title: Outcomes of algorithm-based modifications of insulinotherapy during exercise in MDI vs insulin pump-treated children with type 1 diabetes: Results from the TREAD-DIAB study.
abstract: OBJECTIVE
  To evaluate the evolution of subcutaneous glucose (SG) after a standardized aerobic exercise in children and adolescents treated with continuous subcutaneous insulin infusion (CSII) or multiple daily injection (MDI) regimen before and after adaptation of insulin doses.
  
  
  METHODS
  Eleven CSII- and 13 MDI-treated patients performed 2 30-minute sessions of moderate to vigorous (70% of age-based maximal heart rate) exercise on a treadmill under continuous glucose monitoring (CGM). First sessions were scheduled without insulin modification (TT#1) while patients performed second sessions (TT#2) after preemptive algorithm-based insulin dose modifications.
  
  
  RESULTS
  While insulin adaptations did not modify immediate postexercise drops in blood glucose during TT#2 in either group, CSII-treated patients had their glucose control improved during TT#2 (mean of 141 ± 56 mg/dL vs 144 ± 80 mg/dL in TT#1; P < .05) with up to 86% of SG levels within targets during 16 hours postexercise. Contrarily, SG levels did not normalize during TT#2 in MDI-treated patients who experienced higher rates of hyperglycemia during the afternoon snack. As compared with TT#1, CSII-treated patients had reduced rates of hypoglycemia during 4 hours post-TT#2 (from 19.5% to 2.1%; P < .01) and had shorter duration of nocturnal hypoglycemia (35.5 ± 12.8 vs 204.7 ± 165 minutes; P = .04) whereas in the MDI group no changes in percentages of hypoglycemia were observed during TT#2.
  
  
  CONCLUSIONS
  In our pediatric cohort, algorithmic adaptations of insulin doses were associated with better outcomes in terms of postexercise glucose control in patients with CSII therapy but not with MDI treatment.
authors.affiliation: Pediatric Cardiology, Cliniques Universitaires Saint-Luc, Brussels, Belgium.|Pôle de Pédiatrie (PEDI), Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Leuven, Belgium.
authors.forename: S
authors.initials: S
authors.lastname: Moniotte
authors.affiliation: Pediatric Endocrinology, Cliniques Universitaires Saint-Luc, Brussels, Belgium.
authors.forename: M
authors.initials: M
authors.lastname: Owen
authors.affiliation: Pediatric Endocrinology, Cliniques Universitaires Saint-Luc, Brussels, Belgium.
authors.forename: T
authors.initials: T
authors.lastname: Barrea
authors.affiliation: Pôle Epidémiologie et Biostatistique, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Brussels, Belgium.
authors.forename: A
authors.initials: A
authors.lastname: Robert
authors.affiliation: Pôle de Pédiatrie (PEDI), Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Leuven, Belgium.|Pediatric Endocrinology, Cliniques Universitaires Saint-Luc, Brussels, Belgium.
authors.forename: P A
authors.identifier: http://orcid.org/0000-0003-1598-7998
authors.initials: PA
authors.lastname: Lysy
mesh_terms: D000293:Adolescent; D000465:Algorithms; D001786:Blood Glucose; D002648:Child; D003922:Diabetes Mellitus, Type 1 / Q000188:drug therapy*; D015444:Exercise / Q000502:physiology*; D005080:Exercise Test; D005260:Female; D006801:Humans; D007003:Hypoglycemia; D007004:Hypoglycemic Agents / Q000008:administration & dosage*; D007328:Insulin / Q000008:administration & dosage*; D007332:Insulin Infusion Systems; D008297:Male
chemical_list: D001786:Blood Glucose; D007004:Hypoglycemic Agents; D007328:Insulin
keywords: CGM; adolescents; algorithm; children; exercise; treadmill; type 1 diabetes