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  • 1. Mattsson, Stig
    et al.
    Jendle, Johan
    Örebro University, School of Medical Sciences.
    Adolfsson, Peter
    Department of Pediatrics, The Hospital of Halland, Kungsbacka, Sweden; Institute of Clinical Sciences, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden.
    Carbohydrate Loading Followed by High Carbohydrate Intake During Prolonged Physical Exercise and Its Impact on Glucose Control in Individuals With Diabetes Type 1-An Exploratory Study2019In: Frontiers in Endocrinology, ISSN 1664-2392, E-ISSN 1664-2392, Vol. 10, article id 571Article in journal (Refereed)
    Abstract [en]

    Background: Prolonged physical exercise (PE) is a challenge in type 1 diabetes with an increased incidence of both hypoglycemia and hyperglycemia.

    Purpose: To evaluate the impact of two consecutive days of carbohydrate (CHO) loading, followed by high intermittent CHO-intake during prolonged PE, facilitated by a proactive use of Real-Time Continuous Glucose Monitoring (rtCGM), on glucose control in individuals with type 1 diabetes.

    Methods: Ten physically active individuals with type 1 diabetes were invited to participate in a 3-day long sports camp with the objective to evaluate CHO-loading and high intermittent CHO-intake during prolonged PE. 1.5 months later the same procedure was evaluated in relation to a 90 km cross-country skiing race (Vasaloppet). Participants were instructed to act proactively using rtCGM with predictive alerts to maintain sensor glucose values within target range, defined as 72-180 mg/dl (4-10 mmol/l).

    Results: Mean glucose values during CHO-loading were: day 1; 140.4 +/- 45.0 mg/dl (7.8 +/- 2.5 mmol/l) and day 2; 120.6 +/- 41.4 mg/dl (6.7 +/- 2.3 mmol/l). Mean sensor glucose at start of PE was 126.0 +/- 25.2 mg/dl (7.0 +/- 1.4 mmol/l) and throughout PE 127.8 +/- 25.2 mg/dl (7.1 +/- 1.4 mmol/l). Percentage of time spent in range (TIR) respective time spent in hypoglycemia was: CHO-loading 74.7/10.4% and during PE 94.3/0.6%.

    Conclusions: High intermittent CHO-intake during prolonged PE combined with proactive use of rtCGM is associated with good glycemic control during prolonged exercise in individuals with diabetes type 1. However, the time spent in hypoglycemia during the 2-days of CHO-loading was 10.4% and therefore a lower insulin dose might be suggested to reduce the time spent in hypoglycemia.

  • 2.
    Nyström, Thomas
    et al.
    Department of Clinical Science and Education, Karolinska Institutet, Södersjukhuset, Stockholm, Sweden.
    Santos, Irene Padro
    Department of Clinical Science and Education, Karolinska Institutet, Södersjukhuset, Stockholm, Sweden.
    Hedberg, Fredric
    Department of Clinical Science and Education, Karolinska Institutet, Södersjukhuset, Stockholm, Sweden.
    Wardell, Johan
    Department of Clinical Science and Education, Karolinska Institutet, Södersjukhuset, Stockholm, Sweden.
    Witt, Nils
    Department of Clinical Science and Education, Karolinska Institutet, Södersjukhuset, Stockholm, Sweden.
    Cao, Yang
    Örebro University, School of Medical Sciences. Örebro University Hospital. Unit of Biostatistics, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden; Clinical Epidemiology and Biostatistics, School of Medical Sciences, Örebro University, Örebro, Sweden.
    Bojo, Leif
    Central Hospital, Karlstad, Sweden.
    Nilsson, Bo
    Central Hospital, Karlstad, Sweden.
    Jendle, Johan
    Örebro University, School of Medical Sciences.
    Effects on Subclinical Heart Failure in Type 2 Diabetic Subjects on Liraglutide Treatment vs. Glimepiride Both in Combination with Metformin: A Randomized Open Parallel-Group Study2017In: Frontiers in Endocrinology, ISSN 1664-2392, E-ISSN 1664-2392, Vol. 8, article id 325Article in journal (Refereed)
    Abstract [en]

    Objective: We aimed to investigate the effect of liraglutide treatment on heart function in type 2 diabetes (T2D) patients with subclinical heart failure.

    Methods: Randomized open parallel-group trial. 62 T2D patients (45 male) with subclinical heart failure were randomized to either once daily liraglutide 1.8 mg, or glimepiride 4 mg, both add on to metformin 1 g twice a day. Mitral annular systolic (s') and early diastolic (e') velocities were measured at rest and during bicycle ergometer exercise, using tissue Doppler echocardiography. The primary endpoint was 18-week treatment changes in longitudinal functional reserve index (LFRIdiastolic/systolic).

    Results: Clinical characteristics between groups (liraglutide = 33 vs. glimepiride = 29) were well matched. At baseline left ventricle ejection fraction (53.7 vs. 53.6%) and global longitudinal strain (-15.3 vs. -16.5%) did not differ between groups. There were no significant differences in mitral flow velocities between groups. For the primary endpoint, there was no treatment change [95% confidence interval] for: LFRIdiastolic (-0.18 vs. -0.53 [-0.28, 2.59; p = 0.19]), or LFRIsystolic (-0.10 vs. -0.18 [-1.0, 1.7; p = 0.54]); for the secondary endpoints, there was a significant treatment change in respect of body weight (-3.7 vs. -0.2 kg [-5.5, -1.4; p = 0.001]), waist circumference (-3.1 vs. -0.8 cm [-4.2, -0.4; p = 0.019]), and heart rate (HR) (6.3 vs. -2.3 bpm [-3.0, 14.2; p = 0.003]), with no such treatment change in hemoglobin A1c levels (-11.0 vs. -9.2 mmol/mol [-7.0, 2.6; p = 0.37]), between groups.

    Conclusion: 18-week treatment of liraglutide compared with glimepiride did not improve LFRIdiastolic/systolic, but however increased HR. There was a significant treatment change in body weight reduction in favor for liraglutide treatment.

  • 3.
    Nyström, Thomas
    et al.
    Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden.
    Santos-Pardo, Irene
    Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden.
    Hedberg, Fredric
    Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden.
    Wardell, Johan
    Department of Clinical Science and Education, Karolinska Institutet, Södersjukhuset, Stockholm, Sweden.
    Witt, Nils
    Department of Clinical Science and Education, Karolinska Institutet, Södersjukhuset, Stockholm, Sweden.
    Cao, Yang
    Örebro University, School of Medical Sciences. Örebro University Hospital. Unit of Biostatistics, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.
    Bojö, Leif
    Central Hospital, Karlstad, Sweden.
    Nilsson, Bo
    Central Hospital, Karlstad, Sweden.
    Jendle, Johan
    Örebro University, School of Medical Sciences.
    Effects on Subclinical Heart Failure in Type 2 Diabetic Subjects on Liraglutide Treatment vs. Glimepiride Both in Combination with Metformin: A Randomized Open Parallel-Group Study (vol 8, 325, 2017)2018In: Frontiers in Endocrinology, ISSN 1664-2392, E-ISSN 1664-2392, Vol. 9, article id 50Article in journal (Refereed)
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