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T1D-Exercise improves glucose levels

Evidence Summary

A 2017 systematic review of prospective randomised or controlled trials found no evidence of significant changes in glucose control. [1]

A 2021 study of ten participants investigating post exercise glycemic variability after aerobic training, resistance training and a control day found mean continuous glucose monitoring, time in range and time above/below range was similar among all conditions. [2]

A 2020 systematic review found that compared to endurance, intermittent exercise increased the amount of time spent in hypoglycaemia and reduced the mean interstitial glucose concentration. There was no change in the time spent in hyperglycaemia. [3]

A 2018 systematic review reviewing 15 studies investigating the effects of different exercise types on blood glucose levels found that exercise resulted in lower blood glucose levels than rest but with no significant difference between different types of exercise. [4]

A 2018 study involving 10 adults with T1DM conducting twice weekly sessions of resistance or aerobic exercise compared with an exercise free control week researched the effect on the length of time spent in euglycemia. It found that time spent in euglycemia was statistically different after resistance training compared with the control but there was no statistical significance between the aerobic training and control. [5]

A 2019 study of 14 participants conducting either High intensity training, continuous moderate intensity training or a control found there was no difference in the incidence of or percentage of time spent in hypoglycaemia, hyperglycaemia, or target glucose range over the 24-hour and nocturnal period (12:00 am to 6:00 am) between the different groups. [6]

A 2021 cross sectional study of 12 participants found that both strength and aerobic exercise resulted in lower blood glucose levels but that men showed lower levels than women after aerobic exercise. [7]

Quality of evidence

B – Moderate

Strength of recommendation

1- Strong recommendation


Multiple studies present conflicting evidence on the effect of physical activity on glycemic control in type 1 diabetics. The studies presented here are of relatively weak power due to small sample sizes. The lack of risks involved with including physical activity presented in the studies and other known benefits of physical activity result in the recommendation that type one diabetics include physical activity in their lifestyle is reasonable despite the lack of sufficient evidence to conclude that it affects glycemic control.


[1] – (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. Epub 2017 Dec 6. PMID: 29223408)

[2] – Brockman NK, Sigal RJ, Kenny GP, Riddell MC, Perkins BA, Yardley JE. Afternoon aerobic and resistance exercise have limited impact on 24-h CGM outcomes in adults with type 1 diabetes: A secondary analysis. Diabetes Res Clin Pract. 2021 Jul;177:108874. doi: 10.1016/j.diabres.2021.108874. Epub 2021 May 28. PMID: 34052249.

[3] – Valli G, Minnock D, Tarantino G, Neville RD. Delayed effect of different exercise modalities on glycaemic control in type 1 diabetes mellitus: A systematic review and meta-analysis. Nutr Metab Cardiovasc Dis. 2021 Mar 10;31(3):705-716. doi: 10.1016/j.numecd.2020.12.006. Epub 2020 Dec 13. PMID: 33549457.

[4] – Hasan S, Shaw SM, Gelling LH, et al. Exercise modes and their association with hypoglycemia episodes in adults with type 1 diabetes mellitus: a systematic review. BMJ Open Diabetes Research and Care 2018;6:e000578. doi: 10.1136/bmjdrc-2018-000578

[5] – Reddy, R., Wittenburg, A., Branigan, D., Winters-Stone, K., Castle, J.R., El Youssef, J. and Jacobs, P.G. (2018). Effect of Exercise on Glycemic Control iin Type 1 Diabetes. Diabetes, 67(suppl. 1).

[6] – Scott, S. N., Cocks, M., Andrews, R. C., Narendran, P., Purewal, T. S., Cuthbertson, D. J., … Shepherd, S. O. (2019). Fasted high-intensity interval and moderate-intensity exercise do not lead to detrimental 24-hour blood glucose profiles. Journal of Clinical Endocrinology and Metabolism, 104(1), 111–117

[7] – Paim da Cruz Carvalho, L., dos Santos Oliveira, L., Boufleur Farinha, J., Socorro Nunes de Souza, S., & Luiz de Brito Gomes, J. (2021). Sex-related glycemic changes after intensity- and duration- matched aerobic and strength exercise sessions in type 1 diabetes: A randomized cross-sectional study. Journal of Bodywork and Movement Therapies, 28, 418–424.