The objective of the study is to evaluate whether pre-exercise administration of low-dose subcutaneous glucagon prevents or attenuates exercise-induced declines in plasma glucose concentration during and after moderate-intensity continuous exercise (MICE) performed approximately 90 minutes after a meal in adults with type 1 diabetes using an automated insulin delivery (AID) system. The primary endpoint is the difference in the change in plasma glucose (PG) from exercise initiation to the nadir during exercise and through the 2-hour post-exercise period between the glucagon (GCN) and carbohydrate (CHO) visits.
This is a randomized, non-blinded, two-period crossover study including 18 adults with type 1 diabetes using an EU-approved automated insulin delivery (AID) system. Each participant will attend one screening visit followed by two experimental visits performed in random order, separated by at least seven days. Eligible participants are adults (≥18 years) with type 1 diabetes for at least 2 years, using an automated insulin delivery system for ≥3 months, treated with NovoRapid or Fiasp for at least 1 week prior to enrollment, and proficient in carbohydrate counting. At each experimental visit, participants will perform a standardized bout of MICE approximately 90 minutes after a meal. On one visit, a low-dose glucagon injection will be administered immediately before exercise; on the other, 20 g oral glucose tablets will be consumed. Right before exercise, the AID system's higher glucose target/exercise mode will be activated and will remain active until 15 minutes after exercise.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
PREVENTION
Masking
NONE
Enrollment
18
Participants will be given a low-dose of glucagon before starting the exercise session
Participants will be given a dose of glucose before starting exercise
Change in plasma glucose (PG) from exercise initiation to the nadir during exercise and throughout the 2-hour post-exercise period between visit GCN and CHO
Time frame: From exercise initiation until two hours following exercise
Percent PG time in range (3.9-10.0 mmol/L) between visits GCN and CHO
Time frame: From exercise onset to +120 min
Incidence of hypoglycemia (PG <3.9 mmol/L) between visits GCN and CHO
Binary
Time frame: 0-180 min
Time to hypoglycemia (PG <3.9 mmol/L) between visits GCN and CHO
Time frame: 0-180 min
Percent time below range (PG <3.9 mmol/L) between visit GCN and CHO
Time frame: 0-180 mins
Percent time above range (PG >10.0 mmol/L) between visits GCN and CHO
Continuous
Time frame: 0-180 min
Incidence of hyperglycemia (PG >10.0 mmol/L) between visits GCN and CHO
Binary
Time frame: 0-180 mins
Nadir PG concentration between visits GCN and CHO
Continuous
Time frame: 0-180 mins
Peak PG concentration between visits GCN and CHO
Continuous
Time frame: 0-180 mins
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Incremental peak PG concentration between visits GCN and CHO
Continuous
Time frame: 0-180 mins
Mean PG concentration between visits GCN and CHO
Continuous
Time frame: 0-180 mins
PG area under the curve (AUC) between visits GCN and CHO
Continuous
Time frame: 0-180 mins
Standard deviation of PG between visits GCN and CHO
Continuous
Time frame: 0-180 mins
Coefficient of variation of PG between visits GCN and CHO
Continuous
Time frame: 0-180 mins