Modeling of Carbohydrates Oxidation Rate During Exercise in Type 1 Highly-Trained Diabetic Patients

Management of Type 1 Diabetes (T1D) in the context of exercise or sports competition still represents a great challenge for athletes living with this disease, due to the wide excursions in blood glucose level with increased risk of life threatening hypoglycemia. Recently, an algorithm called ECRES has been developed to estimate patient-exercise tailored carbohydrates (CHO) supplement required to maintain safe blood glucose levels during physical activity. This method estimates a CHO supplement based on the patient's habitual therapy, the specific patient's insulin sensitivity and the overall amount of CHO oxidized during the specific exercise. The last is based on the glucose pulse relation, i.e. the relation between heart rate (HR) and CHO oxidation rate, already studied in sedentary and moderately-trained subjects, but not in well-trained athletes. This study aimed to model the glucose pulse relation during exercise in type 1 highly trained diabetic patients and in healthy subjects. HR, oxygen consumption and carbon dioxide production were acquired breath-by-breath in seven T1D and seven well-matched healthy highly-trained subjects at four different exercise intensity levels, as well as at rest. Results showed a linear CHOox-HR relation (CHOox = 0.76.%HRmax - 19.6; n = 70, R-2 = 0.78) with no significant difference between the T1D and healthy athletes (p-value = 0.11). In conclusion, results of this study can be implemented in an updated version of the ECRES algorithm allowing an easy estimate of CHO supplement also in highly trained subjects. This useful support system can enhance the self-management of glycaemia during the training sessions of athletic patients throughout mHealth technologies.