Objective: Recent guidelines for management of T1D with exercise prompted us to determine if exercise management differs in T1D patients <15 yo with high or low hypoglycemia (hypo) awareness.
Methods: 229 subjects or caretakers in a single academic practice completed a modified T1D Exchange questionnaire, describing hypo awareness and exercise management (changes of carbohydrate (carb) intake and insulin doses). Hypo awareness was self-scored on a 5-point scale. Hypo awareness was defined as high (always/often) or low (never/rarely) (n=167). Patients had to exercise at least 1 day/week (mean 4.9) (n=158). Changes to carb intake for exercise were scored on a Never-to-Always 5-point scale. Insulin changes for exercise were scored on a yes/no scale. Because of differences in hypo awareness (p=0.0002), patients were divided into ages <8 year olds (yo) (n=35) and 8-14 yo (n=123). Fisher exact or Student t-test was applied.
Results: Between high and low hypo awareness groups, no significant differences were seen within each age category for: age at diagnosis, duration of T1D, insulin administration method, daily insulin dose, HbA1C, glucose meter checks/day, glucose checks <70mg/dL, and mean blood glucose. Children <8 yo were more likely to wear continuous glucose monitors (CGM) than 8-14 yo (34% vs. 24%; p=0.0002). Across all ages, hypo awareness was not associated with differences with insulin management (p=0.43) or carb use (p=0.18) before or during exercise. Increased CGM use was observed in low hypo awareness (48%) compared to high hypo awareness children (21%) (p=0.005), particularly among children <8 yo (57% vs. 19%; p=0.03) vs. 8-14 yo (40% vs. 21%; p=0.2).
Discussion: Increased CGM use was observed among patients <8 yo with low hypo awareness. Nonetheless, hypo awareness did not relate to adjustments of carb intake or insulin dose for exercise. This presents an educational opportunity to improve exercise-induced blood glucose fluctuation.
K. Cossen: None. B. Patterson: None. A. Muir: None.