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Purpose <p>To provide a clinically oriented narrative practical review of strategies to reduce exercise-associated dysglycaemia in adolescents and adults with type 1 diabetes (T1D), organized by exercise or sport phenotype and by the timing of management before, during, after, and overnight, with particular attention to continuous glucose monitoring (CGM), automated insulin delivery (AID), multiple daily injections (MDI), and real-world sport settings.</p> Methods <p>This article was developed as a structured narrative practical review rather than as a formal systematic review or meta-analysis. A targeted literature search was conducted in PubMed/MEDLINE, CINAHL, and Google Scholar from database inception to 30 June 2026, supplemented by backward and forward citation tracking from key consensus statements, position papers, and major primary studies. Eligibility was defined a priori to prioritize literature with direct clinical interpretability for exercise-associated dysglycaemia in T1D, including consensus documents, randomized and crossover exercise studies, systematic reviews, technology-focused studies on CGM and AID, athlete-focused reports, and real-world implementation studies. The final synthesis was organized using a predefined dual-axis structure based on exercise phenotype and timing of management.</p> Results <p>Glycaemic responses differ substantially across exercise phenotypes. Continuous aerobic exercise is most consistently associated with progressive glucose decline and increased risk of delayed hypoglycaemia, particularly as duration increases and when insulin-on-board is present. Intermittent and team sports produce more variable responses, including transient hyperglycaemia, declines, and rapid glycaemic swings. Resistance exercise and high-intensity interval training (HIIT) are often associated with stable or rising glucose during activity, especially when performed at high intensity or in the fasting morning state, although later hypoglycaemia remains possible, particularly in mixed or evening sessions. Prolonged endurance exercise presents the greatest management complexity because of interactions among insulin-on-board, fueling strategy, duration, environment, competition stress, device wearability, and delayed increases in insulin sensitivity. Recent real-world evidence reinforces the importance of individualized context, including starting glucose and insulin exposure, and highlights the gap between laboratory paradigms and free-living exercise. Across phenotypes, a proactive approach integrating CGM trend interpretation, insulin exposure, AID strategy, carbohydrate planning, and post-exercise monitoring may support more coherent individualized decision-making.</p> Conclusion <p>This review does not replace existing consensus guidance and does not propose a new guideline-level recommendation system. Its main contribution is practical and integrative: it reorganizes heterogeneous evidence and current guidance into a phenotype-organized, timing-aware, clinic-facing structure intended to support more individualized counseling and self-management discussions in real-world sport settings. CGM and AID improve safety but do not eliminate the need for anticipatory planning, dynamic monitoring, and explicit post-exercise and overnight strategies.</p>

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Exercise and sport in type 1 diabetes in the continuous glucose monitoring and automated insulin delivery era: a phenotype-organized, timing-aware practical narrative review

  • 期刊论文

  • 发表日期：

    2026年7月29日

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  • Danilo Caponio,
  • Giuseppina Alessia Acucella,
  • Michele Acucella

摘要

Purpose

To provide a clinically oriented narrative practical review of strategies to reduce exercise-associated dysglycaemia in adolescents and adults with type 1 diabetes (T1D), organized by exercise or sport phenotype and by the timing of management before, during, after, and overnight, with particular attention to continuous glucose monitoring (CGM), automated insulin delivery (AID), multiple daily injections (MDI), and real-world sport settings.

Methods

This article was developed as a structured narrative practical review rather than as a formal systematic review or meta-analysis. A targeted literature search was conducted in PubMed/MEDLINE, CINAHL, and Google Scholar from database inception to 30 June 2026, supplemented by backward and forward citation tracking from key consensus statements, position papers, and major primary studies. Eligibility was defined a priori to prioritize literature with direct clinical interpretability for exercise-associated dysglycaemia in T1D, including consensus documents, randomized and crossover exercise studies, systematic reviews, technology-focused studies on CGM and AID, athlete-focused reports, and real-world implementation studies. The final synthesis was organized using a predefined dual-axis structure based on exercise phenotype and timing of management.

Results

Glycaemic responses differ substantially across exercise phenotypes. Continuous aerobic exercise is most consistently associated with progressive glucose decline and increased risk of delayed hypoglycaemia, particularly as duration increases and when insulin-on-board is present. Intermittent and team sports produce more variable responses, including transient hyperglycaemia, declines, and rapid glycaemic swings. Resistance exercise and high-intensity interval training (HIIT) are often associated with stable or rising glucose during activity, especially when performed at high intensity or in the fasting morning state, although later hypoglycaemia remains possible, particularly in mixed or evening sessions. Prolonged endurance exercise presents the greatest management complexity because of interactions among insulin-on-board, fueling strategy, duration, environment, competition stress, device wearability, and delayed increases in insulin sensitivity. Recent real-world evidence reinforces the importance of individualized context, including starting glucose and insulin exposure, and highlights the gap between laboratory paradigms and free-living exercise. Across phenotypes, a proactive approach integrating CGM trend interpretation, insulin exposure, AID strategy, carbohydrate planning, and post-exercise monitoring may support more coherent individualized decision-making.

Conclusion

This review does not replace existing consensus guidance and does not propose a new guideline-level recommendation system. Its main contribution is practical and integrative: it reorganizes heterogeneous evidence and current guidance into a phenotype-organized, timing-aware, clinic-facing structure intended to support more individualized counseling and self-management discussions in real-world sport settings. CGM and AID improve safety but do not eliminate the need for anticipatory planning, dynamic monitoring, and explicit post-exercise and overnight strategies.