Peak performance: Putting type 1 diabetes management recommendations for athletes to the test

Athletes with type 1 diabetes (T1D) face unique challenges to maintain optimal glucose levels and therefore require tailored guidance from their healthcare providers. Herein, we aim to summarize and compare recommendations targeted at T1D management in athletes in commonly used clinical practice guidelines and topical position statements. The objective is to assess if the available recommendations are comprehensive enough for athletes to apply to high-performance sport.

From seven clinical practice guidelines and positions statements, we identified recommendations relevant to athletes with T1D, based on a specific hierarchy. For included recommendations, we extracted relevant information including the year of publication, author(s), chapter name or number, text for the recommendation, and level of evidence. Based, on the clinical topic covered, we grouped included recommendations to five themes.

We screened a total of 126 recommendations, of which 60 recommendations were included. The National Athletic Trainers' Association provided the highest number of recommendations relevant to athletes with T1D (n = 27). Insulin modifications was the most covered clinical theme (n = 18). The 2018 Diabetes Canada and 2021 American Diabetic Association guidelines linked recommendations directly with levels and grades of evidence. None of the recommendations had level 1 or grade A evidence. Three recommendations from Diabetes Canada reported level 2, grade B evidence. American Diabetic Association reported 1 recommendation with grade B evidence, and 2 recommendations with grade C evidence.

There is an opportunity for expansion of clinical practice guidelines to increase the depth and breadth of recommendations for high performance athletes with T1D.