Type 1 Diabetes Mellitus Clinical Trial
Official title:
Fructose to Reduce Exercise-associated Hypoglycaemia in Individuals With Type 1 Diabetes Treated With Insulin Degludec: Questioning a Paradigm and Offering a Novel Strategy
To determine and compare the time-to-hypoglycaemia (defined as plasma glucose <3.9mmol/L) in individuals with type 1 diabetes treated with ultra-Long acting insulin degludec during aerobic exercise with or without prior ingestion of a single oral fructose load.
Glycaemic control remains complex and demanding during exercise for type 1 diabetes (T1D)
patients. Traditional treatment guidelines for exercise emphasizing the reduction of insulin
doses and/or ingestion of additional carbohydrates are of limited applicability for patients
treated with ultra-long acting basal insulin analogues. Dose reductions may require two to
three days for modern basal insulin analogues in order to achieve an adapted steady state,
hereby increasing the risk of inadequate insulin-following exercise. If T1D patients engage
in recreational exercise - as recommended by every international treatment guideline -
current treatment strategies may simply not be sufficient.
As a consequence for patients treated with modern basal insulin analogues, it seems more
adequate not to modify insulin doses but to apply alternative strategies for recreational
exercise. The ingestion of fructose, an insulin-independent carbohydrate, which increases
lipid oxidation but attenuates the dependency on carbohydrates may offer a novel strategy. Up
to date, only preliminary data for fructose have been produced regarding clinical
effectiveness and underlying mechanisms in the prevention of hypoglycaemia. The present
comprehensive study aims to investigate the clinical efficacy, feasibility, and safety of a
pre-exercise oral fructose load without modification of insulin degludec in T1D patients.
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