Developmental stage appears to be a major determinant of fear of hypoglycemia in youths with type 1 diabetes, while exercise timing may contribute modestly to perceived hypoglycemia risk, particularly for evening activity.
Key Findings
Results
Age group was significantly associated with both quality of life and fear of hypoglycemia in pooled analyses of youth with type 1 diabetes.
Analysis included 82 complete cases from 100 insulin pump-treated outpatients with T1D in a cross-sectional design.
Age group was significantly associated with QoL (p = 0.037) and FH (p < 0.001).
A large effect size was observed specifically for fear of hypoglycemia.
The age-group effect on FH remained robust in sensitivity analyses adjusting for sex and HbA1c (N = 62), whereas associations with QoL were attenuated.
Results
Exercise timing was associated with fear of hypoglycemia, with higher adjusted FH scores observed among individuals reporting evening exercise.
The association between exercise timing and FH was statistically significant (p = 0.047) in pooled analyses.
Pairwise comparisons were not significant after correction for multiple comparisons.
In sensitivity analyses adjusted for sex and HbA1c, timing showed only borderline significance.
No significant AgeGroup × Timing interactions were detected.
Results
Preferred exercise type and intensity were not independently associated with psychosocial outcomes.
Neither exercise type nor exercise intensity showed significant independent associations with quality of life or fear of hypoglycemia.
This finding held across the pooled analyses of 82 complete cases.
PA characteristics assessed included timing, type, intensity, and volume captured via 7-day PA logs.
Methods
The study used age-appropriate validated instruments to assess quality of life and fear of hypoglycemia across three developmental groups.
Participants were categorized as children, adolescents, and young adults.
All 100 participants were insulin pump-treated outpatients with T1D.
General linear models evaluated associations between PA characteristics and psychosocial outcomes, accounting for age group.
Sensitivity analyses additionally adjusted for sex and HbA1c, reducing the complete case sample to 62.
Conclusions
The authors concluded that developmentally tailored exercise counselling is important for youth with type 1 diabetes, and that longitudinal studies are needed to clarify directionality.
Cross-sectional design limits causal inference about the relationships observed.
The study highlights developmental stage as a major determinant of fear of hypoglycemia.
Evening exercise was identified as a potential contributor to perceived hypoglycemia risk, though findings were attenuated after adjustment.
The authors explicitly note the need for longitudinal studies to clarify directionality of these associations.
What This Means
This research examined how physical activity habits relate to psychological well-being and fear of low blood sugar (hypoglycemia) in 100 young people with type 1 diabetes, ranging from children to young adults. Participants recorded their exercise habits over 7 days, noting when they exercised, what type of activity they did, how hard they worked out, and for how long. Researchers then looked at whether these exercise patterns were linked to quality of life and fear of hypoglycemia.
The most consistent finding was that a person's developmental stage — whether they were a child, adolescent, or young adult — was strongly linked to how much they feared hypoglycemia, with this relationship holding up even after accounting for sex and blood sugar control (HbA1c). People who exercised in the evening tended to report higher fear of hypoglycemia compared to those who exercised at other times of day, though this finding became less clear-cut after statistical adjustments. The type of exercise (e.g., aerobic vs. strength training) and how intense it was did not appear to independently affect either quality of life or fear of hypoglycemia.
This research suggests that age and life stage play a larger role in shaping fear of low blood sugar than the specific details of how someone exercises. The finding about evening exercise being linked to greater hypoglycemia fear is relevant because nighttime low blood sugar episodes are a known concern for people with type 1 diabetes. The authors emphasize that diabetes care and exercise guidance should be adapted to a person's developmental stage, and that future studies following people over time are needed to better understand whether these factors cause changes in psychological outcomes or simply correlate with them.
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Codella R, Bisio A, Gotti D, Bassi M, Minuto N, Ruggeri P, et al.. (2026). Developmental stages and exercise timing in relation to fear of hypoglycemia and quality of life in type 1 diabetes.. Endocrine. https://doi.org/10.1007/s12020-026-04632-5