Traveling a long distance makes management of type 1 diabetes more difficult.
That’s the conclusion of a Sansum Diabetes Research Institute study, in which SDRI flew trial participants with diabetes from Santa Barbara to New York City or Hawaii.
The study was published recently in the American Diabetes Association’s Diabetes Care.
The article, “Travelling Across Time Zones With Type 1 Diabetes” is at https://care.diabetesjournals.org/content/early/2021/10/28/dc21-1524.
The participants in the travel study used multiple daily injections of insulin as part of their self-management of type 1 diabetes. The study compared two different long-acting basal insulins; glargine and degludec, and employed the use of continuous glucose monitoring systems.
“In the study, we found that it’s very difficult for people with type 1 diabetes to maintain good control of blood glucose levels while traveling long distances,” said Dr. David Kerr, SDRI’s director of research and innovation, in a news release. “For people living with type 1 diabetes, international guidelines recommend having a blood glucose level between 70 and 180 milligrams per deciliter (mg/dL) at least 70% of the time. In this study with participants flying across multiple time zones, we found that achieving this proved to be elusive.”
The average time spent in the target blood glucose range was only 50% to 65%. About one-third of study participants’ travel was spent above 180 mg/dL. Ten percent of the time, participants were hypoglycemic, or below 70 mg/dL, according to Sansum Diabetes Research Institute.
“Crossing multiple time zones affects circadian rhythms with impacts on a person’s mood, sleep, and fatigue levels,” said Dr. Kerr. “For people using insulin injections, the impact of changes in circadian rhythms will invariably make maintaining safe and appropriate glucose levels much more difficult.”
“As we come out of the pandemic and global travel increases, there is a challenge for people using insulin in all stages of their journey. From the moment they decide to go on a trip, they need to consider what to pack, what to put in their hand luggage versus in the aircraft hold, but also, what about the timing and dosing of their insulin. On arrival at their destination, there are additional concerns related to supplies, unaccustomed physical activity and foods, in addition to the time zone impacts. This is particularly a problem for people using multiple daily injections of insulin.”
“Sadly, there is not enough research in this area and certainly not enough good quality advice for people on insulin about how to prepare for long distance travel,” added Dr. Kerr. “It means that we need to do much more research to try to create an evidence-based approach helping people on insulin when they wish to travel around the world.”
“We are especially looking to collaborate with medical device companies involved in closed loop systems to provide a safer and better option for insulin-treated individuals planning travel across multiple time zones,” said Dr. Kerr.
For advice on traveling with insulin, go to diabetestravel.sansum.org.