title: Effects of performing morning versus afternoon exercise on glycemic control and hypoglycemia frequency in type 1 diabetes patients on sensor-augmented insulin pump therapy.
abstract: BACKGROUND
  Although physical exercise (PE) is recommended for individuals with type 1 diabetes (DM1), participation in exercise is challenging because it increases the risk of severe hypoglycemia and the available therapeutic options to prevent it frequently result in hyperglycemia. There is no clear recommendation about the best timing for exercise. The aim of this study was to compare the risk of hypoglycemia after morning or afternoon exercise sessions up to 36 hours postworkout.
  
  
  METHODS
  This randomized crossover study enrolled subjects with DM1, older than 18 years of age, on sensor-augmented insulin pump (SAP) therapy. Participants underwent 2 moderate-intensity exercise sessions; 1 in the morning and 1 in the afternoon, separated by a 7 to 14 day wash-out period. Continuous glucose monitoring (CGM) data were collected 24 hours before, during and 36 hours after each session.
  
  
  RESULTS
  Thirty-five subjects (mean age 30.31 ± 12.66 years) participated in the study. The rate of hypoglycemia was significantly lower following morning versus afternoon exercise sessions (5.6 vs 10.7 events per patient, incidence rate ratio, 0.52; 95% CI, 0.43-0.63; P < .0001). Most hypoglycemic events occurred 15-24 hours after the session. On days following morning exercise sessions, there were 20% more CGM readings in near-euglycemic range (70-200 mg/dL) than on days prior to morning exercise (P = .003).
  
  
  CONCLUSIONS
  Morning exercise confers a lower risk of late-onset hypoglycemia than afternoon exercise and improves metabolic control on the subsequent day.
authors.affiliation: Pontificia Universidad Javeriana, Bogota, Colombia Hospital Universitario San Ignacio, Bogota, Colombia amgomezm5@gmail.com.
authors.forename: Ana Maria
authors.initials: AM
authors.lastname: Gomez
authors.affiliation: Pontificia Universidad Javeriana, Bogota, Colombia Hospital Universitario San Ignacio, Bogota, Colombia.
authors.forename: Claudia
authors.initials: C
authors.lastname: Gomez
authors.affiliation: Pontificia Universidad Javeriana, Bogota, Colombia Hospital Universitario San Ignacio, Bogota, Colombia.
authors.forename: Pablo
authors.initials: P
authors.lastname: Aschner
authors.affiliation: Clinica La Colina, Bogota, Colombia.
authors.forename: Angelica
authors.initials: A
authors.lastname: Veloza
authors.affiliation: Pontificia Universidad Javeriana, Bogota, Colombia Hospital Universitario San Ignacio, Bogota, Colombia.
authors.forename: Oscar
authors.initials: O
authors.lastname: Muñoz
authors.affiliation: Hospital Universitario San Ignacio, Bogota, Colombia.
authors.forename: Claudia
authors.initials: C
authors.lastname: Rubio
authors.affiliation: Pontificia Universidad Javeriana, Bogota, Colombia Hospital Universitario San Ignacio, Bogota, Colombia.
authors.forename: Santiago
authors.initials: S
authors.lastname: Vallejo
mesh_terms: D000328:Adult; D000368:Aged; D001786:Blood Glucose / Q000378:metabolism*; D018660:Blood Pressure Monitoring, Ambulatory; D018592:Cross-Over Studies; D003922:Diabetes Mellitus, Type 1 / Q000188:drug therapy* / Q000378:metabolism; D005081:Exercise Therapy / Q000379:methods*; D005260:Female; D006801:Humans; D006943:Hyperglycemia / Q000097:blood / Q000188:drug therapy*; D007003:Hypoglycemia / Q000139:chemically induced / Q000453:epidemiology; D007004:Hypoglycemic Agents / Q000008:administration & dosage* / Q000627:therapeutic use*; D007328:Insulin / Q000008:administration & dosage* / Q000627:therapeutic use*; D007332:Insulin Infusion Systems; D008297:Male; D008875:Middle Aged; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D001786:Blood Glucose; D007004:Hypoglycemic Agents; D007328:Insulin
keywords: diabetes mellitus type 1; exercise; hypoglycemia; insulin infusion system