Extreme exercise in diabetes research

Clare man David Goodstein recently pushed the boundaries when he participated in a 2100km cycle from Brussels to Barcelona in order to raise awareness of diabetes and participate in a study which would reveal the effect of extreme exercise on blood-glucose levels.

World Diabetes Day takes place this week and while the 48 year old doesn’t have diabetes, he was part of the “control group” who were monitored in the same way as those with diabetes in order to compare results.

“I took on the cycle, firstly as a personal challenge and also because I knew that the experience would be fun,” admits Goodstein who works as project director for GSMA, one of the sponsoring organisations.

"I wore a Dexcom G4 Continuous Glucose Monitor [CGM] for two weeks before and during the tour which is a sensor under the skin connected to a small transmitter which sends readings to a receiver device – like a small mobile phone."

Clinical trial
"This was for the 'clinical trial' and when I got to Brussels for registration, I was fitted with a second CGM [Dexcom G5]. The principle is the same but the technology is more sophisticated and flexible, so as well as receiving blood glucose readings, the Dexcom G5 captured information such as heart rate, cycling cadence, distance, speed, time and location.

“All this information was transmitted to the cloud and my stats could be read on the web in real time.”

Having prepared for months beforehand and covered an average of 170km per day during the two-week cycle, Goodstein was pushed to his physical limits, but as a non-diabetic, he was also impressed with the stamina some of his team mates had in reserve.

“I prepared for six months leading up to the event and probably covered every hill in Clare,” he says. “Other riders were far flung but we got to know each other in advance through the internet and many of us exchanged training statistics which was very motivating, particularly if my numbers were low.

“Diabetes requires a lot of management but clearly it doesn’t prohibit endurance challenges. I’m very happy to have completed the tour and much of the achievement can be credited to management of the practicalities.

“I prepared well, rode sensibly and ate correctly. But the diabetics also did all of this and had to manage their blood glucose levels – that’s pretty amazing.”

Huge achievement
Crossing the finishing line was a huge achievement but rather than hanging up his helmet for good, the father-of-two would do it all over again.

“It was sunny and hot when we were escorted by local riders to the finishing line,” recalls Goodstein.

“I was greeted by some colleagues who asked about the highs and lows and it occurred to me then that there actually were no lows. I met many wonderful and impressive people who I’m still in touch with over the internet but instead of training statistics we are exchanging tall stories – all of which are true.

“I had thought before the event that I might be sick of cycling by the end of it but instead the complete opposite is true.”

Jeanine Vos is the executive director for mHealth (Mobile Health) GSMA.

She says while the cycle was undoubtedly a personal achievement for riders like Goodstein, it was also a vitally important study combining the unveiling of new technology with research into the effects of exercise on blood glucose levels.

“A key element of the mHealth Grand Tour was a first-of-its-kind observational study into the effects of multi-day endurance exercise on blood glucose levels, using data captured and transmitted wirelessly through a multi-vendor solution,” she says.

"Designed by Prof Michael Trenell of Newcastle University, the study tracked the health and cycling performance data of elite and sub-elite athletes with type 1 diabetes as well as cyclists without diabetes.

“It was a unique opportunity to conduct a study that’s never been done before and by comparing data from the three groups, we hope to gather information that will benefit everyone with diabetes and those at risk.”

The health technology expert says a physically active lifestyle is vital in managing all types of diabetes and yet there is very little published research on the physiology of how this works.

“Because exercise can also be dangerous for people with diabetes – causing their blood sugar to drop too low and the brain to function erratically – many people with diabetes choose to avoid exercise altogether, in the absence of evidence-based clinical guidance,” says Vos.

Role of mobile technology
"The study, therefore, is important in demonstrating how mobile technology can support diabetes prevention, diagnosis and treatment by increasing the reach and accessibility of healthcare services.

“This, in turn, would help reduce the cost of healthcare services while encouraging patients to be active participants in managing their health and reducing the burden of the illness on their daily lives.”

The findings of the mHealth diabetes study will be released in February/March 2014.