American Diabetes Association
04_Online_Suppl_T1DEXI_12-13-22.pdf (543.68 kB)

The Type 1 Diabetes and EXercise Initiative (T1DEXI): Examining the acute glycemic effects of different types of structured exercise sessions in type 1 diabetes in a real-world setting

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posted on 2023-02-07, 13:45 authored by Michael C. Riddell, Zoey Li, Robin L. Gal, Peter Calhoun, Peter G. Jacobs, Mark A. Clements, Corby K. Martin, Francis J. Doyle, III, Susana R. Patton, Jessica R. Castle, Melanie B. Gillingham, Roy W. Beck, Michael R. Rickels, the T1DEXI Study Group


Objective: Maintenance of glycemic control during and following exercise remains a major challenge for individuals with type 1 diabetes. Glycemic responses to exercise may differ by exercise type (aerobic, interval, resistance), and the effect of activity type on glycemic control following exercise remains unclear.

Research Design-Methods: The Type 1 Diabetes Exercise Initiative (T1Dexi) was a real-world study of at-home exercise. Adult participants were randomly assigned to complete six structured aerobic, interval, or resistance exercise sessions over 4-weeks. Participants self-reported study and non-study exercise, food intake, and insulin dosing (multiple-daily injection [MDI] users) using a custom smart phone application, and provided pump data (pump users), heart rate, and continuous glucose monitoring (CGM) data.

Results: 497 adults with type 1 diabetes, mean±SD age 37±14 years, HbA1c 6.6±0.8% (49±8.7 mmol/mol) assigned to structured aerobic (N=162), interval (N=165), or resistance (N=170) exercise were analyzed. Mean change in glucose during assigned exercise was -18±39, -14±32, and -9±36 mg/dL for aerobic, interval, and resistance, respectively (P<0.001), with similar results for closed loop, standard pump, and MDI users. Time-in-range 70-180 mg/dL [3.9-10.0 mmol/L] was higher during the 24-hours following study exercise when compared to days without exercise (76±20% vs. 70±23%; P<0.001).

Conclusion: Adults with type 1 diabetes experienced the largest drop in glucose level with aerobic followed by interval and resistance exercise, regardless of insulin delivery modality. Even in well controlled adults with type 1 diabetes, days with structured exercise sessions contributed to clinically meaningful improvement in glucose time-in-range but may have slightly increased time below range.


Research reported in this publication was supported by the Leona M. and Harry. B. Helmsley Charitable Trust. The content is solely the responsibility of the authors and does not necessarily represent the official views of the Leona M. and Harry B. Helmsley Charitable Trust. One of the author’s institutions (author CKM, Pennington Biomedical Research Center) is supported by NORC Center Grant P30 DK072476 entitled “Nutrition and Metabolic Health Through the Lifespan” sponsored by NIDDK and by grant U54 GM104940 from the National Institute of General Medical Sciences, which funds the Louisiana Clinical and Translational Science Center. Non-financial Support: Verily (South San Francisco, CA) provided the Study Watch at no cost. Dexcom provided continuous glucose monitors at a discounted rate.