Insulin Pumps, CGM Help Empower Older Adults With Type 1 Diabetes to Exercise

Older patients with type 1 diabetes (T1D) appear to benefit from insulin pumps and continuous glucose monitoring (CGM) when exercising, according to a new report.

The study, based on the experiences of 30 adults aged 60 or older, affirms the benefits of the technology, and also counters concerns that age might be a barrier to embracing newer diabetes management technologies.

Writing in the journal Acta Diabetologica, corresponding author Sybil A. McAuley, PhD, of the University of Melbourne, and co-authors explained that guidelines recommend older adults with T1D exercise for between 120 and 150 minutes each week, including moderate-intensity aerobic activity and resistance training.

However, McAuley and colleagues said exercise can be a challenge for this population, not only because of physical limitations associated with age, but also because exercise brings with it greater glucose variability and the risk of hypoglycemia.

The investigators wanted to better understand the exercise habits of older people with T1D, and the impact insulin pump therapy might have on their self-management practices.

They turned to a list of people who had participated in an earlier trial of closed-loop insulin therapy, identifying 30 people who had been diagnosed with T1D for at least a decade and who were using insulin pumps. In addition to obtaining clinical characteristics and health histories, the investigators also asked patients to complete surveys related to their disease self-management, confidence, goals, and exercise habits.

The patients in the study tended to be active; they exercised a median of 4 days per week for a median duration of 60 minutes.

All of the participants had experience using real-time CGM, and 25 were currently using real-time CGM systems. About half (17 patients) were using a first-generation closed-loop system with automated basal insulin delivery, McAuley and colleagues said.

When asked about their perceptions of exercise and its impact on glucose levels, 21 patients said glucose management influenced their exercise participation, and 3 patients said fears of hypoglycemia limited their exercise levels.

“Twenty-four participants (80%) always checked their glucose levels pre-exercise,” the investigators said. “Five participants (17%) routinely consumed bedtime snacks to avoid exercise-related overnight hypoglycemia; however, 4 of those participants also routinely administered an insulin bolus dose with these snacks.”

The 30 patients universally agreed that their insulin pumps improved their self-management of their diabetes when it came to exercise, but 2 patients felt that CGM negatively affected their diabetes management related to exercise because they ended up needing additional blood glucose testing to calibrate their CGM devices or verify low-glucose alerts.

Seventeen participants used closed-loop systems, and most (11) said the devices helped.

“The other 6 felt that closed-loop therapy did not confer exercise-related glucose benefits; the burdens described included experiencing hypoglycemia despite using a temporary higher glucose target, delayed effects of insulin adjustment, and higher confidence with personally adjusting insulin dosing than the closed-loop algorithm.”

When asked where they got information about how to manage their diabetes while exercising, the most common response was personal experience, followed by consulting with diabetes educators and endocrinologists.

The authors included a number of caveats. They noted that while the participants in the study were very active, half of the participants said leisurely walking was their most strenuous activity, even though that does not meet exercise intensity recommendations for this patient population. In addition, while most patients were careful to check glucose levels before exercise, most did not follow other strategies to avoid exercise-related glucose problems.

Still, McAuley and colleagues said the data suggest tools like insulin pumps and CGM can make a meaningful difference in exercise rates among older adults.

“Our observations imply greater use of technologies for older adults with T1D may assist with reducing barriers to exercise through safer and more optimal exercise-related glucose management,” they wrote.

However, they also warned that patients who are less healthy or have significant comorbidities may face barriers to exercise that will not be fully ameliorated by these devices.

Reference:

Chakrabarti A, Mohammad Alipoor A, Sandra Segaran TR, et al. Exercise habits and glucose management among older adults with type 1 diabetes using insulin pumps. Acta Diabetol. Published online March 1, 2022. doi:10.1007/s00592-022-01858-3