Physical exercise is an important component in the management of type 1 diabetes across the lifespan. Yet, acute exercise increases the risk of dysglycaemia, and the direction of glycaemic excursions depends, to some extent, on the intensity and duration of the type of exercise. Understandably, fear of hypoglycaemia is one of the strongest barriers to incorporating exercise into daily life. Risk of hypoglycaemia during and after exercise can be lowered when insulin-dose adjustments are made and/or additional carbohydrates are consumed. Glycaemic management during exercise has been made easier with continuous glucose monitoring (CGM) and intermittently scanned continuous glucose monitoring (isCGM) systems; however, because of the complexity of CGM and isCGM systems, both individuals with type 1 diabetes and their healthcare professionals may struggle with the interpretation of given information to maximise the technological potential for effective use around exercise (i.e. before, during and after). This position statement highlights the recent advancements in CGM and isCGM technology, with a focus on the evidence base for their efficacy to sense glucose around exercise and adaptations in the use of these emerging tools, and updates the guidance for exercise in adults, children and adolescents with type 1 diabetes. Graphical abstract

John Hunter Childrens Hosp, Dept Endocrinol, Newcastle, NSW, AustraliaAlder Hey Childrens NHS Fdn Trust, Dept Nutr & Dietet, Liverpool, Merseyside, EnglandUniversidade Federal de São Paulo, Dept Endocrinol, São Paulo, BrazilJoslin Diabet Ctr, Pediat Adolescent & Young Adult Sect, Boston, MA 02215 USAUniv Cambridge, Dept Paediat, Cambridge, EnglandUniversidade Federal de São Paulo, Dept Endocrinol, São Paulo, BrazilWeb of Scienc

Aims: To determine if the frequency of severe diabetic ketoacidosis at presentation of new‐onset type 1 diabetes to an Australian tertiary centre increased during the initial period of restrictions resulting from the COVID‐19 pandemic (March to May 2020).Methods: Data were collected on presentations of newly diagnosed type 1 diabetes as well as on all paediatric presentations to the emergency department of a tertiary centre between 2015 and 2020. Data from the period of initial COVID restrictions in Australia (March to May 2020) were compared to the period March to May of the previous 5 years (pre‐pandemic periods).Results: The number of new diagnoses of type 1 diabetes was comparable in the pandemic period and pre‐pandemic periods (11 in 2020 vs range 6–10 in 2015–2019). The frequency of severe diabetic ketoacidosis was significantly higher in the pandemic period compared to the pre‐pandemic periods (45% vs 5%; P <0.003), odds ratio 16.7 (95% CI 2.0, 194.7). The overall frequency of diabetic ketoacidosis was also significantly higher during the pandemic period (73% vs 26%; P <0.007), odds ratio 7.5 (95% CI 1.7, 33.5). None of the individuals tested positive for COVID‐19. Presentations of people aged <18 years to the emergency department decreased by 27% in the pandemic period compared to the average of the pre‐pandemic periods (4799 vs 6550; range 6268 to 7131).Conclusions: A significant increase in the frequency of severe diabetic ketoacidosis at presentation of type 1 diabetes was observed during the initial period of COVID‐19 restrictions. We hypothesize that concern about presenting to hospital during a pandemic led to a delay in diagnosis. These data have important implications for advocacy of seeking healthcare for non‐pandemic‐related conditions during a global pandemic.