Lower objectively measured physical activity is linked with perceived risk of hypoglycemia in type 1 diabetes

Keshawarz, Amena; Piropato, Andrew R.; Brown, Talia L.; Duca, Lindsey M.; Sippl, Rachel; Wadwa, R. Paul; Snell‐Bergeon, Janet K.

doi:10.1016/j.jdiacomp.2018.05.020

Cited by 19 publications

(23 citation statements)

References 34 publications

(19 reference statements)

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“…In fact, the accumulation of high MVPA scores may reduce overall barriers to PA practices; however, the "fear of hypoglycemia" was the only barrier's item that seemed to be unchanged by high levels of MVPA, as per our results. Given that the "fear of hypoglycemia" is the main barrier to PA (Jabbour et al, 2016;Keshawarz et al, 2018), it is still currently unclear which mode of PA may favor an appropriate glycemic balance among individuals with T1D. Consistent with our results, a meta-analysis by Hasan et al (2018) in laboratorybased settings reported that among adults with T1D, engaging in moderate exercise appears to be associated with a high risk of hypoglycemia, and high-intensity exercise may be safer because of a lower decline in blood glucose.…”

Section: Discussionsupporting

confidence: 84%

“…These barriers have been evaluated using the Barriers to Physical Activity in Type 1 Diabetes (BAPAD-1) scale (Dubé et al, 2006;Brazeau et al, 2008Brazeau et al, , 2012b, and fear of hypoglycemia was identified as the main barrier to PA practices in adults (Brazeau et al, 2008) as well as in youth (children and adolescents) (Jabbour et al, 2016). Recently, a cross-sectional study conducted in diabetes adults supports the assumption that PA may be lower in this population due to unique barriers (Keshawarz et al, 2018). Unfortunately, reporting potential barriers, particularly fear of hypoglycemia in relation to PA levels is limited to cross-sectional studies, and no data are available whether any changes in scores for fear of hypoglycemia and/or overall perceived barriers scores over time will affect PA levels.…”

Section: Introductionmentioning

confidence: 99%

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Vigorous Physical Activity Is Associated With Better Glycated Hemoglobin and Lower Fear of Hypoglycemia Scores in Youth With Type 1 Diabetes: A 2-Year Follow-Up Study

Jabbour

2020

Front. Physiol.

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To correlate glycated hemoglobin (HbA1c) and fear of hypoglycemia scores with physical activity (PA) levels in children and adolescents with type 1 diabetes (T1D) over a period of 2 years. Twenty-eight children and 33 adolescents with T1D have been assessed for their PA profile. Personal and medical data for the patients were collected at baseline (visit 0: V0), 1 year later (V1), and 2 years later (V2). At baseline, children with T1D engaged in less moderate to vigorous PA (MVPA) (p < 0.01) per day than adolescents. These results did not differ across visits. On the contrary, adolescents spent fewer time in vigorous physical activity (VPA) (p < 0.01) than children did (p < 0.01). Fear of hypoglycemia scores correlated significantly with VPA levels (β = −0.41, p = 0.03; β = −0.44, p = 0.06; β = −0.61, p = 0.001). For HbA1c (%), significant correlations were reported with VPA levels (β = −0.54, p = 0.02; β = −0.47, p = 0.03; β = −0.62, p = 0.01) across visits. Body mass index percentile correlated with total screen time (β = 0.28, p = 0.02; β = 0.29, p = 0.01; β = 0.31, p = 0.04) and overall PA levels (β = −0.52, p = 0.02; β = −0.42, p = 0.03; β = −0.42, p = 0.01). Performing more vigorous PA a day is associated with better HbA1c with lower perceived fear of hypoglycemia among youth with T1D. Therefore, dedicating more time in VPA may be an appropriate advice for patients with T1D.

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Section: Discussionsupporting

confidence: 84%

Section: Introductionmentioning

confidence: 99%

Vigorous Physical Activity Is Associated With Better Glycated Hemoglobin and Lower Fear of Hypoglycemia Scores in Youth With Type 1 Diabetes: A 2-Year Follow-Up Study

Jabbour

2020

Front. Physiol.

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“…Guidelines recommend that adults with type 1 diabetes should engage in 150 min or more of moderate-tovigorous-intensity physical activity (MVPA), spread over at least 3 days/week, with no more than 2 consecutive days without activity [9]. Despite this recommendation, it would appear that the majority of adults with type 1 diabetes do not meet this level of PA [2,5,7,[10][11][12][13]. Several barriers to exercise in type 1 diabetes have been identified [14].…”

Section: Introductionmentioning

confidence: 99%

“…Several barriers to exercise in type 1 diabetes have been identified [14]. One of the main barriers to PA in children, adolescents [15], and adults [12,14,16] with type 1 diabetes is fear of hypoglycaemia.…”

Section: Introductionmentioning

confidence: 99%

Adherence to physical activity recommendations and barriers to physical activity participation among adults with type 1 diabetes

et al. 2021

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Background Physical activity (PA) is important for those with type 1 diabetes (T1DM); however, accurate information on PA in people with T1DM is limited. Aims This study assessed adherence to PA guidelines using both objective and subjective PA measures and evaluated the relationship between accelerometer-measured PA and cardiovascular disease (CVD) risk factors. Barriers to PA were also assessed. Methods Using an observational cross-sectional design, PA was measured objectively over 7 days in 72 participants (34 males) using an accelerometer (ActiGraph) and subjectively using the International Physical Activity Questionnaire (IPAQ). Perceived barriers to PA were assessed using the Barriers to Physical Activity in Diabetes (type 1) scale. Multiple linear regression models assessed the influence of PA on HbA1c and CVD risk factors. Results Mean age ± SD was 40.9 ± 12.9 years, diabetes duration was 18 ± 11.6 years, and HbA1c was 65 ± 14 mmol/mol /8.0 ± 1.3%. Twenty-three (32%) participants exercised according to PA recommendations as measured by an accelerometer. Sixty-nine (97%) participants reported meeting the recommendations as per the IPAQ. Those meeting recommendations (accelerometry) had a lower HbA1c (p = 0.001), BMI (p = 0.032), waist circumference (p = 0.006), and fat mass (p = 0.032) and a greater number of hypoglycaemic events (p = 0.004). Fear of hypoglycaemia was the strongest barrier to PA (mean 3.4 ± 2.0). Conclusion The majority of participants failed to meet PA recommendations. Meeting the recommendations was associated with healthier CVD risk factor profiles. Individuals with T1DM possibly overestimate their PA using self-reported measures and require support and education to safely improve activity levels.

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“…The physicians and researchers selected patients using the following inclusion criteria: (1) 20–80 years old; and (2) ≥6 months since a diagnosis of diabetes. As well as patients with type 2 diabetes, we included patients with type 1 diabetes, because MVPA is recommended for both disease types (Colberg et al ., 2016) and patients with both types tend to exhibit low physical activity levels (Keshawarz et al ., 2018; Resnick et al ., 2006). The exclusion criteria were (1) HbA1c > 10.0%; (2) exercise restriction due to the progression of diabetic complications (e.g., retinopathy, diabetic nephropathy stage 4–5); (3) change in antidiabetic medication during the survey period; and (4) walking difficulty.…”

Section: Methodsmentioning

confidence: 99%

The effect of real‐time monitoring of physical activity intensity in diabetic patients

Tanaka

Fujita

Maeno

et al. 2021

Japan Journal Nursing Sci

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Aim To evaluate the effects of an intensity display type accelerometer on diabetic patients' physical activity. Methods This was a two‐arm, non‐randomized controlled study. Both groups received information about the recommendation of 150 min/week moderate‐to‐vigorous physical activity (MVPA). The intervention group used an intensity display type accelerometer to monitor their physical activity intensity for 10 days at baseline and 3 months later. We compared intervention and control groups after 3 and 6 months. Primary outcomes were MVPA and number of steps over 7 days. Secondary outcomes were glycosylated hemoglobin (HbA1c), body mass index, and self‐management. Results Of 62 participants, 30 and 32 were included in the intervention and control groups, respectively. Mean age in each group was 59.7 ± 10.8 and 58.8 ± 10.2 years, and mean HbA1c was 6.9 ± 0.9% and 6.9 ± 0.8%, respectively. There were no significant differences between the intervention and control groups at either time point, and no outcomes showed significant changes. In a subgroup analysis by physical activity intensity, MVPA of active individuals in the control group significantly decreased at 6 months from baseline. MVPA and number of steps among inactive individuals in the intervention group significantly increased at 6 months from baseline. Self‐management of the intervention group showed a trend toward improvement, but HbA1c and body mass index showed no significant change. Conclusions Monitoring physical activity intensity led to increased MVPA of inactive patients and maintained MVPA of active patients with diabetes mellitus. This straightforward intervention could be applied in clinical practice.

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Lower objectively measured physical activity is linked with perceived risk of hypoglycemia in type 1 diabetes

Abstract: Individuals with type 1 diabetes engage in less MVPA than those without diabetes despite similar self-reported levels, with the main barrier being perceived risk of hypoglycemia. Adults with type 1 diabetes require guidance to meet current PA guidelines and reduce cardiovascular risk.

Cited by 19 publications

References 34 publications

Vigorous Physical Activity Is Associated With Better Glycated Hemoglobin and Lower Fear of Hypoglycemia Scores in Youth With Type 1 Diabetes: A 2-Year Follow-Up Study

Vigorous Physical Activity Is Associated With Better Glycated Hemoglobin and Lower Fear of Hypoglycemia Scores in Youth With Type 1 Diabetes: A 2-Year Follow-Up Study

Adherence to physical activity recommendations and barriers to physical activity participation among adults with type 1 diabetes

The effect of real‐time monitoring of physical activity intensity in diabetic patients

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