Periodic Reporting for period 1 - The MERIT study (A proposal to optimize postprandial glycaemic control and prevent maternal and neonatal complications: timing of acute exercise and underlying mechanisms in healthy, obese and T1DM pregnant women)
Période du rapport: 2022-01-20 au 2024-01-19
Poor glycaemic control in pregnancy is a major factor leading to obstetric complications and future maternal-offspring diseases. This phenomenon, which is often evidenced in women with type 1 diabetes despite all efforts invested in pre-conception to achieve a good glycaemic control, is worrisome since it is aggravating the disease burden of this and next generations. Therefore, to find strategies aimed at breaking this cycle has become a high priority. Exercise is a promising tool to improve short-term glycaemic responses such as postprandial glucose peaks and glucose variability, and thus reduce adverse maternal-neonatal outcomes. However, it is unknown which timing of exercise is more effective to optimise postprandial glycaemic control in pregnant and non-pregnant women with type 1 diabetes. The mechanisms underlying these benefits are also to be established.
The MERIT study an innovative study that will ascertain which timing of exercise (exercise before or after lunch) is more effective to optimise postprandial glycaemic control in pregnant and non-pregnant women with type 1 diabetes. Moreover, it will provide novel insight into the mechanisms underlying the beneficial effects of exercise on glycaemic excursions.
The MERIT study an innovative study that will ascertain which timing of exercise (exercise before or after lunch) is more effective to optimise postprandial glycaemic control in pregnant and non-pregnant women with type 1 diabetes. Moreover, it will provide novel insight into the mechanisms underlying the beneficial effects of exercise on glycaemic excursions.
Since the beginning of the project, the following experimental procedures have been conducted: recruitment and medical screening, experimental testing, collection and processing of biological samples, creation of datasets and completion of global dataset, data processing and analyses, statistical and computational analyses, scientific writing, and dissemination. As a result, 5 pregnant women with type 1 diabetes at early-middle gestation, and 13 non-pregnant women with type 1 diabetes have been assessed. In he following seven months, 5 additional pregnant women will complete their assessments at early-middle gestation, and 9 pregnant women will complete their assessments in late gestation.
Overall, we have observed that pregnant women with type 1 diabetes spent slightly more time in euglycemia and hyperglycaemia, and less time in hypoglycaemia when they exercised before lunch instead after lunch. However, these differences were minimal and not meaningful. Moreover, we have observed that glucose variability appears to be slightly lower (better) when women exercise after lunch instead before lunch. During the night, pregnant women in the post-meal exercise day showed better glycaemic control than in the pre-meal exercise day. In other words, exercising before and after lunch had overall similar beneficial effects in optimising glucose excursions, except overnight, where exercising after lunch seemed to be slightly more beneficial.
Regarding non-pregnant women with type 1 diabetes, women who exercised after lunchtime spent more time in euglycemia, and less time in hyperglycaemia and hypoglycaemia compared to the day when they exercised before lunch. However, these differences were very small. Moreover, we have observed that women had lower glucose variability (better) when they exercised after lunch compared to before lunch. Overall, post-meal exercise appears to be more effective in non-pregnant women with type 1 diabetes to optimise glucose excursions.
Furthermore, our molecular analysis were able to detect differences in the plasma proteome of the pre- vs. post-meal exercise day, which suggests that exercise before and after lunch rely on different and specific molecular processes.
It is important to highlight that the additional assessments and analyses to be conducted soon will shed more light on these results, and on the underlying mechanisms.
Regarding the results to be exploited in relation to the project, I have submitted one study to Journal of Sports Sciences and I am finishing 2 other studies which will be submitted soon to scientific journals. Regarding articles derived from the MERIT project, I have started analysing data for the first research article regarding the effects of pre- and post-meal exercise on glycaemic control, and we expect to publish 4 articles by next year.
Moreover, I have disseminated results to several audiences. For instance, I have given 2 oral presentations at prestigious congresses and 2 well-regarded invited lectures, I have joined the Marie Curie Alumni Association and LIDERARMAS network, and I am participating in the EASD Early Career Academy Program. In all these activities, I have disseminated our work to researchers around the globe and other audience. Moreover, we have disseminated the MERIT study to the general audience through press releases in newspapers, the Styria region, City of Graz, and via diabetes associations, and via website pages (e.g. Facebook, Studo). By the end of the year, we will make public our results in the official website page of the Graz city council and “Das Land Steiermark”. Moreover, I have brought our research closer to our Department and students from the University through internal seminars, and by teaching practical courses and lectures to the students from the Bachelor’s and Master’s degree.
Once we have collected all data, I will organise open-doors discussions with the participants from the project and general public. I will continue disseminating our results in invited talks, seminars, and congresses.
Overall, we have observed that pregnant women with type 1 diabetes spent slightly more time in euglycemia and hyperglycaemia, and less time in hypoglycaemia when they exercised before lunch instead after lunch. However, these differences were minimal and not meaningful. Moreover, we have observed that glucose variability appears to be slightly lower (better) when women exercise after lunch instead before lunch. During the night, pregnant women in the post-meal exercise day showed better glycaemic control than in the pre-meal exercise day. In other words, exercising before and after lunch had overall similar beneficial effects in optimising glucose excursions, except overnight, where exercising after lunch seemed to be slightly more beneficial.
Regarding non-pregnant women with type 1 diabetes, women who exercised after lunchtime spent more time in euglycemia, and less time in hyperglycaemia and hypoglycaemia compared to the day when they exercised before lunch. However, these differences were very small. Moreover, we have observed that women had lower glucose variability (better) when they exercised after lunch compared to before lunch. Overall, post-meal exercise appears to be more effective in non-pregnant women with type 1 diabetes to optimise glucose excursions.
Furthermore, our molecular analysis were able to detect differences in the plasma proteome of the pre- vs. post-meal exercise day, which suggests that exercise before and after lunch rely on different and specific molecular processes.
It is important to highlight that the additional assessments and analyses to be conducted soon will shed more light on these results, and on the underlying mechanisms.
Regarding the results to be exploited in relation to the project, I have submitted one study to Journal of Sports Sciences and I am finishing 2 other studies which will be submitted soon to scientific journals. Regarding articles derived from the MERIT project, I have started analysing data for the first research article regarding the effects of pre- and post-meal exercise on glycaemic control, and we expect to publish 4 articles by next year.
Moreover, I have disseminated results to several audiences. For instance, I have given 2 oral presentations at prestigious congresses and 2 well-regarded invited lectures, I have joined the Marie Curie Alumni Association and LIDERARMAS network, and I am participating in the EASD Early Career Academy Program. In all these activities, I have disseminated our work to researchers around the globe and other audience. Moreover, we have disseminated the MERIT study to the general audience through press releases in newspapers, the Styria region, City of Graz, and via diabetes associations, and via website pages (e.g. Facebook, Studo). By the end of the year, we will make public our results in the official website page of the Graz city council and “Das Land Steiermark”. Moreover, I have brought our research closer to our Department and students from the University through internal seminars, and by teaching practical courses and lectures to the students from the Bachelor’s and Master’s degree.
Once we have collected all data, I will organise open-doors discussions with the participants from the project and general public. I will continue disseminating our results in invited talks, seminars, and congresses.
The MERIT study has already had social impact on the participants who joined the study, and clinical/scientific impact on the diabetologists/physicians, researchers and Departments who are collaborating with us. The information collected so far has allowed us to better understand how exercise timing influence glucose excursions, and to provide participants/physicians with exercise targeted recommendations about how improving glycaemic control (especially in non-pregnant women where we have more data, e.g. post-meal exercise). Once all data are analysed and published, the social and economic impact is expected to be very noticeable in the field, especially in pregnancy. For instance, identifying which stimulus is more optimal to reduce insulin needs, reduce the risk of hypoglycaemia or prompt a better glycaemic control, and which women require a stricter control, will contribute to reducing considerably the associated economic burden and women’s mental burden. Moreover, it will provide women with easy to implement recommendations about how adapting safe but demanding exercise to their physiological needs.
The potential of the MERIT study is indeed promising, as highlighted by the Austria Diabetes Association, who has invited us to present next year the MERIT results in the Austrian national conference.
Hence, the MERIT study is already having some repercussion in Austria, and we expect it to have a greater impact in the European society. All MERIT remaining data (expected to be available by the end of the year) holds the potential to translate into a better clinical prediction, diagnosis and treatment of glycaemic dysregulations in pre-conception and pregnancy, and will profoundly advance our understanding of the mechanisms driving exercise-induced glycaemic adaptations. Moreover, our groundbreaking research will lay the foundation for future studies to develop exercise synergistic and mimetic therapies in type 1 diabetes and pregnancy, and design more tailored and effective exercise programs.
The potential of the MERIT study is indeed promising, as highlighted by the Austria Diabetes Association, who has invited us to present next year the MERIT results in the Austrian national conference.
Hence, the MERIT study is already having some repercussion in Austria, and we expect it to have a greater impact in the European society. All MERIT remaining data (expected to be available by the end of the year) holds the potential to translate into a better clinical prediction, diagnosis and treatment of glycaemic dysregulations in pre-conception and pregnancy, and will profoundly advance our understanding of the mechanisms driving exercise-induced glycaemic adaptations. Moreover, our groundbreaking research will lay the foundation for future studies to develop exercise synergistic and mimetic therapies in type 1 diabetes and pregnancy, and design more tailored and effective exercise programs.