About this Research Topic

Background

Type 1 diabetes is a challenging condition to manage since it includes many facets such as treatment with insulin, technical devices, physiological and behavioral factors. Regular exercise is a cornerstone in diabetes treatment, but management of different forms of physical activity could be difficult for both the individual with type 1 diabetes as well as the health-care provider.

People with type 1 diabetes tend to be as physically inactive as the general population, where we see a large percentage of individuals not maintaining a healthy body composition nor achieving the minimum recommended amount of moderate to vigorous aerobic activity per week. Regular exercise can improve both health and wellbeing of individuals with type 1 diabetes, and can help them to achieve their targets for lipid, body mass, and fitness. However, improvements in glycemic control is not forgiven when exercise is added to insulin treatment. There are also several additional barriers to exercise, including fear of hypoglycemia, loss of glycemic control, and inadequate knowledge around exercise management that could be a barrier to glucose control.

Regular physical activity has been shown to increase insulin sensitivity, reduces blood pressure and lipid levels, and has the potential to improve time in glucose target and HbA1c levels, and also reduce the risk of diabetes-related complications.

People with type 1 diabetes may have altered physiological and metabolic responses to aerobic and anaerobic exercise. Energy systems used during exercise and hormonal responses to exercise may be altered in some people living type 1 diabetes.
Both the musculature and the vasculature may be influenced by the level of glucose control in type 1 diabetes.

Current guidelines for improving glucose control around exercise in type 1 diabetes are somewhat limited, but in general, insulin dose reductions and carbohydrate feeding typically are initiated to prevent hypoglycemia caused by continuous aerobic exercise. Hyperglycemia associated with sport and exercise is typically managed by conservative insulin dose corrections.

How diabetes impacts exercise performance is somewhat unclear but performance may be suboptimal in some individuals particularly if the metabolic control is poor.
While beneficial, exercise often poses challenges to acute glucose control with prolonged aerobic activities increasing the risk for hypoglycemia whereas, intense exercise can promote hyperglycemia.

There is a need to better understand how to optimize exercise management for individuals with type 1 diabetes who exercise regularly, to identify glucose targets that are safe and effective and if needed enables the individual to maximize their performance. To obtain clinical data on how to optimize nutritional supplementation and insulin doses in order to protect against exercise-related glucose excursions.

Newly developed artificial insulin delivery systems using continuous glucose sensing and exercise smart algorithms are currently being tested in a variety of exercise settings. The administration of glucagon before prolonged aerobic exercise is also actively being studied.
With this Research Topic, we aim to provide an updated overview of clinical studies on diabetes and physical activity. We will welcome original research articles and review articles on, but not limited to, the following topics.

1. Benefits of exercise and physical activity;
2. Insulin action and physical activity;
3. Effects of activity type and timing on glycemic balance;
4. Management of food and insulin with physical activity;
5. Impact of energy balance and performance;
6. Pre-exercise health screening and evaluation;
7. Minimizing exercise-related adverse events in people with diabetes

Keywords: Diabetes, Physical Activity, Glucose Monitoring, Hypoglycemia, Performance

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