Care of the Athlete With Type 1 Diabetes Mellitus: A Clinical Review.
BACKGROUND
Type 1 diabetes mellitus (T1DM) results from a highly specific immune-mediated destruction of pancreatic β cells, resulting in chronic hyperglycemia. For many years, one of the mainstays of therapy for patients with T1DM has been exercise balanced with appropriate medications and medical nutrition. Compared to healthy peers, athletes with T1DM experience nearly all the same health-related benefits from exercise. Despite these benefits, effective management of the T1DM athlete is a constant challenge due to various concerns such as the increased risk of hypoglycemia. This review seeks to summarize the available literature and aid clinicians in clinical decision-making for this patient population.


METHODS
PubMed searches were conducted for "type 1 diabetes mellitus AND athlete" along with "type 1 diabetes mellitus AND exercise" from database inception through November 2015. All articles identified by this search were reviewed if the article text was available in English and related to management of athletes with type 1 diabetes mellitus. Subsequent reference searches of retrieved articles yielded additional literature included in this review.


RESULTS
The majority of current literature available exists as recommendations, review articles, or proposed societal guidelines, with less prospective or higher-order treatment studies available. The available literature is presented objectively with an attempt to describe clinically relevant trends and findings in the management of athletes living with T1DM.


CONCLUSIONS
Managing T1DM in the context of exercise or athletic competition is a challenging but important skill for athletes living with this disease. A proper understanding of the hormonal milieu during exercise, special nutritional needs, glycemic control, necessary insulin dosing adjustments, and prevention/management strategies for exercise-related complications can lead to successful care plans for these patients. Individualized management strategies should be created with close cooperation between the T1DM athlete and their healthcare team (including a physician and dietitian).
Department of Medicine, University of Mississippi Medical Center, Mississippi, United States.
William B
WB
Horton
Department of Medicine, University of Mississippi Medical Center, Mississippi, United States; Division of Endocrinology, University of Mississippi Medical Center, Mississippi, United States; Department of Medicine, G.V. Montgomery VA Medical Center, Mississippi, Jackson, United States.
Jose S
JS
Subauste
Exercise; Hyperglycemia; Hypoglycemia; Type 1 Diabetes Mellitus
J Clin Endocrinol Metab. 2004 Sep;89(9):4656-64
15356077
Diabetes Technol Ther. 2013 Jan;15(1):84-8
23216304
J Sports Sci. 2004 Jan;22(1):15-30
14971430
J Clin Invest. 1981 Aug;68(2):399-404
7263859
J Clin Endocrinol Metab. 2001 May;86(5):2118-24
11344216
Diabetes Metab J. 2013 Feb;37(1):1-21
23441028
Diabetes. 1987 Aug;36(8):932-7
2885238
Br J Sports Med. 1999 Jun;33(3):161-72; quiz 172-3, 222
10378067
Diabetes. 2000 Jan;49(1):73-81
10615952
Prim Care. 2007 Dec;34(4):791-808, vi-vii
18061818
Diabetologia. 1990 Nov;33(11):696-703
2076801
Diabet Med. 1989 Nov;6(8):677-81
2532100
Diabetes Forecast. 2011 Jul;64(7):42-5
21812384
Diabetes Technol Ther. 2011 Aug;13(8):819-25
21599515
Arch Intern Med. 2005 Oct 10;165(18):2114-20
16217001
Exp Clin Endocrinol Diabetes. 2015 Jul;123(7):419-22
25853705
Diabetes Educ. 1996 Sep-Oct;22(5):471-87
8936126
J Clin Endocrinol Metab. 2007 Mar;92(3):963-8
17118993
Metabolism. 2000 Mar;49(3):386-94
10726919
Exerc Sport Sci Rev. 2005 Jan;33(1):17-23
15640716
J Am Diet Assoc. 2009 Mar;109(3):509-27
19278045
JAMA. 2002 May 8;287(18):2414-23
11988062
Am J Clin Nutr. 1995 Oct;62(4):871S-890S
7572722
Biochim Biophys Acta. 1989 Jun 15;1012(1):81-6
2567185
Am J Physiol. 1996 Feb;270(2 Pt 1):E299-304
8779952
J Appl Physiol (1985). 2006 Sep;101(3):934-7
16763099
J Appl Physiol (1985). 2000 Apr;88(4):1277-83
10749819
Diabetes Care. 1985 Jul-Aug;8(4):337-42
3899554
Am J Clin Nutr. 1995 Apr;61(4 Suppl):968S-979S
7900696
Diabetes. 1981 Dec;30(12):1000-7
7030826
PLoS One. 2015 Apr 28;10(4):e0125220
25918842
Proc Natl Acad Sci U S A. 2007 Jul 17;104(29):12017-22
17609368
Diabetes Care. 2003 Apr;26(4):1316-7
12663620
Cell Metab. 2013 Feb 5;17(2):162-84
23395166
Diabetes Forecast. 2012 Mar;65(3):40-3
22439378
Med Sci Sports Exerc. 2000 May;32(5):904-10
10795779
Clin Sports Med. 2009 Jul;28(3):455-68
19505626
Diabetes. 1997 Nov;46(11):1846-52
9356035
Annu Rev Med. 1998;49:235-61
9509261
Med Sci Sports Exerc. 1995 Feb;27(2):200-10
7723643
Diabet Med. 1992 Apr;9(3):252-7
1576807
Diabetes Care. 1997 Dec;20(12):1814-21
9405899
Diabetes Care. 1988 Feb;11(2):201-11
3289869
Diabetes Care. 1990 May;13(5):473-7
2190773
Diabetes Care. 1997 Oct;20(10):1603-11
9314643
Diabetes. 2002 Feb;51 Suppl 1:S271-83
11815492
Endocr Pract. 2015 May;21(5):522-33
25962091
Diabetes Obes Metab. 2011 Feb;13(2):130-6
21199264
Am J Physiol. 1999 Oct;277(4 Pt 1):E733-41
10516134
Diabetes Forecast. 2013 Feb;66(2):40-3
23409295
Curr Sports Med Rep. 2006 Apr;5(2):93-8
16529680
Metabolism. 2004 Sep;53(9):1126-30
15334372
Am J Nurs. 2002 Jun;102(6):47-55; quiz 56
12394077
J Appl Physiol (1985). 2001 Jul;91(1):91-9
11408418
Diabetes Care. 2006 Jun;29(6):1433-8
16732040
J Acad Nutr Diet. 2012 Dec;112(12):2092
23174691
Diabetes Care. 2003 Jan;26 Suppl 1:S131-5
12502641
Diabetes. 1980 Apr;29(4):257-62
7358226
Diabetes. 2012 Nov;61(11):2987-92
22851572
Lancet. 2009 Jun 13;373(9680):2027-33
19481249
J Physiol. 2000 Oct 1;528 Pt 1:221-6
11018120
Exp Physiol. 2004 Sep;89(5):559-63
15184360
Am J Physiol Endocrinol Metab. 2001 Dec;281(6):E1340-6
11701451
Wilderness Environ Med. 2015 Jun;26(2):273-5
25676658
N Engl J Med. 1978 Jan 12;298(2):79-83
619237
Diabetes. 2003 Jul;52(7):1761-9
12829644
J Biol Chem. 2002 Jul 5;277(27):23977-80
11997383
Cell Metab. 2005 Jan;1(1):15-25
16054041
J Clin Invest. 1976 Mar;57(3):791-5
1249209
J Physiol. 2010 May 15;588(Pt 10):1779-90
20308248
Clin Sports Med. 2009 Jul;28(3):479-95
19505628
Diabetes Metab. 2004 Nov;30(5):465-70
15671916
Diabetes Care. 1987 Sep-Oct;10(5):584-8
3677976
Am J Physiol. 1997 Dec;273(6 Pt 1):E1107-12
9435525
Diabetes Technol Ther. 2016 Feb;18 Suppl 2:S253-63
26784131
Diabetes Care. 2002 Oct;25(10):1795-801
12351480