Developmental stages and exercise timing in relation to fear of hypoglycemia and quality of life in type 1 diabetes

PURPOSE: To examine associations between physical activity (PA) characteristics and psychosocial outcomes - quality of life (QoL) and fear of hypoglycemia (FH) - in children, adolescents, and young adults with type 1 diabetes (T1D). METHODS: In this cross-sectional study, 100 insulin pump-treated outpatients T1D completed 7-day PA logs capturing timing, type, intensity, and volume. QoL and FH were assessed using age-appropriate validated instruments. General linear models evaluated associations between PA characteristics and psychosocial outcomes, accounting for age group and, in sensitivity analyses, sex and HbA1c. RESULTS: In pooled analyses (N = 82 complete cases), age group was significantly associated with both QoL (p = 0.037) and FH (p < 0.001), with a large effect size observed for FH. In sensitivity analyses adjusting for sex and HbA1c, the age-group effect on FH remained robust, whereas associations with QoL were attenuated. Exercise timing was associated with FH (p = 0.047), with higher adjusted FH scores observed among individuals reporting evening exercise. However, pairwise comparisons were not significant after correction. No significant AgeGroup×Timing interactions were detected. Preferred exercise type and intensity were not independently associated with psychosocial outcomes. In sensitivity analyses adjusted for sex and HbA1c (N = 62), the age-group effect on FH remained robust, whereas timing showed borderline significance. CONCLUSION: Developmental stage appears to be a major determinant of fear of hypoglycemia in youths with T1D. Exercise timing may contribute modestly to perceived hypoglycemia risk, particularly for evening activity, although findings were attenuated after adjustment. These cross-sectional associations highlight the importance of developmentally tailored exercise counselling, while longitudinal studies are needed to clarify directionality.