Postexercise Glycemic Control in Type 1 Diabetes Is Associated With Residual β-Cell Function.

Abstract

To investigate the impact of residual β-cell function on continuous glucose monitoring (CGM) outcomes following acute exercise in people with type 1 diabetes (T1D). Thirty participants with T1D for ≥3 years were recruited. First, participants wore a blinded CGM unit for 7 days of free-living data capture. Second, a 3-h mixed-meal test assessed stimulated C-peptide and glucagon. Peak C-peptide was used to allocate participants into undetectable (Cpep_und <3 pmol/L), low (Cpep_low 3-200 pmol/L), or high (Cpep_high >200 pmol/L) C-peptide groups. Finally, participants completed 45 min of incline treadmill walking at 60% VO_2peak followed by a further 48-h CGM capture. CGM parameters were comparable across groups during the free-living observation week. In the 12- and 24-h postexercise periods (12 h and 24 h), the Cpep_high group had a significantly greater amount of time spent with glucose 3.9-10 mmol/L (12 h, 73.5 ± 27.6%; 24 h, 76.3 ± 19.2%) compared with Cpep_low (12 h, 43.6 ± 26.1%, <i>P</i> = 0.027; 24 h, 52.3 ± 25.0%, <i>P</i> = 0.067) or Cpep_und (12 h, 40.6 ± 17.0%, <i>P</i> = 0.010; 24 h, 51.3 ± 22.3%, <i>P</i> = 0.041). Time spent in hyperglycemia (12 h and 24 h glucose >10 and >13.9 mmol/L, <i>P</i> < 0.05) and glycemic variability (12 h and 24 h SD, <i>P</i> < 0.01) were significantly lower in the Cpep_high group compared with Cpep_und and Cpep_low. Change in CGM outcomes from pre-exercise to 24-h postexercise was divergent: Cpep_und and Cpep_low experienced worsening (glucose 3.9-10 mmol/L: -9.1% and -16.2%, respectively), with Cpep_high experiencing improvement (+12.1%) (<i>P</i> = 0.017). Residual β-cell function may partially explain the interindividual variation in the acute glycemic benefits of exercise in individuals with T1D. Quantifying C-peptide could aid in providing personalized and targeted support for exercising patients.