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01-12-2020 | Insulins | Position statement

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)

Authors: Othmar Moser, Michael C. Riddell, Max L. Eckstein, Peter Adolfsson, Rémi Rabasa-Lhoret, Louisa van den Boom, Pieter Gillard, Kirsten Nørgaard, Nick S. Oliver, Dessi P. Zaharieva, Tadej Battelino, Carine de Beaufort, Richard M. Bergenstal, Bruce Buckingham, Eda Cengiz, Asma Deeb, Tim Heise, Simon Heller, Aaron J. Kowalski, Lalantha Leelarathna, Chantal Mathieu, Christoph Stettler, Martin Tauschmann, Hood Thabit, Emma G. Wilmot, Harald Sourij, Carmel E. Smart, Peter G. Jacobs, Richard M. Bracken, Julia K. Mader

Published in: Diabetologia | Issue 12/2020

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 (i.e. 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.

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Foster NC, Miller KM, Tamborlane WV, Bergenstal RM, Beck RW (2016) Continuous glucose monitoring in patients with type 1 diabetes using insulin injections. Diabetes Care 39:e81–e82. https://doi.org/10.2337/dc16-0207CrossRef

Beck RW, Riddlesworth T, Ruedy K et al (2017) Continuous glucose monitoring vs conventional therapy for glycemic control in adults with type 1 diabetes treated with multiple daily insulin injections: the gold randomized clinical trial. JAMA 317(4):371. https://doi.org/10.1001/jama.2016.19975CrossRef

van Beers CAJ, DeVries JH, Kleijer SJ et al (2016) Continuous glucose monitoring for patients with type 1 diabetes and impaired awareness of hypoglycaemia (IN CONTROL): a randomised, open-label, crossover trial. Lancet Diabetes Endocrinol 4(11):893–902. https://doi.org/10.1016/S2213-8587(16)30193-0CrossRef

Lind M, Polonsky W, Hirsch IB et al (2017) Continuous glucose monitoring vs conventional therapy for glycemic control in adults with type 1 diabetes treated with multiple daily insulin injections: the GOLD randomized clinical trial. JAMA 317(4):379–387. https://doi.org/10.1001/jama.2016.19976CrossRef

Bolinder J, Antuna R, Geelhoed-Duijvestijn P, Kröger J, Weitgasser R (2016) Novel glucose-sensing technology and hypoglycaemia in type 1 diabetes: a multicentre, non-masked, randomised controlled trial. Lancet 388(10057):2254–2263. https://doi.org/10.1016/S0140-6736(16)31535-5CrossRef

Oskarsson P, Antuna R, Geelhoed-Duijvestijn P, Krӧger J, Weitgasser R, Bolinder J (2018) Impact of flash glucose monitoring on hypoglycaemia in adults with type 1 diabetes managed with multiple daily injection therapy: a pre-specified subgroup analysis of the IMPACT randomised controlled trial. Diabetologia 61(3):539–550. https://doi.org/10.1007/s00125-017-4527-5CrossRef

Evans M, Welsh Z, Ells S, Seibold A (2020) The impact of flash glucose monitoring on glycaemic control as measured by HbA1c: a meta-analysis of clinical trials and real-world observational studies. Diabetes Ther 11(1):83–95. https://doi.org/10.1007/s13300-019-00720-0CrossRef

Reddy M, Jugnee N, Anantharaja S, Oliver N (2018) Switching from flash glucose monitoring to continuous glucose monitoring on hypoglycemia in adults with type 1 diabetes at high hypoglycemia risk: the extension phase of the I HART CGM study. Diabetes Technol Ther 20(11):751–757. https://doi.org/10.1089/dia.2018.0252CrossRef

Feig DS, Donovan LE, Corcoy R et al (2017) Continuous glucose monitoring in pregnant women with type 1 diabetes (CONCEPTT): a multicentre international randomised controlled trial. Lancet 390(10110):2347–2359. https://doi.org/10.1016/S0140-6736(17)32400-5CrossRef

10.

Berg AK, Olsen BS, Thyssen JP et al (2018) High frequencies of dermatological complications in children using insulin pumps or sensors. Pediatr Diabetes 19(4):733–740. https://doi.org/10.1111/pedi.12652CrossRef

11.

Hilliard ME, Levy W, Anderson BJ et al (2019) Benefits and barriers of continuous glucose monitoring in young children with type 1 diabetes. Diabetes Technol Ther 21(9):493–498. https://doi.org/10.1089/dia.2019.0142CrossRef

12.

Messer LH, Berget C, Beatson C, Polsky S, Forlenza GP (2018) Preserving skin integrity with chronic device use in diabetes. Diabetes Technol Ther 20:S254–S264. https://doi.org/10.1089/dia.2018.0080CrossRef

13.

Messer LH, Johnson R, Driscoll KA, Jones J (2018) Best friend or spy: a qualitative meta-synthesis on the impact of continuous glucose monitoring on life with type 1 diabetes. Diabet Med 35:409–418. https://doi.org/10.1111/dme.13568CrossRef

14.

Larson NS, Pinsker JE (2013) The role of continuous glucose monitoring in the care of children with type 1 diabetes. Int J Pediatr Endocrinol 2013(1):8. https://doi.org/10.1186/1687-9856-2013-8CrossRef

15.

Moser O, Yardley J, Bracken R (2018) Interstitial glucose and physical exercise in type 1 diabetes: integrative physiology, technology, and the gap in-between. Nutrients 10(1):93. https://doi.org/10.3390/nu10010093CrossRef

16.

Larose S, Rabasa-Lhoret R, Roy-Fleming A et al (2019) Changes in accuracy of continuous glucose monitoring using Dexcom G4 Platinum over the course of moderate intensity aerobic exercise in type 1 diabetes. Diabetes Technol Ther 21(6):364–369. https://doi.org/10.1089/dia.2018.0400CrossRef

17.

Steineck IIK, Mahmoudi Z, Ranjan A, Schmidt S, Jørgensen JB, Nørgaard K (2019) Comparison of continuous glucose monitoring accuracy between abdominal and upper arm insertion sites. Diabetes Technol Ther 21(5):295–302. https://doi.org/10.1089/dia.2019.0014CrossRef

18.

Moser O, Mader J, Tschakert G et al (2016) Point accuracy of interstitial continuous glucose monitoring during resistance and aerobic exercise in type 1 diabetes. Nutrients 8(8):489. https://doi.org/10.3390/nu8080489CrossRef

19.

Yardley JE, Sigal RJ, Kenny GP, Riddell MC, Perkins BA (2012) Point accuracy of interstitial continuous glucose monitoring during resistance and aerobic exercise in type 1 diabetes. Can J Diabetes 36(5):S14–S15. https://doi.org/10.1016/j.jcjd.2012.07.063CrossRef

20.

Gilligan BJ, Shults MC, Rhodes RK, Updike SJ (1994) Evaluation of a subcutaneous glucose sensor out to 3 months in a dog model. Diabetes Care 17(8):882–887. https://doi.org/10.2337/diacare.17.8.882CrossRef

21.

Maahs DM, DeSalvo D, Pyle L et al (2015) Effect of acetaminophen on CGM glucose in an outpatient setting. Diabetes Care 38(10):e158–e159. https://doi.org/10.2337/dc15-1096CrossRef

22.

Zaharieva DP, Turksoy K, McGaugh SM et al (2019) Lag time remains with newer real-time continuous glucose monitoring technology during aerobic exercise in adults living with type 1 diabetes. Diabetes Technol Ther 21(6):313–321. https://doi.org/10.1089/dia.2018.0364CrossRef

23.

Mcclatchey PM, Mcclain ES, Williams IM, Gregory JM, Cliffel DWD (2019) Continuous glucose monitor readings lag interstitial glucose by several minutes. Diabetes 68(Supplement 1):962-P (Abstract). https://doi.org/10.2337/db19-962-pCrossRef

24.

Moser O, Eckstein ML, Mueller A et al (2019) Impact of physical exercise on sensor performance of the FreeStyle Libre intermittently viewed continuous glucose monitoring system in people with type 1 diabetes: a randomized crossover trial. Diabet Med 36(5):606–611. https://doi.org/10.1111/dme.13909CrossRef

25.

Moser O, Eckstein ML, McCarthy O et al (2019) Performance of the Freestyle Libre flash glucose monitoring (flash GM) system in individuals with type 1 diabetes: a secondary outcome analysis of a randomized crossover trial. Diabetes Obes Metab 21:2505–2512. https://doi.org/10.1111/dom.13835CrossRef

26.

Basu A, Dube S, Slama M et al (2013) Time lag of glucose from intravascular to interstitial compartment in humans. Diabetes 62(12):4083–4087. https://doi.org/10.2337/db13-1132CrossRef

27.

Li A, Riddell MC, Potashner D, Brown RE, Aronson R (2019) Time lag and accuracy of continuous glucose monitoring during high intensity interval training in adults with type 1 diabetes. Diabetes Technol Ther 21(5):286–294. https://doi.org/10.1089/dia.2018.0387CrossRef

28.

Taleb N, Emami A, Suppere C et al (2016) Comparison of two continuous glucose monitoring systems, Dexcom G4 Platinum and Medtronic Paradigm Veo Enlite system, at rest and during exercise. Diabetes Technol Ther 18(9):561–567. https://doi.org/10.1089/dia.2015.0394CrossRef

29.

Breton MD, Cherñavvsky DR, Forlenza GP et al (2017) Closed-loop control during intense prolonged outdoor exercise in adolescents with type 1 diabetes: the artificial pancreas ski study. Diabetes Care 40(12):1644–1650. https://doi.org/10.2337/dc17-0883CrossRef

30.

Gomez AM, Gomez C, Aschner P et al (2015) Effects of performing morning versus afternoon exercise on glycemic control and hypoglycemia frequency in type 1 diabetes patients on sensor-augmented insulin pump therapy. J Diabetes Sci Technol 9(3):619–624. https://doi.org/10.1177/1932296814566233CrossRef

31.

Jayawardene DC, McAuley SA, Horsburgh JC et al (2017) Closed-loop insulin delivery for adults with type 1 diabetes undertaking high-intensity interval exercise versus moderate-intensity exercise. Diabetes Technol Ther 19(6):340–348. https://doi.org/10.1089/dia.2016.0461CrossRef

32.

Zaharieva D, Yavelberg L, Jamnik V, Cinar A, Turksoy K, Riddell MC (2017) The effects of basal insulin suspension at the start of exercise on blood glucose levels during continuous versus circuit-based exercise in individuals with type 1 diabetes on continuous subcutaneous insulin infusion. Diabetes Technol Ther 19(6):370–378. https://doi.org/10.1089/dia.2017.0010CrossRef

33.

Biagi L, Bertachi A, Quirós C et al (2018) Accuracy of continuous glucose monitoring before, during, and after aerobic and anaerobic exercise in patients with type 1 diabetes mellitus. Biosensors 8(1):22. https://doi.org/10.3390/bios8010022CrossRef

34.

Moser O, Pandis M, Aberer F et al (2019) A head-to-head comparison of personal and professional continuous glucose monitoring systems in people with type 1 diabetes: hypoglycaemia remains the weak spot. Diabetes Obes Metab 21:1043–1048. https://doi.org/10.1111/dom.13598CrossRef

35.

Aberer F, Hajnsek M, Rumpler M et al (2017) Evaluation of subcutaneous glucose monitoring systems under routine environmental conditions in patients with type 1 diabetes. Diabetes Obes Metab 19(7):1051–1055. https://doi.org/10.1111/dom.12907CrossRef

36.

Giani E, Macedoni M, Barilli A et al (2018) Performance of the flash glucose monitoring system during exercise in youth with type 1 diabetes. Diabetes Res Clin Pract 146:321–329. https://doi.org/10.1016/j.diabres.2018.10.001CrossRef

37.

Bally L, Zueger T, Pasi N, Carlos C, Paganini D, Stettler C (2016) Accuracy of continuous glucose monitoring during differing exercise conditions. Diabetes Res Clin Pract 112:1–5. https://doi.org/10.1016/j.diabres.2015.11.012CrossRef

38.

Colberg SR, Sigal RJ, Yardley JE et al (2016) Physical activity/exercise and diabetes: a position statement of the American Diabetes Association. Diabetes Care 39(11):2065–2079. https://doi.org/10.2337/dc16-1728CrossRef

39.

Riddell MC, Gallen IW, Smart CE et al (2017) Exercise management in type 1 diabetes: a consensus statement. Lancet Diabetes Endocrinol 8587(17):1–14. https://doi.org/10.1016/S2213-8587(17)30014-1CrossRef

40.

Adolfsson P, Riddell MC, Taplin CE et al (2018) ISPAD clinical practice consensus guidelines 2018: exercise in children and adolescents with diabetes. Pediatr Diabetes 19:205–226. https://doi.org/10.1111/pedi.12755CrossRef

41.

Battelino T, Danne T, Bergenstal RM et al (2019) Clinical targets for continuous glucose monitoring data interpretation: recommendations from the international consensus on time in range. Diabetes Care 42(8):1593–1603. https://doi.org/10.2337/dci19-0028CrossRef

42.

Chiang JL, Kirkman MS, Laffel LMB, Peters AL (2014) Type 1 diabetes through the life span: a position statement of the American Diabetes Association. Diabetes Care 37(7):2034–2054. https://doi.org/10.2337/dc14-1140CrossRef

43.

American Diabetes Association (2014) Standards of medical care in diabetes—2014. Diabetes Care 37:14–80. https://doi.org/10.2337/dc14-S014CrossRef

44.

Burckhardt MA, Chetty T, Smith GJ et al (2019) Use of continuous glucose monitoring trends to facilitate exercise in children with type 1 diabetes. Diabetes Technol Ther 21(1):51–55. https://doi.org/10.1089/dia.2018.0292CrossRef

45.

Riddell MC, Milliken J (2011) Preventing exercise-induced hypoglycemia in type 1 diabetes using real-time continuous glucose monitoring and a new carbohydrate intake algorithm: an observational field study. Diabetes Technol Ther 13(8):819–825. https://doi.org/10.1089/dia.2011.0052CrossRef

46.

Hinkley T, Salmon J, Okely AD, Crawford D, Hesketh K (2012) Preschoolers’ physical activity, screen time, and compliance with recommendations. Med Sci Sports Exerc 44(3):458–465. https://doi.org/10.1249/MSS.0b013e318233763bCrossRef

47.

Bally L, Zueger T, Buehler T et al (2016) Metabolic and hormonal response to intermittent high-intensity and continuous moderate intensity exercise in individuals with type 1 diabetes: a randomised crossover study. Diabetologia 59(4):776–784. https://doi.org/10.1007/s00125-015-3854-7CrossRef

48.

Reddy R, Wittenberg A, Castle JR et al (2019) Effect of aerobic and resistance exercise on glycemic control in adults with type 1 diabetes. Can J Diabetes 43(6):406–414. https://doi.org/10.1016/j.jcjd.2018.08.193CrossRef

49.

Turner D, Gray BJ, Luzio S et al (2016) Similar magnitude of post-exercise hyperglycemia despite manipulating resistance exercise intensity in type 1 diabetes individuals. Scand J Med Sci Sports 26(4):404–412. https://doi.org/10.1111/sms.12472CrossRef

50.

García-García F, Kumareswaran K, Hovorka R, Hernando ME (2015) Quantifying the acute changes in glucose with exercise in type 1 diabetes: a systematic review and meta-analysis. Sports Med 45(4):587–599. https://doi.org/10.1007/s40279-015-0302-2CrossRef

51.

Rabasa-Lhoret R, Bourque J, Ducros F, Chiasson JL (2001) Guidelines for premeal insulin dose reduction for postprandial exercise of different intensities and durations in type 1 diabetic subjects treated intensively with a basal-bolus insulin regimen (ultralente-lispro). Diabetes Care 24(4):625–630. https://doi.org/10.2337/diacare.24.4.625CrossRef

52.

West DJ, Morton RD, Bain SC, Stephens JW, Bracken RM (2010) Blood glucose responses to reductions in pre-exercise rapid-acting insulin for 24 h after running in individuals with type 1 diabetes. J Sports Sci 28(7):781–788. https://doi.org/10.1080/02640411003734093CrossRef

53.

Moser O, Eckstein ML, Mueller A et al (2019) Pre-exercise blood glucose levels determine the amount of orally administered carbohydrates during physical exercise in individuals with type 1 diabetes—a randomized cross-over trial. Nutrients 11(6):1287. https://doi.org/10.3390/nu11061287CrossRef

54.

Scott SN, Cocks M, Andrews RC et al (2019) Fasted high-intensity interval and moderate-intensity exercise do not lead to detrimental 24-hour blood glucose profiles. J Clin Endocrinol Metab 104(1):111–117. https://doi.org/10.1210/jc.2018-01308CrossRef

55.

Riddell MC, Pooni R, Yavelberg L et al (2019) Reproducibility in the cardiometabolic responses to high-intensity interval exercise in adults with type 1 diabetes. Diabetes Res Clin Pract 148:137–143. https://doi.org/10.1016/j.diabres.2019.01.003CrossRef

56.

Harmer AR, Chisholm DJ, McKenna MJ et al (2007) High-intensity training improves plasma glucose and acid-base regulation during intermittent maximal exercise in type 1 diabetes. Diabetes Care 30(5):1269–1271. https://doi.org/10.2337/dc06-1790CrossRef

57.

Farinha JB, Boff W, dos Santos GC et al (2019) Acute glycemic responses along 10-week high-intensity training protocols in type 1 diabetes patients. Diabetes Res Clin Pract 153:111–113. https://doi.org/10.1016/j.diabres.2019.06.001CrossRef

58.

Bohn B, Herbst A, Pfeifer M et al (2015) Impact of physical activity on glycemic control and prevalence of cardiovascular risk factors in adults with type 1 diabetes: a cross-sectional multicenter study of 18,028 patients. Diabetes Care 38(8):1536–1543. https://doi.org/10.2337/dc15-0030CrossRef

59.

Lin YK, Hung M, Sharma A et al (2019) Impaired awareness of hypoglycemia continues to be a risk factor for severe hypoglycemia despite the use of continuous glucose monitoring system in type 1 diabetes. Endocr Pract 25(6):517–525. https://doi.org/10.4158/EP-2018-0527CrossRef

60.

Galassetti P, Tate D, Neill RA, Richardson A, Leu SY, Davis SN (2006) Effect of differing antecedent hypoglycemia on counterregulatory responses to exercise in type 1 diabetes. Am J Physiol Endocrinol Metab 290(6):E1109–E1117. https://doi.org/10.1152/ajpendo.00244.2005CrossRef

61.

American Diabetes Association (2020) Older adults: standards of medical care in diabetes-2020. Diabetes Care 43(Suppl. 1):S152–S162. https://doi.org/10.2337/dc20-S012CrossRef

62.

Kudva YC, Ahmann AJ, Bergenstal RM et al (2018) Approach to using trend arrows in the freestyle libre flash glucose monitoring systems in adults. J Endocr Soc 2(12):1320–1337. https://doi.org/10.1210/js.2018-00294CrossRef

63.

Kennedy A, Nirantharakumar K, Chimen M et al (2013) Does exercise improve glycaemic control in type 1 diabetes? a systematic review and meta-analysis. PLoS One 8(3):e58861. https://doi.org/10.1371/journal.pone.0058861CrossRef

64.

Shivers JP, Mackowiak L, Anhalt H, Zisser H (2013) “Turn it off!”: diabetes device alarm fatigue considerations for the present and the future. J Diabetes Sci Technol 7(3):789–794. https://doi.org/10.1177/193229681300700324CrossRef

65.

Eshghi SRT, Yardley JE (2019) Morning (fasting) vs. afternoon resistance exercise in individuals with type 1 diabetes: a randomized cross-over study. J Clin Endocrinol Metab 104(11):5217–5224. https://doi.org/10.1210/jc.2018-02384CrossRef

66.

McCarthy O, Moser O, Eckstein ML et al (2019) Resistance isn’t futile: the physiological basis of the health effects of resistance exercise in individuals with type 1 diabetes. Front Endocrinol 10:507. https://doi.org/10.3389/fendo.2019.00507CrossRef

67.

Peter Adams O (2013) The impact of brief high-intensity exercise on blood glucose levels. Diabetes, Metab Syndr Obes Targets Ther 6:113–122. https://doi.org/10.2147/DMSO.S29222CrossRef

68.

Aronson R, Brown RE, Li A, Riddell MC (2019) Optimal insulin correction factor in post–high-intensity exercise hyperglycemia in adults with type 1 diabetes: the FIT study. Diabetes Care 42(1):10–16. https://doi.org/10.2337/dc18-1475CrossRef

69.

Turner D, Luzio S, Gray BJ et al (2016) Algorithm that delivers an individualized rapid-acting insulin dose after morning resistance exercise counters post-exercise hyperglycaemia in people with Type 1 diabetes. Diabet Med 33(4):506–510. https://doi.org/10.1111/dme.12870CrossRef

70.

Danne T, Nimri R, Battelino T et al (2017) International consensus on use of continuous glucose monitoring. Diabetes Care 40(12):1631–1640. https://doi.org/10.2337/dc17-1600CrossRef

71.

Cryer PE (2008) The barrier of hypoglycemia in diabetes. Diabetes 57(12):3169–3176. https://doi.org/10.2337/db08-1084CrossRef

72.

Fuchs CJ, Gonzalez JT, Loon LJC (2019) Fructose co-ingestion to increase carbohydrate availability in athletes. J Physiol 597(14):3549–3560. https://doi.org/10.1113/JP277116CrossRef

73.

Temesi J, Johnson NA, Raymond J, Burdon CA, O’Connor HT (2011) Carbohydrate ingestion during endurance exercise improves performance in adults. J Nutr 141(5):890–897. https://doi.org/10.3945/jn.110.137075CrossRef

74.

Moser O, Tschakert G, Mueller A et al (2015) Effects of high-intensity interval exercise versus moderate continuous exercise on glucose homeostasis and hormone response in patients with type 1 diabetes mellitus using novel ultra-long-acting insulin. PLoS One 10(8):e0136489. https://doi.org/10.1371/journal.pone.0136489CrossRef

75.

Scott SN, Anderson L, Morton JP, Wagenmakers AJM, Riddell MC (2019) Carbohydrate restriction in type 1 diabetes: a realistic therapy for improved glycaemic control and athletic performance? Nutrients 11(5):1022. https://doi.org/10.3390/nu11051022CrossRef

76.

Castle JR, Rodbard D (2019) How well do continuous glucose monitoring systems perform during exercise. Diabetes Technol Ther 21:305–309. https://doi.org/10.1089/dia.2019.0132CrossRef

77.

Campbell MD, Walker M, Bracken RM et al (2015) Insulin therapy and dietary adjustments to normalize glycemia and prevent nocturnal hypoglycemia after evening exercise in type 1 diabetes: a randomized controlled trial. BMJ Open Diabetes Res Care 3(1):e000085. https://doi.org/10.1136/bmjdrc-2015-000085CrossRef

78.

Carstens S, Sprehn M (1998) Prehospital treatment of severe hypoglycaemia: a comparison of intramuscular glucagon and intravenous glucose. Prehosp Disaster Med 13(2–4):44–50. https://doi.org/10.1017/s1049023x00030132CrossRef

79.

Maran A, Pavan P, Bonsembiante B et al (2010) Continuous glucose monitoring reveals delayed nocturnal hypoglycemia after intermittent high-intensity exercise in nontrained patients with type 1 diabetes. Diabetes Technol Ther 12(10):763–768. https://doi.org/10.1089/dia.2010.0038CrossRef

80.

Moser O, Eckstein ML, McCarthy O et al (2019) 66-LB: Greater time spent in hypoglycemia during night compared with day during intensified training in professional cyclists with type 1 diabetes—a prospective observational study. Diabetes 68(Supplement 1):66-LB (Abstract). https://doi.org/10.2337/db19-66-lbCrossRef

81.

Tsalikian E, Mauras N, Beck RW et al (2005) Impact of exercise on overnight glycemic control in children with type 1 diabetes mellitus. J Pediatr 147(4):528–534. https://doi.org/10.1016/j.jpeds.2005.04.065CrossRef

82.

MacDonald MJ (1987) Postexercise late-onset hypoglycemia in insulin-dependent diabetic patients. Diabetes Care 10(5):584–588. https://doi.org/10.2337/diacare.10.5.584CrossRef

83.

Iscoe KE, Corcoran M, Riddell MC (2008) High rates of nocturnal hypoglycemia in a unique sports camp for athletes with type 1 diabetes: lessons learned from continuous glucose monitoring systems. Can J Diabetes 32(3):182–189. https://doi.org/10.1016/S1499-2671(08)23008-XCrossRef

84.

Salem MA, Aboelasrar MA, Elbarbary NS, Elhilaly RA, Refaat YM (2010) Is exercise a therapeutic tool for improvement of cardiovascular risk factors in adolescents with type 1 diabetes mellitus? A randomised controlled trial. Diabetol Metab Syndr 2(1):47. https://doi.org/10.1186/1758-5996-2-47CrossRef

85.

Absil H, Baudet L, Robert A, Lysy PA (2019) Benefits of physical activity in children and adolescents with type 1 diabetes: a systematic review. Diabetes Res Clin Pract 156:107810. https://doi.org/10.1016/j.diabres.2019.107810CrossRef

86.

D’hooge R, Hellinckx T, Van Laethem C et al (2011) Influence of combined aerobic and resistance training on metabolic control, cardiovascular fitness and quality of life in adolescents with type 1 diabetes: a randomized controlled trial. Clin Rehabil 25(4):349–359. https://doi.org/10.1177/0269215510386254CrossRef

87.

Heyman E, Toutain C, Delamarche P et al (2007) Exercise training and cardiovascular risk factors in Type 1 diabetic adolescent girls. Pediatr Exerc Sci 19(4):408–419. https://doi.org/10.1123/pes.19.4.408CrossRef

88.

Jabbour G, Henderson M, Mathieu ME (2016) Barriers to active lifestyles in children with type 1 diabetes. Can J Diabetes 40(2):170–172. https://doi.org/10.1016/j.jcjd.2015.12.001CrossRef

89.

Quirk H, Blake H, Dee B, Glazebrook C (2014) “You can’t just jump on a bike and go”: a qualitative study exploring parents’ perceptions of physical activity in children with type 1 diabetes. BMC Pediatr 14(1):1–12. https://doi.org/10.1186/s12887-014-0313-4CrossRef

90.

Erie C, Van Name MA, Weyman K et al (2018) Schooling diabetes: use of continuous glucose monitoring and remote monitors in the home and school settings. Pediatr Diabetes 19(1):92–97. https://doi.org/10.1111/pedi.12518CrossRef

91.

Burckhardt MA, Roberts A, Smith GJ, Abraham MB, Davis EA, Jones TW (2018) The use of continuous glucose monitoring with remote monitoring improves psychosocial measures in parents of children with type 1 diabetes: a randomized crossover trial. Diabetes Care 41(12):2641–2643. https://doi.org/10.2337/dc18-0938CrossRef

92.

McTavish L, Corley B, Weatherall M, Wiltshire E, Krebs JD (2018) Weight-based carbohydrate treatment of hypoglycaemia in people with type 1 diabetes using insulin pump therapy: a randomized crossover clinical trial. Diabet Med 35(3):339–346. https://doi.org/10.1111/dme.13576CrossRef

93.

Riddell MC, Zaharieva DP, Tansey M et al (2019) Individual glucose responses to prolonged moderate intensity aerobic exercise in adolescents with type 1 diabetes: the higher they start, the harder they fall. Pediatr Diabetes 20(1):99–106. https://doi.org/10.1111/pedi.12799CrossRef

94.

Admon G, Weinstein Y, Falk B et al (2005) Exercise with and without an insulin pump among children and adolescents with type 1 diabetes mellitus. Pediatrics 116(3):e348–e355. https://doi.org/10.1542/peds.2004-2428CrossRef

95.

Samuelsson U, Ludvigsson J (2002) When should determination of ketonemia be recommended? Diabetes Technol Ther 4(5):645–650. https://doi.org/10.1089/152091502320798286CrossRef

96.

Laffel LMB, Wentzell K, Loughlin C, Tovar A, Moltz K, Brink S (2006) Sick day management using blood 3-hydroxybutyrate (3-OHB) compared with urine ketone monitoring reduces hospital visits in young people with T1DM: a randomized clinical trial. Diabet Med 23(3):278–284. https://doi.org/10.1111/j.1464-5491.2005.01771.xCrossRef

97.

Hanas R, Adolfsson P (2017) Bolus calculator settings in well-controlled prepubertal children using insulin pumps are characterized by low insulin to carbohydrate ratios and short duration of insulin action time. J Diabetes Sci Technol 11(2):247–252. https://doi.org/10.1177/1932296816661348CrossRef

98.

Chetty T, Shetty V, Fournier PA, Adolfsson P, Jones TW, Davis EA (2019) Exercise management for young people with type 1 diabetes: a structured approach to the exercise consultation. Front Endocrinol 10:326. https://doi.org/10.3389/fendo.2019.00326CrossRef

99.

Kaiserman K, Buckingham BA, Prakasam G et al (2013) Acceptability and utility of the mysentry remote glucose monitoring system. J Diabetes Sci Technol 7(2):356–361. https://doi.org/10.1177/193229681300700211CrossRef

100.

Montfort-Steiger V, Williams CA (2007) Carbohydrate intake considerations for young athletes. J Sports Sci Med 6:343–352

101.

Raju B, Arbelaez AM, Breckenridge SM, Cryer PE (2006) Nocturnal hypoglycemia in type 1 diabetes: an assessment of preventive bedtime treatments. J Clin Endocrinol Metab 91(6):2087–2092. https://doi.org/10.1210/jc.2005-2798CrossRef

102.

Mauras N, Xing D, Beck RW et al (2010) Prolonged nocturnal hypoglycemia is common during 12 months of continuous glucose monitoring in children and adults with type 1 diabetes. Diabetes Care 33(5):1004–1008. https://doi.org/10.2337/dc09-2081CrossRef

103.

Franchini S, Comegna L, Prezioso G, Blasetti A (2016) Hypoglycemia in children with type 1 diabetes: unawareness is a concrete risk. Curr Med Res Opin 32(9):1487–1491. https://doi.org/10.1080/03007995.2016.1185400CrossRef

104.

Reddy R, El Youssef J, Winters-Stone K et al (2018) The effect of exercise on sleep in adults with type 1 diabetes. Diabetes Obes Metab 20(2):443–447. https://doi.org/10.1111/dom.13065CrossRef

105.

Taplin CE, Cobry E, Messer L, McFann K, Chase HP, Fiallo-Scharer R (2010) Preventing post-exercise nocturnal hypoglycemia in children with type 1 diabetes. J Pediatr 157(5):784–788.e1. https://doi.org/10.1016/j.jpeds.2010.06.004CrossRef

106.

Bachmann S, Hess M, Martin-Diener E, Denhaerynck K, Zumsteg U (2016) Nocturnal hypoglycemia and physical activity in children with diabetes: new insights by continuous glucose monitoring and accelerometry. Diabetes Care 39(7):e95–e96. https://doi.org/10.2337/dc16-0411CrossRef

Title: 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)
Authors: Othmar Moser
Michael C. Riddell
Max L. Eckstein
Peter Adolfsson
Rémi Rabasa-Lhoret
Louisa van den Boom
Pieter Gillard
Kirsten Nørgaard
Nick S. Oliver
Dessi P. Zaharieva
Tadej Battelino
Carine de Beaufort
Richard M. Bergenstal
Bruce Buckingham
Eda Cengiz
Asma Deeb
Tim Heise
Simon Heller
Aaron J. Kowalski
Lalantha Leelarathna
Chantal Mathieu
Christoph Stettler
Martin Tauschmann
Hood Thabit
Emma G. Wilmot
Harald Sourij
Carmel E. Smart
Peter G. Jacobs
Richard M. Bracken
Julia K. Mader
Publication date: 01-12-2020
Publisher: Springer Berlin Heidelberg
Keywords: Insulins
Hypoglycemia
Insulins
Type 1 Diabetes
Published in: Diabetologia / Issue 12/2020
Print ISSN: 0012-186X
Electronic ISSN: 1432-0428
DOI: https://doi.org/10.1007/s00125-020-05263-9

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