Popovic Djordje S, Koufakis Theocharis, Patoulias Dimitrios, Stoian Anca Pantea, Papanas Nikolaos
Clinic for Endocrinology, Diabetes and Metabolic Disorders, Clinical Centre of Vojvodina, Medical Faculty, University of Novi Sad, Novi Sad, Serbia.
Second Propaedeutic Department of Internal Medicine, Hippokration General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece.
Diabetes Metab Syndr Obes. 2025 Aug 27;18:3089-3092. doi: 10.2147/DMSO.S538152. eCollection 2025.
Recreational diving with self-contained underwater breathing devices is gaining popularity worldwide as a sport and leisure activity. People living with type 1 diabetes mellitus (PLT1D) are no exception, although historically diabetes mellitus, especially insulin-treated, has been described as an absolute contra-indication for diving. However, based on observational data collected by the Divers Alert Network, the presence of background diabetes mellitus became only a relative contraindication for those without significant co-morbidities or long-term complications. Regarding diving activities among PLT1D, the primary concern is the risk of hypoglycaemia, especially in those with impaired awareness. Furthermore, symptoms consistent with hypoglycaemia could be confused with those originating from other factors related to diving. Although avoidance of hypoglycaemia is imperative among PLT1D practicing diving, the risk of severe hyperglycaemia should also be minimised. Continuous glucose monitoring (CGM) nowadays represents the standard of care for PLT1D, but its accuracy during diving activities is still a matter of debate. This commentary aims to summarize the existing data on accuracy, durability, and underwater performance of different CGM devices among PLT1D who engage in diving, and to call for additional research in the field. Based on available results, the application of real-time CGM still requires extreme caution since none of the existing systems has so far met the standards for accurate use in underwater conditions. Further improvements of contemporary CGM devices, validated through large-scale trials, are necessary before their widespread implementation among PLT1D practicing diving. Such advances should further enhance safety during this popular activity.
使用自给式水下呼吸装置进行休闲潜水作为一项运动和休闲活动在全球越来越受欢迎。1型糖尿病患者（PLT1D）也不例外，尽管从历史上看，糖尿病，尤其是接受胰岛素治疗的糖尿病，一直被视为潜水的绝对禁忌症。然而，根据潜水员警报网络收集的观察数据，对于那些没有严重合并症或长期并发症的人来说，背景性糖尿病仅成为相对禁忌症。关于PLT1D的潜水活动，主要担忧是低血糖风险，尤其是在那些意识受损的人中。此外，与低血糖一致的症状可能与潜水相关的其他因素引起的症状相混淆。虽然在进行潜水的PLT1D中避免低血糖至关重要，但严重高血糖的风险也应降至最低。如今，持续葡萄糖监测（CGM）是PLT1D的标准治疗方法，但其在潜水活动期间的准确性仍存在争议。本评论旨在总结现有关于不同CGM设备在参与潜水的PLT1D中的准确性、耐用性和水下性能的数据，并呼吁在该领域进行更多研究。根据现有结果，实时CGM的应用仍需极度谨慎，因为目前还没有一个现有系统达到在水下条件下准确使用的标准。在当代CGM设备在进行潜水的PLT1D中广泛应用之前，通过大规模试验验证其进一步改进是必要的。这些进展应进一步提高这项热门活动期间的安全性。
