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Observational Study
. 2024 Nov:217:111874.
doi: 10.1016/j.diabres.2024.111874. Epub 2024 Sep 27.

An evaluation of how exercise position statement guidelines are being used in the real world in type 1 diabetes: Findings from the type 1 diabetes exercise initiative (T1DEXI)

Peter G Jacobs  1 , Martin Chase Marak  2 , Peter Calhoun  2 , Robin L Gal  2 , Jessica R Castle  3 , Michael C Riddell  4
Affiliations
Free article
Observational Study

An evaluation of how exercise position statement guidelines are being used in the real world in type 1 diabetes: Findings from the type 1 diabetes exercise initiative (T1DEXI)

Peter G Jacobs et al. Diabetes Res Clin Pract. 2024 Nov.
Free article

Abstract

Aims: Position statement guidelines should help people with type 1 diabetes (T1D) improve glucose outcomes during exercise.

Methods: In a 4-week observational study, continuous glucose, insulin, and nutrient data were collected from 561 adults with T1D. Glucose outcomes were calculated during exercise, post-exercise, and overnight, and were compared for sessions when participants used versus did not use exercise guidelines for open-loop (OL) and automated insulin delivery (AID) therapy.

Results: Guidelines requiring behaviour modification were rarely used while guidelines not requiring modification were often used. The guideline recommending reduced meal insulin before exercise was associated with lower time <3.9 mmol/L during exercise (-2.2 %, P=0.02) for OL but not significant for AID (-1.4 %, P=0.27). Compared to exercise with low glucose (<3.9 mmol/L) in prior 24-hours, sessions without recent low glucose had lower time <3.9 mmol/L during exercise (-1.2 %, P<0.001). The AID guideline for no carbohydrates before exercise when CGM is flat, or increasing, was not associated with improved glycaemia.

Conclusions: Free-living datasets may be used to evaluate usage and benefit of position statement guidelines. Evidence suggests OL participants who reduced meal insulin prior to exercise and did not have low glucose in the prior 24 h had less time below range.

Keywords: Exercise; Observational study; Position statement; Type 1 diabetes.

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Conflict of interest statement

Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Robin Gal reports financial support was provided by The Leona M. and Harry B. Helmsley Charitable Trust. Robin Gal reports equipment, drugs, or supplies was provided by Verily Life Sciences LLC. Robin Gal reports equipment, drugs, or supplies was provided by Dexcom. Peter Jacobs reports a relationship with Dexcom that includes: funding grants. Peter Jacobs reports a relationship with Pacific Diabetes Technologies that includes: board membership and equity or stocks. Peter Jacobs reports a relationship with Eli Lilly and Company that includes: consulting or advisory. Jessica Castle reports a relationship with JDRF that includes: funding grants. Jessica Castle reports a relationship with National Institutes of Health that includes: funding grants. Jessica Castle reports a relationship with Dexcom that includes: funding grants. Jessica Castle reports a relationship with Medtronic Inc that includes: funding grants. Jessica Castle reports a relationship with Novo Nordisk Inc that includes: consulting or advisory. Jessica Castle reports a relationship with Insulet Corporation that includes: consulting or advisory. Jessica Castle reports a relationship with Zealand Pharma US, Inc. that includes: consulting or advisory. Michael Riddell reports a relationship with Zealand Pharma US, Inc. that includes: consulting or advisory. Michael Riddell reports a relationship with Zucara Therapeutics Inc. that includes: consulting or advisory. Michael Riddell reports a relationship with Indigo Diabetes that includes: consulting or advisory. Michael Riddell reports a relationship with Jaeb Center for Health Research that includes: consulting or advisory. Michael Riddell reports a relationship with Dexcom that includes: speaking and lecture fees. Michael Riddell reports a relationship with Novo Nordisk that includes: speaking and lecture fees. Michael Riddell reports a relationship with Sanofi that includes: speaking and lecture fees. If there are other authors, they declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

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