A pilot investigation of an educational intervention, for physical activity and sedentary behaviour within type 1 diabetes management

Abstract

Overview: This study aims to investigate, through a mixed-methods approach, how an educational intervention can affect physical activity, sedentary behaviour and diabetes management alongside behavioural change, in participants with type 1 diabetes mellitus (T1DM). The intervention group would be compared to a control group of apparently healthy counterparts (CONT), consisting of male and female adults.

Methods: Eighteen (n=18) participants took part in a pilot non-randomised controlled study consisting of an intervention group with T1DM (n=9) and a control group of apparently healthy counterparts (CONT; n=9). The T1DM group attended an educational intervention, prior to entering a three-month free-living period where all participants including the CONT group, were asked to increase their physical activity. Venous blood samples were collected at pre- and post-intervention time points to analyse HbA1c, glucose and cholesterol (total, LDL and HDL). GT3X-BT ActiGraph accelerometers were used to collect physical activity and sedentary behaviour data for all participants at both time points. Continuous/flash glucose monitors (CGM/FGM)provided data to monitor T1DM groups glucose concentrations and patterns. All participants completed long last seven-day IPAQ questionnaires throughout the free living period, to monitor changes to physical activity over the free-living period. Postintervention focus groups were carried out (online) to identify if any behavioural changes occurred, resulting in changes to diabetes management.

Results: Significant increases (p<0.05) in moderate physical activity were found in the T1DM group, as well as changes to spending more time in shorter bouts of sedentary behaviour, compared to baseline (p<0.05). The CONT group saw an overall decline in physical activity. The time of day that physical activity was carried out, was compared with FGM/CGM data to compare numbers of hypoglycaemic events. Minor (nonsignificant but clinically relevant) changes to diabetes management were observed due to changes in the number of hypoglycaemic events recorded, alongside increases in physical activity. Significant within-subject effects to total (p=0.043) and LDL cholesterol (p=0.016) as well as between-subject effects for HbA1c (p<0.001) and plasma glucose (p=0.011) were also detected from pre to post intervention time points. Physical activity fragmentation was investigated for the first time in this population and, despite changes to fragmentation, results were not significant (p>0.05). Post-intervention focus groups revealed positive changes to behaviour, as noted by the participants, resulting in better overall management of diabetes.

Conclusion: Overall, the intervention resulted in improved levels of moderate physical activity within the T1DM group when compared to the CONT group. Although the amount of time being sedentary did not significantly change, the way in which the participants spent their time being sedentary did see a significant increase to the 5-9minutes bout. Identification of the time of day that physical activity was carried out and numbers of hypoglycaemic events recorded revealed changes from the pre- to postintervention stage. To the author’s knowledge, this is the first study to investigate physical activity fragmentation within the T1DM population. Positive behavioural changes were also noted alongside improvements in diabetes management within this group. Th results from this study revealed that providing the right education, can lead to improvements for people with T1DM and allow them to incorporate exercise safely into their everyday lives.

Date of Award	Nov 2024
Original language	English
Supervisor	Gareth Davison (Supervisor), Conor McClean (Supervisor) & Jason Wilson (Supervisor)