title: Closing the Loop on Exercise in Type 1 Diabetes.
abstract: BACKGROUND
  Despite its well-established health benefits, exercise imposes challenges on glucose control in individuals with type 1 diabetes due to the complex interactions between exerciseinduced effects on glucose metabolism and exogenous insulin therapy. Although clinical guidelines for exercise management in type 1 diabetes are available, implementation is challenging in daily life. The risk of exercise-induced dysglycaemia deters many people with type 1 diabetes from participating and benefitting from exercise. Rapid progress has been made in the development of closed-loop systems, also known as the artificial pancreas. The autonomous modulation of insulin delivery in a glucoseresponsive manner by closed-loop systems may be beneficial in addressing and overcoming the risk and burden of exercise-induced dysglycaemia.
  
  
  METHODS
  A summative overview of closed-loop application during exercise in type 1 diabetes is discussed, outlining current evidence and limitations, our perspectives in the field and future outlook.
  
  
  RESULTS
  Outcomes from clinical studies evaluating both single- and dual-hormone closed-loop during exercise are reported. Current approaches to enhance closed-loop performance during exercise are described.
  
  
  CONCLUSIONS
  Closed-loop system has the potential to ameliorate exercise management in type 1 diabetes. Promising results have been shown, however innovative approaches are still needed to overcome inherent limitations of closed-loop performance during exercise. Future studies in larger generalizable patient population during real-life settings are still needed, to further evaluate its clinical applicability.
authors.affiliation: Department of Diabetes, Endocrinology, Clinical Nutrition & Metabolism, Inselspital, Bern University Hospital, University of Bern, Bern 3010, Switzerland.|Wellcome Trust-MRC Institute of Metabolic Science, University of Cambridge, Cambridge, United Kingdom.|Department of Diabetes & Endocrinology, Cambridge University Hospitals NHS Foundation Trust, Cambridge CB2 1TN, United Kingdom.
authors.forename: Lia
authors.initials: L
authors.lastname: Bally
authors.affiliation: Wellcome Trust-MRC Institute of Metabolic Science, University of Cambridge, Cambridge, United Kingdom.|Department of Diabetes & Endocrinology, Cambridge University Hospitals NHS Foundation Trust, Cambridge CB2 1TN, United Kingdom.
authors.forename: Hood
authors.initials: H
authors.lastname: Thabit
mesh_terms: D000465:Algorithms; D001786:Blood Glucose / Q000032:analysis / Q000378:metabolism; D015190:Blood Glucose Self-Monitoring / Q000295:instrumentation; D003922:Diabetes Mellitus, Type 1 / Q000097:blood* / Q000188:drug therapy*; D015444:Exercise / Q000502:physiology*; D006801:Humans; D007328:Insulin / Q000008:administration & dosage*; D007332:Insulin Infusion Systems; D019397:Pancreas, Artificial
chemical_list: D001786:Blood Glucose; D007328:Insulin
keywords: Type 1 diabetes; artificial pancreas; closed-loop; exercise; glucagon; glucose control; hypoglycaemia; insulin.