Regular physical activity provides significant health benefits for people living with type 1 diabetes (pwT1D) [1]. Despite these advantages, many pwT1D struggle to meet the recommended activity levels (60 min per day for adolescents and 150 min per week for adults) and only a minority of adolescents and adults achieve recommended targets [2,3].

Understanding the barriers to physical activity in this specific population is crucial for developing effective interventions. The "Barriers to Physical Activity in Type 1 Diabetes" questionnaire (BAPAD1), developed by Dubé et al. (2006), has been instrumental in this regard [4]. Studies using this tool have consistently identified the fear of hypoglycemia as a primary obstacle to physical activity among both young people and adults living with T1D [3,5,6]. A higher BAPAD1 total score, indicative of greater perceived barriers, was positively correlated with a higher HbA1c [5]. Advancements in diabetes-specific technologies such as continuous glucose monitoring (CGM), continuous subcutaneous insulin infusion (CSII) and automated insulin delivery (AID) have improved the ease of glycemic management and transformed care [7]. These new tools could contribute to reducing the risk of exercise-induced hypoglycemia. However, two recent studies involving relatively small groups of PwT1D reported that the fear of hypoglycemia persisted, with no significant impact from technologies like CGM or CSII [3,8]. Surprisingly, Paiement et al. (2022) recently described that PwT1D using CSII reported more hypoglycemia during physical activity compared to those using MDI [9].

Moreover, several studies have identified personal and diseases-related factors that may increase the barriers to physical activity or fear of hypoglycemia in pwT1D. For example, Logan et al. reported that female sex was associated with higher barriers to physical activity [10] while Brazeau et al. found that greater perceived well-being was linked to lower barriers [5]. Fear of hypoglycemia was more pronounced in women or people who reported a depressive symptom [11]. Recent severe hypoglycemia were also significantly positively associated with higher fear of hypoglycemia [12]. Others potential influencing factors, such as sociodemographic characteristics, hypoglycemia awareness and the presence of macro and microvascular complications have not been thoroughly investigated.

In the context of rapid technological advancements (e.g., CGM, CSII, AID) and the growing emphasis on precision medicine, it is crucial to assess the personal and disease-related factors that influence both the prevalence and perceived importance of barriers to physical activity. This understanding is essential for developing targeted interventions to help mitigate these barriers in PwT1D. This registry-based study, using a large modern dataset, aims to identify the most significant barriers to physical activity, with a focus on the impact of new technologies treatment and glycemic monitoring methods. Additionally, we examined the role of personal and medical factors influencing these barriers. We hypothesized that hypoglycemia would remain the primary barrier to regular physical activity, but the use of technology for insulin administration and/or glucose monitoring will be associated with lower perceived barriers.