Striving for control: lessons learned from a successful international Type 1 Diabetes Youth Challenge.
OBJECTIVE
To demonstrate whether young people with T1D using modern insulin treatment and CGM could successfully participate in extreme sport activity while maintaining good glycemic control.


METHODS
The challenge took place in Crete/Greece over 4 days combining a long-distance trek of different levels of severity with final destination the summit of the White Mountains at 2080 m. Eleven participants (5/6 female/male, age 18.2 ± 1.3 years, T1D duration 7.9 ± 3.5 years, HbA1c 7.3 ± .7% (56 ± 16 mmol/mol); mean ± SD) from 11 SWEET centers in Belgium, Brazil, Canada, Germany, Greece, France, India, Italy, Portugal, Slovenia and Sweden participated to the challenge. Five participants were on CSII, six on MDI; all were wearing a continuous glucose monitoring system. The glycemic targets during trekking were defined as 80-180 mg/dl (4.4-10 mmol/l).


RESULTS
All participants completed the challenge. In total, the group walked 54.5 km under varying climate conditions (temperature 14-35 °C). During the challenge, insulin requirements decreased significantly compared to baseline: total daily insulin by 31.1 ± 16.7% (p < .001), basal by 30.8 ± 14.9% (p < .001), and prandial by 32.5 ± 28.0% (p = .023), with no differences between participants with CSII or MDI. No episode of severe hypoglycemia or DKA occurred. Mean glucose levels were 170.7 ± 60.1 mg/dl with 61.5 ± 18.7% of CGM values in the target range, 5.4 ± 5.4% under 80 mg/dl and 32.8 ± 16.6% above 180 mg/dl.


CONCLUSIONS
The results of this SWEET Initiative activity demonstrated that well-educated adolescents and young adults with T1D using modern insulin treatments are able to perform successfully even extraordinary physical challenges while maintaining good glycemic control without diabetes-related acute complications.
Diabetes Center for Children and Adolescents, Children's Hospital AUF DER BULT, Janusz-Korczak-Allee 12, 30173, Hannover, Germany. kordonouri@hka.de.
Olga
http://orcid.org/0000-0001-9563-3537
O
Kordonouri
P&A Kyriakou Children's Hospital, Athens, Greece.
Andriani
A
Vazeou
Centro de Diabetes Curitiba, Division of Pediatric Endocrinology os Hospital Nossa Senhora Das Graças, Curitiba, Brazil.
Mauro
M
Scharf
Diabetes Center for Children and Adolescents, Children's Hospital AUF DER BULT, Janusz-Korczak-Allee 12, 30173, Hannover, Germany.
Martina
M
Würsig
Department of Endocrinology, Diabetes and Metabolic Diseases, University Children's Hospital, Ljubljana, Slovenia.|Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia.
Tadej
T
Battelino
D000293:Adolescent; D000328:Adult; D001786:Blood Glucose / Q000032:analysis / Q000378:metabolism; D015190:Blood Glucose Self-Monitoring / Q000379:methods / Q000592:standards; D048909:Diabetes Complications / Q000097:blood / Q000517:prevention & control*; D003922:Diabetes Mellitus, Type 1 / Q000097:blood* / Q000628:therapy*; D015444:Exercise / Q000502:physiology*; D005260:Female; D006442:Glycated Hemoglobin / Q000032:analysis / Q000378:metabolism; D006115:Greece; D006801:Humans; D007003:Hypoglycemia / Q000188:drug therapy / Q000517:prevention & control; D007004:Hypoglycemic Agents / Q000008:administration & dosage; D007328:Insulin / Q000008:administration & dosage; D007332:Insulin Infusion Systems; D038622:Internationality; D008297:Male; D009051:Mountaineering / Q000502:physiology*; D012189:Retrospective Studies; D055815:Young Adult; D000067009:Youth Sports
D001786:Blood Glucose; D006442:Glycated Hemoglobin; D007004:Hypoglycemic Agents; D007328:Insulin
CGM; CSII; Sports; Type 1 diabetes; Youth