The Use of Automated Insulin Delivery around Physical Activity and Exercise in Type 1 Diabetes: A Position Statement of the European Association for the Study of Diabetes (EASD) and the International Society for Pediatric and Adolescent Diabetes (ISPAD)

Othmar Moser^{1

2

3}, Dessi Zaharieva⁴, Peter Adolfsson^{5

6}, Tadej Battelino^{7

8}, Richard M Bracken⁹, Bruce A Buckingham⁴, Thomas Danne^{10

11}, Elizabeth A Davis^{12

13

14}, Klemen Dovc^{7

8}, Gregory P Forlenza¹⁵, Pieter Gillard¹⁶, Sabine E Hofer¹⁷, Roman Hovorka^{18

19}, Peter J Jacobs²⁰, Julia K Mader², Chantal Mathieu¹⁶, Kirsten Nørgaard^{21

22}, Nick S Oliver²³, David N O'Neal^{24

25

26}, John Pemberton²⁷, Remi Rabasa-Lhoret^{28

29

30}, Jennifer L Sherr³¹, Harald Sourij^{2

3}, Martin Tauschmann³², Jane E Yardley^{28

33}, Michael C Riddell³⁴

Affiliations

¹ Department of Exercise Physiology and Metabolism (Sportsmedicine), University of Bayreuth, Bayreuth, Germany.
² Division of Endocrinology and Diabetology, Medical University of Graz, Graz, Austria.
³ Interdisciplinary Metabolic Medicine Trials Unit, Medical University of Graz, Graz, Austria.
⁴ Division of Pediatric Endocrinology, Department of Pediatrics, Stanford University, Stanford, California, USA.
⁵ Department of Pediatrics, Kungsbacka Hospital, Kungsbacka, Sweden.
⁶ Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
⁷ Department of Endocrinology, Diabetes and Metabolism, University Medical Center, University Children's Hospital, Ljubljana, Slovenia.
⁸ Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia.
⁹ Applied Sport, Technology, Exercise and Medicine Research Centre, Swansea University, Swansea, UK.
¹⁰ Breakthrough T1D (formerly JDRF), New York, New York, USA.
¹¹ Centre for Paediatric Endocrinology, Diabetology and Clinical Research, Auf Der Bult Children's Hospital, Hannover, Germany.
¹² Department of Endocrinology and Diabetes, Perth Children's Hospital, Nedlands, Washington, Australia.
¹³ Telethon Kids Institute, University of Western Australia, Perth, Washington, Australia.
¹⁴ Centre for Child Health Research, University of Western Australia, Perth, Washington, Australia.
¹⁵ Barbara Davis Center for Childhood Diabetes, University of Colorado Denver, Denver, Colorado, USA.
¹⁶ Department of Endocrinology, University Hospitals Leuven, KU Leuven, Leuven, Belgium.
¹⁷ Department of Pediatrics, Medical University of Innsbruck, Innsbruck, Austria.
¹⁸ Department of Paediatrics, University of Cambridge, Cambridge, UK.
¹⁹ Wellcome Trust-MRC Institute of Metabolic Science, University of Cambridge, Cambridge, UK.
²⁰ Artificial Intelligence for Medical Systems, Department of Biomedical Engineering, Oregon Health and Science University, Portland, Oregon, USA.
²¹ Department of Clinical Research, Steno Diabetes Center Copenhagen, Herlev, Denmark.
²² Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
²³ Division of Diabetes, Endocrinology and Metabolism, Department of Medicine, Faculty of Medicine, Imperial College London, London, UK.
²⁴ Department of Medicine, University of Melbourne, Melbourne, Victoria, Australia.
²⁵ Department of Endocrinology and Diabetes, St Vincent's Hospital Melbourne, Melbourne, Victoria, Australia.
²⁶ Australian Centre for Accelerating Diabetes Innovations, Melbourne, Victoria, Australia.
²⁷ Department of Endocrinology and Diabetes, Birmingham Children's Hospital, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK.
²⁸ Montreal Clinical Research Institute (IRCM), Montreal, Québec, Canada.
²⁹ Department of Nutrition, Faculty of Medicine, Université de Montréal, Montreal, Québec, Canada.
³⁰ Centre Hospitalier de l'Université de Montréal Endocrinology Division and CHUM Research Center, Montreal, Québec, Canada.
³¹ Division of Pediatric Endocrinology, Department of Pediatrics, Yale University School of Medicine, New Haven, Connecticut, USA.
³² Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Vienna, Austria.
³³ School of Kinesiology and Physical Activity Sciences, Faculty of Medicine, University of Montreal, Montreal, Québec, Canada.
³⁴ School of Kinesiology and Health Science, York University, Toronto, Ontario, Canada.

PMID: 39657609
DOI: 10.1159/000542287

Free article

Practice Guideline

The Use of Automated Insulin Delivery around Physical Activity and Exercise in Type 1 Diabetes: A Position Statement of the European Association for the Study of Diabetes (EASD) and the International Society for Pediatric and Adolescent Diabetes (ISPAD)

Othmar Moser et al. Horm Res Paediatr. 2024.

Free article

. 2024 Dec 10:1-28.

doi: 10.1159/000542287. Online ahead of print.

Authors

Affiliations

¹ Department of Exercise Physiology and Metabolism (Sportsmedicine), University of Bayreuth, Bayreuth, Germany.
² Division of Endocrinology and Diabetology, Medical University of Graz, Graz, Austria.
³ Interdisciplinary Metabolic Medicine Trials Unit, Medical University of Graz, Graz, Austria.
⁴ Division of Pediatric Endocrinology, Department of Pediatrics, Stanford University, Stanford, California, USA.
⁵ Department of Pediatrics, Kungsbacka Hospital, Kungsbacka, Sweden.
⁶ Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
⁷ Department of Endocrinology, Diabetes and Metabolism, University Medical Center, University Children's Hospital, Ljubljana, Slovenia.
⁸ Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia.
⁹ Applied Sport, Technology, Exercise and Medicine Research Centre, Swansea University, Swansea, UK.
¹⁰ Breakthrough T1D (formerly JDRF), New York, New York, USA.
¹¹ Centre for Paediatric Endocrinology, Diabetology and Clinical Research, Auf Der Bult Children's Hospital, Hannover, Germany.
¹² Department of Endocrinology and Diabetes, Perth Children's Hospital, Nedlands, Washington, Australia.
¹³ Telethon Kids Institute, University of Western Australia, Perth, Washington, Australia.
¹⁴ Centre for Child Health Research, University of Western Australia, Perth, Washington, Australia.
¹⁵ Barbara Davis Center for Childhood Diabetes, University of Colorado Denver, Denver, Colorado, USA.
¹⁶ Department of Endocrinology, University Hospitals Leuven, KU Leuven, Leuven, Belgium.
¹⁷ Department of Pediatrics, Medical University of Innsbruck, Innsbruck, Austria.
¹⁸ Department of Paediatrics, University of Cambridge, Cambridge, UK.
¹⁹ Wellcome Trust-MRC Institute of Metabolic Science, University of Cambridge, Cambridge, UK.
²⁰ Artificial Intelligence for Medical Systems, Department of Biomedical Engineering, Oregon Health and Science University, Portland, Oregon, USA.
²¹ Department of Clinical Research, Steno Diabetes Center Copenhagen, Herlev, Denmark.
²² Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
²³ Division of Diabetes, Endocrinology and Metabolism, Department of Medicine, Faculty of Medicine, Imperial College London, London, UK.
²⁴ Department of Medicine, University of Melbourne, Melbourne, Victoria, Australia.
²⁵ Department of Endocrinology and Diabetes, St Vincent's Hospital Melbourne, Melbourne, Victoria, Australia.
²⁶ Australian Centre for Accelerating Diabetes Innovations, Melbourne, Victoria, Australia.
²⁷ Department of Endocrinology and Diabetes, Birmingham Children's Hospital, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK.
²⁸ Montreal Clinical Research Institute (IRCM), Montreal, Québec, Canada.
²⁹ Department of Nutrition, Faculty of Medicine, Université de Montréal, Montreal, Québec, Canada.
³⁰ Centre Hospitalier de l'Université de Montréal Endocrinology Division and CHUM Research Center, Montreal, Québec, Canada.
³¹ Division of Pediatric Endocrinology, Department of Pediatrics, Yale University School of Medicine, New Haven, Connecticut, USA.
³² Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Vienna, Austria.
³³ School of Kinesiology and Physical Activity Sciences, Faculty of Medicine, University of Montreal, Montreal, Québec, Canada.
³⁴ School of Kinesiology and Health Science, York University, Toronto, Ontario, Canada.

PMID: 39657609
DOI: 10.1159/000542287

Abstract

Regular physical activity and exercise (PA) are cornerstones of diabetes care for individuals with type 1 diabetes. In recent years, the availability of automated insulin delivery (AID) systems has improved the ability of people with type 1 diabetes to achieve the recommended glucose target ranges. PA provides additional health benefits but can cause glucose fluctuations, which challenges current AID systems. While an increasing number of clinical trials and reviews are being published on different AID systems and PA, it seems prudent at this time to collate this information and develop a position statement on the topic. This joint European Association for the Study of Diabetes (EASD)/International Society for Pediatric and Adolescent Diabetes (ISPAD) position statement reviews current evidence on AID systems and provides detailed clinical practice points for managing PA in children, adolescents and adults with type 1 diabetes using AID technology. It discusses each commercially available AID system individually and provides guidance on its use in PA. Additionally, it addresses different glucose responses to PA and provides stratified therapy options to maintain glucose levels within the target ranges for these age groups.

Keywords: Automated insulin delivery; Continuous glucose monitoring; Exercise; Glucose; Insulin pump; Physical activity; Position statement; Type 1 diabetes.

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The Use of Automated Insulin Delivery around Physical Activity and Exercise in Type 1 Diabetes: A Position Statement of the European Association for the Study of Diabetes (EASD) and the International Society for Pediatric and Adolescent Diabetes (ISPAD)

Affiliations

The Use of Automated Insulin Delivery around Physical Activity and Exercise in Type 1 Diabetes: A Position Statement of the European Association for the Study of Diabetes (EASD) and the International Society for Pediatric and Adolescent Diabetes (ISPAD)

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Abstract

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