![]() People with type 1 diabetes on oral antidiabetic agents or inhaled insulin were excluded from the study. For glargine U100, the suggested regimen was based on the travel algorithm from Pinsker et al ( 20). The regimen advised for insulin degludec used a simplified dosing regimen (see above). During travel, the average dose of basal insulin was similar comparing both insulins (21.7 ± 11.3 units on insulin degludec and 23.2 ± 10.8 units on glargine U100, P = NS). Prior to enrollment, 40% of participants were taking a formulation of glargine U100 at baseline 32% were taking insulin degludec, and the rest were on insulin detemir or glargine U300. Three identified as Hispanic/Latino, one as American Indian or Alaska Native, and one as Asian. Fourteen identified as female, and the majority ( n = 23) were White. Overall, participants were an average age of 35 ± 14.5 (mean ± SD) years, had HbA 1c of 7.4 ± 1.2% (57 ± 13.1 mmol/mol), and diabetes duration of 20.6 ± 15 years. If there were >3,600 s between consecutive glucose readings, then the time elapsed between the consecutive glucose readings was not counted toward duration of TIR. The duration of TIR was defined as all the remaining time not allocated to hypo- or hyperglycemia except where data “gaps” occurred: 1) if only one glucose reading was below or above the TIR boundary of either 70-140 mg/dL or 70-180 mg/dL, then the duration was not affected and the participant was still considered to be in range 2) when there were more than one glucose reading missing, then the last glucose reading could be held as long as 3,600 s. The duration of a hypo- or hyperglycemic excursion was defined as the time elapsed from the first excursion to the first reading outside of the excursion. Hypoglycemia was defined as excursions of at least 15 min with glucose values 140 mg/dL (i.e., for 15-min data at least two observations of the sensor data outside the boundary 70–140 mg/dL). TIR was defined as percentage of time glucose values were between 70 and 140 mg/dL and the percentage of time glucose values were between 70 and 180 mg/dL. Below are the methods used here for the TIR calculation: Number of awakenings and the average length (min) of the awakening.Ĭlinical targets for continuous glucose monitoring have been published, including an international consensus on time in range, and these metrics were also included in our secondary end points ( 19). The higher the index, the more sleep is disrupted. Sleep Fragmentation Index-Sleep Fragmentation is an index of restlessness during the sleep period expressed as a percentage. Wake after sleep onset-The total number of minutes the subject was awake after sleep onset occurred. Sleep efficiency (%)-Number of sleep minutes divided by the total number of minutes the subject was in bed. Total sleep time-The total number of minutes scored as “asleep.” Sleep was monitored during each flight and for 24 h at the destination with an ActiGraph wGT3X-BT activity monitor (ActiGraph, Pensacola, FL) worn on the nondominant wrist. The Liverpool Jet-Lag Questionnaire ( 15) was administered after 24 and 48 h at the destination. No group traveled in the summer, and we avoided any changes in time due to daylight savings time.įor each flight, the relevant basal insulin was adjusted as described below, and interstitial blood glucose was measured with blinded CGM (Freestyle Libre Pro, Abbott Diabetes Care). Most traveling was done in the winter and spring, and one group traveled in the fall. All participants and study staff traveled in the economy or coach section of the plane for all flights, and all flights were nonstop. Participants traveled in the same direction of travel as for the first trip but on the new basal insulin. After 2 weeks, the alternative basal insulin was started (glargine U100 to insulin degludec or insulin degludec to glargine U100), and the optimization protocol outlined above was repeated. The return to Santa Barbara was followed by a 2-week period where the participants returned to their original insulin regimen. After this, they flew to New York, NY, where they spent 72 h before returning to Honolulu, HI, to spend 72 h there and then returned to Santa Barbara, CA. Participants were recruited in Santa Barbara, CA, and traveled to Honolulu, HI, where they spent 2 days adjusting to that time zone.
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