Barriers to physical activity in children and adults living with type 1 diabetes: a complex link with real-life glycemic excursions.

Ever since the first research on barriers to physical activity (PA) highlighting fear of hypoglycemia as a major barrier in type 1 diabetes (T1D), many studies have attempted to understand their demographic and behavioral determinants. However, no research has been conducted on whether these perceived barriers towards PA are based on real life-experienced adverse glycemic effects of exercise.

We have included 62 adults, and 53 children/adolescents living with T1D along with their parents, who have completed the BAPAD-1 questionnaire on barriers to PA and wore a glucose sensor. Continuous glucose monitoring data were collected during one week of everyday life for 26 adults and 33 children/adolescents. Multiple linear regressions were used to explore links between BAPAD- 1 scores and glycemic excursions experienced during and after everyday life self-reported PA sessions, controlling for behavioral (accelerometry) and demographic confounders.

We show that in children/adolescents, the more time spent in hypoglycemia on nights following PA sessions, the more they reported hypoglycemic risk as a barrier (ß = +0.365, P = 0.034). Conversely, in adults, the higher the proportion of PA sessions accompanied by a drop in blood glucose, the less hypoglycemia was a barrier (ß = –0.046, P = 0.004). In parents, BAPAD-1 scores were unrelated to children/adolescents’ everyday life exercise-induced hypo/hyperglycemia.

In conclusion, in children/adolescents, fear of hypoglycemia was predominant in those exposed to nocturnal hypoglycemia associated with PA sessions. In adults, fewer barriers may mean they accept a bigger drop in their glycemia during PA. This shows the importance of finding and promoting age specific solutions to prevent exercise-induced hypoglycemia.