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  • 1.
    Adolfsson, Peter
    et al.
    Institute of Clinical Sciences, The Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden; Endocrine and Diabetes Center, The hospital of Halland Kungsbacka, Kungsbacka, Sweden.
    Mattsson, Stig
    Faculty of Health Sciences and Medicine, Örebro University Hospital, Örebro, Sweden; Endocrine and Diabetes Center, Falun Hospital, Falun, Sweden.
    Jendle, Johan
    Faculty of Health Sciences and Medicine, Örebro University Hospital, Örebro, Sweden; Endocrine and Diabetes Center, Karlstad Hospital, Karlstad, Sweden.
    Evaluation of glucose control when a new strategy of increased carbohydrate supply is implemented during prolonged physical exercise in type 1 diabetes2015In: European Journal of Applied Physiology, ISSN 1439-6319, E-ISSN 1439-6327, Vol. 115, no 12, p. 2599-2607Article in journal (Refereed)
    Abstract [en]

    Purpose: In healthy individuals, high carbohydrate intake is recommended during prolonged exercise for maximum performance. In type 1 diabetes (T1D), this would alter the insulin requirements. The aim of the study was to evaluate the safety of high glucose supplementation during prolonged exercise and the glucose control when a novel strategy of increased carbohydrate supply was implemented during prolonged exercise in T1D.

    Methods: Eight subjects with T1D participated in a sports camp including sessions of prolonged exercise and individualized feedback during three consecutive days. This was later followed by a 90 km cross-country skiing race. Large amounts of carbohydrates, 75 g/h, were supplied during exercise and the insulin requirements were registered. Glucose was measured before, during and after exercise aiming at euglycaemia, 4-8 mmol/L (72-144 mg/dL). During the race, continuous glucose monitoring (CGM) was used as an aspect of safety and to allow direct and individual adjustments.

    Results: Compared to ordinary carbohydrate supply during exercise, the high carbohydrate supplementation resulted in significantly increased insulin doses to maintain euglycaemia. During the cross-country skiing race, the participants succeeded to reach mean target glucose levels; 6.5 ± 1.9 mmol/L (117 ± 34 mg/dL) and 5.7 ± 1.5 mmol/L (103 ± 27 mg/dL) at the start and finish of the race, respectively. Episodes of documented hypoglycemia (<4 mmol/L/72 mg/dL) were rare. CGM was used for adjustments.

    Conclusion: In this study, large carbohydrate supplementation in T1D individuals during prolonged aerobic exercise is safe and allows the subjects to maintain glycaemic control and indicates the feasibility of CGM under these conditions.

  • 2.
    Adolfsson, Peter
    et al.
    Institute of Clinical Sciences, Sahlgrenska Academy at University of Gothenburg, Sweden .
    Strömgren, Agneta
    The Hospital of Halland, Sweden .
    Mattsson, Stig
    Faculty of Health Sciences and Medicine, Örebro University Hospital, Sweden .
    Chaplin, John E.
    Institute of Clinical Sciences, Sahlgrenska Academy at University of Gothenburg, Sweden.
    Jendle, Johan
    Faculty of Health Sciences and Medicine, Örebro University Hospital, Orebro, Sweden.
    Education and individualized support regarding exercise and diabetes improves glucose control and level of physical activity in type 1 diabetes individuals2015In: Journal of Endocrinology Diabetes & Obesity, E-ISSN 2333-6692, Vol. 3, no 2, p. 1071-1077Article in journal (Refereed)
    Abstract [en]

    Background: Physical activity is advocated in all individuals with diabetes. However, good glycemic control can be difficult to achieve due to exercise induced glucose excursions.

    Objective: To evaluate the impact on glucose control of a structured diabetes education concerning physical activity, delivered via the web/internet together with telemedical care (individualized feedback by phone).

    Methods: Eighty-two individuals with type 1 (T1D) were included in the pre-race intervention and randomized into two groups: intervention (I) (n=48) and control (C) (n=48). Both groups received web-based training of sports and nutrition in relation to diabetes. The intervention group also received structured and individualized feedback on two different occasions. HbA1c was measured at baseline, after 3 and 6 months when a 45 km cross-country skiing race (the HalvVasa) was performed. Only the individuals attending the skiing race were eligible to be included in the study. Level of Physical Activity (LPA), Multidimensional Health Locus of Control (MHLC) and Confidence In Diabetes Self-care (CIDS) were assessed at baseline and after 7 months.

    Results: HbA1c at start was 58.5 ± 10.0 (I) respectively 60.7 ± 9.5 (C) mmol/mol. At 3 months 56.7 ± 8.7 (I) respectively 61.0 ± 9.6 (C) mmol/mol and at 6 months 55.7 ± 8.1 (I) respectively 60.3 ± 9.7 (C) mmol/mol. A significant in (I) at 3 months: 2.2 ± 3.8 mmol/mol (0.7-3.7, 95% CI), (p<0.05) and after 6 months: 2.8 ± 5.5 mmol/mol (0.5-5.0, 95% CI), (p<0.05). No reduction was seen in (C). However between the two groups no difference was noted. The LPA was increased in 52% of the participants in (I) respectively 7% in (C), a significant difference, p<0.05. No differences were seen regarding HbA1c or LPA in the control group.

    Conclusion: Education and individualized feedback, delivered via telemedicine, to physical active individuals with T1D resulted in improvements in glycemic control within the intervention group and improved level of physical activity and locus of control when compared to the control group(12) (PDF) Education and individualized support regarding exercise and diabetes improves glucose control and level of physical activity in type 1 diabetes individuals.

  • 3.
    Carr, Amelia
    et al.
    Mid Sweden University, Sweden; Deakin University, Geelong, Australia.
    McGawley, Kerry
    Mid Sweden University, Sweden.
    Govus, Andrew
    Mid Sweden University, Sweden.
    Andersson, Erik P
    Mid Sweden University, Sweden.
    Shannon, Oliver M.
    Newcastle University, Newcastle-upon-Tyne, Storbritannien.
    Mattsson, Stig
    Örebro University, School of Medical Sciences.
    Melin, Anna
    University of Copenhagen, Copenhagen, Denmark.
    Nutritional Intake in Elite Cross-Country Skiers During Two Days of Training and Competition2019In: International Journal of Sport Nutrition & Exercise Metabolism, ISSN 1526-484X, E-ISSN 1543-2742, Vol. 29, no 3, p. 273-281Article in journal (Refereed)
    Abstract [en]

    This study investigated the energy, macronutrient, and fluid intakes, as well as hydration status (urine specific gravity), in elite cross-country skiers during a typical day of training (Day 1) and a sprint skiing competition the following day (Day 2). A total of 31 (18 males and 13 females) national team skiers recorded their food and fluid intakes and urine specific gravity was measured on Days 1 and 2. In addition, the females completed the Low Energy Availability in Females Questionnaire to assess their risk of long-term energy deficiency. Energy intake for males was 65 +/- 9 kcal/kg on Day 1 versus 58 +/- 9 kcal/kg on Day 2 (p = .002) and for females was 57 +/- 10 on Day 1 versus 55 +/- 5 kcal/kg on Day 2 (p = .445). Carbohydrate intake recommendations of 10-12 g.kg(-l) .day(-1) were not met by 89% of males and 92% of females. All males and females had a protein intake above the recommended 1.2-2.0 g/kg on both days and a postexercise protein intake above the recommended 0.3 g/kg. Of the females, 31% were classified as being at risk of long-term energy deficiency. In the morning of Day 1, 50% of males and 46% of females were dehydrated; on Day 2, this was the case for 56% of males and 38% of females. In conclusion, these data suggest that elite cross-country skiers ingested more protein and less carbohydrate than recommended and one third of the females were considered at risk of long-term energy deficiency. Furthermore, many of the athletes were dehydrated prior to training and competition.

  • 4.
    Mattsson, Stig
    et al.
    Örebro University, School of Medical Sciences. Department of Endocrine and Diabetes Centre, Falun Hospital, Falun, Sweden.
    Adolfsson, P.
    Department of Paediatrics, The hospital of Halland, Kungsbacka, Sweden; Institute of Clinical Sciences, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden.
    Jendle, Johan
    Örebro University, School of Medical Sciences.
    Diabetes Sports Camps for Individuals with Type 1 Diabetes Associated with Improved Glycemic Control and Self-Estimated Level of Knowledge2017In: Journal of Diabetes Research and Therapy, ISSN 2380-5544, Vol. 3, no 2Article in journal (Refereed)
    Abstract [en]

    Purpose: To evaluate the effect of a novel sports camp containing education and individualized feedback, on glycemic control and self-estimated level of knowledge in individuals with type 1 diabetes (T1DM).

    Method: Participants with T1DM attended a three-day sports camp with education and individualized feedback on insulin and carbohydrate adjustments. Continuous Glucose Monitoring (CGM) and carbohydrate counting was used. A1c was assessed at baseline, 3 and 12 months after the sports camps. Questionnaires using Visual Analogue Scale (VAS) were used before and after the camp to estimate attitudes and knowledge regarding insulin and carbohydrate adjustments in relation to exercise.

    Results: During eight sports camps 105 TIDM participants were included, 53% females, mean age 40.5 ± 10.0 years.

    A1c was significantly reduced from 7.5 ± 3.0% (58.7 ± 9.2 mmol/mol) at baseline to 7.3 ± 2.9% (56.2 ± 8.1 mmol/mol), P<.005, after 3 months and maintained after 12 months 7.3 ± 2.9% (56.4 ± 8.1 mmol/mol), P<.005. Self-estimated level of knowledge was significantly improved in the area of insulin adjustments, P<.001 and carbohydrate intake, P<.001, in connection to exercise.

    99% of the participants wanted to continue on CGM and 85% of the participants stated they would like to continue with carbohydrate counting after the sports camp.

    Conclusion: Sports camps for adults with T1DM, was associated with improved glycemic control and increased self-estimated knowledge regarding insulin and carbohydrate adjustments in relation to exercise. This improvement in A1c, might be linked to the participants’ increased level of knowledge but also to increased use of CGM and carbohydrate counting.

    Abbreviations: A1c: Glycated Hemoglobin; BG: Blood Glucose; BMI: Body Mass Index; CGM: Continuous Glucose Monitoring; CHO: Carbohydrates; CSII: Continuous Subcutaneous Insulin Infusion; DSME: Diabetes Self-Management Education; IFCC: International Federation of Clinical Chemistry; IG: Interstitial Glucose; MDI: Multiple Daily Injections; NGSP: National Glycohemoglobin Standardization Program; PG: Plasma Glucose; PE: Physical Exercise; RPE: Rate of Perceived Exertion; SMBG: Self-Monitoring of Blood Glucose; T1DM: Type 1 Diabetes; VAS: Visual Analogue Scale.

  • 5. 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.

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