A systematic review and meta-analysis published in 2019 reviewed the cardiovascular health benefits of regular exercise in people with type 1 diabetes from 28 controlled trials . Reductions in daily insulin dose requirements were reported in 6 trials with a weighted mean treatment effect of -0.88 U·kg−1·day−1 (95% CI -1.27 to -0.48; p<0.001) in people with type 1 diabetes who participated in exercise. There was also a statistically significant reduction in daily insulin dosage reported in children and adolescents of 1.69 U·kg−1·day−1 (95% CI -2.43 to -0.95; p<0.001) who were physically active. An earlier systematic review and meta-analysis published in 2018 also reported a significant reduction in daily insulin doses in children who exercised [2 – 2]. The reported mean difference (MD) was 0.23 IU/kg (95% CI 0.37 to 0.09; p = 0.002) .
Reductions to daily insulin doses ranging from 6% to >15% were also reported in a literature review regarding the health benefits of physical activity in people with type 1 diabetes . The studies evaluated in this literature review from 2012 were two non-randomised controlled trials and one case series, including a non-randomised controlled trial comparing 12-weeks of aerobic training (Group A) and resistance training (Group B) and the effects on daily insulin doses . There was a significant reduction in the total mean of daily insulin doses in both Groups A and B before (0.95 + 0.34 U·kg−1·day−1) and after (0.79 + 0.28 U·kg−1·day−1) 12 weeks of training (p<0.05) .
These studies show that physical activity reduces the daily dose of insulin required in people with type 1 diabetes despite a limited impact observed in glycaemic control [1, 3].
Quality of Evidence
A – High
Strength of Recommendation
1 – Strong recommendation
Exercise interventions result in a reduction in daily doses of insulin required in adults, children and young people with type 1 diabetes. Exercise intervention can be recommended to most people, in most circumstances, to help reduce insulin doses unless there are compelling reasons to do otherwise.
 Wu N, Bredin SSD, Guan Y, et al. Cardiovascular Health Benefits of Exercise Training in Persons Living with Type 1 Diabetes: A Systematic Review and Meta-Analysis. Journal of Clinical Medicine 2019; 8(2):253. https://doi.org/10.3390/jcm8020253
 Ostman C, Jewiss D, King N, Smart NA. Clinical outcomes to exercise training in type 1 diabetes: A systematic review and meta-analysis. Diabetes Res Clin Pract. 2018 May;139:380-391. doi: 10.1016/j.diabres.2017.11.036.
 Chimen M, Kennedy A, Nirantharakumar K, et al. What are the health benefits of physical activity in type 1 diabetes mellitus? A literature review. Diabetologia 2012;55:542-551. https://doi.org/10.1007/s00125-011-2403-2
 Ramalho AC, de Lourdes LM, Nunes F et al. The effect of resistance versus aerobic training on metabolic control in patients with type-1 diabetes mellitus. Diabetes Res Clin Pract 2006;72:271–276. https://doi.org/10.1016/j.diabres.2005.11.011