Endocrine Abstracts

Introduction: Hypoglycaemia is a key barrier to physical activity in people with diabetes. We explored the association between hypoglycaemia fear and daily step-count in adults with type 1 diabetes (T1D) and insulin treated type 2 diabetes (T2D).

Methods: Participants from the Hypo-METRICS study wore a Fitbit Charge 4 activity monitor, blinded continuous glucose monitor and reported episodes of hypoglycaemia on a smartphone app for 10-weeks. Participants also completed the Hypoglycaemia Fear Survey-II (HFS-II) score, which measures fear of hypoglycaemia and comprises of behaviour (behaviours to avoid hypoglycaemia and their negative consequences) and worry (specific concerns about hypoglycaemic episodes) subscales. Associations between HFS-II scores and median daily step-count were modelled using a generalised regression model, controlling for age, gender, time below range 3.9mmol/l, rate of reported hypoglycaemia, and hypoglycaemia awareness (as measured by GOLD score).

Results: A total of 266 people with T1D and 306 people with T2D (88% vs 91% white, 46% vs 63% male, median age 46 vs 63 years, HbA1c 7.3% vs 7.5%, HFS-II total score 27 vs 22, average step-count 8790 vs 5880 steps/day) were included. In people with T2D increased HFS-II behaviour sub-score and worry sub-score were independently correlated with reduced-step count (incidence rate ratio [IRR] 0.95, confidence interval [CI] 0.93-0.97, P < 0.001 and IRR 0.95, CI 0.92-0.98, P = 0.005 respectively). In people with T1D, increased HFS-II behaviour sub-score was associated with a reduction in step-count (IRR 0.98, CI 0.96-1.00, P = 0.048), however the worry sub-score was not significantly associated with step count (P = 0.2).

Conclusion: In people with T2D, both fear of hypoglycaemia worry and behaviour are associated with reduced daily step-count. In people with T1D only hypoglycaemia avoidance behaviour is associated with reduced daily step-count. Addressing fear of hypoglycaemia and providing education and clinical support for managing glucose and exercise may support physical activity in people with diabetes.