Introduction and Objective: People living with type 1 diabetes (pwT1D) face barriers to physical activity (PA), such as fear of hypoglycemia, which may evolve over time. This longitudinal study aimed to evaluate changes in barriers to PA and to identify clinical and psychological factors influencing these changes.Methods: Data were obtained from adults pwT1D (≥18 years) in the Canadian BETTER registry. Participants who completed the Barriers to Physical Activity in Diabetes (BAPAD) questionnaire at baseline and at the one-year follow-up were included. Associations between changes in BAPAD score (ΔBAPAD = one year score – baseline score) and clinical or psychological factors were analyzed using Spearman and Pearson correlations. Factors assessed included treatment modality, glucose monitoring method, confidence in managing hypoglycemia (HCS), fear of hypoglycemia (HFS), diabetes-related distress (DDS), diabetes-related stigma (DSAS), and body mass index (BMI).Results: Among the 316 participants included, BAPAD score significantly decreased over time (2.62±1.20 vs. 2.40±1.08, p<0.001). No correlation was found between BAPAD score and initiating an insulin pump, initiating a continuous glucose monitor (CGM), or a change in HbA1c. Score increase was associated with discontinuation of CGM (r=0.128; p=0.033). Score decrease was associated with: decrease in BMI (r=0.192; p<0.001), increased confidence in managing hypoglycemia (r = -0.126, p = 0.026), decreased fear of hypoglycaemia (r=0.138; p=0.014), and decreased diabetes-related distress and stigma (respectively, r=0.18; p=0.001 and r=0.294; p< 0.001).Conclusion: Changes in barriers to PA are influenced by clinical and psychological factors. Maintaining access to technology, increasing confidence in managing hypoglycemia and addressing diabetes-related distress and stigma could reduce barriers to physical activity and support long-term engagement in physical activity.
C. Guédet: None. L. Alexandre-Heymann: None. J.E. Yardley: Research Support; Diabetes Canada, Canadian Institutes of Health Research. Speaker’s Bureau; Dexcom, Inc. V. Messier: None. V. Boudreau: None. M. Mathieu: None. A. Brazeau: Speaker’s Bureau; Dexcom, Inc. Research Support; Canadian Institutes of Health Research. Speaker’s Bureau; Juvenile Diabetes Research Foundation (JDRF). Research Support; Juvenile Diabetes Research Foundation (JDRF), Diabète Québec, Fonds de recherches du Québec-Santé, Mitacs. S. Tagougui: None. R.P. Rabasa-Lhoret: Advisory Panel; Abbott, Eli Lilly and Company, Novo Nordisk, Sanofi, Insulet Corporation. Other Relationship; Medtronic. Advisory Panel; Bayer Pharmaceuticals, Inc.
The BETTER registry is supported by grants from the Canadian Institutes of Health Research (grant number JT1- 157204), Breakthrough T1D Canada (grant number 3- SRA-2024–1523-M-N), and Diabète Québec as well as through non-restrictive grants from Eli Lilly Canada Inc., Novo Nordisk Canada and Sanofi-Aventis Canada and a donation from Dexcom Canada.
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