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Selected Publication:
Yildirim, H.
The effects of prolonged fasting on glucose metabolism and hormonal regulation in people with type 1 diabetes
Humanmedizin; [ Diplomarbeit ] Medical University of Graz; 2021. pp. 89
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- Authors Med Uni Graz:
- Advisor:
- Moser Othmar
- Tripolt Norbert
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- Abstract:
- Background: Although fasting has been shown to improve several metabolic parameters, there is little information about the effects of prolonged intermittent fasting on individuals with type 1 diabetes mellitus (T1D). Especially glucose metabolism and hormonal regulation after breaking the prolonged fast need particular attention as this presents a critical moment. Therefore, we compared the first carbohydrate intake after overnight fasting and after prolonged fasting in people with T1D. Methods: In this monocentric, open-label and cross-over controlled trial, adults with T1D, negative C-peptide, treated with multiple daily injections (MDI) or continuous subcutaneous insulin infusion (CSII), HbA1c <9.5%, diagnosis >12 months ago, stable insulin therapy, and using a form of continuous glucose monitoring system (CGM) were included. Participants first fasted for 12 hours and then for 36 hours before undergoing an 75gr oral glucose tolerance Test (OGTT) after every fast. Same amount of bolus insulin was administered at both trial visits. Blood samples were taken before carbohydrate intake and 15min, 30min, 60min, 120min and 240min afterwards. Plasma glucose, C-peptide, glucagon, cortisol, and exogenous insulin levels were measured. Additional laboratory measurements, resting spirometry and bioelectric impedance analysis were also performed. Data were compared via paired t-tests and mixed-model regressions (p ≤ 0.05). Results: Twenty individuals with T1D (7 females) with a mean ± SD age of 35±11 years, body mass index (BMI) 24.8±2.8 kg/m2, HbA1c 7.1±0.6% (54±7 mmol/mol), diabetes duration of 20±11 years, and total daily dose (TDD) of 40±14 IU insulin finished the trial. Eleven participants used MDI therapy, while 9 participants were treated with CSII. Primarily, mean glucose at the 120th minute of OGTT (308 ± 91 mg/dL vs. 313 ± 71 mg/dL; p = 0.73), and area under the curve of plasma glucose levels during the first 120 minutes of OGTT (31823 ± 8557 vs. 29957 ± 5826; p = 0.21) were comparable after 12h and 36h fasting. Secondarily, plasma glucose courses (p = 0.68) and corresponding rate of change (p = 0.44) were also similar in both trial arms. Compared to baseline, bodyweight was significantly lower after prolonged fasting (76.7 ± 13.5 kg vs. 75.4 ± 13.4 kg; p = 0.0002). During prolonged fasting, participants with a total daily basal dose (TDBD) greater than 0.25 IU insulin per kg body weight had significantly more hypoglycaemic events than the comparison group with ≤ 0.25 IU/kg (1.3 ± 0.9 vs. 2.5 ± 0.9 events; p = 0.009). Conclusion: Single prolonged fasting led to desired weight loss in people with T1D participating in this study. Plasma glucose courses and (dys-)glycaemia after the first high carbohydrate intake presented no statistical differences after 36h fasting compared to 12h fasting. Therefore, adjustments in bolus insulin application are not needed after prolonged fasting. Instead, TDBD should be evaluated before people with T1D start prolonged fasting periods.