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21.           Rawshani, A., et al. Excess mortality and cardiovascular disease in young adults with type 1 diabetes in relation to age at onset: a nationwide, register-based cohort study. Lancet. 2018;392(10146):477-486.

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27.           ElSayed, N. A., et al. 2. Classification and Diagnosis of Diabetes: Standards of Care in Diabetes-2023. Diabetes care. 2023;46(Suppl 1):S19-S40.

28.           Pociot, F. – Lernmark, A. Genetic risk factors for type 1 diabetes. Lancet (London, England). 2016;387(10035):2331-2339.

29.           Krischer, J. P., et al. The 6 year incidence of diabetes-associated autoantibodies in genetically at-risk children: the TEDDY study. Diabetologia. 2015;58(5):980-7.

30.           Ziegler, A. G., et al. Seroconversion to multiple islet autoantibodies and risk of progression to diabetes in children. Jama. 2013;309(23):2473-9.

31.           Insel, R. A., et al. Staging presymptomatic type 1 diabetes: a scientific statement of JDRF, the Endocrine Society, and the American Diabetes Association. Diabetes care. 2015;38(10):1964-74.

32.           Concannon, P., et al. Genetics of type 1A diabetes. N Engl J Med. 2009;360(16):1646-54.

33.           Noble, J. A. Immunogenetics of type 1 diabetes: A comprehensive review. Journal of autoimmunity. 2015;64:101-12.

34.           Rewers, M. – Ludvigsson, J. Environmental risk factors for type 1 diabetes. Lancet (London, England). 2016;387(10035):2340-2348.

35.           Ferrara, C. T., et al. Excess BMI in Childhood: A Modifiable Risk Factor for Type 1 Diabetes Development? Diabetes care. 2017;40(5):698-701.

36.           Agiostratidou, G., et al. Standardizing Clinically Meaningful Outcome Measures Beyond HbA1c for Type 1 Diabetes: A Consensus Report of the American Association of Clinical Endocrinologists, the American Association of Diabetes Educators, the American Diabetes Association, the Endocrine Society, JDRF International, The Leona M. and Harry B. Helmsley Charitable Trust, the Pediatric Endocrine Society, and the T1D Exchange. Diabetes Care. 2017;40(12):1622-1630.

37.           Freckmann, G., et al. Continuous glucose profiles in healthy subjects under everyday life conditions and after different meals. Journal of diabetes science and technology. 2007;1(5):695-703.

38.           Gastaldelli, A., et al. Effect of physiological hyperinsulinemia on gluconeogenesis in nondiabetic subjects and in type 2 diabetic patients. Diabetes. 2001;50(8):1807-12.

39.           Cryer, P. E. The barrier of hypoglycemia in diabetes. Diabetes. 2008;57(12):3169-76.

40.           Sherwin, R. S. – Sacca, L. Effect of Epinephrine on Glucose-Metabolism in Humans - Contribution of the Liver. American Journal of Physiology. 1984;247(2):E157-E165.

41.           Cryer, P. E. Death during intensive glycemic therapy of diabetes: mechanisms and implications. The American journal of medicine. 2011;124(11):993-6.

42.           Cryer, P. E. Severe hypoglycemia predicts mortality in diabetes. Diabetes care. 2012;35(9):1814-6.

43.           International Hypoglycaemia Study, G. Hypoglycaemia, cardiovascular disease, and mortality in diabetes: epidemiology, pathogenesis, and management. The lancet. Diabetes & endocrinology. 2019;7(5):385-396.

44.           ElSayed, N. A., et al. 9. Pharmacologic Approaches to Glycemic Treatment: Standards of Care in Diabetes-2023. Diabetes care. 2023;46(Suppl 1):S140-S157.

45.           Dutta, D., et al. Performance of Fast-Acting Aspart Insulin as Compared to Aspart Insulin in Insulin Pump for Managing Type 1 Diabetes Mellitus: A Meta-Analysis. Diabetes & metabolism journal. 2023;47(1):72-81.

46.           Malecki, M. T., et al. Ultra-Rapid Lispro Improves Postprandial Glucose Control and Time in Range in Type 1 Diabetes Compared to Lispro: PRONTO-T1D Continuous Glucose Monitoring Substudy. Diabetes technology & therapeutics. 2020;22(11):853-860.

47.           Wilson, L. M., et al. Opportunities and challenges in closed-loop systems in type 1 diabetes. The lancet. Diabetes & endocrinology. 2022;10(1):6-8.

48.           Sherr, J. L., et al. Glucagon Nasal Powder: A Promising Alternative to Intramuscular Glucagon in Youth With Type 1 Diabetes. Diabetes care. 2016;39(4):555-62.

49.           Deeb, L. C., et al. A phase 3 multicenter, open-label, prospective study designed to evaluate the effectiveness and ease of use of nasal glucagon in the treatment of moderate and severe hypoglycemia in children and adolescents with type 1 diabetes in the home or school setting. Pediatric diabetes. 2018;19(5):1007-1013.

50.           Rickels, M. R., et al. Intranasal Glucagon for Treatment of Insulin-Induced Hypoglycemia in Adults With Type 1 Diabetes: A Randomized Crossover Noninferiority Study. Diabetes care. 2016;39(2):264-70.

51.           Seaquist, E. R., et al. Prospective study evaluating the use of nasal glucagon for the treatment of moderate to severe hypoglycaemia in adults with type 1 diabetes in a real-world setting. Diabetes, obesity & metabolism. 2018;20(5):1316-1320.

52.           Haymond, M. W., et al. Nonaqueous, Mini-Dose Glucagon for Treatment of Mild Hypoglycemia in Adults With Type 1 Diabetes: A Dose-Seeking Study. Diabetes care. 2016;39(3):465-8.

53.           Haymond, M. W. – Schreiner, B. Mini-dose glucagon rescue for hypoglycemia in children with type 1 diabetes. Diabetes care. 2001;24(4):643-5.

54.           El-Khatib, F. H., et al. Home use of a bihormonal bionic pancreas versus insulin pump therapy in adults with type 1 diabetes: a multicentre randomised crossover trial. Lancet (London, England). 2017;389(10067):369-380.

55.           Lyons, S. K., et al. Use of Adjuvant Pharmacotherapy in Type 1 Diabetes: International Comparison of 49,996 Individuals in the Prospective Diabetes Follow-up and T1D Exchange Registries. Diabetes care. 2017;40(10):e139-e140.

56.           Fisher, L., et al. Diabetes distress in adults with type 1 diabetes: Prevalence, incidence and change over time. Journal of diabetes and its complications. 2016;30(6):1123-8.

57.           Nathan, D. M., et al. The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin-dependent diabetes mellitus. N Engl J Med. 1993;329(14):977-86.

58.           Diabetes, C., et al. Intensive Diabetes Treatment and Cardiovascular Outcomes in Type 1 Diabetes: The DCCT/EDIC Study 30-Year Follow-up. Diabetes care. 2016;39(5):686-93.

59.           Writing Group for the, D. E. R. G., et al. Association between 7 years of intensive treatment of type 1 diabetes and long-term mortality. Jama. 2015;313(1):45-53.

60.           American Diabetes Association Professional Practice, C. 6. Glycemic Goals and Hypoglycemia: Standards of Care in Diabetes-2024. Diabetes care. 2024;47(Suppl 1):S111-S125.

61.           Blonde, L., et al. American Association of Clinical Endocrinology Clinical Practice Guideline: Developing a Diabetes Mellitus Comprehensive Care Plan-2022 Update. Endocrine practice : official journal of the American College of Endocrinology and the American Association of Clinical Endocrinologists. 2022;28(10):923-1049.

62.           ElSayed, N. A., et al. 6. Glycemic Targets: Standards of Care in Diabetes-2023. Diabetes care. 2023;46(Suppl 1):S97-S110.

63.           Bunn, H. F. – Higgins, P. J. Reaction of monosaccharides with proteins: possible evolutionary significance. Science (New York, N.Y.). 1981;213(4504):222-4.

64.           Bunn, H. F. Evaluation of glycosylated hemoglobin diabetic patients. Diabetes. 1981;30(7):613-7.

65.           Rohlfing, C. L., et al. Defining the relationship between plasma glucose and HbA(1c): analysis of glucose profiles and HbA(1c) in the Diabetes Control and Complications Trial. Diabetes care. 2002;25(2):275-8.

66.           Tahara, Y. – Shima, K. The response of GHb to stepwise plasma glucose change over time in diabetic patients. Diabetes care. 1993;16(9):1313-4.

67.           Beck, R. W., et al. The Fallacy of Average: How Using HbA1c Alone to Assess Glycemic Control Can Be Misleading. Diabetes Care. 2017;40(8):994-999.

68.           Vigersky, R. A. Going beyond HbA1c to understand the benefits of advanced diabetes therapies. Journal of diabetes. 2019;11(1):23-31.

69.           Wright, L. A., Hirsch, I. B. Metrics Beyond Hemoglobin A1C in Diabetes Management: Time in Range, Hypoglycemia, and Other Parameters. Diabetes Technol Ther. 2017;19(S2):S16-s26.

70.           Monnier, L., et al. Near normal HbA1c with stable glucose homeostasis: the ultimate target/aim of diabetes therapy. Rev Endocr Metab Disord. 2016;17(1):91-101.

71.           Monnier, L., et al. The glycemic triumvirate and diabetic complications: is the whole greater than the sum of its component parts? Diabetes Res Clin Pract. 2012;95(3):303-11.

72.           Group, B. H. c. W. Need for Regulatory Change to Incorporate Beyond A1C Glycemic Metrics. Diabetes Care. 2018;41(6):e92-e94.

73.           Danne, T., et al. International Consensus on Use of Continuous Glucose Monitoring. Diabetes Care. 2017;40(12):1631-1640.

74.           2024., A. D. A. S. o. M. C. Section 6: Glycemic Goals and Hypoglycemia. Clinical diabetes : a publication of the American Diabetes Association. 2024;42(2):196-200.

75.           Beck, R. W., et al. Effect of Continuous Glucose Monitoring on Glycemic Control in Adults With Type 1 Diabetes Using Insulin Injections: The DIAMOND Randomized Clinical Trial. Jama. 2017;317(4):371-378.

76.           Rodbard, D. Interpretation of Continuous Glucose Monitoring Data: Glycemic Variability and Quality of Glycemic Control (vol 11, pg S-55, 2009). Diabetes Technology & Therapeutics. 2018;20(4):320-320.

77.           Advani, A. Positioning time in range in diabetes management. Diabetologia. 2019.

78.           Maiorino, M. I., et al. Effects of Continuous Glucose Monitoring on Metrics of Glycemic Control in Diabetes: A Systematic Review With Meta-analysis of Randomized Controlled Trials. Diabetes care. 2020;43(5):1146-1156.

79.           Battelino, T., et al. Clinical Targets for Continuous Glucose Monitoring Data Interpretation: Recommendations From the International Consensus on Time in Range. Diabetes Care. 2019;42(8):1593-1603.

80.           Bellido, V., et al. Time-in-range for monitoring glucose control: Is it time for a change? Diabetes research and clinical practice. 2021;177:108917.

81.           Beck, R. W., et al. Validation of Time in Range as an Outcome Measure for Diabetes Clinical Trials. Diabetes care. 2019;42(3):400-405.

82.           El Malahi, A., et al. Relationship Between Time in Range, Glycemic Variability, HbA1c, and Complications in Adults With Type 1 Diabetes Mellitus. The Journal of clinical endocrinology and metabolism. 2022;107(2):e570-e581.

83.           Ranjan, A. G., et al. Improved Time in Range Over 1 Year Is Associated With Reduced Albuminuria in Individuals With Sensor-Augmented Insulin Pump-Treated Type 1 Diabetes. Diabetes Care. 2020;43(11):2882-2885.

84.           Beck, R. W. The Association of Time in Range and Diabetic Complications: The Evidence is Strong. Diabetes technology & therapeutics. 2023.

85.           Ceriello, A., et al. Glycaemic management in diabetes: old and new approaches. The lancet. Diabetes & endocrinology. 2021.

86.           De Meulemeester, J., et al. The association of chronic complications with time in tight range and time in range in people with type 1 diabetes: a retrospective cross-sectional real-world study. Diabetologia. 2024.

87.           Shah, V. N., et al. Time in Range Is Associated with Incident Diabetic Retinopathy in Adults with Type 1 Diabetes: A Longitudinal Study. Diabetes Technol Ther. 2024;26(4):246-251.

88.           Beck, R. W. Is It Time to Replace Time-in-Range with Time-in-Tight-Range? Maybe Not. Diabetes Technol Ther. 2024;26(3):147-150.

89.           Ceriello, A., et al. Glycaemic variability in diabetes: clinical and therapeutic implications. Lancet Diabetes & Endocrinology. 2019;7(3):221-230.

90.           Hallstrom, S., et al. Characteristics of Continuous Glucose Monitoring Metrics in Persons with Type 1 and Type 2 Diabetes Treated with Multiple Daily Insulin Injections. Diabetes technology & therapeutics. 2021;23(6):425-433.

91.           Helleputte, S., et al. The Added and Interpretative Value of Cgm-Derived Parameters in Type 1 Diabetes Depends on the Level of Glycemic Control. Endocrine practice : official journal of the American College of Endocrinology and the American Association of Clinical Endocrinologists. 2021;27(1):44-50.

92.           Kilpatrick, E. S., et al. Relating mean blood glucose and glucose variability to the risk of multiple episodes of hypoglycaemia in type 1 diabetes. Diabetologia. 2007;50(12):2553-61.

93.           Monnier, L., et al. Respective Contributions of Glycemic Variability and Mean Daily Glucose as Predictors of Hypoglycemia in Type 1 Diabetes: Are They Equivalent? Diabetes care. 2020;43(4):821-827.

94.           Ayano-Takahara, S., et al. Glycemic variability is associated with quality of life and treatment satisfaction in patients with type 1 diabetes. Diabetes care. 2015;38(1):e1-2.

95.           Brandt, R., et al. Sleep quality and glycaemic variability in a real-life setting in adults with type 1 diabetes. Diabetologia. 2021;64(10):2159-2169.

96.           Yapanis, M., et al. Complications of Diabetes and Metrics of Glycemic Management Derived From Continuous Glucose Monitoring. The Journal of clinical endocrinology and metabolism. 2022;107(6):e2221-e2236.

97.           Smith-Palmer, J., et al. Assessment of the association between glycemic variability and diabetes-related complications in type 1 and type 2 diabetes. Diabetes Research and Clinical Practice. 2014;105(3):273-284.

98.           Soupal, J., et al. Glycemic variability is higher in type 1 diabetes patients with microvascular complications irrespective of glycemic control. Diabetes technology & therapeutics. 2014;16(4):198-203.

99.           Helleputte, S., et al. The relationship between glycaemic variability and cardiovascular autonomic dysfunction in patients with type 1 diabetes: a systematic review. Diabetes/metabolism research and reviews. 2020.

100.         Wilmot, E. G., et al. Glycaemic variability: The under-recognized therapeutic target in type 1 diabetes care. Diabetes, obesity & metabolism. 2019;21(12):2599-2608.

101.         Aleppo, G. Clinical Application of Time in Range and Other Metrics. Diabetes spectrum : a publication of the American Diabetes Association. 2021;34(2):109-118.

102.         Johnson, M. L., et al. Utilizing the Ambulatory Glucose Profile to Standardize and Implement Continuous Glucose Monitoring in Clinical Practice. Diabetes Technol Ther. 2019;21(S2):S217-S225.

103.         Rodbard, D. The Ambulatory Glucose Profile: Opportunities for Enhancement. Diabetes Technol Ther. 2021;23(5):332-341.

104.         Bergenstal, R. M., et al. Glucose Management Indicator (GMI): A New Term for Estimating A1C From Continuous Glucose Monitoring. Diabetes Care. 2018;41(11):2275-2280.

105.         Leelarathna, L., et al. Glucose Management Indicator (GMI): Insights and Validation Using Guardian 3 and Navigator 2 Sensor Data. Diabetes Care. 2019;42(4):e60-e61.

106.         Riddell, M. C., et al. More Time in Glucose Range During Exercise Days than Sedentary Days in Adults Living with Type 1 Diabetes. Diabetes technology & therapeutics. 2021;23(5):376-383.

107.         Muntis, F. R., et al. Relationship Between Moderate-to-Vigorous Physical Activity and Glycemia Among Young Adults with Type 1 Diabetes and Overweight or Obesity: Results from the Advancing Care for Type 1 Diabetes and Obesity Network (ACT1ON) Study. Diabetes Technol Ther. 2022;24(12):881-891.

108.         Parent, C., et al. Barriers to Physical Activity in Children and Adults Living With Type 1 Diabetes: A Complex Link With Real-life Glycemic Excursions. Can J Diabetes. 2023;47(2):124-132.

 

REFERENCES CHAPTER 2

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5.             Bohn, B., et al. Impact of Physical Activity on Glycemic Control and Prevalence of Cardiovascular Risk Factors in Adults With Type 1 Diabetes: A Cross-sectional Multicenter Study of 18,028 Patients. Diabetes care. 2015;38(8):1536-43.

6.             Waden, J., et al. Leisure-time physical activity and development and progression of diabetic nephropathy in type 1 diabetes: the FinnDiane Study. Diabetologia. 2015;58(5):929-36.

7.             Tikkanen-Dolenc, H., et al. Frequent and intensive physical activity reduces risk of cardiovascular events in type 1 diabetes. Diabetologia. 2017;60(3):574-580.

8.             Mavridis, A., et al. Physical activity trajectories and all-cause mortality in type 1 diabetes: A nationwide longitudinal study. Diabetes research and clinical practice. 2024:111702.

9.             Tikkanen-Dolenc, H., et al. Physical Activity Reduces Risk of Premature Mortality in Patients With Type 1 Diabetes With and Without Kidney Disease. Diabetes care. 2017;40(12):1727-1732.

10.           Tielemans, S. M., et al. Association of physical activity with all-cause mortality and incident and prevalent cardiovascular disease among patients with type 1 diabetes: the EURODIAB Prospective Complications Study. Diabetologia. 2013;56(1):82-91.

11.           Finn, M., et al. Adherence to physical activity recommendations and barriers to physical activity participation among adults with type 1 diabetes. Irish journal of medical science. 2022;191(4):1639-1646.

12.           Patience, M., et al. 24-Hour Movement Behaviours (Physical Activity, Sedentary Behaviour and Sleep) Association with Glycaemic Control and Psychosocial Outcomes in Adolescents with Type 1 Diabetes: A Systematic Review of Quantitative and Qualitative Studies. International journal of environmental research and public health. 2023;20(5).

13.           Riddell, M. C., et al. Exercise management in type 1 diabetes: a consensus statement. The lancet. Diabetes & endocrinology. 2017;5(5):377-390.

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16.           Wojtaszewski, J. F., et al. Insulin signaling in human skeletal muscle: time course and effect of exercise. Diabetes. 1997;46(11):1775-81.

17.           Turner, L. V., et al. Associations between daily step count classifications and continuous glucose monitoring metrics in adults with type 1 diabetes: analysis of the Type 1 Diabetes Exercise Initiative (T1DEXI) cohort. Diabetologia. 2024;67(6):1009-1022.

18.           Riddell, M. C., et al. More Time in Glucose Range During Exercise Days than Sedentary Days in Adults Living with Type 1 Diabetes. Diabetes technology & therapeutics. 2021;23(5):376-383.

19.           Riddell, M. C., et al. Examining the Acute Glycemic Effects of Different Types of Structured Exercise Sessions in Type 1 Diabetes in a Real-World Setting: The Type 1 Diabetes and Exercise Initiative (T1DEXI). Diabetes care. 2023;46(4):704-713.

20.           Tonoli, C., et al. Effects of different types of acute and chronic (training) exercise on glycaemic control in type 1 diabetes mellitus: a meta-analysis. Sports Med. 2012;42(12):1059-80.

21.           Sigal, R. J., et al. The Resistance Exercise in Already Active Diabetic Individuals (READI) Randomized Clinical Trial. The Journal of clinical endocrinology and metabolism. 2023;108(5):e63-e75.

22.           Balkau, B., et al. Physical activity and insulin sensitivity: the RISC study. Diabetes. 2008;57(10):2613-8.

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24.           Landt, K. W., et al. Effects of exercise training on insulin sensitivity in adolescents with type I diabetes. Diabetes care. 1985;8(5):461-5.

25.           Minnebeck, K., et al. Four weeks of high-intensity interval training (HIIT) improve the cardiometabolic risk profile of overweight patients with type 1 diabetes mellitus (T1DM). European journal of sport science. 2021;21(8):1193-1203.

26.           Lee, A. S., et al. High-intensity interval exercise and hypoglycaemia minimisation in adults with type 1 diabetes: A randomised cross-over trial. Journal of diabetes and its complications. 2020;34(3):107514.

27.           McCarthy, O., et al. Resistance Isn't Futile: The Physiological Basis of the Health Effects of Resistance Exercise in Individuals With Type 1 Diabetes. Frontiers in endocrinology. 2019;10:507.

28.           Yardley, J. E., et al. Resistance exercise in type 1 diabetes. Canadian journal of diabetes. 2013;37(6):420-6.

29.           Jimenez, C., et al. Insulin-sensitivity response to a single bout of resistive exercise in type 1 diabetes mellitus. Journal of sport rehabilitation. 2009;18(4):564-71.

30.           Cleland, S. J., et al. Insulin resistance in type 1 diabetes: what is 'double diabetes' and what are the risks? Diabetologia. 2013;56(7):1462-70.

31.           Brazeau, A. S., et al. Physical activity level and body composition among adults with type 1 diabetes. Diabetic medicine : a journal of the British Diabetic Association. 2012;29(11):e402-8.

32.           Helleputte, S., et al. Physical activity and sedentary behaviour in relation to body composition, estimated insulin sensitivity and arterial stiffness in adults with type 1 diabetes. Diabetes Res Clin Pract. 2024:111860.

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34.           Cosentino, F., et al. 2019 ESC Guidelines on diabetes, pre-diabetes, and cardiovascular diseases developed in collaboration with the EASD. Eur Heart J. 2020;41(2):255-323.

35.           Visseren, F. L. J., et al. 2021 ESC Guidelines on cardiovascular disease prevention in clinical practice. Eur Heart J. 2021;42(34):3227-3337.

36.           Livingstone, S. J., et al. Risk of Cardiovascular Disease and Total Mortality in Adults with Type 1 Diabetes: Scottish Registry Linkage Study. Plos Medicine. 2012;9(10):11.

37.           Rawshani, A., et al. Mortality and Cardiovascular Disease in Type 1 and Type 2 Diabetes. N. Engl. J. Med. 2017;376(15):1407-1418.

38.           Jorgensen, M. E., et al. Time trends in mortality rates in type 1 diabetes from 2002 to 2011. Diabetologia. 2013;56(11):2401-4.

39.           Rawshani, A., et al. Excess mortality and cardiovascular disease in young adults with type 1 diabetes in relation to age at onset: a nationwide, register-based cohort study. Lancet. 2018;392(10146):477-486.

40.           Verges, B. Cardiovascular disease in type 1 diabetes: A review of epidemiological data and underlying mechanisms. Diabetes & Metabolism. 2020;46(6):442-449.

41.           Marshall, Z. A., et al. Using compositional analysis to explore the relationship between physical activity and cardiovascular health in children and adolescents with and without type 1 diabetes. Pediatric diabetes. 2022;23(1):115-125.

42.           Marshall, Z. A., et al. Association of physical activity metrics with indicators of cardiovascular function and control in children with and without type 1 diabetes. Pediatric diabetes. 2021;22(2):320-328.

43.           Scott, S. N., et al. High-Intensity Interval Training Improves Aerobic Capacity Without a Detrimental Decline in Blood Glucose in People With Type 1 Diabetes. The Journal of clinical endocrinology and metabolism. 2019;104(2):604-612.

44.           Alobaid, A. M., et al. Reducing Sitting Time in Type 1 Diabetes: Considerations and Implications. Canadian journal of diabetes. 2023.

45.           Huerta-Uribe, N., et al. Association Between Physical Activity, Sedentary Behavior and Physical Fitness and Glycated Hemoglobin in Youth with Type 1 Diabetes: A Systematic Review and Meta-analysis. Sports Med. 2023;53(1):111-123.

46.           Huerta-Uribe, N., et al. Youth with type 1 diabetes mellitus are more inactive and sedentary than apparently healthy peers: A systematic review and meta-analysis. Diabetes research and clinical practice. 2023;200:110697.

47.           Campbell, M. D., et al. Interrupting prolonged sitting with frequent short bouts of light-intensity activity in people with type 1 diabetes improves glycaemic control without increasing hypoglycaemia: The SIT-LESS randomised controlled trial. Diabetes, obesity & metabolism. 2023.

48.           Lascar, N., et al. Attitudes and barriers to exercise in adults with type 1 diabetes (T1DM) and how best to address them: a qualitative study. PloS one. 2014;9(9):e108019.

 

 

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38.           DeFronzo, R. A., et al. Synergistic interaction between exercise and insulin on peripheral glucose uptake. The Journal of clinical investigation. 1981;68(6):1468-74.

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48.           Yardley, J. E., et al. Could Age, Sex and Physical Fitness Affect Blood Glucose Responses to Exercise in Type 1 Diabetes? Frontiers in endocrinology. 2018;9:674.

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50.           Scott, S. N., et al. Fasted High-Intensity Interval and Moderate-Intensity Exercise Do Not Lead to Detrimental 24-Hour Blood Glucose Profiles. The Journal of clinical endocrinology and metabolism. 2019;104(1):111-117.

51.           Toghi-Eshghi, S. R. – Yardley, J. E. Morning (Fasting) vs Afternoon Resistance Exercise in Individuals With Type 1 Diabetes: A Randomized Crossover Study. The Journal of clinical endocrinology and metabolism. 2019;104(11):5217-5224.

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53.           Bergford, S., et al. The Type 1 Diabetes and EXercise Initiative: Predicting Hypoglycemia Risk During Exercise for Participants with Type 1 Diabetes Using Repeated Measures Random Forest. Diabetes Technol Ther. 2023;25(9):602-611.

54.           Riddell, M. C., et al. Individual glucose responses to prolonged moderate intensity aerobic exercise in adolescents with type 1 diabetes: The higher they start, the harder they fall. Pediatr Diabetes. 2019;20(1):99-106.

55.           Kristensen, K. B., et al. Effects of a Low-Carbohydrate-High-Protein Pre-Exercise Meal in Type 1 Diabetes-a Randomized Crossover Trial. The Journal of clinical endocrinology and metabolism. 2023;109(1):208-216.

56.           Riddell, M. C., et al. Examining the Acute Glycemic Effects of Different Types of Structured Exercise Sessions in Type 1 Diabetes in a Real-World Setting: The Type 1 Diabetes and Exercise Initiative (T1DEXI). Diabetes care. 2023;46(4):704-713.

57.           Basu, R., et al. Exercise, hypoglycemia, and type 1 diabetes. Diabetes technology & therapeutics. 2014;16(6):331-7.

58.           Kraemer, W. J. – Ratamess, N. A. Hormonal responses and adaptations to resistance exercise and training. Sports Med. 2005;35(4):339-61.

59.           Yardley, J. E., et al. Resistance versus aerobic exercise: acute effects on glycemia in type 1 diabetes. Diabetes Care. 2013;36(3):537-42.

60.           Yardley, J. E., et al. Effects of performing resistance exercise before versus after aerobic exercise on glycemia in type 1 diabetes. Diabetes Care. 2012;35(4):669-75.

61.           Turner, D., et al. Algorithm that delivers an individualized rapid-acting insulin dose after morning resistance exercise counters post-exercise hyperglycaemia in people with Type 1 diabetes. Diabetic medicine : a journal of the British Diabetic Association. 2016;33(4):506-10.

62.           Turner, D., et al. Impact of single and multiple sets of resistance exercise in type 1 diabetes. Scandinavian journal of medicine & science in sports. 2015;25(1):e99-109.

63.           Smilios, I., et al. Hormonal responses after various resistance exercise protocols. Med Sci Sports Exerc. 2003;35(4):644-54.

64.           Tan, R., et al. Skeletal muscle fiber-type-specific changes in markers of capillary and mitochondrial content after low-volume interval training in overweight women. Physiol Rep. 2018;6(5).

65.           Cocks, M., et al. Sprint interval and moderate-intensity continuous training have equal benefits on aerobic capacity, insulin sensitivity, muscle capillarisation and endothelial eNOS/NAD(P)Hoxidase protein ratio in obese men. J Physiol. 2016;594(8):2307-21.

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67.           Guelfi, K. J., et al. Intermittent high-intensity exercise does not increase the risk of early postexercise hypoglycemia in individuals with type 1 diabetes. Diabetes Care. 2005;28(2):416-8.

68.           Harmer, A. R., et al. High-intensity training improves plasma glucose and acid-base regulation during intermittent maximal exercise in type 1 diabetes. Diabetes Care. 2007;30(5):1269-71.

69.           Aronson, R., et al. Optimal Insulin Correction Factor in Post-High-Intensity Exercise Hyperglycemia in Adults With Type 1 Diabetes: The FIT Study. Diabetes Care. 2019;42(1):10-16.

70.           Bussau, V. A., et al. A 10-s sprint performed prior to moderate-intensity exercise prevents early post-exercise fall in glycaemia in individuals with type 1 diabetes. Diabetologia. 2007;50(9):1815-1818.

71.           Bussau, V. A., et al. The 10-s maximal sprint: a novel approach to counter an exercise-mediated fall in glycemia in individuals with type 1 diabetes. Diabetes Care. 2006;29(3):601-6.

72.           Davey, R. J., et al. A 10-s sprint performed after moderate-intensity exercise neither increases nor decreases the glucose requirement to prevent late-onset hypoglycemia in individuals with type 1 diabetes. Diabetes Care. 2013;36(12):4163-5.

73.           Fahey, A. J., et al. The effect of a short sprint on postexercise whole-body glucose production and utilization rates in individuals with type 1 diabetes mellitus. The Journal of clinical endocrinology and metabolism. 2012;97(11):4193-200.

74.           Guelfi, K. J., et al. The decline in blood glucose levels is less with intermittent high-intensity compared with moderate exercise in individuals with type 1 diabetes. Diabetes care. 2005;28(6):1289-94.

75.           Moser, O., et al. Effects of High-Intensity Interval Exercise versus Moderate Continuous Exercise on Glucose Homeostasis and Hormone Response in Patients with Type 1 Diabetes Mellitus Using Novel Ultra-Long-Acting Insulin. PloS one. 2015;10(8):e0136489.

76.           Riddell, M. C., et al. Reproducibility in the cardiometabolic responses to high-intensity interval exercise in adults with type 1 diabetes. Diabetes research and clinical practice. 2019;148:137-143.

77.           Helleputte, S., et al. Glycaemic management around postprandial exercise in people with type 1 diabetes: Challenge accepted. The Journal of clinical endocrinology and metabolism. 2024.

78.           Helleputte, S., et al. Effects of postprandial exercise on blood glucose levels in adults with type 1 diabetes: a review. Diabetologia. 2023.

79.           Wojtaszewski, J. F., et al. Insulin signaling in human skeletal muscle: time course and effect of exercise. Diabetes. 1997;46(11):1775-81.

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87.           Maran, A., et al. Continuous glucose monitoring reveals delayed nocturnal hypoglycemia after intermittent high-intensity exercise in nontrained patients with type 1 diabetes. Diabetes technology & therapeutics. 2010;12(10):763-8.

88.           Iscoe, K. E., et al. Efficacy of continuous real-time blood glucose monitoring during and after prolonged high-intensity cycling exercise: spinning with a continuous glucose monitoring system. Diabetes Technol Ther. 2006;8(6):627-35.

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REFERENCES CHAPTER 4

1.             Bergford, S., et al. The Type 1 Diabetes and EXercise Initiative: Predicting Hypoglycemia Risk During Exercise for Participants with Type 1 Diabetes Using Repeated Measures Random Forest. Diabetes Technol Ther. 2023;25(9):602-611.

2.             Riddell, M. C., et al. Individual glucose responses to prolonged moderate intensity aerobic exercise in adolescents with type 1 diabetes: The higher they start, the harder they fall. Pediatr Diabetes. 2019;20(1):99-106.

3.             Riddell, M. C., et al. Examining the Acute Glycemic Effects of Different Types of Structured Exercise Sessions in Type 1 Diabetes in a Real-World Setting: The Type 1 Diabetes and Exercise Initiative (T1DEXI). Diabetes care. 2023;46(4):704-713.

4.             Riddell, M. C., et al. Exercise management in type 1 diabetes: a consensus statement. The lancet. Diabetes & endocrinology. 2017;5(5):377-390.

5.             Riddell, M. C. – Peters, A. L. Exercise in adults with type 1 diabetes mellitus. Nat Rev Endocrinol. 2023;19(2):98-111.

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7.             Moser, O., et al. Pre-Exercise Blood Glucose Levels Determine the Amount of Orally Administered Carbohydrates during Physical Exercise in Individuals with Type 1 Diabetes-A Randomized Cross-Over Trial. Nutrients. 2019;11(6).

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10.           Yardley, J. E., et al. Resistance versus aerobic exercise: acute effects on glycemia in type 1 diabetes. Diabetes Care. 2013;36(3):537-42.

11.           Yardley, J. E., et al. Effects of performing resistance exercise before versus after aerobic exercise on glycemia in type 1 diabetes. Diabetes Care. 2012;35(4):669-75.

12.           Turner, D., et al. Impact of single and multiple sets of resistance exercise in type 1 diabetes. Scandinavian journal of medicine & science in sports. 2015;25(1):e99-109.

13.           Turner, D., et al. Similar magnitude of post-exercise hyperglycemia despite manipulating resistance exercise intensity in type 1 diabetes individuals. Scandinavian journal of medicine & science in sports. 2016;26(4):404-12.

14.           Ruegemer, J. J., et al. Differences between prebreakfast and late afternoon glycemic responses to exercise in IDDM patients. Diabetes care. 1990;13(2):104-10.

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16.           Maran, A., et al. Continuous glucose monitoring reveals delayed nocturnal hypoglycemia after intermittent high-intensity exercise in nontrained patients with type 1 diabetes. Diabetes technology & therapeutics. 2010;12(10):763-8.

17.           Guelfi, K. J., et al. Intermittent high-intensity exercise does not increase the risk of early postexercise hypoglycemia in individuals with type 1 diabetes. Diabetes Care. 2005;28(2):416-8.

18.           Moser, O., et al. Effects of High-Intensity Interval Exercise versus Moderate Continuous Exercise on Glucose Homeostasis and Hormone Response in Patients with Type 1 Diabetes Mellitus Using Novel Ultra-Long-Acting Insulin. PloS one. 2015;10(8):e0136489.

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30.           Hershon, K. S., et al. Importance of Postprandial Glucose in Relation to A1C and Cardiovascular Disease. Clinical diabetes : a publication of the American Diabetes Association. 2019;37(3):250-259.

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32.           Cavalot, F., et al. Postprandial blood glucose predicts cardiovascular events and all-cause mortality in type 2 diabetes in a 14-year follow-up: lessons from the San Luigi Gonzaga Diabetes Study. Diabetes care. 2011;34(10):2237-43.

33.           Ceriello, A. The emerging role of post-prandial hyperglycaemic spikes in the pathogenesis of diabetic complications. Diabetic medicine : a journal of the British Diabetic Association. 1998;15(3):188-93.

34.           Coutinho, M., et al. The relationship between glucose and incident cardiovascular events. A metaregression analysis of published data from 20 studies of 95,783 individuals followed for 12.4 years. Diabetes care. 1999;22(2):233-40.

35.           Dimitriadis, G. D., et al. Regulation of Postabsorptive and Postprandial Glucose Metabolism by Insulin-Dependent and Insulin-Independent Mechanisms: An Integrative Approach. Nutrients. 2021;13(1).

36.           Woerle, H. J., et al. Pathways for glucose disposal after meal ingestion in humans. American journal of physiology. Endocrinology and metabolism. 2003;284(4):E716-25.

37.           DeFronzo, R. A., et al. The effect of insulin on the disposal of intravenous glucose. Results from indirect calorimetry and hepatic and femoral venous catheterization. Diabetes. 1981;30(12):1000-7.

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39.           DeFronzo, R. A., et al. Synergistic interaction between exercise and insulin on peripheral glucose uptake. The Journal of clinical investigation. 1981;68(6):1468-74.

40.           Helleputte, S., et al. Effects of postprandial exercise on blood glucose levels in adults with type 1 diabetes: a review. Diabetologia. 2023.

41.           Yardley, J. E. Reassessing the evidence: prandial state dictates glycaemic responses to exercise in individuals with type 1 diabetes to a greater extent than intensity. Diabetologia. 2022.

42.           Shetty, V. B., et al. Effect of Exercise Intensity on Exogenous Glucose Requirements to Maintain Stable Glycemia At High Insulin Levels in Type 1 Diabetes. The Journal of clinical endocrinology and metabolism. 2021;106(1):e83-e93.

43.           Yardley, J. E. – Sigal, R. J. Glucose management for exercise using continuous glucose monitoring: should sex and prandial state be additional considerations? Diabetologia. 2021;64(4):932-934.

44.           Helleputte, S., et al. Glycaemic management around postprandial exercise in people with type 1 diabetes: Challenge accepted. The Journal of clinical endocrinology and metabolism. 2024.

45.           Colberg, S. R., et al. Physical Activity/Exercise and Diabetes: A Position Statement of the American Diabetes Association. Diabetes care. 2016;39(11):2065-2079.

46.           West, D. J., et al. A combined insulin reduction and carbohydrate feeding strategy 30 min before running best preserves blood glucose concentration after exercise through improved fuel oxidation in type 1 diabetes mellitus. J Sports Sci. 2011;29(3):279-89.

47.           Molveau, J., et al. Assessing the influence of insulin type (ultra-rapid vs rapid insulin) and exercise timing on postprandial exercise-induced hypoglycaemia risk in individuals with type 1 diabetes: a randomised controlled trial. Diabetologia. 2024;67(11):2408-2419.

48.           Paldus, B., et al. A Randomized Crossover Trial Comparing Glucose Control During Moderate-Intensity, High-Intensity, and Resistance Exercise With Hybrid Closed-Loop Insulin Delivery While Profiling Potential Additional Signals in Adults With Type 1 Diabetes. Diabetes care. 2022;45(1):194-203.

49.           Tagougui, S., et al. The Benefits and Limits of Technological Advances in Glucose Management Around Physical Activity in Patients Type 1 Diabetes. Frontiers in endocrinology. 2018;9:818.

50.           Moser, O. – Pemberton, J. S. Rethinking the safety and efficacy assessment of (Hybrid) Closed Loop systems: Should we promote the need for a minimum of exercise data within the regulatory approval? Diabetic medicine : a journal of the British Diabetic Association. 2024;41(3):e15305.

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52.           Taleb, N., et al. Efficacy of single-hormone and dual-hormone artificial pancreas during continuous and interval exercise in adult patients with type 1 diabetes: randomised controlled crossover trial. Diabetologia. 2016;59(12):2561-2571.

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55.           Cryer, P. E. Mechanisms of hypoglycemia-associated autonomic failure and its component syndromes in diabetes. Diabetes. 2005;54(12):3592-601.

56.           Briscoe, V. J., et al. Type 1 diabetes: exercise and hypoglycemia. Appl Physiol Nutr Metab. 2007;32(3):576-82.

57.           Cryer, P. E. Hypoglycemia-associated autonomic failure in diabetes. Handbook of clinical neurology. 2013;117:295-307.

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59.           Galassetti, P., et al. Effects of antecedent prolonged exercise on subsequent counterregulatory responses to hypoglycemia. American journal of physiology. Endocrinology and metabolism. 2001;280(6):E908-17.

60.           Molveau, J., et al. Minimizing the Risk of Exercise-Induced Glucose Fluctuations in People Living With Type 1 Diabetes Using Continuous Subcutaneous Insulin Infusion: An Overview of Strategies. Canadian journal of diabetes. 2021;45(7):666-676.

61.           Roy-Fleming, A., et al. Timing of insulin basal rate reduction to reduce hypoglycemia during late post-prandial exercise in adults with type 1 diabetes using insulin pump therapy: A randomized crossover trial. Diabetes & metabolism. 2019;45(3):294-300.

62.           Tagougui, S., et al. Anticipated Basal Insulin Reduction to Prevent Exercise-Induced Hypoglycemia in Adults and Adolescents Living with Type 1 Diabetes. Diabetes technology & therapeutics. 2022;24(5):307-315.

63.           Zaharieva, D. P., et al. Improved Open-Loop Glucose Control With Basal Insulin Reduction 90 Minutes Before Aerobic Exercise in Patients With Type 1 Diabetes on Continuous Subcutaneous Insulin Infusion. Diabetes care. 2019;42(5):824-831.

64.           Franc, S., et al. Insulin-based strategies to prevent hypoglycaemia during and after exercise in adult patients with type 1 diabetes on pump therapy: the DIABRASPORT randomized study. Diabetes, obesity & metabolism. 2015;17(12):1150-7.

65.           Molveau, J., et al. Impact of pre- and post-exercise strategies on hypoglycemic risk for two modalities of aerobic exercise among adults and adolescents living with type 1 diabetes using continuous subcutaneous insulin infusion: A randomized controlled trial. Diabetes Metab. 2024;51(1):101599.

66.           Taplin, C. E., et al. Preventing post-exercise nocturnal hypoglycemia in children with type 1 diabetes. The Journal of pediatrics. 2010;157(5):784-8 e1.

67.           Zaharieva, D. P., et al. Practical Aspects and Exercise Safety Benefits of Automated Insulin Delivery Systems in Type 1 Diabetes. Diabetes spectrum : a publication of the American Diabetes Association. 2023;36(2):127-136.

68.           Jayawardene, D. C., et al. Closed-Loop Insulin Delivery for Adults with Type 1 Diabetes Undertaking High-Intensity Interval Exercise Versus Moderate-Intensity Exercise: A Randomized, Crossover Study. Diabetes technology & therapeutics. 2017;19(6):340-348.

69.           McCarthy, O. M., et al. Automated Insulin Delivery Around Exercise in Adults with Type 1 Diabetes: A Pilot Randomized Controlled Study. Diabetes technology & therapeutics. 2023.

70.           Myette-Cote, E., et al. A Randomized Crossover Pilot Study Evaluating Glucose Control During Exercise Initiated 1 or 2 h After a Meal in Adults with Type 1 Diabetes Treated with an Automated Insulin Delivery System. Diabetes technology & therapeutics. 2023;25(2):122-130.

71.           Seckold, R., et al. A Comparison of Glucose and Additional Signals for Three Different Exercise Types in Adolescents with Type 1 Diabetes Using a Hybrid Closed-Loop System. Diabetes Technol Ther. 2025.

72.           Tagougui, S., et al. Artificial Pancreas Systems and Physical Activity in Patients with Type 1 Diabetes: Challenges, Adopted Approaches, and Future Perspectives. Journal of diabetes science and technology. 2019;13(6):1077-1090.

73.           Castle, J. R., et al. Randomized Outpatient Trial of Single- and Dual-Hormone Closed-Loop Systems That Adapt to Exercise Using Wearable Sensors. Diabetes care. 2018;41(7):1471-1477.

74.           Jacobs, P. G., et al. Randomized trial of a dual-hormone artificial pancreas with dosing adjustment during exercise compared with no adjustment and sensor-augmented pump therapy. Diabetes, obesity & metabolism. 2016;18(11):1110-1119.

75.           Lindkvist, E. B., et al. Performance of a dual-hormone closed-loop system versus insulin-only closed-loop system in adolescents with type 1 diabetes. A single-blind, randomized, controlled, crossover trial. Frontiers in endocrinology. 2023;14:1073388.

76.           Moser, O., et al. The use of automated insulin delivery around physical activity and exercise in type 1 diabetes: a position statement of the European Association for the Study of Diabetes (EASD) and the International Society for Pediatric and Adolescent Diabetes (ISPAD). Diabetologia. 2024.

77.           McMahon, S. K., et al. Glucose requirements to maintain euglycemia after moderate-intensity afternoon exercise in adolescents with type 1 diabetes are increased in a biphasic manner. The Journal of clinical endocrinology and metabolism. 2007;92(3):963-8.

78.           Frier, B. M. Hypoglycaemia in diabetes mellitus: epidemiology and clinical implications. Nat Rev Endocrinol. 2014;10(12):711-22.

79.           Pedersen-Bjergaard, U., et al. Severe hypoglycaemia in 1076 adult patients with type 1 diabetes: influence of risk markers and selection. Diabetes/metabolism research and reviews. 2004;20(6):479-86.

80.           Reddy, R., et al. The effect of exercise on sleep in adults with type 1 diabetes. Diabetes, obesity & metabolism. 2018;20(2):443-447.

81.           Campbell, M. D., et al. A low-glycemic index meal and bedtime snack prevents postprandial hyperglycemia and associated rises in inflammatory markers, providing protection from early but not late nocturnal hypoglycemia following evening exercise in type 1 diabetes. Diabetes Care. 2014;37(7):1845-53.

82.           Raju, B., et al. Nocturnal hypoglycemia in type 1 diabetes: an assessment of preventive bedtime treatments. The Journal of clinical endocrinology and metabolism. 2006;91(6):2087-92.

83.           Moser, O., et al. Comparison of Insulin Glargine 300 U/mL and Insulin Degludec 100 U/mL Around Spontaneous Exercise Sessions in Adults with Type 1 Diabetes: A Randomized Cross-Over Trial (ULTRAFLEXI-1 Study). Diabetes technology & therapeutics. 2023;25(3):161-168.

84.           Drenthen, L. C. A., et al. No insulin degludec dose adjustment required after aerobic exercise for people with type 1 diabetes: the ADREM study. Diabetologia. 2023:1-10.

85.           Borella, N. D., et al. Comparison of the night-time effectiveness in achieving glycemic targets in adults with type 1 diabetes of three advanced hybryd closed-loop systems. Acta diabetologica. 2024.

86.           Phillip, M., et al. Consensus Recommendations for the Use of Automated Insulin Delivery Technologies in Clinical Practice. Endocrine reviews. 2023;44(2):254-280.

87.           Bussau, V. A., et al. The 10-s maximal sprint: a novel approach to counter an exercise-mediated fall in glycemia in individuals with type 1 diabetes. Diabetes Care. 2006;29(3):601-6.

88.           Bally, L., et al. Metabolic and hormonal response to intermittent high-intensity and continuous moderate intensity exercise in individuals with type 1 diabetes: a randomised crossover study. Diabetologia. 2016;59(4):776-84.

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56.           Marquet, L. A., et al. Periodization of Carbohydrate Intake: Short-Term Effect on Performance. Nutrients. 2016;8(12).

 

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87.           Monaco, C. M. F., et al. Altered mitochondrial bioenergetics and ultrastructure in the skeletal muscle of young adults with type 1 diabetes. Diabetologia. 2018;61(6):1411-1423.

88.           Mattsson, S., et al. Carbohydrate Loading Followed by High Carbohydrate Intake During Prolonged Physical Exercise and Its Impact on Glucose Control in Individuals With Diabetes Type 1-An Exploratory Study. Front Endocrinol (Lausanne). 2019;10:571.

89.           Adolfsson, P., et al. Evaluation of glucose control when a new strategy of increased carbohydrate supply is implemented during prolonged physical exercise in type 1 diabetes. Eur J Appl Physiol. 2015;115(12):2599-607.

90.           Lespagnol, E., et al. In Amateur Athletes With Type 1 Diabetes, a 9-Day Period of Cycling at Moderate-to-Vigorous Intensity Unexpectedly Increased the Time Spent in a State of Hyperglycemia, Which Was Associated With Impairment in Heart Rate Variability. Diabetes Care. 2020.

91.           Dutta, T., et al. Impact of Long-Term Poor and Good Glycemic Control on Metabolomics Alterations in Type 1 Diabetic People. The Journal of clinical endocrinology and metabolism. 2016;101(3):1023-33.

92.           Coleman, S. K., et al. Skeletal muscle as a therapeutic target for delaying type 1 diabetic complications. World J Diabetes. 2015;6(17):1323-36.

93.           Krause, M. P., et al. Effects of type 1 diabetes mellitus on skeletal muscle: clinical observations and physiological mechanisms. Pediatr Diabetes. 2011;12(4 Pt 1):345-64.

94.           Rothacker, K. M., et al. Acute hyperglycaemia does not have a consistent adverse effect on exercise performance in recreationally active young people with type 1 diabetes: a randomised crossover in-clinic study. Diabetologia. 2021;64(8):1737-1748.

95.           Riddell, M. C., et al. The competitive athlete with type 1 diabetes. Diabetologia. 2020.

96.           Riddell, M. C., et al. Exercise management in type 1 diabetes: a consensus statement. The lancet. Diabetes & endocrinology. 2017;5(5):377-390.

97.           Galassetti, P., et al. Effect of differing antecedent hypoglycemia on counterregulatory responses to exercise in type 1 diabetes. American journal of physiology. Endocrinology and metabolism. 2006;290(6):E1109-17.

98.           Bao, S., et al. Effects of differing antecedent increases of plasma cortisol on counterregulatory responses during subsequent exercise in type 1 diabetes. Diabetes. 2009;58(9):2100-8.

 

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