M Fairchild, K Cummer, MB Brown, S Trikudanathan

University of Washington, Seattle, WA

Obesity has long been an issue for those with Type 2 diabetes, however it is a growing concern in Type 1 diabetes (T1D). Environmental factors, increased carbohydrate consumption and intensive insulin therapy are potential contributing factors. Physical activity (PA) is an integral part of combating obesity, but decreased participation and disease-specific barriers impact T1D. PURPOSE: The purpose of this study was to explore the relation between PA and barriers to PA, health measures, and diabetes specific measures in a unique group of obese T1D (BMI≥30). METHODS: Individuals with T1D completed the International Physical Activity Questionnaire (IPAQ) and Barriers to Physical Activity in Type 1 Diabetes (BAPAD1). Blood labs and continuous glucose monitor (CGM) data were obtained. PA values included moderate to vigorous PA (MVPA) and BAPAD1 scores. Health measures included total daily dose of insulin (TDD), body mass index (BMI), hemoglobin A1C (HbA1C)%, systolic blood pressure (SBP) and waist circumference. CGM metrics included % time in range (TIR), above range (TAR) and below range (TBR). Pearson correlations examined the relation between PA, health measures and CGM metrics. Significance was set at p<0.05. RESULTS n=30(16 female), (mean(SD)) age 49(14)yrs, time with T1D 31(11)yrs, systolic BP 124(11.4) mmHg, BMI 32.8(2.8) and waist circumference 107.4(0)cm. HbA1C 7.0(0.8)%, TIR 67(13)%, and TDD 59.3(23.3)units. 91% of participants reported MVPA. The top 3 barriers to participation in PA were 1) work schedule, 2) weather conditions, 3) risk of hypoglycemia. Correlations were observed for BMI and TDD (r=0.41,p=0.04), SBP and TDD (r=0.52,p<0.001), waist circumference and TDD (r=0.64,p<0.001), and MVPA and TBR (r=0.43,p=0.04). CONCLUSION: This unique group of obese T1D demonstrates better A1C values through improved insulin delivery, however this correlated with elevated BMI, BP, and waist circumference. Individuals meeting MVPA guidelines showed greater risk of hypoglycemia, suggesting the need for improved guidance of insulin management during exercise. It is important for exercise specialists to understand the changing phenotype in T1D as well as the barriers to and risks of exercise when encouraging PA for this population.

Supported by the University of Washington Medicine Diabetes Institute.

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