Isoenergetic High Intensity Interval Training and Moderate Intensity Training in Adults With Type I Diabetes

Study Overview
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Brief Summary
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Type 1 diabetes (T1D) is associated with increased risk of poor cardiometabolic health. Regular exercise is recommended for optimal management of comorbidities in T1D. Unique barriers to exercise exist for T1D, including fear of hypoglycemia, unpredictable glycemic excursions with exercise, and inadequate knowledge about exercise. Unlike traditional moderate intensity continuous training (MICT) which requires extended periods of time, high intensity interval training (HIIT) requires minimal time ( 10 minutes of exercise per session), with the potential to rapidly stimulate mitochondrial biogenesis and metabolism. The extent to which these exercise strategies alter metabolomic signatures of carbohydrate, fat, and amino acid metabolism in T1D is unknown. The overall goal of the proposed project is to identify the acute metabolic effects and physiological modifiers of HIIT compared to MICT and control (CON) using metabolomic profiling and cardiometabolic assessments in 14 adults with T1D. Using a randomized cross-over approach, the primary aim is to compare the metabolomics response immediately post, 1 hr post, and glycemic control through 48 hrs after HIIT, compared to MICT matched for total energy expenditure, versus a no exercise CON. An additional aim will be to characterize the influence of biological sex and physiological outcomes (i.e. body composition, lean mass, visceral fat) on the metabolomics profile of these subjects. Outcomes from the present study, with existing data from our team, will lay the foundation for a larger diet and exercise lifestyle intervention that will ultimately lead to changes in clinical practice to co-manage glycemia and cardiometabolic comorbidities.

Official Title
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Metabolic, Hormonal, and Physiological Characterization of Isoenergetic High Intensity Interval Training and Moderate Intensity Continuous Training in Adults With Type I Diabetes

Conditions
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Diabetes Mellitus, Type 1

Intervention / Treatment
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* Other: High Intensity Interval Exercise
* Other: Moderate Intensity Continuous Exercise


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Clinical diagnosis of presumed autoimmune T1D, receiving daily insulin Last hemoglobin A1c <9% 18-51 years Duration of T1D: ≥ 1 year Body mass index (BMI) <30 kg/m^2 Generally healthy, with no conditions that could influence the outcome of the trial, and in the judgement of the investigators is a good candidate for the study, based on a review of health history Exclusion Criteria: Physician diagnosis of active diabetic retinopathy that could be worsened by exercise Physician diagnosis of peripheral neuropathy with insensate feet Physician diagnosis of autonomic neuropathy Medications: beta-blockers, agents that affect hepatic glucose production such as beta adrenergic agonists, xanthine derivatives; any hypoglycemic agent other than insulin. Severe hypoglycemic event defined as the individual requiring a third party of hospitalization in the last 6 months Diabetic ketoacidosis in the last 6 months Has a closed-loop pump and not willing to use manual mode Physician diagnosis of cardiovascular disease that would affect exercise tolerance Currently doing HIIT Severely impaired hearing or speech Pregnancy

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 51 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Supportive Care
Allocation: Randomized
Intervention Model: Crossover Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: High intensity interval training, then Moderate Intensity Continuous Training<br>Participants randomly assigned to this arm will first receive high intensity interval training followed by moderate intensity continuous training. | Other: High Intensity Interval Exercise<br>* One session of high intensity interval exercise<br>Other: Moderate Intensity Continuous Exercise<br>* One session of calorically matched moderate intensity exercise<br>|
| Experimental: Moderate Intensity Continous Training, then High Intensity Training<br>Participants randomly assigned to this arm will first receive moderate intensity continuous training followed by high intensity interval training. | Other: High Intensity Interval Exercise<br>* One session of high intensity interval exercise<br>Other: Moderate Intensity Continuous Exercise<br>* One session of calorically matched moderate intensity exercise<br>|
| No Intervention: Control: No exercise<br>Participants will complete the same pre- post measurements, with no exercise in between. | |

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Change in Carbohydrate Metabolism | Tricarboxylic acid intermediates (concentration) | Baseline and 1 hour post exercise | 
| Change in Fat Metabolism | Acylcarnitine concentration | Baseline and 1 hour post | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Change in Continuous Glucose (Area Under the Curve) | Continuous glucose monitoring | Baseline and 48 hours post exercise |