{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,28]],"date-time":"2026-09-28T21:29:54Z","timestamp":1790630994463,"version":"4.1.0"},"reference-count":48,"publisher":"SAGE Publications","issue":"5","license":[{"start":{"date-parts":[[2025,12,3]],"date-time":"2025-12-03T00:00:00Z","timestamp":1764720000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"funder":[{"DOI":"10.13039\/100007028","name":"Leona M. and Harry B. Helmsley Charitable Trust","doi-asserted-by":"crossref","award":["G-2404-06905"],"award-info":[{"award-number":["G-2404-06905"]}],"id":[{"id":"10.13039\/100007028","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Diabetes Technology &amp; Therapeutics"],"published-print":{"date-parts":[[2026,5,1]]},"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>Physical activity (PA) poses significant challenges in glucose management for individuals with type 1 diabetes (T1D). Real-world PA is more frequent than structured PA, but remains underexplored. We analyzed 8171 real-world PA sessions comprising 45 activity types from the Type 1 Diabetes Exercise Initiative, examining hypoglycemia risk correlations with PA-level and population-level factors.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>Hypoglycemia risk was measured by change in continuous glucose monitoring (\u0394CGM) from PA onset to end, low blood glucose index (LBGI), and hypoglycemia event occurrence. Primary analyses used analysis of variance and Tukey\u2019s range test to measure correlations. Secondary analyses compared risk across activity types and categories (aerobic, mixed, and anaerobic).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>\n                      Higher hypoglycemia risk was associated with longer PA duration (median [Interquartile Range (IQR)] \u0394CGM \u221224 [\u221260, 11] mg\/dL for 60\u2013120 min vs. \u221212 [\u221231, 5] mg\/dL for 15\u201330 min), lower starting glucose (90% of sessions starting &lt;50 mg\/dL had hypoglycemia), and declining glucose rates before PA (all\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &lt; 0.05). Carbohydrate (CHO) intake 2\u20134 h before and during PA was associated with higher hypoglycemia risk (\u0394CGM \u221237 [\u221267, \u221214] mg\/dL with rescue CHO vs. \u221215 [\u221242, 8] mg\/dL without,\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &lt; 0.05), but this paradoxical effect was explained by higher insulin on board (IoB) and lower starting glucose. Males had larger glucose drops (\u0394CGM \u221220 [\u221246, 4] mg\/dL vs. \u221216 [\u221244, 7] mg\/dL in females,\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &lt; 0.05). Closed-loop users exhibited lower LBGI compared with open-loop users (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &lt; 0.05). Secondary analyses showed significant glycemic variability across activity types (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &lt; 0.05). Aerobic activities caused the greatest glucose drop, followed by mixed and anaerobic (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &lt; 0.05), whereas LBGI differences were nonsignificant (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = 0.32).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>Real-world PA has a highly variable glycemic impact, with longer duration, lower starting glucose, and higher IoB increasing hypoglycemia risk. Glycemic responses differed significantly by activity type, with aerobic activities resulting in the greatest decline. These findings highlight the need for tailored strategies to mitigate PA-related hypoglycemia in T1D.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/15209156251400209","type":"journal-article","created":{"date-parts":[[2025,12,5]],"date-time":"2025-12-05T04:09:41Z","timestamp":1764907781000},"page":"428-443","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":7,"title":["Variation in Hypoglycemia Risk During Real-World Physical Activity in Adults with Type 1 Diabetes: Insights from the Type 1 Diabetes Exercise Initiative"],"prefix":"10.1177","volume":"28","author":[{"given":"Mehak","family":"Dhaliwal","sequence":"first","affiliation":[{"name":"University of California, Santa Barbara, California, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kenan","family":"Tang","sequence":"additional","affiliation":[{"name":"University of California, Santa Barbara, California, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eleonora M.","family":"Aiello","sequence":"additional","affiliation":[{"name":"Department of Computer Science and Engineering, University of Trento, Povo di Trento, Italy."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dessi P.","family":"Zaharieva","sequence":"additional","affiliation":[{"name":"Division of Endocrinology, Department of Pediatrics, Stanford University School of Medicine, Stanford, California, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rayhan A.","family":"Lal","sequence":"additional","affiliation":[{"name":"Division of Endocrinology, Department of Pediatrics, Stanford University School of Medicine, Stanford, California, USA."},{"name":"Stanford Diabetes Research Center, Stanford, California, USA."},{"name":"Division of Endocrinology, Department of Medicine, Stanford University School of Medicine, Stanford, California, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cameron","family":"Summers","sequence":"additional","affiliation":[{"name":"Tidepool, Palo Alto, California, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brandon","family":"Arbiter","sequence":"additional","affiliation":[{"name":"Tidepool, Palo Alto, California, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kelly","family":"Watson","sequence":"additional","affiliation":[{"name":"Tidepool, Palo Alto, California, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mark J.","family":"Connolly","sequence":"additional","affiliation":[{"name":"Tidepool, Palo Alto, California, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lauren E.","family":"Figg","sequence":"additional","affiliation":[{"name":"Division of Endocrinology, Department of Pediatrics, Stanford University School of Medicine, Stanford, California, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ilenia","family":"Balistreri","sequence":"additional","affiliation":[{"name":"Division of Endocrinology, Department of Pediatrics, Stanford University School of Medicine, Stanford, California, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ana L.","family":"Cortes","sequence":"additional","affiliation":[{"name":"Division of Endocrinology, Department of Pediatrics, Stanford University School of Medicine, Stanford, California, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ryan S.","family":"Kingman","sequence":"additional","affiliation":[{"name":"Division of Endocrinology, Department of Pediatrics, Stanford University School of Medicine, Stanford, California, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bailey","family":"Suh","sequence":"additional","affiliation":[{"name":"Division of Endocrinology, Department of Pediatrics, Stanford University School of Medicine, Stanford, California, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael C.","family":"Riddell","sequence":"additional","affiliation":[{"name":"School of Kinesiology and Health Science, Faculty of Health, Muscle Health Research Centre, York University, Toronto, Canada."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yao","family":"Qin","sequence":"additional","affiliation":[{"name":"University of California, Santa Barbara, California, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2025,12,3]]},"reference":[{"key":"e_1_3_2_2_2","doi-asserted-by":"publisher","DOI":"10.2337\/cd18-0105"},{"issue":"2","key":"e_1_3_2_3_2","first-page":"126","article-title":"Physical activity, exercise, and physical fitness: Definitions and distinctions for health-related research","volume":"100","author":"Caspersen CJ","year":"1985","unstructured":"Caspersen CJ, , Powell KE, , Christenson GM. 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