Closing the Loop on Exercise in Type 1 Diabetes

Lia Bally, Hood Thabit

Research output: Contribution to journalReview articlepeer-review


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.

Original languageEnglish
Pages (from-to)257-265
Number of pages9
JournalCurrent Diabetes Reviews
Issue number3
Publication statusPublished - 2018


  • Algorithms
  • Blood Glucose/analysis
  • Blood Glucose Self-Monitoring/instrumentation
  • Diabetes Mellitus, Type 1/blood
  • Exercise/physiology
  • Humans
  • Insulin/administration & dosage
  • Insulin Infusion Systems
  • Pancreas, Artificial


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