Most patients with Type 1 diabetes not meeting the recommended exercise goals

Posted on: 29 September 2021

Physical activity (PA) is known to reduce cardiovascular disease risk (CVD) among patients with type 1 diabetes. Guidelines recommend that adults with type 1 diabetes should engage in at least 150 minutes of moderate-to-vigorous-intensity PA per week. Accurate information on activity levels is limited however with possibly inaccurate self-reporting measures being employed rather than objective data collection via electronic devices.

Researchers from Trinity College Dublin at Tallaght University Hospital have studied how well patients with type 1 diabetes in Ireland comply with PA guidelines, and what the barriers to compliance are. The study examined PA among a broad range of participants with type 1 diabetes and looked at the association between PA and CVD risk factors. The findings suggest that patients overestimate their activity levels using self-reported measures, with only one third of patents actually meeting the PA guidelines when activity levels were measured using an accelerometer. The fear of developing exercise-induced hypoglycaemia was the strongest barrier to exercise for patients with Type 1 diabetes.

The study is published in the Irish Journal of Medical Science here [Wednesday, September 29^th, 2021].

The research team assessed adherence to PA guidelines using both objective and subjective measures. Physical activity was measured objectively over seven days in 72 participants using an Actigraph accelerometer, and subjectively using the International Physical Activity Questionnaire (IPAQ). Perceived barriers to activity were assessed using the Barriers to Physical Activity in Diabetes scale. Researchers also determined the influence of physical activity on HbA1c (a common measure of diabetes control) as well as risk factors for cardiovascular disease.

KEY FINDINGS

• The majority of participants with type 1 diabetes failed to meet PA recommendations.
• Exercise was positively correlated with body mass index (BMI), waist circumference, body fat and HbA1c (blood glucose levels), highlighting the importance of PA among this group.
• Overestimation in PA is a serious concern, as it almost certainly results in individuals not getting sufficient exercise and therefore not realizing the associated improvements in CVD risk factors.
• Diabetes-specific barriers do exist, specifically fear of hypoglycaemia, which result in poor uptake of exercise among this group.

Mary Finn, School of Medicine, Trinity College Dublin, Department of Nutrition and Dietetics, Tallaght University Hospital and Department of Endocrinology Tallaght University Hospital, and senior author said:

Physical activity is a crucial cornerstone of health for those with type 1 diabetes, and this study highlighted that most patients are not meeting the recommended exercise goals. Safely correcting this deficit will require a concerted effort.

Healthcare professionals must offer more support and education to help these individuals increase their exercise levels without increasing the risk of exercise-induced hypoglycaemia.

Our study results highlight practical gaps that need to be addressed through appropriate education on the impact of exercise on glucose variability and implementation of strategies to avoid exercise-induced hypoglycaemia.

One educational strategy is the development of targeted online resources and factsheets. Patients could also be directed to the growing number of platforms for accurate information and advice (some examples: www.EXTOD.org, www.Runsweet.org and www.JDRF.org.uk).

Technology is also likely to offer a solution and individuals should be encouraged to use wearable fitness tracking devices to monitor and validate their level of activity. Medical devices including Continuous Glucose Monitors and closed-loop systems should also be encouraged to increase ‘time in range’, i.e. the percentage of time that individuals are within normal blood sugar range. These appliances are also valuable in preventing potentially dangerous exercise-induced hypoglycaemia and can therefore increase patient safety whilst providing considerable reassurance while exercising. Mary described some future planned work:

As part of my master’s study we developed a type 1 diabetes app to provide support and education regarding exercising with type 1 diabetes, and we plan to launch this app in due course.

The paper: Adherence to physical activity recommendations and barriers to physical activity participation amongst adults with Type 1 diabetes, is open access and can be freely downloaded here: https://link.springer.com/article/10.1007/s11845-021-02741-w

This research was funded by the Meath Foundation of Tallaght University Hospital.