328-OR: Hypoglycemia Associated with Physical Activity in Automated Insulin Delivery Users—Frequency and Prevention Strategies
Authors: BOUDREAU VALERIE , YARDLEY JANE E. , RUSSON CATHERINE L. , CHAHAL TAMANNA , ST-AMAND ROXANE , RABASA-LHORET RÉMI P.R. , MOLVEAU JOSÉPHINE 
Published: June 2024

Introduction & Objectives: Even with automated insulin delivery (AID), hypoglycemia during and after physical activity (PA) remains a concern for people living with type 1 diabetes (pwT1D). The aim is to evaluate frequency of and strategies to prevent and treat hypoglycemic events (HE).
Methods: Active pwT1D shared glycemic and pump data, PA logbook and food diaries for any HE prevention or correction strategy for 6-weeks. Values are presented as median (interquartile range) unless specified. We looked at HE on CGM defined according to international consensus in AID-treated pwT1D during, 1-h and 4-h post-PA using Chi2 or Anova tests.
Results: A total of 25 pwT1D (17 females) aged 50 (23 to 75) years and A1c 6.7 (6.4-7.0) % completed 436 PA sessions: 17 (6-49) per participant lasting 50 (35-60) minutes, with 25.2% low, 63.8% moderate and 11.0% vigorous intensity. Participants’ prevention strategies included: pre-exercise snack (37.4%; 20 (15-25) g of carbohydrates), PA mode (18.8%), meal bolus reduction (15.6%), snacking during/after (11.2%; 24 (15-35) g of carbohydrates), pump disconnection (4.6%), and other strategies (16.5%; e.g. PA session suspended, or basal insulin reduced/suspended). Reported strategies per session were 29.6% for no strategy, 34.6% for one and 35.8% for &gt; 1. HE occurred 5 times during PA (1.1%), 28 (6.4%) 1-h post PA and 61 (14.0%) 4-h post-PA. PA intensity and duration are associated with HE during PA (p = 0.006 and p = 0.001, respectively). Insulin on board at PA start was not associated with HE, but last meal insulin bolus (before PA) was associated to 1-h post-PA HE (p = 0.018). Participants (n = 7) using an open-source AID had significantly less hypoglycemia 4-h post-PA (6.6 vs. 15.4% of sessions, p = 0.021).
Conclusion: Carbohydrate intake is the most common prevention strategy. Incidence of hypoglycemia during PA is low but tends to increase after PA. Open-source AID may reduce post-PA hypoglycemia.

Disclosure
V. Boudreau: None. J.E. Yardley: Speaker's Bureau; Dexcom, Inc. Research Support; LifeScan Diabetes Institute. C.L. Russon: None. T. Chahal: None. R. St-Amand: None. R.P.R. Rabasa-Lhoret: Other Relationship; Abbott, AstraZeneca, Bayer Inc., Boehringer-Ingelheim, Dexcom, Inc. Research Support; Diabetes Canada. Other Relationship; Eli Lilly and Company. Research Support; Cystic Fibrosis Canada, Canadian Institutes of Health Research, FFRD - Fondation Francophone pour la Recherche du Diabète. Other Relationship; Janssen Pharmaceuticals, Inc. Research Support; Juvenile Diabetes Research Foundation (JDRF). Other Relationship; Novo Nordisk, GlaxoSmithKline plc. Consultant; HLS Therapeutics Inc., Insulet Corporation. Speaker's Bureau; CPD Networks. Other Relationship; Medtronic. Consultant; Pfizer Inc. Speaker's Bureau; Tandem Diabetes Care, Inc. Other Relationship; Sanofi. Speaker's Bureau; Vertex Pharmaceuticals Incorporated. Research Support; SFD - Société Francophone du Diabète. J. Molveau: None.

Funding
Diabetes Canada (OG-3-21-5586-RR)