Stratégies pour réduire la variabilité glycémique chez les patients diabétiques de type 1

Chercheurs-boursiers cliniciens- Senior | Concours 2012-2013


Rémi Rabasa-Lhoret

Institut de recherches cliniques de Montréal (IRCM)

 

Domaine : Nutrition et métabolisme

Secretion of insulin, an hormone to reduce blood glucose, is lost in type 1 diabetes (T1D). Consequently, T1D patient are currently treated by insulin therapy using multiple daily injections or insulin pump. Despite these treatments, hypoglycemia (low blood glucose) and hyperglycemia (high blood glucose) remain frequent in T1D patients and can lead to serious complications. In case of hypoglycemia, patients might need glucagon, an hormone to raise blood glucose. The main objective of this research program is to develop a wearable external artificial pancreas to regulate glucose levels in T1D patients. The artificial pancreas is composed of: a continuous glucose monitoring system (to read blood glucose changes), a pump to infuse insulin with or without glucagon and an intelligent dosing method to indicate the insulin or glucagon dose to be infused. Proposed studies will validate the algorithm both at the research center and in free living conditions at patients' home.

Despite the numerous benefits related to exercise, most of T1D adults remain sedentary. We showed that the strongest barrier to undertake physical activity is the fear of hypoglycemia induced by exercise and that sedentary T1D adults are at risk of being overweight/obese and more likely to present hypertension and/or high cholesterol. The second objective of our program will be to test an education and physical activity promotion program in order to improve the cardiovascular risk profile without increasing the risk of hypoglycemia.

Nocturnal hypoglycemia (NH) represents more than half of hypoglycemia. Taking a bedtime snack to prevent NH is usually recommended, but largely empirical. The third objective of our program will be to determine if a bedtime snack is associated with a reduction of NH without increasing the time spent in hyperglycemia. We will also investigate the impact of components of bedtime snack on the risk of NH.