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Closing the Loop on Exercise in Type 1 Diabetes

[ Vol. 14 , Issue. 3 ]


Lia Bally* and Hood Thabit   Pages 257 - 265 ( 9 )


Background: Despite its well-established health benefits, exercise imposes challenges on glucose control in individuals with type 1 diabetes due to the complex interactions between exerciseinduced effects on glucose metabolism and exogenous insulin therapy. Although clinical guidelines for exercise management in type 1 diabetes are available, implementation is challenging in daily life. The risk of exercise-induced dysglycaemia deters many people with type 1 diabetes from participating and benefitting from exercise. Rapid progress has been made in the development of closed-loop systems, also known as the artificial pancreas. The autonomous modulation of insulin delivery in a glucoseresponsive manner by closed-loop systems may be beneficial in addressing and overcoming the risk and burden of exercise-induced dysglycaemia.

Methods: A summative overview of closed-loop application during exercise in type 1 diabetes is discussed, outlining current evidence and limitations, our perspectives in the field and future outlook.

Results: Outcomes from clinical studies evaluating both single- and dual-hormone closed-loop during exercise are reported. Current approaches to enhance closed-loop performance during exercise are described.

Conclusion: Closed-loop system has the potential to ameliorate exercise management in type 1 diabetes. Promising results have been shown, however innovative approaches are still needed to overcome inherent limitations of closed-loop performance during exercise. Future studies in larger generalizable patient population during real-life settings are still needed, to further evaluate its clinical applicability.


Type 1 diabetes, artificial pancreas, closed-loop, exercise, glucose control, hypoglycaemia, insulin, glucagon.


Wellcome Trust-MRC Institute of Metabolic Science, University of Cambridge, Cambridge, Wellcome Trust-MRC Institute of Metabolic Science, University of Cambridge, Cambridge

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