60th EASD Annual Meeting of the European Association for the Study of Diabetes

Background and aims: Regular physical activity has recognised health benefits for people with type 1 diabetes (T1D). However, a significant proportion of them do not undertake the recommended levels of activity. A number of studies have examined barriers to exercise in T1D, but these studies have generally only sampled small numbers of individuals. We aimed to assess the knowledge and barriers to PA in adults with T1D and to determine the associated predictive factors in a large population of people with T1D using an anonymous web-based questionnaire.

Materials and methods: Participants were recruited from the NHS Research Scotland Diabetes Network (research register) and internationally via social media. The questionnaire content was co-developed with PPI group. The 61-point online questionnaire was divided into 5 sections: participant characteristics, PA barriers (modified BAPAD1), diabetes management, exercise and sport. Participants were asked to rate on a 7-point Likert scale (1, extremely unlikely to 7, extremely likely) the chance that each item would keep them from doing regular PA in the next 6 months. Mean scores were calculated for each item on the modified BAPD1, item-total correlation was used to judge the quality of the items. Pearson’s correlations and two-tailed significance tests were used to determine which of the assessed factors were most correlated with perceived barriers to PA. Factors with Pearson’s correlations (r) >0.30 were used in linear regressions and partial eta squared (ηp2) calculated to determine independent predictors and effect size on BADAP1 score.

Results: A total of 474 individuals with T1D participated in the study, 11 participants were excluded from the analysis. Analysis was conducted on full data sets from 463 adults (52% female). Age, HbA1c and disease duration were participant reported and categorised; median age 45-54 years, disease duration 21-25 years, and HbA1c 50-55 mmol/mol. Continuous or flash glucose monitoring was used by 78.8% of participants, 63.7% treated with MDI and 36.3% CSII. Overall, the total BAPAD1 score was low (mean [SD] 2.72 [0.52]). However, fear of hypoglycaemia (FOH) remained the most significant barrier (3.60 [2.02]). Being asked about exercise/sport within a diabetes clinic was negatively correlated with FOH (r = -0.141; P = 0.002), as were knowledge of insulin and carbohydrate (CHO) adjustments before and after exercise, and CHO respectively (r = -0.394; P < 0.001), (r = -0.402; P < 0.001), (r = -0.418; P < 0.001). Exercise confidence was the factor that predicted the highest proportion of variance in BAPAD1 score (ηp2 = 0.483) and therefore the largest effect size on BAPAD1 score.

Conclusion: Despite high use of continuous glucose monitoring and CSII, these findings suggest that fear of hypoglycaemia remains a significant barrier to PA and exercise and, if exercise and diabetes management are discussed in the clinic, this fear is less. These results demonstrate that to breakdown this barrier, and empower our patients to exercise, we need to improve the education we provide and our dialogue about exercise in clinics.