Is Better Understanding of Management Strategies for Adults With Type 1 Diabetes Associated With a Lower Risk of Developing Hypoglycemia During and After Physical Activity?

Background: We aim to determine how knowledge and type 1 diabetes (T1D) management strategies are associated with hypoglycemic risk for physical activity (PA)-induced hypoglycemia among people with T1D (PWT1D). Methods: One hundred thirty-seven physically active adults with T1D completed diabetes management, PA habits and PA-associated hypoglycemia questionnaire. Results: PA-associated hypoglycemia (during PA, within 1 hour of PA and overnight after PA) was reported by 49% to 61% of respondents, with 18% indicating that they felt inadequately equipped to perform regular PA safely. For during PA, more hypoglycemia was reported by PWT1D with more knowledge of hypoglycemia prevention strategies and those using continuous subcutaneous insulin infusion (CSII) vs multiple injections, those with decreasing basal rate 30 to 60 minutes before PA vs no adjustment before PA, and those taking snacks for unplanned PA vs no snacking. For within 1 hour after PA, more hypoglycemia was reported by PWT1D less knowledgeable about insulin pharmacokinetics and those practicing pre- vs post-dinner PA. For overnight after PA, more hypoglycemia was reported by PWT1D with shorter diabetes duration; CSII users having greater understanding of exercise-induced glucose fluctuations; those reporting reducing nocturnal insulin infusion rates vs no adjustment at night; those engaged in PA for at least 31 minutes; and those engaged in moderate and vigorous PA (vs light PA) as well as regularly performing interval training vs non-regular practice. Glycated hemoglobin and use of continuous glucose monitoring were not associated with any timing of reported PA-associated hypoglycemia. Conclusions: PA-associated hypoglycemia is common among PWT1D. Greater knowledge of PA and T1D management is not associated with less PA-associated hypoglycemia. Diabetes management confidence could encourage higher tolerance for hypoglycemic risk. (C) 2022 Canadian Diabetes Association.