Applying technologies to simplify strategies for exercise in type 1 diabetes

Area of Science:

• Endocrinology and Metabolism
• Exercise Physiology
• Diabetes Technology

Background:

• Managing blood glucose during physical activity presents significant challenges for individuals with type 1 diabetes (T1D), impacting both health outcomes and quality of life.
• Technological advancements like continuous glucose monitoring (CGM), open-loop insulin pump therapy, and hybrid closed-loop (HCL) systems offer potential solutions for exercise-related glucose management in T1D.

Purpose of the Study:

• To translate current research findings and expert experience into simplified, patient-centered strategies for managing glucose levels during exercise in people with T1D.
• To provide clinicians with a practical, six-step framework for effectively communicating exercise management guidelines to individuals with T1D.

Main Methods:

• A review synthesizing published literature, clinical experience, and personal insights from three T1D experts.
• Development of a six-step strategy focusing on understanding insulin pharmacokinetics, exercise-induced glucose utilization, and technological system capabilities.
• Proposed strategies include estimating carbohydrate needs for exercise ('ExCarbs') and recommending pre-emptive basal insulin reduction or HCL exercise modes for planned exercise.

Main Results:

• A simplified, six-step approach is proposed to guide clinicians in communicating exercise management strategies to T1D patients.
• Key recommendations involve estimating extra carbohydrate intake ('ExCarbs') for spontaneous exercise and implementing pre-emptive basal insulin adjustments or HCL exercise modes for planned exercise.
• Specific modifications are discussed for both aerobic and anaerobic exercise types.

Conclusions:

• Available technologies like HCL systems require pre-emptive basal insulin reduction and 'ExCarbs' consumption, representing current limitations.
• These strategies are essential for safe exercise management with current T1D technologies, with future innovations potentially alleviating these burdens.
• Effective communication of these simplified strategies is vital for improving the quality of life and exercise outcomes for individuals with T1D.