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ISPAD Clinical Practice Consensus Guidelines 2018: Exercise in children and adolescents with diabetes

Promotion of regular physical activity is an integral part of diabetes care delivery and health care providers should promote this message at every available opportunity

Citation:
Adolfsson P, Riddell MC, Taplin CE, Davis EA, Fournier PA, Annan F, et al. ISPAD Clinical Practice Consensus Guidelines 2018: Exercise in children and adolescents with diabetes. Pediatric Diabetes. 2018;19:205-26

Abstract:
In the field of technology, intermittent scanning continuous glucose monitoring (isCGM) offers the opportunity to obtain glucose values more easily than with self-monitored blood glucose monitoring (SMBG). This technology also provides the user with information on the direction and the rate of glucose value changes. However, the individual must actively scan the sensor to receive a value. Alerts or alarms are not currently linked to this technology.

Real-time continuous glucose monitoring (rtCGM) is a technology also including the possibility to use individualized alerts and safety alarms besides information on glucose values on continuous basis along with information on the direction and the rate of glucose value changes.

Technology allows access to applications in smart phones to view and enable followers, for example, a legal guardian, teacher, coach, which may increase safety during and after exercise. Recent clinical studies and clinical experience suggest that exercise itself may be a setting in which both isCGM and rtCGM could misrepresent the true dynamic changes in actual blood glucose concentrations because of apparent lag time between blood glucose levels and interstitial glucose levels.

Insulin pumps that include predictive low-glucose management (PLGM) systems may be advantageous as physical activity is associated with increased risk of hypoglycemia, not only during but also after physical activity. The step being currently evaluated is hybrid
closed loop where physical activity clearly represents one of the biggest challenges for such a system.

A variety of wearable technologies offer the possibility to track glucose values (eg, smart watches) as well as level of physical activity (eg, wrist bands), heart rate, sleep quality, etc. The current trend is that the different wearables are used to an increasing extent where device connectivity and data openness might create new opportunities in the future.