The effect of timing of remotely supervised exercise on glucose control in people with type 1 diabetes during Ramadan: A randomised crossover study

Aim: The aim of the current study was to compare glucose responses when remotely supervised exercise was performed before or after breaking the fast, during Ramadan, in people with type 1 diabetes. Methods: People with type 1 diabetes were recruited to this randomised cross over design study, which took place in Kuwait during Ramadan in 2021–2022. Interstitial glucose was measured using continuous glucose monitors during a baseline week of normal activity and during weeks where remotely supervised exercise was performed, three times per week, either before (afternoon) or after (evening) breaking the fast, in a randomised crossover design. Exercise involved resistance and aerobic exercise and was supervised during a video call. Results: Thirty-two participants were recruited to the study (age 34(9) years and BMI 26(4)kg/m²). Mean interstitial glucose levels were lower on exercise days, compared to equivalent days in the baseline week, during both afternoon (8.6(1.8) mmol/L vs 9.1(1.4) mmol/L, p = 0.035) and evening (8.7(1.8) mmol/L vs 9.6(1.8) mmol/L, p < 0.001) exercise weeks. Mean glucose levels were lower the day after exercise, relative to both baseline (p < 0.001) and exercise (p = 0.011) days, in the evening exercise week only. Conclusions: Remotely supervised exercise performed during Ramadan can safely reduce interstitial glucose levels and may be of greater benefit when performed in the evening, further work is required to confirm this in a larger trial.