A randomised controlled study of high intensity exercise as a dishabituating stimulus to improve hypoglycaemia awareness in people with type 1 diabetes: a proof-of-concept study

• Published in: Diabetologia 2020-04, Vol.63 (4), p.853-863
• Main Authors: Farrell, Catriona M., McNeilly, Alison D., Fournier, Paul, Jones, Timothy, Hapca, Simona M., West, Daniel, McCrimmon, Rory J.
• Format: Article
• Language: English
• Subjects: Adult; Awareness - physiology; Blood Glucose - metabolism; Cognition - physiology; Cognitive ability; Cross-Over Studies; Diabetes; Diabetes mellitus (insulin dependent); Diabetes Mellitus, Type 1 - blood; Diabetes Mellitus, Type 1 - psychology; Diabetes Mellitus, Type 1 - therapy; Diagnostic Self Evaluation; Epinephrine; Exercise; Exercise - physiology; Female; Glycated Hemoglobin A - metabolism; Habits; Habituation; Habituation, Psychophysiologic - physiology; Human Physiology; Humans; Hypoglycemia; Hypoglycemia - psychology; Insulin; Internal Medicine; Male; Medicine; Medicine & Public Health; Metabolic Diseases; Middle Aged; Physical Conditioning, Human - physiology; Physical Stimulation - methods; Proof of Concept Study; Young Adult
• ISSN: 0012-186X; 1432-0428
• DOI: 10.1007/s00125-019-05076-5

Aims/hypothesis Approximately 25% of people with type 1 diabetes have suppressed counterregulatory hormonal and symptomatic responses to insulin-induced hypoglycaemia, which renders them at increased risk of severe, disabling hypoglycaemia. This is called impaired awareness of hypoglycaemia (IAH), the cause of which is unknown. We recently proposed that IAH develops through habituation, a form of adaptive memory to preceding hypoglycaemia. Consistent with this hypothesis, we demonstrated restoration of defective counterregulatory hormonal responses to hypoglycaemia (referred to as dishabituation) in a rodent model of IAH following introduction of a novel stress stimulus (high intensity training [HIT]). In this proof-of-concept study we sought to further test this hypothesis by examining whether a single episode of HIT would amplify counterregulatory responses to subsequent hypoglycaemia in people with type 1 diabetes who had IAH (assessed by Gold score ≥4, modified Clarke score ≥4 or Dose Adjustment For Normal Eating (DAFNE) hypoglycaemia awareness rating 2 or 3). The primary outcome was the difference in adrenaline response to hypoglycaemia following both a single episode of HIT and rest. Methods In this randomised, crossover study 12 participants aged between 18 and 55 years with type 1 diabetes for ≥5 years and an HbA 1c