Optimising the CamAPS FX automated insulin delivery system for exercise and complex meals in adolescents with type 1 diabetes: A prospective interventional study in a camp setting

n this prospective interventional study, 26 adolescents with type 1 diabetes using the CamAPS FX system were monitored during a structured diabetes camp. The aim was to optimize AID system settings during physical activity (PA) and in response to complex meals, both recognized glycaemic challenges in youth. Three PA strategies were tested: Ease-Off with a 104 mg/dL target, Ease-Off with a 120 mg/dL target, and raising the glucose target to 150 mg/dL without Ease-Off. Despite higher energy expenditure, the 150 mg/dL target reduced hypoglycaemia but led to greater hyperglycaemia. The combination of Ease-Off plus a 120 mg/dL target provided the best balance between hypoglycaemia prevention, time-in-range, and reduced need for carbohydrate interventions. For complex meals rich in carbohydrates, fats, and proteins, three bolus strategies were compared: 100% standard bolus, 50/50 split bolus, and 70/30 split with “slowly absorbed meal.” The 50/50 split bolus resulted in the highest post-prandial time-in-range and the lowest hyperglycaemic exposure. Overall system performance during the camp remained strong, with improved glycaemic variability and reduced insulin requirements. These findings highlight the continued importance of user-driven adjustments even when advanced AID systems are employed. The study provides practical guidance for managing PA and complex meals with CamAPS FX, though its small sample size and camp setting limit generalizability.