Regular exercise is an important part of healthy lifestyle for people with diabetes (PWD). However, the complexities around adjusting insulin doses and food intake to maintain glucose control during exercise are major barriers. Current paper-based guidelines are difficult to apply in practice and provide limited individualisation of recommendations, and there is an unmet need for software-based clinical decision support tools. Here we describe an application (app), which we have developed, to provide personalised proactive guidance with the goal of facilitating improved glucose control around exercise.
In the software development process, the decision tree from the current international consensus guidelines (Riddell et al.) was deconstructed and expanded from 8 branches in total to 3 separate decision trees for aerobic, mixed and anaerobic exercise with 20, 20 and 6 pathways, respectively. The app provides recommendations for insulin dose adjustments throughout the day and weight-based carbohydrate supplements, as well as pre-emptive bedtime guidance to prevent nocturnal hypoglycaemia following exercise. Guidance is customised based on insulin delivery modality (pump vs injection therapy), insulin-on-board status and includes specific exercise suggestions based on current glucose levels and hypoglycaemia risk. This latter functionality, specifically recommendations for mixed or anaerobic exercise activity to minimise carbohydrate supplementation requirements, could facilitate the use of exercise to support weight management goals in PWD on insulin.
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This personalised exercise advisor app addresses an important therapeutic need for a tool to facilitate exercise in PWD on insulin.
Reference:
Riddell et al. Lancet Diabetes Endocrinol. 2017;5:377-390.