Abstract

We applaud the consensus statement on exercise management in type 1 diabetes by Michael Riddell and colleagues1 published in The Lancet Diabetes & Endocrinology. An agreed set of guidelines on how to best manage physical activity alongside type 1 diabetes is urgently needed by health-care professionals and those living with the disease. However, we question how relevant the consensus statement is for the average person with type 1 diabetes. Although the publication accurately captures the physiological challenges faced by people with type 1 diabetes during exercise, sport, or competitive events and offers suitably pragmatic guidance for effective self-management, the focus remains on exercise rather than physical activity; here is where we see an important disconnect. Exercise-specific recommendations translate poorly to general physical activity, including daily living and recreational activities (eg, from housework and washing the car to walking the dog and caring for and playing with children), from which most of the people with type 1 diabetes have most to gain. With 70% of people with type 1 diabetes failing to achieve their treatment targets, the scale of that challenge is clear.2