Hypoglycemia Fear Affect Autonomic Function, Physical Activity, and Exercise Capacity in Type I Diabetes

C-LBSS was developed to assess FoH in children and adolescents. The Turkish version of C-LBSS with Cronbach's alpha of 0.843 and a test-retest correlation of 0.997 will used to assess FoH in this study. It consists of 25 items and includes two sub-dimensions measuring children's/adolescents' levels of hypoglycemia-related behaviors (items 1-10) and anxiety (items 11-25). Items are rated on a 5-point Likert scale (0 = "never" to 4 = "almost always"), and the total score on the scale ranges from 0 to 100, with an increase in the score indicating increased FoH.

Heart rate (HR), heart rate variability (HRV), blood pressure (BP), and peripheral oxygen saturation (SpO₂) will evaluate. Polar H10 chest-type HR sensor (Polar Electro Oy, Kempele, Finland) will use. The Polar H10 is a sensor that records R-R intervals based on electrocardiographic principles and provides data suitable for HRV analysis. The sensor was placed at heart level, at the sternum level, via a chest strap according to the manufacturer's instructions. The obtained data will transferred via Bluetooth connection to an iPhone 13 (Apple Inc., Cupertino, CA, USA) used as a mobile device and recorded via the Polar Flow application (© Polar Electro, 2024). HRV analyses will performed using Kubios HRV Standard software (version 3.5.0, Kubios Oy, Finland).

Consisting of ten items and two sub-dimensions, nine of these are used to calculate the physical activity score. The tenth item assesses whether the child has been unable to perform their normal activities due to illness or disability in the last week. The total score is obtained by calculating the average of the scores from the first 9 items, with an average close to 1 indicating a low level of physical activity and an average close to 5 indicating a high level. The first sub-dimension of the questionnaire includes items 1, 5, 6, 7, 8, and 9, which cover physical activities performed "outside of school," while the second sub-dimension includes items 2, 3, and 4, which cover physical activities performed "inside of school."

It consists of nine items, the first eight of which are scored on a five-point Likert scale. The ninth item asks whether normal activities were performed in the last week due to illness or another reason, and it is not included in the total score calculation. The total score is obtained by calculating the average of the first eight items' scores, with an average close to 1 indicating a low level of physical activity and an average close to 5 indicating a high level.

ISWT will use to assess exercise capacity of participants. Two cones will used on a flat, non-slip surface, 9 m apart in this test. The course is calculated as 10 m, assuming a 50 cm turning distance around the cones. Participants are asked to walk back and forth between the two cones, following signals from a pre-recorded standard audio file. The test will start with the first tempo signal given after three preparatory signals. Participants must be at the opposite cone each time an audio signal is given. The starting walking speed in the test is 0.50 m/s, and the speed is increased by 0.17 m/s every minute. The protocol consists of a total of 12 levels, each representing one-minute increments. Each 10 m walk is considered a shuttle, and the total walking distance is calculated by the number of shuttles completed.