Association between fear of hypoglycemia and physical activity in youth with type 1 diabetes: The SEARCH for diabetes in youth study

Abstract

Background: Youth with type 1 diabetes (T1D) are encouraged to participate in physical activity (PA). Studies have identified fear of hypoglycemia (FOH) as a barrier to participating in PA. Objectives: To examine (a) PA patterns in youth with T1D by age group and (b) the relationship between both parental and youth FOH and youth PA. Methods: A cross-sectional analysis from the SEARCH cohort study visit of youth ages 10 to 17 years with T1D (n = 1129) was conducted. Linear regression models estimated the association between self-reported number of days of vigorous PA (VPA) and moderate PA (MPA) and both youth-and parent-reported FOH. Multivariable models were adjusted for age, sex, race, duration of T1D, HbA1c, use of continuous glucose monitoring (CGM), recent severe hypoglycemia, primary insulin regimen, and BMI. Results: Participants were 52% female, had mean (sd) age 14.4 (4.2) years, diabetes duration 7.5 years (1.8), HbA1c 9.2% (1.7). Older youth were less likely to engage in VPA (P < .01), or sports teams (P < .01), but more likely to engage in MPA (P < .01). Higher youth FOH (behavior subscale) was associated with increased levels of VPA (β (se) 0.30 (0.11), P = .01) but not significantly associated with MPA (P = .06). There was no statistically significant association between parental FOH and youth PA. Conclusions: In SEARCH participants with T1D, VPA, and team sports participation declined with age, while MPA increased. We observed that higher scores on the youth FOH behavioral subscale were associated with increased VPA levels, suggesting that FOH may be less of a barrier to PA than previously thought.

Youth and Parent Perspectives on the Acceptability of a Group Physical Activity and Coping Intervention for Adolescents With Type 1 Diabetes

“…6,[34][35][36] However, recent evidence suggests that vigorous physical activity is associated with lower fear of hypoglycemia and improved glycemic levels. 37,38 Reducing fear of hypoglycemia among adolescents and their families may be a critical step to increasing MVPA in youth.…”

“…5,[33][34][35] However, recent evidence suggests that vigorous physical activity is associated with lower fear of hypoglycemia and improved glycemic levels. 36,37 Reducing fear of hypoglycemia among adolescents and their families may be a critical step to increasing MVPA in youth. It is possible that advancements in medical device technologies (e.g., continuous glucose monitoring) might make it easier for adolescents and their families to monitor glucose and make changes to prevent hypoglycemia during MVPA.…”

Challenges and Barriers of Physical Activity Among Pediatric Patients with Type 1 Diabetes Mellitus and Their Parents: A Systematic Review

“…Four qualitative studies with an average number of 7, 14, and 116 T1DM participants and their parents were employed in this study (Alburno et al, 2022) (Collard et al, 2020;Fried et al, 2021;Morrow et al, 2022). We also enrolled three quantitative studies that involved 96 to 1,129 T1DM patients and their parents (Livny et al, 2020;Michaud et al, 2017;Roberts et al, 2021).…”

“…A study mentioned that their participants were aged between 17 to 18, however, did not state the age of the parents or patient's guardians (Alburno et al, 2022). However, six studies had mentioned the age of the patients and their parents, with the age range of the patient from 9 to 18 years (Collard et al, 2020;Fried et al, 2021;Livny et al, 2020;Michaud et al, 2017;Morrow et al, 2022;Roberts et al, 2021).…”

Obesity in Patients with Type 1 Diabetes: Links, Risks and Management Challenges

“…The prescription of physical exercise must be individualized and the participation of physical activity professionals should be considered for a better adaptation to the characteristics and functional capacity of the patient, with the aim of improving adherence. The main barrier to do exercise in T1D is the fear of severe hypoglycemia 78 that may occur during or up to 24 h after exercise due to increased insulin sensitivity and delayed replenishment of liver and muscle glycogen following exercise. On the other hand, an excessive and/or frequent intake of carbohydrates is not advisable in people with obesity because it promotes weight gain.…”