Fear of Hypoglycemia and Longer Disease Duration Associated with Physical Activity Avoidance in Children and Adolescents with Type 1 Diabetes Mellitus

Abstract

Objective: To determine physical activity (PA) avoidance and its associated factors among children with type 1 diabetes in four situations: leisure time (LT) PA out of school, LT PA at school during breaks, attendance at physical education (PE) classes and activity during PE classes. Methods: Cross-sectional study. The cohort consisted of 137 children, aged 9-18 years, with type 1 diabetes registered at a tertiary center between August 2019 and February 2020, 92 of whom attended for face-to-face interview. Responses were rated on a 5-point-Likert scale for PA in the four situations. Never/rarely/occasionally responses were defined as avoidance. Chi-square, parametric/non-parametric comparison and multivariate logistic regression analysis were used to detect and confirm variables associated with each avoidance situation. Results: Among the children 46.7% avoided PA during LT out of school and 52.2% during breaks, 15.2% avoided PE classes and 25.0% avoided active play during PE classes. Older children (14-18 year-olds) avoided PE classes [odds ratio (OR)=6.49, 95% confidence interval (CI)=1.10-38.13] and PA during breaks [OR=2.85, 95% CI=1.05-7.72] and girls avoided PA out of school (OR=3.18, 95% CI=1.18-8.06) and during breaks (OR=4.12, 95% CI=1.49-11.40). Those who had a sibling (OR=4.50, 95% CI=1.04-19.40) or had a poorly-educated mother (OR=3.63, 95% CI=1.15-11.46) avoided PA during breaks and those from low-income households avoided PE classes (OR=14.93, 95% CI=2.23-99.67). As the duration of disease prolonged, avoiding PA during LT out of school increased (4-9 years; OR=4.21, 95% CI=1.14-15.52 and ≥10 years; OR=5.94, 95% CI=1.20-29.36). Conclusion: Adolescence, gender, and socioeconomic inequalities deserve greater focus for better PA behavior among young people with type 1 diabetes. As the disease duration prolongs, revising and strengthening intervention to encourage PA may be needed.

Taking a Walk in Their Shoes: The Lived Experiences of Emerging Adults with Type 1 Diabetes

“…It is already known that some individuals with type 1 diabetes are hesitant to engage in physical activity because of fear of hypoglycemia, and that food intake before or during exercise is used to prevent or treat it. 25,26 However, this is one of the first studies in the literature describing the frustration with needing to eat before exercise in order to prevent or minimize a low blood sugar. Fourth, the comments the emerging adults in this study made about drinking alcohol were very mature and totally unexpected by the research team, and also something that has only previously been published by this research team.…”

Recommendations for recognizing, risk stratifying, treating, and managing children and adolescents with hypoglycemia

“…Despite hypoglycemia still being a significant impediment to glycemic control, especially in the pediatric age range, the inappropriate self-management of some PWD may be due to FoH rather than the hypoglycemia itself ( 71 ). Fear of hypoglycemia can lead to an excessive delay in the administration of boluses with negative effects on metabolic control ( 72 ). Furthermore, FoH reduces the propensity for physical activity ( 73 ).…”