Exercising Safely with the MiniMedTM 780G Automated Insulin Delivery System

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The physical and psychological benefits of exercise are particularly pertinent to people with type 1 diabetes (T1D). The variability in subcutaneous insulin absorption and the delay in offset and onset in glucose lowering action impose limitations, given the rapidly varying insulin requirements with exercise. Simultaneously, there are challenges to glucose monitoring. Consequently, those with T1D are less likely to exercise because of concerns regarding glucose instability. While glucose control with exercise can be enhanced using automated insulin delivery (AID), all commercially available AID systems remain limited by the pharmacokinetics of subcutaneous insulin delivery. Although glycemic responses may vary with exercises of differing intensities and durations, the principles providing the foundation for guidelines include minimization of insulin on board before exercise commencement, judicious and timely carbohydrate supplementation, and when possible, a reduction in insulin delivered in anticipation of planned exercise. There is an increasing body of evidence in support of superior glucose control with AID over manual insulin dosing in people in T1D who wish to exercise. The MiniMed™ 780G AID system varies basal insulin delivery with superimposed automated correction boluses. It incorporates a temporary (elevated glucose) target of 8.3 mmol/L (150 mg/dL) and when it is functioning, the autocorrection boluses are stopped. As the device has recently become commercially available, there are limited data assessing glucose control with the MiniMed™ 780G under exercise conditions. Importantly, when exercise was planned and implemented within consensus guidelines, %time in range and %time below range targets were met. A practical approach to exercising with the device is provided with illustrative case studies. While there are limitations to spontaneity imposed on any AID device due to the pharmacokinetics associated with the subcutaneous delivery of current insulin formulations, the MiniMed™ 780G system provides people with T1D an excellent option for exercising safely if the appropriate strategies are implemented.
OriginalsprogEngelsk
TidsskriftDiabetes Technology and Therapeutics
Vol/bind26
Udgave nummerS3
Sider (fra-til)84-96
Antal sider13
ISSN1520-9156
DOI
StatusUdgivet - 2024

Bibliografisk note

Funding Information:
D.N.O. has received honoraria from Medtronic, Insulet, Abbott, Novo, and Sanofi. Research Support was from Medtronic, Insulet, Dexcom, Roche, GlySense, BioCapillary, Endogenex. Advisory board membership with Medtronic, Insulet, Abbott, Ypsomed, Novo, and Sanofi. D.P.Z. has received honoraria for speaking engagements from Ascensia Diabetes, Insulet Canada, and Medtronic Diabetes. D.P.Z. also serves as a member of the DexCom Advisory Board. O.M. has nothing to declare. K.N. holds shares in Novo Nordisk; has been a paid consultant for Novo Nordisk and Medtronic; and has received speaker honorarium and honorarium for Advisory Board to her institution from Medtronic, Novo Nordisk, Insulet, Convatec; her institution has received research funding from Zealand Pharma, Novo Nordisk, Medtronic, and Dexcom. None of the investigators has any personal financial interest in the conduct or the outcome of this article.

Publisher Copyright:
© 2024 Mary Ann Liebert Inc.. All rights reserved.

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