Type 1 DiabetesNCT03583268
Determining the Appropriate Intensity of Exercise to Prevent Post-exercise Hypoglycemia in Persons Living With T1D
A study testing Exercise in people with Type 1 Diabetes, run by University of Manitoba at 1 site in Canada.
Trial summary
Over 300, 000 youth and young adults across Canada are living with Type 1 Diabetes (T1D) which is considered the most common endocrine condition. Physical activity offers numerous health benefits however the majority of persons living with T1D are physically inactive, primarily due to fear of low blood sugar… Read more about this study
- Who is it for?
- Ages 15 to 35 years
- Conditions the study is for
- Type 1 Diabetes
- What is being tested?
- Exercise
- Could I receive a placebo?
- No, everyone receives an active treatment
- How many people
- 10 participants
- Where
- 1 siteCanada
- Study dates
- May 2013to Mar 2016
- Phase
- Interventional
- Are there results?
- None posted in the registry
Key requirements
Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.
- Ages 15 to 35 years
- All sexes
- No healthy volunteers
- Child, Adult
Who may be able to join
- Persons with type 1 diabetes
- Hemoglobin A1c <9.9%
- Diabetes duration >/= 2 years
- Sedentary Participants: participate in <150 minutes of moderate to vigorous physical activity per week
- Active Participants: regular performance of vigorous physical activity >3 times/week for over one year. Display a maximal oxygen uptake that is at least 40.9 ml/kg/min for females, and 49.3 ml/kg/min for males.
Who cannot join
- HbA1c ≥9.9% as the lack of compliance with insulin suggests they may not be able to comply with the prescribed exercise requirements
- Have frequent and unpredictable hypoglycemia as they will be at a greater risk of serious hypoglycemic events
- Had a change in insulin management strategy, including adoption of a pump within two months of enrolment or switching back to multiple daily injections in the last two months, as they may be at risk for a hypoglycemic event due to the novel insulin management approach
- Have conditions that would render vigorous intensity activity contraindicated including: uncontrolled hypertension: BP >150 mm Hg systolic or >95 mm Hg diastolic in a sitting position; severe peripheral neuropathy; or history of cardiovascular disease
- Cognitive deficit resulting in an inability to provide informed consent
- Are currently taking beta-blockers as this would limit the ability to achieve target heart rates within the prescribed range
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- Are currently being treated with medications (other than insulin) that alter glucose metabolism (i.e. atypical antipsychotics, corticosteroids)
- Are women who are pregnant, breastfeeding, or planning to get pregnant
- Have a job or profession that involves shift work (working during the night time, and being asleep during the daytime, as this alters glucose levels.
Trial locations and contacts
1 site in 1 country.
Canada1 site
Children's Hospital Research Institute of Manitoba
Winnipeg, Manitoba, R3E 3P4
About this study
Official title: Determining the Appropriate Intensity of Vigorous Intensity Exercise to Prevent Post-exercise Hypoglycemia in Persons Living With Type 1 Diabetes
Over 300, 000 youth and young adults across Canada are living with Type 1 Diabetes (T1D) which is considered the most common endocrine condition. Physical activity offers numerous health benefits however the majority of persons living with T1D are physically inactive, primarily due to fear of low blood sugar (hypoglycemia). This fear of hypoglycemia continues to exist for physically active persons with T1D as no established physical activity guidelines exist. Several acute studies have used high intensity interval training as a way to reduce the risk of hypoglycemia as it has the ability to activate fight or flight hormones which can raise blood sugar; however the intensity needed to elicit this response is unknown.
The purpose of this project is to determine the acute effects of varying exercise intensities on the time spent in a low blood sugar range in 10 sedentary (VIGOR acute sedentary) and 16 physically active (VIGOR acute trained) individuals with T1D. Each participant will complete a maximal exercise test prior to the exercise sessions. Sedentary participants will complete 45 minutes of continuous moderate intensity exercise at 45-55% heart rate reserve (HRR) and three high intensity interval sessions with six one minute burst of high intensity at 70%, 80%, or 90% of HRR every four minutes. Active participants will complete 45 minutes of moderate intensity exercise at 45-55% of HRR and one high intensity interval session at 90% of HRR with intervals spaced every two minutes.
Read more
The investigators will track the blood sugar response to exercise using a device called a continuous glucose monitor (CGM) which records blood sugar every five minutes over a period of six days. The CGM will help determine which exercise intensity does a better job at reducing the time spent in a low blood sugar range. The information gained through this study will help individuals with T1D remain active without fear of low blood sugar and provide guidelines for professionals working with this population.
Adding high intensity bursts at 80% and 90% of maximum aerobic capacity (active participants) or heart rate reserve (sedentary participants) to a moderate intensity exercise session will significantly reduce the amount of time spent in a low blood sugar range in sedentary and active persons with T1D compared to moderate intensity exercise alone.
Read the detailed description
Sedentary Arm: This portion of the study is complete. 10 participants completed the study in its entirety. Maximal exercise testing utilized a Parvomedics Metabolic cart to analyze oxygen consumption in ml/kg/min and maximum heart rate. Results from this test were used to estimate intensity using heart rate for the exercise sessions. Prior to each exercise session, participants arrived at 4:00 PM ate a Glucerna bar (to prevent drastic falls in glycemia with exercise) and had an IV inserted. A total of six blood samples were taken at each session at the following timepoints: (1) 0 mins-baseline, (2) 10 mins- end of warm up, (3) 35 mins-end of intervals, (4) 45 mins-end of exercise, (5) 75 mins-mid recovery, and (6) 105 mins-end of exercise. Each blood draw was sampled for glucose, cortisol, and growth hormone. Before exercise, blood glucose was measured on a handheld glucometer. If blood glucose was <5.7 mmol/L glucose was administered via Dex4 tablets. Exercise did not begin until blood glucose was at least 5.7 mmol/L. If blood glucose was greater than 16.7 mmol/L but less than 20.0 mmol/L ketones were tested on a urine ketone strip. If ketones were negative or trace exercise began.
The first exercise session was 45 minutes of moderate intensity exercise at 45-55% of heart rate reserve (HRR). The intensity determined from this session (speed and incline) was used as the recovery intensity for the high intensity sessions. The high intensity sessions were allocated in a random order from www.random.org where 1=70%, 2=80%, and 3=90%. Each high intensity session started with 10 minutes of moderate intensity exercise (at the same speed and incline from the first session) and six one minute bursts of high intensity every four minutes followed by a 10 minute cool down.
Because of the small sample size and non-normal glucose profiles, data was analyzed using a Friedman analysis of variance (non-parametric test).
Active Arm: This portion is still recruiting participants. The procedures for this experiment are very similar to the sedentary component. Blood glucose targets prior to exercise are the same however no blood samples will be taken. Participants will arrive at the lab for 4:30 PM and eat a Glucerna bar (to avoid drastic falls in glycemia with exercise). The two exercise sessions, moderate and 90%, will be allocated in a random order from a coin flip where heads is moderate exercise and tails is the 90% intervals. The moderate intensity session will consist of 45 minutes of exercise at 45-55% of HRR. The 90% session will consist of 15 minutes of moderate intensity at 45-55% of HRR followed by six one minute bursts of exercise at 90% of HRR every two minutes followed by a 10 minute cooldown.
Data will be analyzed using a general linear model and logistic regression.
- Conditions
- Type 1 Diabetes
- Being tested
- Exercise
- Keywords
- Type 1 diabetes, Physical activity, Hypoglycemia, Glucose variability
- Medical subject headings
- Diabetes Mellitus, Type 1, Motor Activity, Hypoglycemia
What participants receive
What participants receive. In a randomised study each person is assigned to one group by chance.
ExerciseOther
The intervention will be the different high intensity sessions. Time spent in hypoglycemia and glucose variability will be compared as follows: 70% vs. moderate, 80% vs. moderate, and 90% vs. moderate to see if high intensity is protective against hypoglycemia and provides lower glucose variability levels.
| Study group | Role | What they receive |
|---|---|---|
| Moderate Intensity Exercise Alone | Active comparator | 45 minutes of moderate intensity exercise at 45-55% of maximum aerobic capacity (active participants) or heart rate reserve (sedentary participants) used as a control condition. Participants will consume a glucerna bar at 10pm following this session. Receives: Other: Exercise |
| 70% Session | Experimental | 45 minutes of moderate intensity exercise interspersed with one minute bouts at 70% heart rate reserve every 4 minutes. Note: this session is not included for the active participants. Participants will consume a glucerna bar at 10pm following this session. Receives: Other: Exercise |
| 80% Session | Experimental | 45 minutes of moderate intensity exercise interspersed with one minute bouts at 80% of heart rate reserve every 4 minutes. Note: this session is not included for the active participants. Participants will consume a glucerna bar at 10pm following this session. Receives: Other: Exercise |
| 90% Session | Experimental | 45 minutes of moderate intensity exercise interspersed with one minute bouts at 90% of maximum aerobic capacity (active participants every two minutes) or heart rate reserve (sedentary participants every 4 minutes). Participants will consume a glucerna bar at 10pm following this session. Receives: Other: Exercise |
What is being measured
The primary outcome is the main question the study is designed to answer.
Percent time spent </= 3.9 mmol/L as measured by continuous glucose monitor
The time spent </= 3.9 mmol/L is measured through the continuous glucose monitor and is represented as a percentage.
Measured: 12 hours post exercise (6:00 PM to 6:00 AM)
Secondary outcomes (2)
Mean absolute glucose change (MAG-mmol/L/h) as measured by continuous glucose monitor
Glucose variability will be measured using a continuous glucose monitor assessed through mean absolute glucose change (MAG) which is a measure of inter-day variability (mmol/L/h)
Measured: 12 hours post exercise (6:00 PM to 6:00 AM)
Continuous overall net glycemic action (CONGA-mmol/L) as measured by continuous glucose monitor
CONGA will be measured using a continuous glucose monitor assessed through overall net glycemic action (CONGA) which is a measure of intra-day variability (mmol/L).
Measured: 12 hours post exercise (6:00 PM to 6:00 AM)
Timeline
From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.
- First posted11 Jul 2018
- Study startMay 2013
- Primary completionMar 2016
- Study completionMar 2016
Resources
- Official record on ClinicalTrials.govThe registry entry this page is built from, with its full change history.
- Other trials for Type 1 DiabetesStudies of the same condition, open and under way.
- What the trial phases meanHow a treatment moves from first tests in people to approval.
More details
For doctors and researchers: how the study is designed, who runs it, and its registry IDs.
Study design
- Study type
- Interventional
- Phase
- Phase N/A
- Primary purpose
- Prevention
- Allocation
- Randomised
- Intervention model
- Crossover
- Masking
- Single blind
- Who is masked
- Participant
- Enrolment
- 10 participants (actual)
Sponsor and investigators
- Lead sponsor
- University of Manitoba
- Sponsor type
- University, hospital or other
- Collaborators
- The Lawson Foundation
- Responsible party
- Principal investigator, Jon McGavock, University of Manitoba
- Investigators
- Jonathan McGavock, PhD, Principal investigator, University of Manitoba; Children's Hospital Research Institute of Manitoba
IDs, dates and publications
- ClinicalTrials.gov ID
- NCT03583268
- Sponsor's protocol ID
- B2014:095
- Status last verified
- Jun 2018
- First submitted
- 18 Mar 2015
- Last updated
- 11 Jul 2018
- Results posted
- No
- Data monitoring committee
- No
Study at a glance
From the registry record, last updated by the sponsor on 11 Jul 2018. Recruitment status is as the sponsor reported it: confirm with the study team.
- Official title
- Determining the Appropriate Intensity of Vigorous Intensity Exercise to Prevent Post-exercise Hypoglycemia in Persons Living With Type 1 Diabetes
- ClinicalTrials.gov ID
- NCT03583268
- Acronym / sponsor ID
- B2014:095
- Conditions
- Type 1 Diabetes
- Keywords
- Type 1 diabetes, Physical activity, Hypoglycemia, Glucose variability
- Study type
- Interventional
- Recruitment status
- Completed
- Enrolment
- 10 participants (actual)
- Lead sponsor
- University of ManitobaUniversity, hospital or other
- Collaborators
- The Lawson Foundation
- Study start
- May 2013
- Primary completion
- Mar 2016 (actual)
- Study completion
- Mar 2016 (actual)
- First posted
- 11 Jul 2018 (actual)
- Results
- Not posted in the source record
Clinical summary
The research question as the sponsor registered it. This describes what the study plans to test, not what it found.
Over 300, 000 youth and young adults across Canada are living with Type 1 Diabetes (T1D) which is considered the most common endocrine condition. Physical activity offers numerous health benefits however the majority of persons living with T1D are physically inactive, primarily due to fear of low blood sugar (hypoglycemia). This fear of hypoglycemia continues to exist for physically active persons with T1D as no established physical activity guidelines exist. Several acute studies have used high intensity interval training as a way to reduce the risk of hypoglycemia as it has the ability to activate fight or flight hormones which can raise blood sugar; however the intensity needed to elicit this response is unknown.
The purpose of this project is to determine the acute effects of varying exercise intensities on the time spent in a low blood sugar range in 10 sedentary (VIGOR acute sedentary) and 16 physically active (VIGOR acute trained) individuals with T1D. Each participant will complete a maximal exercise test prior to the exercise sessions. Sedentary participants will complete 45 minutes of continuous moderate intensity exercise at 45-55% heart rate reserve (HRR) and three high intensity interval sessions with six one minute burst of high intensity at 70%, 80%, or 90% of HRR every four minutes. Active participants will complete 45 minutes of moderate intensity exercise at 45-55% of HRR and one high intensity interval session at 90% of HRR with intervals spaced every two minutes.
The investigators will track the blood sugar response to exercise using a device called a continuous glucose monitor (CGM) which records blood sugar every five minutes over a period of six days. The CGM will help determine which exercise intensity does a better job at reducing the time spent in a low blood sugar range. The information gained through this study will help individuals with T1D remain active without fear of low blood sugar and provide guidelines for professionals working with this population.
Adding high intensity bursts at 80% and 90% of maximum aerobic capacity (active participants) or heart rate reserve (sedentary participants) to a moderate intensity exercise session will significantly reduce the amount of time spent in a low blood sugar range in sedentary and active persons with T1D compared to moderate intensity exercise alone.
Detailed description
Sedentary Arm: This portion of the study is complete. 10 participants completed the study in its entirety. Maximal exercise testing utilized a Parvomedics Metabolic cart to analyze oxygen consumption in ml/kg/min and maximum heart rate. Results from this test were used to estimate intensity using heart rate for the exercise sessions. Prior to each exercise session, participants arrived at 4:00 PM ate a Glucerna bar (to prevent drastic falls in glycemia with exercise) and had an IV inserted. A total of six blood samples were taken at each session at the following timepoints: (1) 0 mins-baseline, (2) 10 mins- end of warm up, (3) 35 mins-end of intervals, (4) 45 mins-end of exercise, (5) 75 mins-mid recovery, and (6) 105 mins-end of exercise. Each blood draw was sampled for glucose, cortisol, and growth hormone. Before exercise, blood glucose was measured on a handheld glucometer. If blood glucose was <5.7 mmol/L glucose was administered via Dex4 tablets. Exercise did not begin until blood glucose was at least 5.7 mmol/L. If blood glucose was greater than 16.7 mmol/L but less than 20.0 mmol/L ketones were tested on a urine ketone strip. If ketones were negative or trace exercise began.
The first exercise session was 45 minutes of moderate intensity exercise at 45-55% of heart rate reserve (HRR). The intensity determined from this session (speed and incline) was used as the recovery intensity for the high intensity sessions. The high intensity sessions were allocated in a random order from www.random.org where 1=70%, 2=80%, and 3=90%. Each high intensity session started with 10 minutes of moderate intensity exercise (at the same speed and incline from the first session) and six one minute bursts of high intensity every four minutes followed by a 10 minute cool down.
Because of the small sample size and non-normal glucose profiles, data was analyzed using a Friedman analysis of variance (non-parametric test).
Active Arm: This portion is still recruiting participants. The procedures for this experiment are very similar to the sedentary component. Blood glucose targets prior to exercise are the same however no blood samples will be taken. Participants will arrive at the lab for 4:30 PM and eat a Glucerna bar (to avoid drastic falls in glycemia with exercise). The two exercise sessions, moderate and 90%, will be allocated in a random order from a coin flip where heads is moderate exercise and tails is the 90% intervals. The moderate intensity session will consist of 45 minutes of exercise at 45-55% of HRR. The 90% session will consist of 15 minutes of moderate intensity at 45-55% of HRR followed by six one minute bursts of exercise at 90% of HRR every two minutes followed by a 10 minute cooldown.
Data will be analyzed using a general linear model and logistic regression.
Study design
- Primary purpose
- Prevention
- Allocation
- Randomised
- Intervention model
- Crossover
- Masking
- Single blind (participant)
- Number of arms
- 4
| Arm | Type | Receives |
|---|---|---|
| Moderate Intensity Exercise Alone | Active comparator | Other: Exercise45 minutes of moderate intensity exercise at 45-55% of maximum aerobic capacity (active participants) or heart rate reserve (sedentary participants) used as a control condition. Participants will consume a glucerna bar at 10pm following this session. |
| 70% Session | Experimental | Other: Exercise45 minutes of moderate intensity exercise interspersed with one minute bouts at 70% heart rate reserve every 4 minutes. Note: this session is not included for the active participants. Participants will consume a glucerna bar at 10pm following this session. |
| 80% Session | Experimental | Other: Exercise45 minutes of moderate intensity exercise interspersed with one minute bouts at 80% of heart rate reserve every 4 minutes. Note: this session is not included for the active participants. Participants will consume a glucerna bar at 10pm following this session. |
| 90% Session | Experimental | Other: Exercise45 minutes of moderate intensity exercise interspersed with one minute bouts at 90% of maximum aerobic capacity (active participants every two minutes) or heart rate reserve (sedentary participants every 4 minutes). Participants will consume a glucerna bar at 10pm following this session. |
Who may qualify
- Ages
- 15 to 35 years
- Sex
- All
- Healthy volunteers
- Not accepted
- Age groups
- Child, Adult
Key inclusion criteria (5 listed)
- Persons with type 1 diabetes
- Hemoglobin A1c <9.9%
- Diabetes duration >/= 2 years
- Sedentary Participants: participate in <150 minutes of moderate to vigorous physical activity per week
- Active Participants: regular performance of vigorous physical activity >3 times/week for over one year. Display a maximal oxygen uptake that is at least 40.9 ml/kg/min for females, and 49.3 ml/kg/min for males.
Key exclusion criteria (9 listed)
- HbA1c ≥9.9% as the lack of compliance with insulin suggests they may not be able to comply with the prescribed exercise requirements
- Have frequent and unpredictable hypoglycemia as they will be at a greater risk of serious hypoglycemic events
- Had a change in insulin management strategy, including adoption of a pump within two months of enrolment or switching back to multiple daily injections in the last two months, as they may be at risk for a hypoglycemic event due to the novel insulin management approach
- Have conditions that would render vigorous intensity activity contraindicated including: uncontrolled hypertension: BP >150 mm Hg systolic or >95 mm Hg diastolic in a sitting position; severe peripheral neuropathy; or history of cardiovascular disease
- Cognitive deficit resulting in an inability to provide informed consent
Eligibility is decided by the study team after screening; this overview does not establish that a patient qualifies. Full inclusion and exclusion criteria.
Interventions
| Intervention | Type | Arms |
|---|---|---|
| ExerciseThe intervention will be the different high intensity sessions. Time spent in hypoglycemia and glucose variability will be compared as follows: 70% vs. moderate, 80% vs. moderate, and 90% vs. moderate to see if high intensity is protective against hypoglycemia and provides lower glucose variability levels. | Other | 70% Session, 80% Session, 90% Session, Moderate Intensity Exercise Alone |
Primary outcome
Percent time spent </= 3.9 mmol/L as measured by continuous glucose monitor
Time frame: 12 hours post exercise (6:00 PM to 6:00 AM)
The time spent </= 3.9 mmol/L is measured through the continuous glucose monitor and is represented as a percentage.
2 secondary outcomes
Mean absolute glucose change (MAG-mmol/L/h) as measured by continuous glucose monitor
Time frame: 12 hours post exercise (6:00 PM to 6:00 AM)
Continuous overall net glycemic action (CONGA-mmol/L) as measured by continuous glucose monitor
Time frame: 12 hours post exercise (6:00 PM to 6:00 AM)
Results and safety
The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.
Research links
- Official record on ClinicalTrials.govLast updated by the sponsor 11 Jul 2018.
- Facebook page for recruitmentLink provided by the sponsor.
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Referral and contact
AzTrials does not enrol participants or take referrals. Contact the study team or a site listed below; they decide who can take part. This study is not recruiting at the moment.
Jonathan McGavock, PhD principal investigator
University of Manitoba; Children's Hospital Research Institute of Manitoba
1 site in 1 country: see every site and its status.
Questions about this trial
What is this clinical trial studying?
A study testing Exercise in people with Type 1 Diabetes, run by University of Manitoba at 1 site in Canada.
The full registered description is in the About this study section and the official record.
Who may be eligible to take part?
The sponsor lists 5 inclusion and 9 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.
Is this clinical trial currently recruiting?
The record says: finished, as of the sponsor's last update on 11 Jul 2018. Status can change between updates, so confirm with the study contact before making plans.
Where is the study taking place?
The record lists 1 site in Canada. Whether a site is taking part right now should be confirmed with that site. See every site.
What are the possible benefits and risks?
They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.
Are results available for this study?
The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.
How can a doctor refer a patient or contact the research team?
The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.
What does the primary outcome measure?
Percent time spent </= 3.9 mmol/L as measured by continuous glucose monitor (time frame: 12 hours post exercise (6:00 PM to 6:00 AM)). It is what the study was designed to measure, not a finding.
Where can I read the original study information?
Does a listing mean the treatment is approved or proven to work?
No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.
How often is this information updated?
AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 11 Jul 2018.