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Aims/hypothesis <p>This large observational cohort real-world study explored the effects of three forms of exercise (walking [WALK], aerobic excluding walking [AER] and anaerobic [ANAER]) on glucose levels and hypoglycaemia risk in type 1 diabetes.</p> Methods <p>Data were collected from 3248 users of mySugr Logbook and Apple Health (mean ± SD age 41.23±12.25 years; glucose management index of 7.05±1.09%; 41.5% were female) over a total of 428,058 exercise sessions. Acute and 24 h glycaemic effects were examined across exercise types. Post-exercise glycaemia data over 24 h were compared with sedentary glycaemic data. Time of exercise was used to assess the probability of nocturnal hypoglycaemia.</p> Results <p>Independent of type, exercise decreased glucose by −1.06±0.89 mmol/l. For the individual types of exercise, WALK decreased levels by −1.24±0.81 mmol/l, AER by −1.43±1.02 mmol/l and ANAER by −0.52±0.81 mmol/l (all <i>p</i>&lt;0.001). Comparing sedentary days vs active days, the time in range (3.9–10 mmol/l glucose) increased by +2.08±6.06% for WALK, +2.94±6.46% for AER and +3.93±7.16% for ANAER, and the time below range (&lt;3.9 mmol/l) increased by 0.37±1.57% for WALK, 0.74±1.70% for AER and 0.68±1.79% for ANAER (all <i>p</i>&lt;0.001). ANAER yielded a smaller chance of acute hypoglycaemia and WALK yielded a smaller chance of nocturnal hypoglycaemia (<i>p</i>&lt;0.001). Activities done after 15:30 hours did not increase the risk of nocturnal hypoglycaemia when compared with earlier exercise sessions (+0.9±0.34%; <i>p</i>&lt;0.01).</p> Conclusions/interpretation <p>Aerobic activities decreased glucose more during exercise sessions than anaerobic exercise and yielded larger acute hypoglycaemia risk; anaerobic activities yielded the largest 24 h glycaemic improvements. More-intense exercise resulted in a larger nocturnal hypoglycaemia than walking; exercise timing was not a relevant contributor to nocturnal hypoglycaemia.</p> Graphical Abstract <p></p>

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Exercise in type 1 diabetes: real-world data on glucose levels and hypoglycaemia risk from over 420,000 exercise sessions

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年2月13日

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  • Josip Zivkovic,
  • Michael Mitter,
  • Delphine Theodorou,
  • Othmar Moser,
  • Timor Glatzer

摘要

Aims/hypothesis

This large observational cohort real-world study explored the effects of three forms of exercise (walking [WALK], aerobic excluding walking [AER] and anaerobic [ANAER]) on glucose levels and hypoglycaemia risk in type 1 diabetes.

Methods

Data were collected from 3248 users of mySugr Logbook and Apple Health (mean ± SD age 41.23±12.25 years; glucose management index of 7.05±1.09%; 41.5% were female) over a total of 428,058 exercise sessions. Acute and 24 h glycaemic effects were examined across exercise types. Post-exercise glycaemia data over 24 h were compared with sedentary glycaemic data. Time of exercise was used to assess the probability of nocturnal hypoglycaemia.

Results

Independent of type, exercise decreased glucose by −1.06±0.89 mmol/l. For the individual types of exercise, WALK decreased levels by −1.24±0.81 mmol/l, AER by −1.43±1.02 mmol/l and ANAER by −0.52±0.81 mmol/l (all p<0.001). Comparing sedentary days vs active days, the time in range (3.9–10 mmol/l glucose) increased by +2.08±6.06% for WALK, +2.94±6.46% for AER and +3.93±7.16% for ANAER, and the time below range (<3.9 mmol/l) increased by 0.37±1.57% for WALK, 0.74±1.70% for AER and 0.68±1.79% for ANAER (all p<0.001). ANAER yielded a smaller chance of acute hypoglycaemia and WALK yielded a smaller chance of nocturnal hypoglycaemia (p<0.001). Activities done after 15:30 hours did not increase the risk of nocturnal hypoglycaemia when compared with earlier exercise sessions (+0.9±0.34%; p<0.01).

Conclusions/interpretation

Aerobic activities decreased glucose more during exercise sessions than anaerobic exercise and yielded larger acute hypoglycaemia risk; anaerobic activities yielded the largest 24 h glycaemic improvements. More-intense exercise resulted in a larger nocturnal hypoglycaemia than walking; exercise timing was not a relevant contributor to nocturnal hypoglycaemia.

Graphical Abstract