The effect of timing of remotely supervised exercise on glucose control in people with type 1 diabetes during Ramadan: A randomised crossover study.

AIM: The aim of the current study was to compare glucose responses when remotely supervised exercise was performed before or after breaking the fast, during Ramadan, in people with type 1 diabetes. METHODS: People with type 1 diabetes were recruited to this randomised cross over design study, which took place in Kuwait during Ramadan in 2021-2022. Interstitial glucose was measured using continuous glucose monitors during a baseline week of normal activity and during weeks where remotely supervised exercise was performed, three times per week, either before (afternoon) or after (evening) breaking the fast, in a randomised crossover design. Exercise involved resistance and aerobic exercise and was supervised during a video call. RESULTS: Thirty-two participants were recruited to the study (age 34(9) years and BMI 26(4)kg/m2). Mean interstitial glucose levels were lower on exercise days, compared to equivalent days in the baseline week, during both afternoon (8.6(1.8) mmol/L vs 9.1(1.4) mmol/L, p = 0.035) and evening (8.7(1.8) mmol/L vs 9.6(1.8) mmol/L, p < 0.001) exercise weeks. Mean glucose levels were lower the day after exercise, relative to both baseline (p < 0.001) and exercise (p = 0.011) days, in the evening exercise week only. CONCLUSIONS: Remotely supervised exercise performed during Ramadan can safely reduce interstitial glucose levels and may be of greater benefit when performed in the evening, further work is required to confirm this in a larger trial.

Risk of mortality among inpatients with COVID-19 and type 2 diabetes: National data from Kuwait.

INTRODUCTION: To investigate type 2 diabetes as a risk factor for COVID-19 death following hospital admission in Kuwait. METHODS: A retrospective cohort study using data from a central hospital that cared for all hospitalized COVID-19 patients in Kuwait. We investigated the association between type 2 diabetes, with COVID-19 mortality using multiply imputed logistic regression and calculated the population attributable fraction. RESULTS: A total of 5333 patients were admitted with COVID-19, of whom 244 died (4.6%). Diabetes prevalence was 24.8%, but 53.7% of those who died had diabetes. After adjusting for age, sex, ethnicity and other comorbidities, diabetes was associated with death (OR 1.70 [95% CI 1.23, 2.34]) and admission to the intensive care unit more than 3 days after initial admission (OR 1.78 [95% CI 1.17, 2.70]). Assuming causality, the population attributable fraction for type 2 diabetes in COVID-19 death was 19.6% (95% CI 10.8, 35.6). CONCLUSION: Type 2 diabetes is a strong risk factor for COVID-19 death in the Middle East. Given the high prevalence of type 2 diabetes in the Middle East, as well as many Western countries, the public health implications are considerable.