title: Efficacy of single-hormone and dual-hormone artificial pancreas during continuous and interval exercise in adult patients with type 1 diabetes: randomised controlled crossover trial.
abstract: The aim of this study was to assess whether the dual-hormone (insulin and glucagon) artificial pancreas reduces hypoglycaemia compared with the single-hormone (insulin alone) artificial pancreas during two types of exercise.
  
  
  
  An open-label randomised crossover study comparing both systems in 17 adults with type 1 diabetes (age, 37.2 ± 13.6 years; HbA1c,8.0 ± 1.0% [63.9 ± 10.2 mmol/mol]) during two exercise types on an ergocycle and matched for energy expenditure: continuous (60% [Formula: see text] for 60 min) and interval (2 min alternating periods at 85% and 50% [Formula: see text] for 40 min, with two 10 min periods at 45% [Formula: see text] at the start and end of the session). Blocked randomisation (size of four) with a 1:1:1:1 allocation ratio was computer generated. The artificial pancreas was applied from 15:30 hours until 19:30 hours; exercise was started at 18:00 hours and announced 20 min earlier to the systems. The study was conducted at the Institut de recherches cliniques de Montréal.
  
  
  
  During single-hormone control compared with dual-hormone control, exercise-induced hypoglycaemia (plasma glucose <3.3 mmol/l with symptoms or <3.0 mmol/l regardless of symptoms) was observed in four (23.5%) vs two (11.8%) interventions (p = 0.5) for continuous exercise and in six (40%) vs one (6.25%) intervention (p = 0.07) for interval exercise. For the pooled analysis (single vs dual hormone), the median (interquartile range) percentage time spent at glucose levels below 4.0 mmol/l was 11% (0.0-46.7%) vs 0% (0-0%; p = 0.0001) and at glucose levels between 4.0 and 10.0 mmol/l was 71.4% (53.2-100%) vs 100% (100-100%; p = 0.003). Higher doses of glucagon were needed during continuous (0.126 ± 0.057 mg) than during interval exercise (0.093 ± 0.068 mg) (p = 0.03), with no reported side-effects in all interventions.
  
  
  
  The dual-hormone artificial pancreas outperformed the single-hormone artificial pancreas in regulating glucose levels during announced exercise in adults with type 1 diabetes.
  
  
  
  ClinicalTrials.gov NCT01930110 FUNDING: : Société Francophone du Diabète and Diabète Québec.
authors.affiliation: Institut de recherches cliniques de Montréal, 110 Avenue des Pins Ouest, Montréal, Québec, Canada, H2W 1R7.|Division of Biomedical Sciences, Faculty of Medicine, Université de Montréal, Montréal, Québec, Canada.
authors.forename: Nadine
authors.initials: N
authors.lastname: Taleb
authors.affiliation: Institut de recherches cliniques de Montréal, 110 Avenue des Pins Ouest, Montréal, Québec, Canada, H2W 1R7.|Division of Experimental Medicine, Department of Medicine, McGill University, Montréal, Québec, Canada.
authors.forename: Ali
authors.initials: A
authors.lastname: Emami
authors.affiliation: Institut de recherches cliniques de Montréal, 110 Avenue des Pins Ouest, Montréal, Québec, Canada, H2W 1R7.
authors.forename: Corinne
authors.initials: C
authors.lastname: Suppere
authors.affiliation: Institut de recherches cliniques de Montréal, 110 Avenue des Pins Ouest, Montréal, Québec, Canada, H2W 1R7.
authors.forename: Virginie
authors.initials: V
authors.lastname: Messier
authors.affiliation: Montreal Children's Hospital, McGill University Health Centre, Montréal, Québec, Canada.
authors.forename: Laurent
authors.initials: L
authors.lastname: Legault
authors.affiliation: Centre de recherche du Centre hospitalier de l'université de Montréal (CRCHUM), Montréal, Québec, Canada.
authors.forename: Martin
authors.initials: M
authors.lastname: Ladouceur
authors.affiliation: Centre de recherche du Centre hospitalier de l'université de Montréal (CRCHUM), Montréal, Québec, Canada.|Montreal Diabetes Research Center, Montréal, Québec, Canada.
authors.forename: Jean-Louis
authors.initials: JL
authors.lastname: Chiasson
authors.affiliation: Department of Biomedical Engineering, Faculty of Medicine, McGill University, Montréal, Québec, Canada.|Division of Endocrinology, Faculty of Medicine, McGill University, Montréal, Québec, Canada.
authors.forename: Ahmad
authors.initials: A
authors.lastname: Haidar
authors.affiliation: Institut de recherches cliniques de Montréal, 110 Avenue des Pins Ouest, Montréal, Québec, Canada, H2W 1R7. remi.rabasa-lhoret@ircm.qc.ca.|Montreal Diabetes Research Center, Montréal, Québec, Canada. remi.rabasa-lhoret@ircm.qc.ca.|Nutrition department, Faculty of Medicine, Université de Montréal, Montréal, Québec, Canada. remi.rabasa-lhoret@ircm.qc.ca.
authors.forename: Rémi
authors.initials: R
authors.lastname: Rabasa-Lhoret
mesh_terms: D000328:Adult; D000465:Algorithms; D001786:Blood Glucose / Q000187:drug effects; D018592:Cross-Over Studies; D003922:Diabetes Mellitus, Type 1 / Q000188:drug therapy* / Q000503:physiopathology*; D015444:Exercise / Q000502:physiology*; D005260:Female; D005934:Glucagon / Q000627:therapeutic use*; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use; D007328:Insulin / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D019397:Pancreas, Artificial; D055815:Young Adult
chemical_list: D001786:Blood Glucose; D007004:Hypoglycemic Agents; D007328:Insulin; D005934:Glucagon
keywords: Artificial pancreas; Exercise; Glucagon; Hypoglycaemia; Type 1 diabetes