Interaction between physical activity timing and behavioral determinants in predicting hypoglycemia among patients with type 2 diabetes mellitus
DOI:
https://doi.org/10.47197/retos.v80.119369Keywords:
Behavioral factors, hypo-glycemia, medication adherence, physical activity, type 2 diabetes mellitusAbstract
Background: Hypoglycemia is a common complication among patients with type 2 diabetes mellitus and is influenced by physical activity and behavioral factors.
Objective: This study aimed to analyze the association between physical activity and behavioral determinants and the incidence of hypoglycemia.
Methods: A cross-sectional study was conducted among 106 participants in a primary healthcare setting. Physical activity was assessed using the International Physical Activity Questionnaire (IPAQ), dietary intake using the Food Frequency Questionnaire (FFQ), and medication adherence using the Morisky Medication Adherence Scale (MMAS-8). Data were analyzed using Chi-square tests, logistic regression, and Poisson regression.
Results: A total of 45.3% of participants experienced hypoglycemia, with a mean of 2.14 ± 1.26 episodes per month. Low physical activity was significantly associated with hypoglycemia (OR = 3.52; 95% CI: 1.55–7.98; p = 0.003), as were skipping meals (OR = 2.84; 95% CI: 1.26–6.38; p = 0.012), low medication adherence (OR = 2.97; 95% CI: 1.32–6.66; p = 0.008), and insulin use (OR = 2.45; 95% CI: 1.10–5.45; p = 0.028). Low physical activity was also associated with an increased number of hypoglycemic episodes (IRR = 1.92; 95% CI: 1.34–2.74; p = 0.001). A significant interaction was observed between pre-meal physical activity and hypoglycemia (OR = 2.36; 95% CI: 1.18–4.72; p = 0.015).
Conclusion: Physical activity and behavioral determinants, particularly timing-related factors, play a critical role in the occurrence of hypoglycemia among patients with type 2 diabetes mellitus.
References
Ahrén, B. (2013). Avoiding hypoglycemia: a key to success for glucose-lowering therapy in type 2 diabetes. Vascular Health and Risk Management, 155–163.
Azami, Y., Funakoshi, M., Matsumoto, H., Ikota, A., Ito, K., Okimoto, H., Shimizu, N., Tsujimura, F., Fukuda, H., & Miyagi, C. (2019). Long working hours and skipping breakfast concomitant with late evening meals are associated with suboptimal glycemic control among young male Japanese patients with type 2 diabetes. Journal of Diabetes Investigation, 10(1), 73–83.
Carrillo, B. J. P., Sivasengh, R., Johnstone, A. M., & Gabriel, B. M. (2026). Exercise, nutrition and medicine timing in metabolic health: implications for management of type 2 diabetes. Proceedings of the Nutrition Society, 85(1), 68–73.
Cryer, P. E., & Polonsky, K. S. (2008). Glucose homeostasis and hypoglycemia. Williams Textbook of Endocrinology, 88, 1589–1590.
Gómez-Ruiz, R. P., Cabello-Hernández, A. I., Gómez-Pérez, F. J., & Gómez-Sámano, M. Á. (2024). Meal frequency strategies for the management of type 2 diabetes subjects: A systematic review. PLoS One, 19(2), e0298531.
Handwerk, P. (2025). The effect of physical exercises on glucose control in patients with type 1 diabetes mellitus. literature review. Vilniaus universitetas.
Kanaley, J. A., Colberg, S. R., Corcoran, M. H., Malin, S. K., Rodriguez, N. R., Crespo, C. J., Kirwan, J. P., & Zierath, J. R. (2022). Exercise/physical activity in individuals with type 2 diabetes: a consensus statement from the American College of Sports Medicine. Medicine and Science in Sports and Exercise, 54(2), 353.
Kemenkes. (2023). Laporan Riskesdas 2023. April 2024. https://www.badankebijakan.kemkes.go.id/laporan-hasil-survei/
Morisky, D. E., Ang, A., Krousel‐Wood, M., & Ward, H. J. (2008). Retracted: predictive validity of a medication adherence measure in an outpatient setting. The Journal of Clinical Hypertension, 10(5), 348–354.
Mphasha, M. H., & Vagiri, R. (2025). A narrative review of the interplay between carbohydrate intake and diabetes medications: unexplored connections and clinical implications. International Journal of Molecular Sciences, 26(2), 624.
Muntis, F. R., Mayer-Davis, E. J., Shaikh, S. R., Crandell, J., Evenson, K. R., & Smith-Ryan, A. E. (2023). Post-exercise protein intake may reduce time in hypoglycemia following moderate-intensity continuous exercise among adults with type 1 diabetes. Nutrients, 15(19), 4268.
Nakhleh, A., & Shehadeh, N. (2021). Hypoglycemia in diabetes: An update on pathophysiology, treatment, and prevention. 12(12), 2036–2049. https://doi.org/10.4239/wjd.v12.i12.2036
Pilotto, A., Noale, M., Maggi, S., Addante, F., Tiengo, A., Perin, P. C., Rengo, G., & Crepaldi, G. (2014). Hypoglycemia is independently associated with multidimensional impairment in elderly diabetic patients. BioMed Research International, 2014(1), 906103.
Porter, J. W., Pettit-Mee, R. J., Ready, S. T., Liu, Y., Lastra, G., Chockalingam, A., Winn, N. C., Clart, L., & Kanaley, J. A. (2020). Post meal exercise may lead to transient hypoglycemia irrespective of glycemic status in humans. Frontiers in Endocrinology, 11, 578.
Riddell, M. C., Turner, L. V, & Patton, S. R. (2023). Is there an optimal time of day for exercise? A commentary on when to exercise for people living with type 1 or type 2 diabetes. Diabetes Spectrum, 36(2), 146–150.
Rilstone, S., Oliver, N., Godsland, I., Tanushi, B., Thomas, M., & Hill, N. (2024). A randomized controlled trial assessing the impact of continuous glucose monitoring with a predictive hypoglycemia alert function on hypoglycemia in physical activity for people with type 1 diabetes (PACE). Diabetes Technology & Therapeutics, 26(2), 95–102.
Sember, V., Meh, K., Sorić, M., Starc, G., Rocha, P., & Jurak, G. (2020). Validity and reliability of international physical activity questionnaires for adults across EU countries: systematic review and meta analysis. International Journal of Environmental Research and Public Health, 17(19), 7161.
Sims, T. J., Boye, K. S., Robinson, S., & Kennedy-Martin, T. (2022). Treatment-related attributes of diabetes therapies and how people with type 2 diabetes report their impact on indicators of medication-taking behaviors. Patient Preference and Adherence, 1919–1939.
Teich, T., Zaharieva, D. P., & Riddell, M. C. (2019). Advances in exercise, physical activity, and diabetes mellitus. Diabetes Technology & Therapeutics, 21(1_suppl), S-112.
Tian, C., Bürki, C., Westerman, K. E., & Patel, C. J. (2023). Association between timing and consistency of physical activity and type 2 diabetes: a cohort study on participants of the UK Biobank. Diabetologia, 66(12), 2275–2282.
Walz, L., Pettersson, B., Rosenqvist, U., Deleskog, A., Journath, G., & Wändell, P. (2014). Impact of symptomatic hypoglycemia on medication adherence, patient satisfaction with treatment, and glycemic control in patients with type 2 diabetes. Patient Preference and Adherence, 593–601.
Downloads
Published
Issue
Section
License
Copyright (c) 2026 Netha Damayantie, Ernawati Ernawati, Mursidah Dewi, Nur Insani
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
Authors who publish with this journal agree to the following terms:
- Authors retain copyright and ensure the magazine the right to be the first publication of the work as licensed under a Creative Commons Attribution License that allows others to share the work with an acknowledgment of authorship of the work and the initial publication in this magazine.
- Authors can establish separate additional agreements for non-exclusive distribution of the version of the work published in the journal (eg, to an institutional repository or publish it in a book), with an acknowledgment of its initial publication in this journal.
- Is allowed and authors are encouraged to disseminate their work electronically (eg, in institutional repositories or on their own website) prior to and during the submission process, as it can lead to productive exchanges, as well as to a subpoena more Early and more of published work (See The Effect of Open Access) (in English).
This journal provides immediate open access to its content (BOAI, http://legacy.earlham.edu/~peters/fos/boaifaq.htm#openaccess) on the principle that making research freely available to the public supports a greater global exchange of knowledge. The authors may download the papers from the journal website, or will be provided with the PDF version of the article via e-mail.
