Foreword by Dr Thomas Züger

I can still remember it very well. It was late afternoon on the 31st of July 2019, the day before Swiss National Day, and I was working as a clinician in Bern when my phone rang. SamSco tt, the new postdoctoral researcher from England, had just arrived in Switzerland. Although Sam had arranged to move into his new apartment in Bern, the landlady responsible had left early for her holidays and wouldn’t return for at least four days. This being Switzerland on a national holiday, everything was closed, and all the hotels were full. Sam was stranded in a new country with nothing but his suitcase. With everything closed for the holiday celebrations, I offered him a place to stay for the long weekend. That's how I met Sam, and we have been good friends and colleagues since.

Sam was quickly introduced to my circle of colleagues and friends as he had no choice but to join me at the National Day celebrations. The ice quickly broke, and we soon discovered we shared a deep fascination with exercise and diabetes. It turned out that Sam was not only joining our clinic as a diabetes researcher but also as the Head of Research for Team Novo Nordisk, a professional cycling team composed exclusively of athletes with type 1 diabetes.

Soon after, I had the pleasure of meeting Federico Fontana, the illustrator of this book. Fede, a coach for the same cycling team, frequently visited Bern to collaborate on training camp planning and some scientific projects. To welcome Sam and Fede into Swiss culture and cuisine, I invited them to my home for a traditional raclette dinner. We ate heartily, drank fine wine that Fede had brought from Italy, and soon found ourselves brainstorming ideas for future collaborations.

As a passionate cyclist, I was fascinated by their work with the cycling team. Before I knew it, I was invited to one of the following training camps in Spain, tasked with providing medical advice on diabetes management for the riders. Soon thereafter, I witnessed firsthand Sam and Fede working with the team. Their knowledge of diabetes and exercise and their commitment to supporting the riders left a lasting impression on me. For the first time, I saw how professional sports and diabetes management could be seamlessly integrated to create optimal conditions – always aiming to improve the riders’ chances of winning races. Despite the challenges of managing diabetes at this level, I saw that it was possible to balance high-level athletic performance with effective diabetes care. It was immediately apparent that a great deal of experience in the field of exercise and diabetes is combined with a profound scientific background. Moreover, Sam and Fede always strived for innovation and progress.

Through our ongoing collaboration, we achieved numerous improvements in diabetes management for athletes and initiated additional projects. During this time, I also met Simon Helleputte. Simon was conducting research on type 1 diabetes and exercise as part of his PhD at our clinic in Bern. Over time, he has built impressive knowledge in this field. As a dedicated cyclist, he was ideally suited to work with physically active individuals living with diabetes.

After a few years of working closely with Sam and Fede, they co-founded a start-up called Enhance-d that aims to support people in managing their diabetes during exercise. Despite continuous advancements in diabetes care, exercise remains a significant challenge for many people with diabetes and their healthcare teams. These challenges, particularly the difficulty of finding the right information related to glucose management and exercise, led to the idea of writing this book. 

This book is the culmination of years of practical experience working with physically active individuals with diabetes – ranging from recreational athletes to professionals. This work comprehensively covers all aspects of diabetes management around exercise in what I believe is a unique resource. Each topic has been meticulously elaborated and supported by a wealth of scientific studies. It is an evidence-based guide written by experts in the field for a broad audience. Countless hours of literature review, clinical experience, and stimulating discussions have contributed to creating this book. It is a must-read for anyone involved in this field, particularly for people with type 1 diabetes who are interested in sports.

This book not only provides a clear understanding of this complex topic but also provides practical recommendations that can be immediately applied to improving diabetes management. For years, I have often been asked by people with diabetes if I could recommend a comprehensive resource on diabetes and exercise. My answer was always the same: there wasn’t a single resource that addressed the topic in a holistic and accessible way. That is no longer the case. Now, I can confidently say: read the book "Empowered: The Science of Exercise with Type 1 Diabetes" – it contains everything you need to know about this topic!

Finally, I would like to express my deepest gratitude to the authors. Thank you for everything you have done for people with diabetes, for all that I have learned from you over the years, and above all, for the wonderful and always respectful collaboration that has evolved into a friendship.

Thomas Züger, MD

Department of Diabetes, Endocrinology, and Metabolism

Kantonsspital Olten

Switzerland