Type I diabetes in athletes is a relatively rare condition and as a certified athletic trainer it is critical to know how to manage all aspects of this disease in an athlete. Current National Athletic Trainers’ Association (NATA) guidelines exist for developing a basic plan for management and care of an athlete with Type I Diabetes, but there is room to improve current guidelines, using evidence-based practice. Purpose: to address: medical management of a type I diabetic athlete as a case study, obtain first person observations from the athlete’s perspective, and provide additional evidence based practice recommendations to athletic trainers based on the findings. Methods: case study narrative with one subject, a 22-year-old male collegiate soccer player was performed. Data were collected via open-ended questionnaire, open-ended interview, and subject’s submission of pertinent medical information and records. Results: The NATA Position Statement on Type I Diabetes and other peer review articles informed this study. While NATA guidelines created a good general baseline for how to approach providing diabetic athlete care; additional recommendations are suggested based on the findings of this case study. These recommendations include: Creating safe pre-participation blood glucose ranges to prevent hypoglycemia during exercise, establishing greater knowledge about the technology the patient uses, what medical supplies the patient should be responsible for versus the athletic trainer, developing a relationship with the patient’s endocrinologist or primary care physician, and administration of insulin by an athletic trainer. These additional suggested recommendations inform athletic trainers to attain a better understanding of how to manage and care for a patient with Type I Diabetes, and increase the likelihood of both streamlining patient care and preventing metabolic crisis.

京都大学 / 0048 / 新制・課程博士 / 博士(工学) / 甲第19996号 / 工博第4240号 / 新制||工||1656(附属図書館) / 33092 / 京都大学大学院工学研究科電気工学専攻 / (主査)教授 土居 伸二, 教授 小林 哲生, 准教授 蛯原 義雄 / 学位規則第4条第1項該当 / Doctor of Philosophy (Engineering) / Kyoto University / DFAM

京都大学 / 0048 / 新制・課程博士 / 博士(人間・環境学) / 甲第20464号 / 人博第814号 / 新制||人||195(附属図書館) / 28||人博||814(吉田南総合図書館) / 京都大学大学院人間・環境学研究科共生人間学専攻 / (主査)教授 林 達也, 教授 石原 昭彦, 准教授 久代 恵介 / 学位規則第4条第1項該当 / Doctor of Human and Environmental Studies / Kyoto University / DGAM

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abstract: Background: Research has found that nearly a quarter of the American population follows a gluten-free diet in some capacity, while only about 1% of the population is diagnosed with celiac disease. Although the amount of research-based evidence supporting any health benefits of a gluten-free diet in an individual without a gluten- related disorder is limited, the number of people claiming to follow a gluten-free diet continues to rise. Also, despite an increasing belief that gluten is harmful for health, the potentially undesirable effects of gluten substitutions used in gluten-free foods are largely unknown. Due to the protein network encapsulating starch granules, gluten is thought to lengthen the amount of time needed during starch digestion, thereby reducing postprandial glycemia. Therefore, it is predicted that breads containing gluten will produce a lower glycemic response compared to gluten-free breads. Aim: The aim of this study was to investigate the glycemic response of gluten-free bread made with different types of flour compared to bread made with gluten-containing wheat flour. Methods: This study involved a 3-week, randomized, single blind crossover study in which 17 healthy individuals were asked to consume a different type of bread each week, 2 of which were gluten-free. Blood glucose was taken by finger prick at fasting as a baseline measurement, then for 2 hours after bread consumption in 30-minute increments. Results: Across the three groups, there was no significant difference in iAUC values after 120 minutes (p=0.192 ). The greatest mean was seen in the gluten-containing bread (145.3 ± 82.6), then the gluten-free bread made with rice flour (125.5 ± 62.8), and lastly the gluten-free bread made with potato and fava bean flour (112.4 ± 64.5). Conclusion: The inconsistent results of this study compared to previous, similar studies suggests that the postprandial glycemic response of gluten-free products can not be generalized as a whole, but instead is dependent on the type of product and the ingredients used to replace the gluten. Although the results did not show a significant difference, it does argue against the belief that gluten-free products are invariably better for health in the general, non-gluten sensitive population. / Dissertation/Thesis / Masters Thesis Nutrition 2019

Background People with type 1 diabetes make up approximately two million of the American population. Every day, these two million people struggle to fight this lifelong, sometimes life threatening disease. While type 1 diabetes currently has no cure, there are technologies that can make diabetes management more effective. This study surveyed the type 1 diabetes (T1D) young adult population aged 18-30, to evaluate what technologies and tools are most often associated with achieving optimal glycemic control (OGC). Methodology The instrument is a 35 question, investigator developed survey that is designed to measure how often a participant utilizes the technology identified in each question, with the response choices ranging from 0 (never) to 5 (multiple times daily). In addition, there were some yes/no and fill-in-the-blank questions to identify demographic variables. The technology topics that were explored are 1) mode of insulin therapy, 2) mode of blood glucose monitoring therapy, 3) mode of communication with designated care provider, 4) electronic applications used, 5) demographic variables, and 6) pertinent comorbidities. This information was used to evaluate variables that assist T1Ds in achieving optimal glycemic control. Participants were invited to participate in this study via email using the Students with Diabetes email listserv. The email contained the IRB approved explanation of research letter, which informed participants of the study and the research being conducted. If the student chose to participate, they checked a box that served as an electronic signature, and they continued on to the 35-question survey. All responses to the survey will be kept confidential; as the survey and research did not require any personal identifying information. Data regarding the specific demographics, technologies used for diabetes control, and hemoglobin A1C levels were recorded and analyzed. The results of the survey will be shared with the participants via the same email list-serv by which they were originally recruited. Results There were 59 participants. A total of 21 out of 59 respondents had optimal glycemic control (A1C less than 7.0, per American Diabetes Association guidelines). Eighty eight percent of those with OGC wore their CGMs all the time, while only 66% of those with IGC wore their CGMs all the time. Ninety five percent of those with OGC used their insulin pumps all the time, while 89% of those with IGC did. It is likely that the combination of both CGMs and insulin pumps worn all the time are the most powerful tools to achieving OGC. Students that were employed, enrolled in classes, and still under their parent’s insurance plans had a higher incidence of optimal glycemic control. Discussion It was hypothesized that those with OGC would have a higher incidence of diabetes technology use. This PI found that even though almost all participants had access to the diabetes technology, still only 37% of the participants had optimal glycemic control. There are many components to diabetes care that impact glycemic control that were not explored within this scope of this diabetes technology study. Conclusions It is likely that both CGMs and insulin pumps worn all the time are the most powerful tools to achieving OGC. Students who graduate from college and transition to adulthood are vulnerable as they may encounter added stressors such as employment, and financial responsibility that cause them to deviate from the recommendations for diabetes technology use. Care providers need to be cognizant that young adulthood is a vulnerable time in terms of OGC and optimal diabetes management. Providers need to work with young adults, and encourage them to adhere to the recommended diabetes care regime.

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