Exercise and type 1 diabetes: treatment strategies and glucose management

Regular physical activity and exercise are cornerstones of modern type 1 diabetes mellitus management. In recent years, the availability of automated insulin delivery systems (AID; dynamic insulin delivery + continuous glucose monitoring + dosing algorithm) has improved glycemic control in people with type 1 diabetes. Physical activity and exercise provide additional health benefits but may result in glucose fluctuations that present various challenges for current AID systems. Although clinical studies and reviews on AID systems, physical activity, and exercise have been published, a new position paper on type 1 diabetes, AID, and exercise will not be published until September 2024 at the European Association for the Study of Diabetes (EASD) conference. This joint position statement from the EASD and the International Society for Pediatric and Adolescent Diabetes (ISPAD) discusses the existing evidence on AID systems and provides detailed recommendations on how to manage physical activity and exercise for children, adolescents, and adults with type 1 diabetes using AID. Hence, the aim of this publication is to provide preliminary insights into the new recommendations and at the same time present basic knowledge about physical activity, exercise, and type 1 diabetes. In general, it is important to understand that the presented recommendations are only considered as initial recommendations and must be further individualized.