A 150‐mile ultra‐endurance type 1 diabetes cycling event: qualitative analysis of knowledge, preparation and management strategies

Purpose: The purpose of this study is to characterise the decision-making and self-management strategies of individuals with type 1 diabetes (T1D) participating in a 150-mile ultra-endurance cycling event and inform health care professionals working in T1D. Participation in ultra-endurance exercise is becoming increasingly popular in the T1D community and self-management in this context needs further investigation. Method: Qualitative, semi-structured interviews were conducted with 12 participants with T1D who took part in the ‘Coast to Coast in a Day’ cycling sportive. Event-specific and T1D self-management strategies in the context of endurance exercise were assessed using the Thematic Network Approach to analysis. Results: Participants reported that they took part in the event ‘as a cyclist rather than a type 1 diabetic’. A range of self-management strategies to manage glycaemic control were identified, but all were grounded in experience of a ‘trial-and-error’ approach to determine ‘successful practice’. Engagement with health care professionals in preparation for the event was limited due to a perceived lack of endurance exercise knowledge. Participants reflected that T1D can be controlled in ultra-endurance events through careful and practised self-management of energy intake and insulin strategies. Conclusions: Individuals with T1D are capable of taking part and excelling in ultra-endurance events, but current health care professional advice does not match patient ambition and practice, which is grounded in an identity that is first and foremost as a ‘cyclist and person’. Limitations in participants’ ‘trial-and-error’ practices require further understanding from health care professionals to provide advice around existing knowledge, preparation and self-management strategies for ultra-endurance exercise.