Predicting Hypoglycemia and Hyperglycemia Risk During and After Activity for Adolescents with Type 1 Diabetes

Objective: To predict hypoglycemia and hyperglycemia risk during and after activity for adolescents with type 1 diabetes (T1D) using real-world data from the Type 1 Diabetes Exercise Initiative Pediatric (T1DEXIP) study. Methods: Adolescents with T1D (n = 225; [mean ± SD] age = 14 ± 2 years; HbA1c = 7.1 ± 1.3%; T1D duration = 5 ± 4 years; 56% using hybrid closed loop), wearing continuous glucose monitors (CGMs), logged 3738 total activities over 10 days. Repeated Measures Random Forest (RMRF) and Repeated Measures Logistic Regression (RMLR) models were used to predict a composite risk of hypoglycemia (<70 mg/dL) and hyperglycemia (>250 mg/dL) within 2 h after starting exercise. Results: RMRF achieved high precision predicting composite risk and was more accurate than RMLR Area under the receiver operating characteristic curve (AUROC 0.737 vs. 0.661; P < 0.001). Activities with minimal composite risk had a starting glucose between 132 and 160 mg/dL and a glucose rate of change at activity start between -0.4 and -1.9 mg/dL/min. Time <70 mg/dL and time >250 mg/dL during the prior 24 h, HbA1c level, and insulin on board at activity start were also predictive. Separate models explored factors at the end of activity; activities with glucose between 128 and 133 mg/dL and glucose rate of change between 0.4 and -0.6 mg/dL/min had minimal composite risk. Conclusions: Physically active adolescents with T1D should aim to start exercise with an interstitial glucose between 130 and 160 mg/dL with a flat or slightly decreasing CGM trend to minimize risk for developing dysglycemia. Incorporating factors such as historical glucose and insulin can improve prediction modeling for the acute glucose responses to exercise.