Barriers to Exercise in Adults with Type 1 Diabetes and Insulin Resistance

Objective

To explore attitudes to exercise and quality of life (QoL) in adults with type 1 diabetes (T1D) with and without insulin resistance (IR).

Design

We pooled baseline pre-treatment data from a subset of T1D individuals from two randomised controlled trials (RCT). Estimated glucose disposal rate (eGDR), a validated surrogate marker of IR, was calculated using an established formula to classify individuals according to IR status with a cut-point of <6mg/kg/min for the determination of IR. Self-reported barriers to exercise were obtained using a validated questionnaire, the Barriers to Physical Activity in T1D (BAPAD-1). In addition, QoL was determined using the 36-item short form (SF-36) questionnaire. Differences between dichotomised variables were assessed using independent t-tests, Mann-Whitney U tests or Fisher’s exact tests. Linear regression was employed to explore the association of eGDR with BAPAD-1 and QoL scores, with sequential adjustment for potential confounders.

Results

Of 85 individuals included, n=39 were classified as having IR. The mean BAPAD-1 total score was higher for individuals with IR (IR 3.87±0.61 vs. non-IR 2.83±0.55; P<0.001). The highest exercise barrier scores for individuals with IR were risk of hypoglycaemia (5.67±1.26) and risk of hyperglycaemia (5.23±1.20), whereas the highest scoring exercise barrier scores for non-IR individuals were non-diabetes related; low level of fitness (3.91±1.26) and physical health status excluding diabetes (3.67±1.48) were ranked highest. QoL scores were comparable between groups (P>0.05).

Conclusions

Risk of hypoglycaemia was the greatest barrier to exercise in T1D individuals with IR, whereas non-diabetes related barriers to exercise were more salient in T1D individuals without IR.