Management and Medical Care for Individuals with Type 1 Diabetes Running a Marathon

Background: Limited data exist on managing type 1 diabetes mellitus (T1DM) during long-distance endurance events such as marathons. This study aimed to assess glycemic control and participant safety during a marathon. Methods: Five men with T1DM, participating in the 22nd Poznan Marathon, were recruited. They completed health questionnaires and received training on glycemic management. Their physical capacity was assessed (including maximal oxygen uptake on a cycle ergometer). Participants reduced their insulin doses and consumed breakfast 2.5-3 h before the race. During the marathon, self-monitoring blood glucose (SMBG) and ketone levels were measured at five checkpoints (start, 10 km, 19 km, 30 km, and finish). The medical team followed a pre-approved protocol, providing carbohydrate and fluid supplementation as needed. Glycemia was monitored by two continuous glucose monitoring (CGM) systems (FreeStyle Libre 2 and Dexcom G6) and SMBG. Results: The participants' median age was 44 years (34-48), with a diabetes duration of 10 years (6-14), and a BMI of 22.5 kg/m2 (22.0-23.3). All finished the marathon in an average time of 4:02:56 (+/- 00:43:11). Mean SMBG was 125.6 (+/- 43.5) mg/dL, while CGM readings were 149.6 (+/- 17.9) mg/dL (FreeStyle Libre 2) and 155.4 (+/- 12.9) mg/dL (Dexcom G6). One participant experienced prolonged hypoglycemia undetected by CGM, whereas another developed symptomatic hypoglycemia between SMBG measurements. Conclusions: Safe marathon completion in people with T1DM requires individualized insulin dose adjustments, appropriate carbohydrate supplementation, and dedicated medical support at checkpoints. Combining CGM with periodic SMBG measurements further enhances safety and helps to detect potential glycemic excursions.