To compare glucose control with hybrid closed-loop (HCL) when challenged by high intensity exercise (HIE), moderate intensity exercise (MIE), and resistance exercise (RE) while profiling counterregulatory hormones, lactate, ketones, and kinetic data in adults with type 1 diabetes.

Open-label multisite randomized crossover trial. Adults with type 1 diabetes undertook 40 min of HIE, MIE, and RE in random order while using HCL (Medtronic MiniMed^TM 670G) with a temporary target set 2 h prior to and during exercise and 15 g carbohydrates if pre-exercise glucose was <126 mg/dL to prevent hypoglycemia. Primary outcome was median (interquartile range) continuous glucose monitoring time-in-range (TIR; 70–180 mg/dL) for 14 h post–exercise commencement. Accelerometer data and venous glucose, ketones, lactate, and counterregulatory hormones were measured for 280 min post–exercise commencement.

Median TIR was 81% (67, 93%), 91% (80, 94%), and 80% (73, 89%) for 0–14 h post–exercise commencement for HIE, MIE, and RE, respectively (n = 30), with no difference between exercise types (MIE vs. HIE; P = 0.11, MIE vs. RE, P = 0.11; and HIE vs. RE, P = 0.90). Time-below-range was 0% for all exercise bouts. For HIE and RE compared with MIE, there were greater increases, respectively, in noradrenaline (P = 0.01 and P = 0.004), cortisol (P < 0.001 and P = 0.001), lactate (P ≤ 0.001 and P ≤ 0.001), and heart rate (P = 0.007 and P = 0.015). During HIE compared with MIE, there were greater increases in growth hormone (P = 0.024).

Under controlled conditions, HCL provided satisfactory glucose control with no difference between exercise type. Lactate, counterregulatory hormones, and kinetic data differentiate type and intensity of exercise, and their measurement may help inform insulin needs during exercise. However, their potential utility as modulators of insulin dosing will be limited by the pharmacokinetics of subcutaneous insulin delivery.

比较在高强度运动 (HIE)、中等强度运动 (MIE) 和阻力运动 (RE) 的挑战下血糖控制与混合闭环 (HCL) 控制，同时分析成人的反调节激素、乳酸、酮和动力学数据1型糖尿病。

开放标签多站点随机交叉试验。患有 1 型糖尿病的成年人在使用 HCL（美敦力 MiniMed ^TM 670G）时以随机顺序进行了 40 分钟的 HIE、MIE 和 RE，在运动前和运动期间设定了一个临时目标，如果运动前葡萄糖 < 126 mg/dL 以防止低血糖。主要结果是运动开始后 14 小时的中位数（四分位距）连续血糖监测范围（TIR；70-180 mg/dL）。在运动开始后 280 分钟测量加速度计数据和静脉葡萄糖、酮体、乳酸和反调节激素。

HIE、MIE 和 RE 运动开始后 0-14 小时的 TIR 中位数分别为 81%（67、93%）、91%（80、94%）和 80%（73、89%）（n = 30），运动类型之间没有差异（MIE 与 HIE；P = 0.11，MIE 与 RE，P = 0.11；和 HIE 与 RE，P = 0.90）。所有锻炼回合的时间低于范围为 0%。HIE 和 RE 与 MIE 相比，去甲肾上腺素（P = 0.01 和P = 0.004）、皮质醇（P < 0.001 和P = 0.001）、乳酸（P ≤ 0.001 和P ≤ 0.001）和心率 ( P = 0.007 和P= 0.015)。与MIE相比，HIE期间生长激素升高幅度更大（P =0.024）。

在受控条件下，HCL 提供了令人满意的血糖控制，运动类型之间没有差异。乳酸、反调节激素和动力学数据区分运动的类型和强度，它们的测量可能有助于告知运动期间的胰岛素需求。然而，它们作为胰岛素给药调节剂的潜在效用将受到皮下胰岛素递送的药代动力学的限制。