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Can Type 1 Diabetics Master Ultra-Trail Running?
Elite athletic performance is possible in individuals with insulin-dependent diabetes. In addition to managing blood glucose levels, sports can help build essential psychosocial skills. This is the message from Jean-Charles Vauthier, MD, PhD, a sports medicine physician and researcher at the PRISME/InterPsy (EA 4432) laboratory at the University of Lorraine in Nancy, France. He explored this through interviews with ultra-trail runners living with type 1 diabetes (T1D) and presented his findings at the 2025 French-speaking Diabetes Society Congress, held April 1-4 at the Palais des Congrès in Paris, France.
An ultra-trail is a long-distance trail running competition, usually held in natural settings such as forests, plains, or mountains, and typically covers more than 80 km. It is a physically and mentally demanding event, particularly for athletes with insulin-dependent diabetes who must also regulate their blood glucose levels.
Vauthier initially focused on physiological changes and their effects on performance and alertness. As the director of the Trail Scientifique de Clécy in Normandy, France, he and his team monitored 55 non-diabetic athletes using masked continuous glucose monitors (CGMs) over the course of a 156-km ultra-trail (six laps of 26 km, with +6000 m elevation gain). The athletes wore CGMs starting the day before the race and continued wearing them for 10 days thereafter. Building on his earlier physiological research, Vauthier shifted his focus to the subjective experiences of insulin-dependent athletes. In collaboration with the InterPsy Laboratory at the University of Lorraine, he conducted remote interviews with 13 ultra-trail runners to better understand the challenges they face and the psychosocial skills they develop through long-distance competitions.
'As a diabetic myself and an ultra-trail runner, I am considered a peer and have access to social networks dedicated to this practice,' he explained in the preamble. 'This allowed me to approach the runners more easily on the theme: 'Tell me about your last race.''
Each interview lasted an hour and focused on the paradox of living with a chronic illness while pursuing extreme athletic goals.
Qualitative analysis identified recurring themes, including their stories, and revealed several key themes, including how the experience shaped their self-understanding, helped them manage their diabetes, boosted their motivation, built their expertise, and increased their sense of independence.
Digital Communities
'We are seeing communities being created where everyone contributes pieces — like a puzzle — which creates a kind of nebula of collective intelligence. No two do the same thing, but no one copies each other; therefore, everyone benefits. Of course, by 2025, these are essentially digital communities,' said Vauthier.
'It is really a form of peer support,' he explained. 'It is a bit like the model used in addiction recovery, such as Alcoholics Anonymous — except in this case, the groups are not created for therapeutic purposes, but they end up serving that role. They are not activist groups and have no specific agenda, yet they are still incredibly powerful.' He continued.
'What is also quite striking is the almost familial relationships that individuals with T1D have with each other. With the sensors, pumps, and omnipods, they easily recognise each other on the beach, and it is pretty much the only case where athletes accept their role as role models and will say to a child with a sensor, look at me too, I have one, and you see, anything is possible. I participate in marathons with T1D. I do a lot of ultra trails. These communities also offer practical solutions to a wide range of challenges, particularly technical challenges. For example, how to display blood sugar readings on a watch while running, how to interpret an error message on a pump, or how to keep a sensor in place during hot weather or rain.' 'You post a question and get 40 replies in 10 minutes. Patients with T1D are highly responsive. It is truly the art of resourcefulness, elite version,' Vauthier noted.
Building Flexibility
The study also explored psychosocial skills, which play a key role in many educational programs. Researchers have found that trail running has a notably positive impact on individuals with T1D, helping them manage stress, give and receive social support, and improve their problem-solving abilities.
'When you are able to manage when your pump breaks down in the middle of a run in the mountains, if there is no more food at the refreshment point because you had to stop unexpectedly, then you are able to manage your daily worries thanks to a strong approach to empowerment and a great ability to be flexible — a useful quality in everyday life.' Finally, being able to run an ultra-trail when you are diabetic requires you to know your illness perfectly and tame it completely. 'And we feel that it is not the same thing to know your illness to avoid theoretical complications at 20 years old than to prepare for a race that you dream of. The motivations are not the same. Ultimately, they become hyper-experts without any desire — as we might have thought beforehand — to put themselves in danger. This study shows that the patient's experience is extremely important and that it is always interesting to listen to them talk about their illness,' Vauthier said.
The Clinician's Role
Vauthier raised important questions about how healthcare professionals should engage with these highly skilled patient communities: should they act as mentors and join GroupSat at the risk of affecting their spontaneity? 'Are we ready to prescribe WhatsApp groups, especially when there is so much talk about social prescribing these days?' he asked.
He also emphasised that the athletes interviewed were not representative of the general diabetic population. They all came from higher socio-professional backgrounds, with strong technical abilities and high health literacy levels. 'To me, they are a bit like the 'Formula 1' of diabetes,' he said.
Continuing this metaphor, Vauthier questioned whether the lessons learned from these athletes could be applied to the general population. 'Is this a kind of laboratory — or a sign of growing health inequalities between those who have access to strong networks and advanced technologies and those who do not?' The athletes voiced concerns about this gap and admitted that researchers did not yet have a clear answer.
