Executive summary of the consensus statement of: Clinical recommendations for sport practice in people with diabetes (RECORD Guide). Update 2021. Diabetes Mellitus Area of the Spanish Society of Endocrinology and Nutrition (SEEN)

Elsevier

Available online 18 November 2022

Endocrinología, Diabetes y Nutrición (English ed.)Author links open overlay panelAbstractObjective

To guide professionals involved in the care of people with diabetes mellitus who practice sport.

Participants

Members of the Diabetes Mellitus Working Group of the Spanish Society of Endocrinology and Nutrition.

Methods

A group of experts in each area covered by the statement carried out a bibliographic review of the available evidence for each topic, based on which recommendations were subsequently agreed upon within the Diabetes Mellitus Working Group.

Conclusions

The statement provides practical recommendations for the management of diabetes mellitus during sports practice.

ResumenObjetivo

Orientar a los profesionales involucrados en la asistencia de personas con diabetes mellitus que realizan deporte.

Participantes

Miembros del Grupo de Trabajo de Diabetes Mellitus de la Sociedad Española de Endocrinología y Nutrición.

Métodos

Un grupo de expertos en cada área del documento realizó una revisión bibliográfica de la evidencia disponible para cada tema, en base a las cuales se establecieron unas recomendaciones posteriormente consensuadas dentro del Grupo de Trabajo de Diabetes Mellitus.

Conclusiones

El documento aporta cuestiones prácticas para el manejo de la diabetes mellitus durante la práctica deportiva.

Introduction

In 2015, the Grupo de Trabajo de Diabetes Mellitus (GTDM) [Diabetes Mellitus Working Group] of the Sociedad Española de Endocrinología y Nutrición (SEEN) [Spanish Society of Endocrinology and Nutrition] (GTDM-SEEN) prepared its "Clinical recommendations for the practice of sport by people with diabetes mellitus (RECORD Guide)",1 to offer guidance for professionals involved in the care of people with DM who do sport.

With the appearance of new drugs, continuous glucose monitoring (CGM) systems, and new publications in this field, these recommendations have been updated.

The complete document to which this executive summary corresponds can be consulted at:

https://www.seen.es/ModulGEX/workspace/publico/modulos/web/docs/apartados/2814/270122_032340_8130974046.pdf.

Section snippetsMethodology

Within the GTDM-SEEN, a group of experts was selected who carried out a bibliographic review of the available evidence for each topic with an inclusion date until 31 September 2020.

Given the practical absence of clinical studies related to most of the aspects reviewed, it was not possible to establish recommendations based on the level of evidence. Therefore, it was decided to formulate “expert recommendations” based on the available data discussed jointly by the Working Group and have

Effects on glycaemic control of different types of exercise

Exercise increases muscle glucose uptake by improving insulin sensitivity (IS) in an insulin-independent manner. These effects differ according to the type of DM.2

The intensity of aerobic exercise is usually defined by the consumption of O2 by the muscles In practice, the percentage of maximum heart rate (MHR) can be used. The intensity is mild if the %MHR is <40-50%, moderate if it is 50–70% and high if it is >70−80%.

Pre-exercise medical evaluation

People with DM should undergo an assessment before starting an exercise programme3 that will include the following points:

Setting some goals:

o

Finding out if the patient has any associated disease or complication.

o

Planning and scheduling exercise.

o

Preventing injuries.

Reviewing the diabetes care plan (glycaemic control, therapy, education, etc.).

Pre-exercise medical examination.4

Formulation of specific recommendations (Table 1).5

Special examinations (stress test, spirometry, ECG).

Assessment of sport

Modifications to be made in the diet

The recommended balance of macronutrients is 45–65% carbohydrates (CH), 20–35% fats and 10–35% proteins2, although it should be personalised. Ensure the intake of B vitamins, iron, calcium and vitamin D. They should only be supplemented if there are deficits in the diet or if they are found to be lacking.7

Before, during and after exercise, adjustments will be made according to Table 2. In prolonged exercise or recovery, slowly absorbed CH (sCH) reduces the risk of hypoglycaemia and avoids

Glucose monitoring

The EASD-ISPAD-ADA position on the use of CGM and flash glucose monitoring during exercise6 suggests doing the following when taking exercise:

Pre-exercise preparation:

o

Set the hypoglycaemia alarm at the highest level allowed during peak exercise and the hyperglycaemia alarm above 180 md/dl to avoid alarm fatigue.

During exercise:

o

Maintain a time in the range of 90−180 mg/dl (126−180 mg/dl in the case of prolonged aerobic exercise).

After exercise:

o

Time in range of 80−180 mg/dl for the first 90 min after

Insulin therapeutic strategy (injectable)

The intensity, duration and type of exercise, and the corresponding individual metabolic response to it, must be predetermined to consider specific adjustments of the insulin dose.2 The increasingly widespread use of CGM makes it possible to take into account the current glucose levels and the prediction of their trend in the following hours when making these decisions (Fig. 1).

Adjustment of non-insulin drugs

In general, it is not necessary to modify the regimen of non-insulin drugs for sporadic exercise, but secretagogue drugs and SGLT2 inhibitors should be reduced or discontinued when intense and long-lasting exercise is performed.

People with DM on continuous subcutaneous insulin infusion (CSII)

The following considerations should be taken into account:

Choose the place of insertion of the catheter avoiding areas where it can receive blows or cause rubbing or friction.

In general, it is not recommended to turn off the CSII, but it may be necessary for some sports (aquatic, contact, etc).

In the event of disconnection (try not to exceed 1−2 h), previously administer a bolus equivalent to the basal rate (BR) x 1.25, applying a reduction of 20–50%. In disconnections >3−4 h, administer the

Training guidelines for physical exercise

Training for people with DM has dual aspects which must go in parallel: on the one hand, the physical training incorporates and increases physical fitness, and on the other, the training is supported by structured diabetes education to minimise the risk of dysglycaemia.

It is a planned and complex process that organises progressive and increasing workloads that stimulate the development of different physical capacities. The glycaemic response to exercise depends on variables related to DM and

Peculiarities of specific sports

The special characteristics of each sport can influence the practical management of people with DM.

Diving can be practised safely by patients with DM as long as a series of conditions are followed, and various guides deal with this aspect.9 Cases have been published on the effective use of IGM during repetitive dives. To prevent decompression sickness, good hydration is very important, and it would be advisable for subjects with DM to readjust their dive computers to more conservative safety

Exercise for adolescents with type 1 diabetes

Table 6, Table 7 provide recommendations for treatment with insulin and CH before and during exercise in children and adolescents with DM1 adapted to the ESAD, ISADP and ADA recommendations.6

After finishing exercise (90 min post-exercise), the recommended glucose range is 80−180 mg/dl or higher, depending on the risk of hypoglycaemia. If sensor glucose levels rise rapidly, a correction bolus of insulin (50% of the usual correction dose) may be considered, except around bedtime, to avoid

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© 2021 SEEN and SED. Published by Elsevier España, S.L.U. All rights reserved.

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