Managing type 1 diabetes during sustained physical activity at a diabetes camp: An adaptive prandial bolus reduction algorithm for children using automated insulin delivery

AIMS: Managing diabetes during exercise remains challenging, particularly in settings of sustained physical activity such as diabetes-camps. This study aimed to evaluate the efficacy and safety of a diabetes-camp protocol including an adaptive algorithm for prandial bolus reduction and the use of automated insulin delivery (AID) exercise modes in children with type 1 diabetes (CwD). METHODS: Data from two 7-day camps for 77 CwD aged 8-14 years using 780G, Control-IQ, or CamAPS were evaluated. Exercise modes were active throughout each camp, and meal boluses were adjusted by an adaptive algorithm. Continuous glucose monitoring metrics were evaluated and compared among AID systems and the 14-day pre-camp period. Hypoglycemia episodes and carbohydrates were recorded. RESULTS: Median time in range (TIR) was 80% during the camps, with time below range 3% (level 1; TBR1) and 1% (level 2; TBR2). Participants experienced a median of 2 hypoglycemia episodes/day. No severe hypoglycemia or diabetic ketoacidosis occurred. Median prandial bolus reduction in comparison with the calculated bolus was 45% (range 10-110%). Outcomes were similar across AID systems. TIR increased (80% vs. 78%, p = 0.015) and TBR rose modestly (TBR1 3% vs. 2%, p < 0.001; TBR2 1% vs. 0%, p = 0.002) compared to the pre-camp period. CONCLUSIONS: The protocol provided a safe and effective option to achieve glycemic targets across assessed AID systems during sustained physical activity at diabetes camps.