Are people who use automated insulin delivery systems doing more exercise?

Physical activity has many benefits for both physical and mental health. For people living with type 1 diabetes (T1D), physical activity improves insulin sensitivity but often causes unstable blood sugar levels.  While high-intensity exercise can induce hyperglycemia, hypoglycemia is common during and after moderate intensity exercise and is the greatest barrier to exercising. Thus, better strategies for preventing hypoglycemia are important for both promoting more physical activity and ensuring safety for people living with T1D. 

In recent decades, technology to help manage T1D has come a long way with continuous glucose monitors (CGM), insulin pumps, and automated insulin delivery (AID) systems (aka artificial pancreas). AID systems typically increase the time that blood sugar is within the target range and can help to manage blood sugar during exercise; though, management strategies can vary by device type. 

Is physical activity more common among AID users?

The BETTER registry is a Canadian research initiative that collects self-reported data from people living with T1D. BETTER has previously published a study on reported barriers to physical activity among AID users, but are people using AID systems engaging in exercise more often than people using different technology?

This BETTER registry study included 1156 Canadian adults living with T1D. Participants were divided into four groups, based on the T1D technology that they use: AID, insulin pump and CGM (without automation), insulin injections and CGM, and non-CGM.

AID users more often hit HbA1c targets

Half of AID users reported an HbA1c less than 7% whereas 31-37% of people in the other three groups achieved this target. However, the AID users had higher rates of postsecondary education and more often had household income that surpassed $100 000. The AID group also less commonly reported mild hypoglycemia in general. 

Physical activity was similar across groups

Across technology groups, the majority (77-87%) of people reported at least 10 min of physical activity (any movement, sports, or physical labour that makes you breathe harder than normal) in the previous week and AID users were on the higher end. Yet, 31% or less of participants in all groups hit the recommended physical activity target specific for people living with diabetes: 150 min of moderate to vigorous physical activity per week. 

Regardless of technology use, overall barriers to physical activity (e.g., fear of injury, weather conditions, fear of hypo/hyperglycemia, other physical health issues) were reported as similar across groups

What can we learn?

In the general population, it is estimated that around 50% of adults are meeting the 150 minutes of moderate to vigorous physical activity per week target, 20% higher than participants in this study. This tells us that current technologies for T1D are not sufficiently removing barriers to exercise. Thus, better support for exercise with T1D and improved understanding of how to use technology to its fullest potential are needed. Finally, use of the newer technology (CGM, insulin pumps, and AID systems) was more common in people with greater household income, highlighting inequities that can impact management choices.

Add your voice!

Contribute your experience with T1D technology, physical activity, and more by joining the BETTER registry today!

Reference:

• Chahal T, Alexandre-Heymann L, Yardley JE, Grou C, Guédet C, Messier V, Boudreau V, Courchesne A, Brazeau AS, Rabasa-Lhoret R, Wu Z. Automated insulin delivery system use and physical activity levels in adults with type 1 diabetes: A BETTER registry analysis. Diabet Med. 2026 Feb;43(2):e70192. doi: 10.1111/dme.70192. Epub 2025 Dec 13. PMID: 41389295; PMCID: PMC12857871.
• Colberg SR, Sigal RJ, Yardley JE, Riddell MC, Dunstan DW, Dempsey PC, Horton ES, Castorino K, Tate DF. Physical Activity/Exercise and Diabetes: A Position Statement of the American Diabetes Association. Diabetes Care. 2016 Nov;39(11):2065-2079. doi: 10.2337/dc16-1728. PMID: 27926890; PMCID: PMC6908414.