Use of Continuous Glucose Monitoring Trends to Facilitate Exercise in Children with Type 1 Diabetes

Diabetes care during exercise frequently requires interruptions to activity and adds extra challenges particularly for young individuals with type 1 diabetes (T1D). This study investigated the use of a carbohydrate (CHO) intake algorithm based on continuous glucose monitoring (CGM) trends during physical activity. Children with T1D diagnosed for >1 year, ages 8-12 years, with a glycated hemoglobin of <10% were recruited into a randomized crossover study. They attended two similar mornings of fun-based physical activity and adhered to either a CHO intake algorithm based on CGM trends (intervention) or to standard exercise guidelines (consumption of 0.5 g CHO/kg/h when glucose <8 mmol/L) (control). Outcome measures included events such as exercise interruptions, CHO intake, and hypoglycemia events and percentage time spent in different sensor glucose ranges. Fourteen children completed the study. No episodes of significant hypoglycemia (sensor glucose level <3.0 mmol/L) occurred in either arm. Mean CHO intake was the same in both arms, 0.3 +/- 0.2 g/kg/h. However, the intervention algorithm resulted in fewer CHO intake events per day: rate [95% confidence interval] 2.4 [1.6-2.3] versus 0.9 [0.4-1.5], P < 0.001, and exercise interruptions: 7.2 [5.9-8.8] versus 1.4 [0.8-2.1], P < 0.001, compared with control. There was no evidence of a difference in percentage time in range (3.9-10 mmol/L) and percentage time spent high between study arms. Both control and intervention protocols prevented significant hypoglycemia. Using a CHO intake algorithm based on CGM trends resulted in fewer CHO intake events and fewer interruptions to exercise. Use of this algorithm may reduce the burden of diabetes management with potential to facilitate activity in young people with T1D.