Individualized Exercise Consultation in Type 1 Diabetes

Overview

People with type 1 diabetes often experience challenges managing blood glucose levels during and around physical activity, which may reduce participation in exercise. The ACTIVE-T1D project aims to evaluate whether individualized video-based exercise consultations can improve exercise-related confidence, physical activity levels, and glycemic management in adults with type 1 diabetes. Participants will receive individualized consultations focused on exercise, glucose management, insulin adjustment, and nutrition strategies related to physical activity. Consultations are tailored to the participant's exercise habits, goals, and challenges. The study will assess self-reported exercise management, physical activity, and glucose metrics obtained from continuous glucose monitoring systems. A subgroup of participants will also complete objective physical activity measurements using accelerometers. The study is conducted as a prospective quality improvement project at Steno Diabetes Center Aarhus.

Background Physical activity is a recommended and integral component of T1D treatment, as it confers a range of health benefits, including improved insulin sensitivity, better glycaemic regulation, enhanced cardiovascular fitness, healthier lipid profiles, weight management, reduced blood pressure, and a lower risk of diabetes-related complications (1). Additionally, regular exercise supports psychological well-being and overall quality of life for people living with type 1 diabetes (2). However, despite written guidelines on the topic (3), individuals with type 1 diabetes often experience challenges with blood glucose excursions before, during, and after exercise (4, 5), limiting participation in regular exercise. In recognition of limited guidance for individuals with type 1 diabetes regarding exercise (6), the Clinic for Athletes with Type One Diabetes (CATOD) was established in 2019 at the Steno Diabetes Center Aarhus (SDCA). CATOD is the first clinic of its kind and has transformed care for individuals with type 1 diabetes who exercise. Initially, the clinic primarily supported highly active athletes with type 1 diabetes through sports camps followed by a 6-12 month consultation programme focused on exercise and diabetes management strategies(7). Since 2023 the clinic has expanded to provide 1-3 videoconsultations to a broad range of individuals with type 1 diabetes across the nation in order to help them with exercise obstacles. The problems presented span from going for a walk or bicycling to work without getting a low blood glucose to how to manage glucose during marathon training and competition. During the consultations, the individual with type 1 diabetes receives individualized guidance on exercise, glucose management, insulin adjustment, and nutrition. Evidence from a prior questionnaire administered to participants who received the intervention suggests that many benefited from the advice and were able to modify their exercise habits, facilitating more effective and less burdensome physical activity. Aim This study aims to expand current knowledge on the effectiveness of individualized exercise consultations in people with type 1 diabetes. Specifically, we will evaluate whether individualized, video-based exercise consultations can improve physical activity levels, glycemic control and patient empowerment. Objectives To determine whether individualized, exercise-specific consultations: 1. Increase physical activity levels 2. Improve glycemic control during and around exercise, as well as overall glycemic control 3. Enhance confidence and self-management related to exercise