epinephrine response to hypoglycemia in the exercise group, but a “small difference” with hypoglycemia in the control arm. Norepinephrine levels were maintained during hypoglycemia in the exercise group, compared with a significant decrease in the control group.

Consistent with these findings, analysis of symptom awareness as measured by the Edinburgh hypoglycemic symptom scores indicated “preservation of hypoglycemic awareness in participants who underwent high-intensity exercise”, compared to a “significant decrease in symptom awareness in the control group”. ‘,” Farrell said.

She noted that the mechanisms underlying high-intensity exercise to restore awareness of hypoglycemia are unknown, but indicated that it may involve autonomic nervous system reactivity, increased sensitivity of adrenergic receptors, or increased glucagon secretion in the central nervous system.

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EASD Annual Meeting; Stockholm, Sweden: September 19-23, 2022