Association Between Daily Steps, Diabetes Management and Health Indicators in People Living with Type 1 Diabetes: A Cross-Sectional Study from the BETTER Registry

Aims: In people with type 1 diabetes, physical activity provides important health benefits but is mainly limited by fear of hypoglycaemia. Daily step count is a simple indicator of ambulatory activity. This study examined associations between step count and health indicators. Materials and Methods: Adults from the Behaviours, Therapies, Technologies and Hypoglycaemic Risk in Type 1 Diabetes registry wore a validated pedometer (PiezoRxD (R)) for 7-12 days and were classified based on mean daily steps: <7000 (group 1), 7000-10 000 (group 2), and >10 000 (group 3). Between-group comparisons used analysis of variance and chi-square/Fisher's tests with Bonferroni correction. Multivariable models adjusted for potential confounders. Results: A total of 383 participants (333 T1D, 50 latent autoimmune diabetes) were included (group 1: 163; group 2: 125; group 3: 95). Mean age was 46.7 +/- 13.3 years, 63% were women, diabetes duration was 24.2 +/- 15.6 years, and body mass index (BMI) 26.1 +/- 4.5 kg/m(2). Overall, 43.6% had glycated haemoglobin (HbA1c) <= 7%. A higher proportion of participants in groups 2 and 3 had HbA1c <= 7% compared with group 1. Level 1 and 2 hypoglycaemia frequency did not differ significantly across groups. Groups 2 and 3 had lower waist circumference than group 1, and group 3 additionally had lower BMI and a lower proportion of depression/anxiety medication use. Conclusions: Among adults living with type 1 diabetes, higher daily step counts were associated with more favourable glycaemic and anthropometric profiles, as well as lower use of depression/anxiety medication without evidence of increased hypoglycaemia. Causality cannot be inferred, and reverse causation is possible.