Thesis

24-hour movement behaviours in adolescents living with type 1 diabetes : balancing healthy days

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Awarding institution
  • University of Strathclyde
Date of award
  • 2026
Thesis identifier
  • T17982
Person Identifier (Local)
  • 202051865
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Department, School or Faculty
Abstract
  • Background: Adolescents living with type 1 diabetes (T1D) must manage their condition across the entire 24-hour day. How adolescents combine physical activity (PA), sedentary behaviour (SB), and sleep throughout the day, referred to collectively as 24-hour movement behaviours (24-h MBs), can influence health and wellbeing outcomes. This thesis aimed to explore 24-h MBs in adolescents living with T1D and how such an approach might be understood and applied. Methods: This thesis presents three interconnected studies. Study one presents a mixed methods systematic review and meta-analysis synthesising existing evidence on the relationships between PA, SB, and sleep with glycaemic control and psychosocial outcomes in adolescents living with T1D. Study two employed a micro-longitudinal design using wrist-worn accelerometery to objectively assess 24-h MBs in a sample of UK adolescents living with T1D (n=28), with additional self-reported data on HbA1c and diabetes-specific quality of life. Study three was a qualitative investigation involving semi-structured interviews (n=15) with adolescents living with T1D to explore their lived experiences, beliefs, and perceptions of 24-h MBs and their interactions with diabetes self-management. Results: The systematic review (n=84 studies) identified a favourable association between PA and glycaemic control, but limited and inconsistent findings for SB and sleep. Critically, no studies examined these behaviours in combination, nor explored their interaction. The accelerometery study (n=28) revealed low compliance with moderate to vigorous physical activity (MVPA) and sleep guidelines and high levels of SB. Although no statistically significant associations were found between movement behaviours, HbA1c and quality of life, trends suggested potential benefits of higher MVPA and longer sleep duration. The qualitative study (n=15) found that adolescents recognised the interconnection of 24-h MBs and linked them to mood, glycaemic control, and their broader environments (i.e., school routines, caregiver support). Conclusion: To the author’s knowledge, this is the first thesis to apply the 24-h MB paradigm to adolescents living with T1D. The findings from this thesis have informed updates to international clinical guidance and contributes new evidence to the field. This work serves as a foundation for future 24-h MB intervention development specific to this population aiming to improve health outcomes by promoting balance across each 24-h MB, rather than targeting behaviours in isolation.
Advisor / supervisor
  • Crawford, Megan
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