Glucose management for exercise using continuous glucose monitoring (CGM) and intermittently scanned CGM (isCGM) systems in type 1 diabetes: position statement of the European Association for the Study of Diabetes (EASD) and of the International Society for Pediatric and Adolescent Diabetes (ISPAD) endorsed by JDRF and supported by the American Diabetes Association (ADA)

Abstract

Physical exercise is an important component in the management of type 1 diabetes across the lifespan. Yet, acute exercise increases the risk of dysglycaemia, and the direction of glycaemic excursions depends, to some extent, on the intensity and duration of the type of exercise. Understandably, fear of hypoglycaemia is one of the strongest barriers to incorporating exercise into daily life. Risk of hypoglycaemia during and after exercise can be lowered when insulin-dose adjustments are made and/or additional carbohydrates are consumed. Glycaemic management during exercise has been made easier with continuous glucose monitoring (CGM) and intermittently scanned continuous glucose monitoring (isCGM) systems; however, because of the complexity of CGM and isCGM systems, both individuals with type 1 diabetes and their healthcare professionals may struggle with the interpretation of given information to maximise the technological potential for effective use around exercise (ie, before, during and after). This position statement highlights the recent advancements in CGM and isCGM technology, with a focus on the evidence base for their efficacy to sense glucose around exercise and adaptations in the use of these emerging tools, and updates the guidance for exercise in adults, children and adolescents with type 1 diabetes.

Keywords: Adolescents; Adults; CGM; Children; Continuous glucose monitoring; Exercise; Physical activity; Position statement; Type 1 diabetes.

FIGURE 1

MARD (%) of current CGM and isCGM devices during exercise. MARD data are weighted for the number of participants and SD of MARD for different manufacturers of all CGM and isCGM devices. The dashed line and the green diamond represent the MARD of all CGM and isCGM devices. Red diamonds represent the MARD for each specific company. Horizontal bars represent the 95% CIs for the specific studies. All types of studies using CGM and/or isCGM during exercise in people with type 1 diabetes were included (the studies by Giani et al [36] and Breton et al [29] were performed in children and adolescents). This figure is available as part of a downloadable slideset

FIGURE 2

Assessment of exercise experience and risk of hypoglycaemia. Exercise (Ex) represents how often people with type 1 diabetes are exercising with a duration ≥45 min per session per week. Assessment of risk of hypoglycaemia should be based on scoring systems for being aware of hypoglycaemia (AH) or showing IAH. In addition, if the scoring system reveals AH, the time below range (TBR; <3.9 mmoL/L, <70 mg/dL) over the last 3 months should be evaluated to detail the degree of awareness. Furthermore, if an episode of severe hypoglycaemia (SH) occurred within the last 6 months, then there might be a high risk of hypoglycaemia during exercise. This figure is available as part of a downloadable slideset