ISPAD Clinical Practice Consensus Guidelines 2022: Exercise in children and adolescents with diabetes

Adding glycemic and physical activity metrics to a multimodal algorithm-enabled decision-support tool for type 1 diabetes care: Keys to implementation and opportunities

“…For example, a ≥50 mg/dL drop or hypoglycemia (<70 mg/dL) during structured exercise will be flagged in the TIDE care model for review. This information may help healthcare providers understand whether dysglycemia occurs during exercise, but also determine the risk of nocturnal hypoglycemia with increased levels of physical activity ( 7 , 26 ).…”

“…Exercise consensus guidelines recommend that children and adolescents should aim to achieve at least 60 minutes of daily physical activity (7)(8)(9). However, research has demonstrated that around 2/3 of youth with T1D were not participating in even 30 minutes of daily physical activity (10).…”

Perceived Knowledge and Confidence for Providing Youth-Specific Type 1 Diabetes Exercise Recommendations amongst Pediatric Diabetes Healthcare Professionals: An International, Cross-Sectional, Online Survey

“…For youth with type 1 diabetes (T1D), maintaining glycemia in a targeted range during and after physical activity (PA or "exercise" for this research) is challenging. Although daily PA should be encouraged by healthcare professionals (HCP) for youth with T1D, a large percentage of the T1D youth and young adult population are not meeting the target guidelines [1][2][3]. According to a cross-sectional multicenter study of 18,028 adults (≥18 to <80 years of age) from Germany and Austria with T1D, ∼63% of adults with T1D are not physically active enough, as defned by the World Health Organization (WHO) [4].…”

“…As such, encouraging and "prescribing" PA to youth with T1D should be a priority, with some additional emphasis on how to manage activity safely from a glycemic management perspective. According to the International Society for Pediatric and Adolescent Diabetes (ISPAD) exercise guidelines [6], all children and adolescents between 6 and 18 years of age should aim for at least 60 minutes of moderate-to-vigorousintensity PA each day, a recommendation that is given for all youth globally by other authorities including the WHO [7]. Vigorous-intensity aerobic activities, like running, bicycle riding, and some individual and team sports, as well as those that strengthen muscle and bone, such as climbing, games of tug of war, and resistance exercises using body weight, should be incorporated into this 60 minutes of PA per day, at least three days a week for a variety of health and ftness reasons [2,7,8].…”

“…Prescribing "exercise" by HCP can help sedentary adults, with or without risk factors, overcome physical inactivity [10], but the efectiveness of this approach for sedentary youth with T1D is unclear. Some starting points for education around exercise management in T1D may include describing the types and amounts of PA that should be done, some nutritional support and general insulin dose adjustments based on the PA type and timing, and reasonable and individualized target glucose ranges for the various activities [1,6,11,12]. However, common barriers to engaging in exercise for youth with T1D include the fear of hypoglycemia, a loss of glucose stability, low ftness levels, and insufcient or inadequate knowledge of strategies to prevent hypoglycemia [13][14][15].…”