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Variation in Hypoglycemia Risk During Real-World Physical Activity in Adults with Type 1 Diabetes: Insights from the
Mehak Dhaliwal1, Kenan Tang1, Eleonora M Aiello2
1University of California, Santa Barbara, California, USA.
Diabetes Technology & Therapeutics
|December 8, 2025
Summary
Real-world physical activity (PA) significantly impacts glucose control in type 1 diabetes (T1D), increasing hypoglycemia risk with longer duration and lower starting glucose. Aerobic activities pose the greatest glycemic challenge, necessitating personalized management strategies for T1D.
Area of Science:
- Endocrinology
- Exercise Physiology
- Metabolic Health
Background:
- Physical activity (PA) presents significant glucose management challenges for individuals with type 1 diabetes (T1D).
- Real-world PA, unlike structured exercise, is frequent but less understood regarding its glycemic impact.
- Analyzing real-world PA data is crucial for understanding and mitigating hypoglycemia risk in T1D.
Purpose of the Study:
- To investigate the correlations between real-world physical activity (PA) characteristics and hypoglycemia risk in type 1 diabetes (T1D).
- To examine how PA duration, intensity, type, and individual factors influence glycemic control and hypoglycemia.
- To compare glycemic responses across different activity types and between open-loop and closed-loop insulin delivery systems.
Main Methods:
- Analysis of 8171 real-world PA sessions across 45 activity types from the Type 1 Diabetes Exercise Initiative.
- Measurement of hypoglycemia risk using continuous glucose monitoring (CGM) changes (ΔCGM), low blood glucose index (LBGI), and hypoglycemia event occurrence.
- Statistical analyses including ANOVA and Tukey's test to identify correlations between PA factors and glycemic outcomes, comparing activity types and categories (aerobic, mixed, anaerobic).
Main Results:
- Longer PA duration, lower starting glucose, and pre-PA glucose decline were associated with increased hypoglycemia risk.
- Carbohydrate intake before/during PA showed a paradoxical association with higher risk, explained by higher insulin on board (IoB) and lower starting glucose.
- Aerobic activities induced the largest glucose drops compared to mixed and anaerobic activities; closed-loop system users had lower LBGI.
Conclusions:
- Real-world PA exhibits substantial glycemic variability in T1D, with duration, starting glucose, and IoB being key risk factors for hypoglycemia.
- Significant differences in glycemic response exist across various activity types, with aerobic exercise posing the highest risk of glucose decline.
- Tailored strategies are essential for effectively managing and mitigating the risks of PA-induced hypoglycemia in individuals with T1D.
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