Physical activity and exercise recommendations for prescreening of patients with type 1 diabetes mellitus
| RECOMMENDATION | LEVEL* | GRADE† |
|---|---|---|
| For all individuals with type 1 diabetes, vigilance is required to limit PA-associated hypoglycemia, as the risk for this adverse event can be high | 2 | A |
| Individuals with signs and symptoms of CVD should be sent for CVD screening before the initiation of a new exercise program more vigorous than brisk walking | 3 | C |
| No exercise restrictions should be placed on previously sedentary persons with type 1 diabetes younger than 30 years of age (or those older than 30 years of age who have had diabetes for less than 10 years) and who are free from symptoms of CVD and diabetes-related complications, as the risk for clinically significant adverse events (except for hypoglycemia) is low | 3 | C |
| For previously sedentary patients with type 1 diabetes older than 30 years of age (and those who have had diabetes for 10 years or longer) or with any diabetes-related complications (microvascular or macrovascular), exercise programming of activities more vigorous than walking should be suspended until medical assessment is complete, which might include exercise stress testing for the evaluation of CVD | 4 | C |
| Individuals with excessive hyperglycemia (fasting blood glucose >15 mmol/L) and elevated ketone levels in their urine (ketonuria) should refrain from initiating vigorous exercise until glycemic control is reestablished | 4 | C |
CVD—cardiovascular disease, PA—physical activity.
↵* Level I evidence includes randomized controlled trials; level II evidence includes randomized controlled trials with important limitations or observational trials with overwhelming evidence; level III evidence includes observational trials; and level IV evidence includes anecdotal evidence or expert opinion.
↵† Grade A recommendations are strong; grade B recommendations are intermediate; and grade C recommendations are weak.