{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,7]],"date-time":"2026-07-07T00:16:53Z","timestamp":1783383413332,"version":"3.54.6"},"reference-count":33,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2026,5,13]],"date-time":"2026-05-13T00:00:00Z","timestamp":1778630400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,7,7]],"date-time":"2026-07-07T00:00:00Z","timestamp":1783382400000},"content-version":"vor","delay-in-days":55,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/100007465","name":"UiT The Arctic University of Norway","doi-asserted-by":"crossref","id":[{"id":"10.13039\/100007465","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["BMC Endocr Disord"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>Type 1 diabetes mellitus (T1DM) requires lifelong insulin treatment based on blood glucose (BG) values affected by many factors, making the treatment complex. Automated insulin delivery through hybrid closed loop (HCL) technology has now shown to be an effective and safe treatment option. However, these systems still perform sub-optimally during physical activity (PA). This study aimed to analyze challenges experienced during PA by people with T1DM using HCL technology and how they addressed these challenges.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We conducted a qualitative interview study based on semi-structured individual interviews with five participants. All participants used the Medtronic 780G insulin pump. Systematic text condensation was used as analysis method.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The main findings of the study are summarized in five major themes: (1) Challenges in Optimisation of Pre-Conditions for Exercise, (2) Limitations of user equipment, (3) Challenges in maintaining glycemic control during PA, (4) Challenging consequences after PA and (5) Need for manual override.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Achieving good BG control during PA is challenging despite good prerequisites and use of HCL technology. There is a need for improvements in attaching the pump and sensor, more accessible ways to monitor sensor glucose values, and increased education. Specifically, more opportunities for regulating insulin delivery during PA, and better guidance that focuses on how to avoid both hypo- and hyperglycemia in relation to PA when using HCL technology.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1186\/s12902-026-02297-9","type":"journal-article","created":{"date-parts":[[2026,5,13]],"date-time":"2026-05-13T04:29:42Z","timestamp":1778646582000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Physical activity and hybrid closed loop technology in adults with type 1 diabetes mellitus \u2013 what are the challenges experienced by the users and how are these met? A qualitative interview study"],"prefix":"10.1186","volume":"26","author":[{"given":"Frida Juliussen","family":"Hjortdahl","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eirik","family":"\u00c5rsand","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ragnar Martin","family":"Joakimsen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,5,13]]},"reference":[{"issue":"2","key":"2297_CR1","doi-asserted-by":"publisher","first-page":"165","DOI":"10.1503\/cmaj.060244","volume":"175","author":"KM Gillespie","year":"2006","unstructured":"Gillespie KM. Type 1 diabetes: pathogenesis and prevention. CMAJ. 2006;175(2):165\u201370.","journal-title":"CMAJ"},{"issue":"1","key":"2297_CR2","doi-asserted-by":"publisher","first-page":"137","DOI":"10.1186\/s12967-021-02778-6","volume":"19","author":"AA Akil","year":"2021","unstructured":"Akil AA, Yassin E, Al-Maraghi A, Aliyev E, Al-Malki K, Fakhro KA. Diagnosis and treatment of type 1 diabetes at the dawn of the personalized medicine era. J Transl Med. 2021;19(1):137.","journal-title":"J Transl Med"},{"key":"2297_CR3","doi-asserted-by":"crossref","unstructured":"Misso ML, Egberts KJ, Page M, O\u2019Connor D, Shaw J. Continuous subcutaneous insulin infusion (CSII) versus multiple insulin injections for type 1 diabetes mellitus. Cochrane Database Syst Rev. 2010;(1):Cd005103.","DOI":"10.1002\/14651858.CD005103.pub2"},{"issue":"5","key":"2297_CR4","doi-asserted-by":"publisher","first-page":"1007","DOI":"10.1007\/s00125-021-05391-w","volume":"64","author":"CK Boughton","year":"2021","unstructured":"Boughton CK, Hovorka R. New closed-loop insulin systems. Diabetologia. 2021;64(5):1007\u201315.","journal-title":"Diabetologia"},{"issue":"1","key":"2297_CR5","first-page":"Cd008101","volume":"1","author":"M Langendam","year":"2012","unstructured":"Langendam M, Luijf YM, Hooft L, Devries JH, Mudde AH, Scholten RJ. Continuous glucose monitoring systems for type 1 diabetes mellitus. Cochrane Database Syst Rev. 2012;1(1):Cd008101.","journal-title":"Cochrane Database Syst Rev"},{"issue":"7","key":"2297_CR6","doi-asserted-by":"publisher","first-page":"707","DOI":"10.1080\/17434440.2020.1784724","volume":"17","author":"J Fuchs","year":"2020","unstructured":"Fuchs J, Hovorka R. Closed-loop control in insulin pumps for type-1 diabetes mellitus: safety and efficacy. Expert Rev Med Dev. 2020;17(7):707\u201320.","journal-title":"Expert Rev Med Dev"},{"key":"2297_CR7","doi-asserted-by":"crossref","unstructured":"Cameron FM, Ly TT, Buckingham BA, Maahs DM, Forlenza GP, Levy CJ, et al. Closed-loop control without meal announcement in type 1 diabetes. Diabetes Technology & Theerapeutics [Internet]. 2017 [cited 2021 15.10]; 19(9). Available from: https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC5647490\/.","DOI":"10.1089\/dia.2017.0078"},{"issue":"3","key":"2297_CR8","doi-asserted-by":"publisher","first-page":"279","DOI":"10.1111\/dme.13816","volume":"36","author":"CK Boughton","year":"2019","unstructured":"Boughton CK, Hovorka R. Is an artificial pancreas (closed-loop system) for Type 1 diabetes effective? Diabet Med. 2019;36(3):279\u201386.","journal-title":"Diabet Med"},{"key":"2297_CR9","unstructured":"MiniMed 780G Brukerh\u00e5ndbok for systemet [Internett]. Medtronic Minimed. 2020 [cited 2023 13.05]. Available from: https:\/\/medhb.no\/wp-content\/uploads\/2020\/11\/Medtronic-Minimed-780G-brukarmanual.pdf."},{"key":"2297_CR10","unstructured":"Sykehusinnkj\u00f8p, Insulinpumper. CGM og forbruksmateriell [Internett]. Sykehusinnkj\u00f8p; 2023 [updated 04.01.2023]. Available from: https:\/\/www.sykehusinnkjop.no\/nasjonale-avtaler\/insulinpumper-cgm-og-forbruksmateriell-\/."},{"key":"2297_CR11","doi-asserted-by":"publisher","first-page":"k1310","DOI":"10.1136\/bmj.k1310","volume":"361","author":"E Bekiari","year":"2018","unstructured":"Bekiari E, Kitsios K, Thabit H, Tauschmann M, Athanasiadou E, Karagiannis T, et al. Artificial pancreas treatment for outpatients with type 1 diabetes: systematic review and meta-analysis. BMJ. 2018;361:k1310.","journal-title":"BMJ"},{"key":"2297_CR12","doi-asserted-by":"crossref","unstructured":"Pease A, Lo C, Earnest A, Kiriakova V, Liew D, Zoungas S. The efficacy of technologi in type 1 diabetes: a systematic review, network meta-analysis and narriative synthesis. Diabetes, Technology & Therapeutics [Internet]. 2020 [cited 2021 15.10]; 22(5):411\u201321. Available from: https:\/\/pubmed.ncbi.nlm.nih.gov\/31904262\/.","DOI":"10.1089\/dia.2019.0417"},{"issue":"3","key":"2297_CR13","doi-asserted-by":"publisher","first-page":"324","DOI":"10.1111\/dom.13898","volume":"22","author":"H Hanaire","year":"2020","unstructured":"Hanaire H, Franc S, Borot S, Penfornis A, Benhamou PY, Schaepelynck P, et al. Efficacy of the Diabeloop closed-loop system to improve glycaemic control in patients with type 1 diabetes exposed to gastronomic dinners or to sustained physical exercise. Diabetes Obes Metab. 2020;22(3):324\u201334.","journal-title":"Diabetes Obes Metab"},{"issue":"12","key":"2297_CR14","doi-asserted-by":"publisher","first-page":"1644","DOI":"10.2337\/dc17-0883","volume":"40","author":"MD Breton","year":"2017","unstructured":"Breton MD, Cher\u00f1avvsky DR, Forlenza GP, DeBoer MD, Robic J, Wadwa RP, et al. Closed-Loop Control During Intense Prolonged Outdoor Exercise in Adolescents With Type 1 Diabetes: The Artificial Pancreas Ski Study. Diabetes Care. 2017;40(12):1644\u201350.","journal-title":"Diabetes Care"},{"issue":"8","key":"2297_CR15","doi-asserted-by":"publisher","first-page":"740","DOI":"10.1016\/j.jcjd.2020.06.003","volume":"44","author":"DP Zaharieva","year":"2020","unstructured":"Zaharieva DP, Messer LH, Paldus B, O\u2019Neal DN, Maahs DM, Riddell MC. Glucose Control During Physical Activity and Exercise Using Closed Loop Technology in Adults and Adolescents with Type 1 Diabetes. Can J Diabetes. 2020;44(8):740\u20139.","journal-title":"Can J Diabetes"},{"issue":"6","key":"2297_CR16","doi-asserted-by":"publisher","first-page":"1217","DOI":"10.1177\/1932296815609370","volume":"9","author":"MC Riddell","year":"2015","unstructured":"Riddell MC, Zaharieva DP, Yavelberg L, Cinar A, Jamnik VK. Exercise and the Development of the Artificial Pancreas: One of the More Difficult Series of Hurdles. J Diabetes Sci Technol. 2015;9(6):1217\u201326.","journal-title":"J Diabetes Sci Technol"},{"key":"2297_CR17","doi-asserted-by":"crossref","unstructured":"Dovc K, Battelino T. Evolution of diabetes technology elsevier [Internet]. 2020 [cited 2021 14.10];49(1):1 -18. Available from: https:\/\/www.sciencedirect.com\/science\/article\/pii\/S088985291930091X?via%3Dihub.","DOI":"10.1016\/j.ecl.2019.10.009"},{"issue":"4","key":"2297_CR18","doi-asserted-by":"publisher","first-page":"401","DOI":"10.1007\/s00592-020-01589-3","volume":"58","author":"I Dicembrini","year":"2021","unstructured":"Dicembrini I, Cosentino C, Monami M, Mannucci E, Pala L. Effects of real-time continuous glucose monitoring in type 1 diabetes: a meta-analysis of randomized controlled trials. Acta Diabetol. 2021;58(4):401\u201310.","journal-title":"Acta Diabetol"},{"issue":"1","key":"2297_CR19","doi-asserted-by":"publisher","first-page":"140","DOI":"10.1177\/1932296818804550","volume":"13","author":"DP Zaharieva","year":"2019","unstructured":"Zaharieva DP, Riddell MC, Henske J. The Accuracy of Continuous Glucose Monitoring and Flash Glucose Monitoring During Aerobic Exercise in Type 1 Diabetes. J Diabetes Sci Technol. 2019;13(1):140\u20131.","journal-title":"J Diabetes Sci Technol"},{"issue":"5","key":"2297_CR20","doi-asserted-by":"publisher","first-page":"286","DOI":"10.1089\/dia.2018.0387","volume":"21","author":"A Li","year":"2019","unstructured":"Li A, Riddell MC, Potashner D, Brown RE, Aronson R. Time Lag and Accuracy of Continuous Glucose Monitoring During High Intensity Interval Training in Adults with Type 1 Diabetes. Diabetes Technol Ther. 2019;21(5):286\u201394.","journal-title":"Diabetes Technol Ther"},{"issue":"1","key":"2297_CR21","doi-asserted-by":"publisher","first-page":"158","DOI":"10.1177\/193229680800200125","volume":"2","author":"B Kovatchev","year":"2008","unstructured":"Kovatchev B, Clarke W. Peculiarities of the continuous glucose monitoring data stream and their impact on developing closed-loop control technology. J Diabetes Sci Technol. 2008;2(1):158\u201363.","journal-title":"J Diabetes Sci Technol"},{"issue":"5","key":"2297_CR22","doi-asserted-by":"publisher","first-page":"934","DOI":"10.2337\/dc07-1967","volume":"31","author":"SA Weinzimer","year":"2008","unstructured":"Weinzimer SA, Steil GM, Swan KL, Dziura J, Kurtz N, Tamborlane WV. Fully automated closed-loop insulin delivery versus semiautomated hybrid control in pediatric patients with type 1 diabetes using an artificial pancreas. Diabetes Care. 2008;31(5):934\u20139.","journal-title":"Diabetes Care"},{"key":"2297_CR23","doi-asserted-by":"publisher","first-page":"107810","DOI":"10.1016\/j.diabres.2019.107810","volume":"156","author":"H Absil","year":"2019","unstructured":"Absil H, Baudet L, Robert A, Lysy PA. Benefits of physical activity in children and adolescents with type 1 diabetes: A systematic review. Diabetes Res Clin Pract. 2019;156:107810.","journal-title":"Diabetes Res Clin Pract"},{"key":"2297_CR24","doi-asserted-by":"crossref","unstructured":"Czenczek-Lewandowska E, Leszczak J, Baran J, Weres A, Wyszy\u0144ska J, Lewandowski B, et al. Levels of physical activity in children and adolescents with type 1 diabetes in relation to the healthy comparators and to the method of insulin therapy used. Int J Environ Res Public Health. 2019;16(18).","DOI":"10.3390\/ijerph16183498"},{"issue":"7","key":"2297_CR25","doi-asserted-by":"publisher","first-page":"485","DOI":"10.1089\/dia.2019.0469","volume":"22","author":"M Jackson","year":"2020","unstructured":"Jackson M, Castle JR. Where Do We Stand with Closed-Loop Systems and Their Challenges? Diabetes Technol Ther. 2020;22(7):485\u201391.","journal-title":"Diabetes Technol Ther"},{"issue":"4","key":"2297_CR26","doi-asserted-by":"publisher","first-page":"436","DOI":"10.1111\/dme.13567","volume":"35","author":"C Farrington","year":"2018","unstructured":"Farrington C. Psychosocial impacts of hybrid closed-loop systems in the management of diabetes: a review. Diabet Med. 2018;35(4):436\u201349.","journal-title":"Diabet Med"},{"issue":"6","key":"2297_CR27","doi-asserted-by":"publisher","first-page":"1077","DOI":"10.1177\/1932296819869310","volume":"13","author":"S Tagougui","year":"2019","unstructured":"Tagougui S, Taleb N, Molvau J, Nguyen \u00c9, Raffray M, Rabasa-Lhoret R. Artificial Pancreas Systems and Physical Activity in Patients with Type 1 Diabetes: Challenges, Adopted Approaches, and Future Perspectives. J Diabetes Sci Technol. 2019;13(6):1077\u201390.","journal-title":"J Diabetes Sci Technol"},{"key":"2297_CR28","volume-title":"Kvalitative forskningsmetoder for medisin og helsefag. 4. utg","author":"K Malterud","year":"2017","unstructured":"Malterud K. Kvalitative forskningsmetoder for medisin og helsefag. 4. utg. ed. Oslo: Universitetsforl.; 2017."},{"issue":"5","key":"2297_CR29","doi-asserted-by":"publisher","first-page":"377","DOI":"10.1016\/S2213-8587(17)30014-1","volume":"5","author":"MC Riddell","year":"2017","unstructured":"Riddell MC, Gallen IW, Smart CE, Taplin CE, Adolfsson P, Lumb AN, et al. Exercise management in type 1 diabetes: a consensus statement. Lancet Diabetes Endocrinol. 2017;5(5):377\u201390.","journal-title":"Lancet Diabetes Endocrinol"},{"issue":"11","key":"2297_CR30","doi-asserted-by":"publisher","first-page":"1832","DOI":"10.1111\/dme.14309","volume":"37","author":"A Quintal","year":"2020","unstructured":"Quintal A, Messier V, Rabasa-Lhoret R, Racine E. A qualitative study exploring the expectations of people living with type 1 diabetes regarding prospective use of a hybrid closed-loop system. Diabet Med. 2020;37(11):1832\u201340.","journal-title":"Diabet Med"},{"issue":"12","key":"2297_CR31","doi-asserted-by":"publisher","first-page":"2561","DOI":"10.1007\/s00125-016-4107-0","volume":"59","author":"N Taleb","year":"2016","unstructured":"Taleb N, Emami A, Suppere C, Messier V, Legault L, Ladouceur M, et al. Efficacy of single-hormone and dual-hormone artificial pancreas during continuous and interval exercise in adult patients with type 1 diabetes: randomised controlled crossover trial. Diabetologia. 2016;59(12):2561\u201371.","journal-title":"Diabetologia"},{"issue":"11","key":"2297_CR32","doi-asserted-by":"publisher","first-page":"2108","DOI":"10.2337\/dc08-0720","volume":"31","author":"AS Brazeau","year":"2008","unstructured":"Brazeau AS, Rabasa-Lhoret R, Strychar I, Mircescu H. Barriers to physical activity among patients with type 1 diabetes. Diabetes Care. 2008;31(11):2108\u20139.","journal-title":"Diabetes Care"},{"issue":"8","key":"2297_CR33","doi-asserted-by":"publisher","first-page":"750","DOI":"10.1016\/j.jcjd.2021.02.006","volume":"45","author":"LR Wang","year":"2021","unstructured":"Wang LR, Malcolm J, Arnaout A, Humphrey-Murto S, LaDonna KA. Real-World Patient Experience of Long-Term Hybrid Closed-Loop Insulin Pump Use. Can J Diabetes. 2021;45(8):750\u2013e63.","journal-title":"Can J Diabetes"}],"container-title":["BMC Endocrine Disorders"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s12902-026-02297-9","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12902-026-02297-9.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12902-026-02297-9.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,6]],"date-time":"2026-07-06T23:56:48Z","timestamp":1783382208000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1186\/s12902-026-02297-9"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,5,13]]},"references-count":33,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2026,12]]}},"alternative-id":["2297"],"URL":"https:\/\/doi.org\/10.1186\/s12902-026-02297-9","relation":{},"ISSN":["1472-6823"],"issn-type":[{"value":"1472-6823","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,5,13]]},"assertion":[{"value":"9 July 2024","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"27 April 2026","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"13 May 2026","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The Regional Committee for Medical and Health Research Ethics (REK) found that this project did not require an application under the Norwegian Health Research Act (ref 417336\/REK Nord, S1 appendix). We received approval from the research responsible institution\u2019s Data Protection Officer (S2 appendix, 2021-11-10) and the Norwegian Centre for Research Data (ref 962742\/S3 appendix). Participants were informed in writing and verbally about the study and their rights prior to the interviews and provided written consent to participate in the study. Audio recordings were made with written consent (S4 appendix) and stored on an encrypted offline memory stick. The material was processed offline. Transcriptions were done by the interviewer (FJH) and the audio recordings were deleted within 7 days of post-interview. Participants were recruited through the local diabetes outpatient clinic at the University Hospital of North-Norway and social forums, with approval from the Norwegian Centre for Research Data (ref 962742\/S3 appendix).","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethical approval, consent to participate and consent for publication"}},{"value":"The authors declare no competing interests.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"198"}}