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Impact of carbohydrate timing on glucose metabolism and substrate oxidation following high-intensity evening aerobic exercise in athletes: a randomized controlled study
Örebro universitet, Institutionen för medicinska vetenskaper. (Diabetes Endocrinology and Metabolism Research Center)ORCID-id: 0000-0001-8444-1505
University of Gothenburg, Department of Food and Nutrition, and Sport Science, Centre for Health and Performance, Gothenburg, Sweden.
University of Gothenburg, Department of Food and Nutrition, and Sport Science, Centre for Health and Performance, Gothenburg, Sweden.
Örebro University, School of Medicine and Health, Institute of Medical Sciences, Örebro, Sweden; Sahlgrenska Academy at University of Gothenburg, Institute of Clinical Sciences, Gothenburg, Sweden. (Diabetes Endocrinology and Metabolism Research Center)ORCID-id: 0000-0001-7615-9737
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2025 (Engelska)Ingår i: Journal of the International Society of Sports Nutrition, E-ISSN 1550-2783, Vol. 22, nr 1, artikel-id 2494839Artikel i tidskrift (Refereegranskat) Published
Abstract [en]

OBJECTIVE: The study aimed to investigate the impact of nutrient timing in relation to evening exercise. Specifically, it examined the effects of pre- or post-exercise carbohydrate (CHO) ingestion on glucose metabolism, glucose regulation, and overall substrate oxidation in well-trained athletes during and after physical exercise (PE), spanning the nocturnal period and the subsequent morning.

METHODS: Ten male endurance cyclists participated in the study. The initial assessments included body composition measurements and an incremental cycle test to determine maximal oxygen uptake (V˙O2 max) and maximum power output (Wmax). Following this, participants underwent a control (rest previous day) oral glucose tolerance test (OGTT) and a familiarization exercise trial that had two objectives: (1) to establish the appropriate amount of CHO to use in the pre- or post-exercise drink during the experimental trials, and (2) to familiarize participants with the equipment and study protocol. In the three days prior to both the control and experimental trials, participants followed a standardized, individualized diet designed to meet their energy needs. During the experimental trials, participants completed two separate evening exercise sessions (50 min@70%Wmax +  ~24 min time-trial (TT)) with either pre- or post-exercise CHO ingestion (253 ± 52 g), matching the CHO oxidized during exercise. The CHO drink and a volume-matched placebo (PLA) drink (containing no energy) were randomly assigned to be consumed two hours before and directly after the experimental exercise sessions. Post-exercise nocturnal interstitial glucose levels (24:00-06:00) were continuously monitored, and a 120-min OGTT was conducted the following morning to assess substrate oxidation rates and glucose control.

RESULTS: Pre-exercise CHO intake significantly lowered capillary glucose levels during steady-state exercise (mean difference 0.41 ± 0.27 mmol/L, p = 0.001) without affecting perceived exertion and TT-performance. No difference was observed in nocturnal glucose regulation (00:00-06:00) regardless of whether CHO was consumed before or after exercise. Post-exercise CHO ingestion reduced glucose tolerance during the OGTT compared to the iso-caloric pre-exercise CHO intake (mean difference 0.76 ± 0.21 mmol/L, p = 0.017). However, a post-exercise CHO intake improved respiratory exchange ratio/metabolic flexibility (MetF) significantly. Enhanced MetF during the first OGTT hour after post-exercise CHO ingestion resulted in 70% and 91% higher CHO oxidation compared to pre-exercise CHO and control, respectively (p ≤ 0.029). Average 120-min OGTT fat oxidation rates were higher with both pre- and post-exercise CHO ingestion compared to control (p ≤ 0.008), with no difference between pre- and post-exercise CHO intake.

CONCLUSION: Morning glucose tolerance was markedly reduced in healthy athletes when CHO was ingested after evening exercise. However, the observed improvements in MetF during the OGTT compared to placebo post-exercise suggest a potential for enhanced athletic performance in subsequent exercise sessions. This opens exciting possibilities for future research to explore whether enhanced MetF induced by CHO-timing can translate to improved athletic performance, offering new avenues for optimizing training and performance.

Ort, förlag, år, upplaga, sidor
Taylor & Francis, 2025. Vol. 22, nr 1, artikel-id 2494839
Nyckelord [en]
Carbohydrate metabolism, continuous glucose monitoring, exercise, fat metabolism, glucose tolerance test, nutrition
Nationell ämneskategori
Idrottsvetenskap och fitness
Identifikatorer
URN: urn:nbn:se:oru:diva-120766DOI: 10.1080/15502783.2025.2494839ISI: 001472968000001PubMedID: 40259503Scopus ID: 2-s2.0-105003390507OAI: oai:DiVA.org:oru-120766DiVA, id: diva2:1954442
Forskningsfinansiär
Örebro universitetTillgänglig från: 2025-04-24 Skapad: 2025-04-24 Senast uppdaterad: 2026-01-14Bibliografiskt granskad
Ingår i avhandling
1. Strategies for Glycemic Control in Type 1 Diabetes Before, During and After Prolonged Exercise
Öppna denna publikation i ny flik eller fönster >>Strategies for Glycemic Control in Type 1 Diabetes Before, During and After Prolonged Exercise
2025 (Engelska)Doktorsavhandling, sammanläggning (Övrigt vetenskapligt)
Abstract [en]

Background: Physical exercise (PE) represents a challenge in achieving stable glycemic control in individuals with type 1 diabetes (T1D), especially during prolonged PE. Achieving euglycemia requires careful adjustments of carbohydrate (CHO) intake and insulin doses before, during, and after PE, by proactive use of continuous glucose monitoring (CGM).

Aim: This thesis evaluated strategies for achieving glucose control in T1D before, during, and after prolonged PE, focusing on CHO intake, insulin adjustments assisted by CGM, and education intended to improve self-management.

Methods: Four studies were conducted: (1) High CHO intake with insulin adjustments during prolonged PE; (2) CHO loading, tailored pre-race insulin dose, and high CHO intake during PE; (3) CHO replenishment after evening exercise on nocturnal glucose regulation in healthy individuals; and (4) impact of a diabetes sports camp for adults integrating education and exercise and long-term self-management.

Results: Before PE: CHO loading with basal insulin adjustment maintained stable glycemia. Tailored pre-race insulin supported euglycemia. During PE: High CHO intake (75–100 g/h) with individualized insulin strategies enabled stable glucose levels. After PE: The timing of CHO intake did not affect nocturnal glucose levels when daily energy and CHO needs were met. Self-management: The diabetes sports camp was associated with improvements in perceived diabetes self-management skills.

Conclusion: Glycemic stability in T1D before, during, and after prolonged PE is achievable through individualized CHO and insulin strategies, supported by CGM and structured education.

Ort, förlag, år, upplaga, sidor
Örebro: Örebro University, 2025. s. 139
Serie
Örebro Studies in Medicine, ISSN 1652-4063 ; 342
Nyckelord
Carbohydrates, Continuous glucose monitoring, Diabetes self-management, Diabetes sports camps, Education, Exercise, Hypoglycemia, Insulin, Type 1 diabetes
Nationell ämneskategori
Allmänmedicin
Identifikatorer
urn:nbn:se:oru:diva-123540 (URN)9789175297156 (ISBN)9789175297163 (ISBN)
Disputation
2025-12-05, Örebro universitet, Campus USÖ, Tidefeltsalen, Södra Grev Rosengatan 32, Örebro, 13:00 (Svenska)
Opponent
Handledare
Tillgänglig från: 2025-09-09 Skapad: 2025-09-09 Senast uppdaterad: 2025-11-17Bibliografiskt granskad

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Mattsson, StigJendle, Johan

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