Hypoglycaemia avoidance behaviour and exercise levels in active youth with type 1 diabetes

• Published in: Endocrinology, diabetes & metabolism Vol. 3; no. 3; pp. e00153 - n/a
• Main Authors: Roberts, Alissa J., Yi‐Frazier, Joyce P., Carlin, Kristen, Taplin, Craig E.
• Format: Journal Article
• Language: English
• Published: England John Wiley & Sons, Inc 01.07.2020; John Wiley and Sons Inc; Wiley
• Subjects: Adjustment; Behavior; Children & youth; Diabetes; Exercise; Glucose; Hyperglycemia; hypoglycaemia; Hypoglycemia; Independent sample; Insulin; Metabolism; Original; Original s; Physical fitness; Questionnaires; Studies; type 1 diabetes mellitus; type 1 diabetes mellitus; hypoglycaemia; exercise
• ISSN: 2398-9238; 2398-9238
• DOI: 10.1002/edm2.153

Aims The primary goal of this exploratory study was to examine the association between fear of hypoglycaemia (FOH), hypoglycaemia avoidance behaviours and exercise in active youth with type 1 diabetes (T1D). Methods 30 youth with T1D who participate in some physical activity (PA), age 15.0 ± 2.4 years, on insulin pump therapy completed the ‘Type 1 Diabetes Report of Exercise Practices Survey (T1D‐REPS)’ and parent and child hypoglycaemia fear surveys (HFS). Twenty‐eight participants completed the 3‐day PA recall survey. Clinical data and pump downloads were obtained at the time of the survey collection. Results Higher child HFS behaviour and total scores were associated with higher PA levels (P = .003, P = .027), and higher parent HFS behaviour score was associated with higher youth PA levels (P = .031), after adjusting for age, sex, duration of diabetes and BMI. Higher child HFS behaviour score was associated with a higher exercise hypoglycaemia avoidance score on T1D‐REPS (r = .38, P = .043). Higher child HFS worry and total scores were associated with higher HbA1c (r = .48, P = .008; r = .46, P = .012). Conclusions This study demonstrated that, in a generally active cohort of youth with T1D, increased hypoglycaemia avoidance behaviour was associated with higher PA levels. Higher overall FOH scores were associated with PA level, driven by higher behaviour subscale scores, while worry subscales were not correlated with PA level. Those with more FOH intervene more to specifically avoid exercise‐associated hypoglycaemia and appear to have worse overall glycaemic control. Thus, improved education is required to improve glycaemic control around exercise while maintaining avoidance of hypoglycaemia. In youth with type 1 diabetes, fear of hypoglycaemia may be a barrier to physical activity, but little is known about whether FOH impacts the amount of exercise, or whether FOH impacts optimal glycaemic management around exercise. Higher physical activity level was associated with increased reported exercise‐specific hypoglycaemia avoidance behaviour and with overall fear of hypoglycaemia in youth with type 1 diabetes who perform some activity. Active youth report employing strategies to reduce hypoglycaemia risk with exercise, but this may be at the expense of excessive hyperglycaemia. Improved education around strategies to safely exercise without permissive hyperglycaemia is needed.