UNCORRECTED PROOF Please cite this article in press as: Bonomo M, et al. Safety of recreational scuba diving in type 1 diabetic patients: The Deep Monitoring programme. Diabetes Metab (2009), doi:10.1016/j.diabet.2008.08.007 ARTICLE IN PRESS +Model DIABET 171 1–7 Diabetes & Metabolism xxx (2009) xxx–xxx Original article 1 Safety of recreational scuba diving in type 1 diabetic patients: The Deep Monitoring programme 2 3 M. Bonomo a,∗ , R. Cairoli b , G. Verde c , L. Morelli d , A. Moreo e , M. Delle Grottaglie f , M.-C. Brambilla a , E. Meneghini a , P. Aghemo g , G. Corigliano h , A. Marroni i 4 5 a Departments of Diabetology and Metabolic Diseases, Niguarda Ca’ Granda Hospital, Milan, Italy 6 b Departments of Haematology, Niguarda Ca’ Granda Hospital, Milan, Italy 7 c Departments of Endocrinology, Niguarda Ca’ Granda Hospital, Milan, Italy 8 d Departments of Hyperbaric Medicine, Niguarda Ca’ Granda Hospital, Milan, Italy 9 e Departments of Cardiology, Niguarda Ca’ Granda Hospital, Milan, Italy 10 f Departments of Ophthalmology, Niguarda Ca’ Granda Hospital, Milan, Italy 11 g Sport Physiology Center, Milan, Italy 12 h Diabetes Unit AID ASL Napoli-1, Naples, Italy 13 i DAN Europe, Roseto, Italy 14 Received 2 January 2008; received in revised form 21 August 2008; accepted 24 August 2008 15 Abstract 16 Aim. – To verify whether, with thorough practical and theoretical training, well-controlled, non-complicated diabetic patients can safely go diving underwater with no additional medical or metabolic risks. 17 18 Methods. – Twelve diabetic patients participated in the study after undergoing training focused on their diabetic status. Two dives per day were scheduled during two five-day stays on the island of Ventotene (Italy). Capillary blood glucose (BG) was checked at 60, 30 and ten minutes before diving, and corrective measures adopted if necessary, based on BG absolute levels and dynamics. A device for continuous subcutaneous glucose monitoring (CGM), expressly modified for the purpose, was worn during each dive. 19 20 21 22 Results. – Data were gathered from 90 dives; mean BG at 60, 30 and ten minutes before diving was 205.8 ± 69.6 mg/dL, 200.0 ± 66.4 mg/dL and 200.5 ± 61.0 mg/dL, respectively. In 56 of the 90 dives, supplementary carbohydrates or insulin were necessary, but only one dive was interrupted on account of hypoglycaemic symptoms. Mean post-dive BG was 158.9 ± 80.8 mg/dL. CGM recordings showed that glucose levels gradually decreased during the dives (nadir: –19.9%). 23 24 25 26 Conclusion. – Experienced, well-controlled, complication-free young diabetic patients can safely go scuba diving, provided that they apply a rigorous protocol based on serial pre-dive BG measurements. The specific variables of underwater diving do not appear to involve significant additional risks of hypoglycaemia. 27 28 29 © 2009 Published by Elsevier Masson SAS. 30 Keywords: Scuba diving; Continuous glucose monitoring; Physical activity; Diabetes and sports 31 Résumé 32 Sécurité de la plongée sous-marine pour les personnes diabétiques de type 1 : le programme Deep Monitoring. 33 Objectif. – Le but de cette étude est de vérifier si, après avoir rec ¸ u une formation spécifique, des jeunes diabétiques bien équilibrés, sans complications, peuvent plonger en conditions de sécurité, sans sur-risques médicaux et métaboliques. 34 35 Méthodes. – Douze jeunes diabétiques de type 1 ont participé à l’étude, après un cours de plongée dont le programme était ciblé sur la condition diabétique. Pendant deux stages de cinq jours sur l’île de Ventotene (Italie), deux plongées par jour ont été programmées. La glycémie capillaire (GC) était mesurée 60, 30, et dix minutes avant la mise à l’eau, et des mesures de correction étaient adoptées en cas de nécessité, en fonction des niveaux absolus de GC et de leur dynamique. Un dispositif portable de mesure en continu du glucose subcutané (CGM), expressément modifié à cette fin, a été utilisé aussi en immersion. 36 37 38 39 40 ∗ Corresponding author. S.C. Diabetologia e Malattie Metaboliche, Ospedale Niguarda Ca’ Granda, Piazza Ospedale Maggiore 3, 20162 Milano, Italy. E-mail address: matteo.bonomo@ospedaleniguarda.it (M. Bonomo). 1262-3636/$ – see front matter © 2009 Published by Elsevier Masson SAS. doi:10.1016/j.diabet.2008.08.007