Objective: Managing blood glucose levels is challenging for elite athletes with type 1 diabetes (T1D) as competition can cause unpredictable fluctuations. Hyperglycemia-related anxiety (HRA) likely affects performance and diabetes management, but research is limited. This study investigates current strategies employed to mitigate HRA during competition and the development of alternative approaches.    Research Design and Methods: Elite athletes with TID, aged >14 who self-reported HRA during competition were recruited. Elite athletes were defined as individuals exercising >10 hours per week whose athletic performance has achieved the highest competition level. 60 to 90-minute virtual semi-structured  interviews were analyzed using an Interpretative Phenomenological Analysis.    Results: Ten elite athletes with T1D (average age 25 ± 3 years; T1D duration 12 ± 8 years; # of competitions per year 27 ± 19; training time per week 12 ± 6 hours) reported the strategies they currently use to mitigate HRA. These strategies include managing insulin and nutrition intake, embracing social support networks, using technology, practicing relaxation techniques, establishing routines, performing pre-competition aerobic exercise, and maintaining adequate sleep hygiene. Several additional approaches that could be implemented were identified including establishing targeted support networks, developing peer-reviewed resources on HRA, ensuring support teams have sufficient tools, and improving existing technology.    Conclusions: Elite athletes with T1D use physiological and psychological strategies to mitigate HRA during competition. This finding highlights the need for increased support and education for these athletes, and advancements in technology. Targeted strategies and personalized approaches are also needed to optimize performance and diabetes management in this population.

The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: A.K., A.S., MA.F., J.K. A.H., and M.K.T. have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper. J.Y. has Dexcom and OneTouch in-kind research support. A.S.B. is a fond de recherche du Québec en santé research scholar and holds grants from CIHR, JDRF and Diabete Quebec. She also has speaker?s fees from Dexcom and Abbott. R.R.L. has: 1. Research grants: Diabetes Canada, Astra-Zeneca, E Lilly, Cystic Fibrosis Canada, CIHR, FFRD, Janssen, JDRF, Merck, NIH, Novo-Nordisk, Societe Francophone du Diabete, Sanofi-Aventis, Vertex Pharmaceutical. 2. Consulting/advisory panel: Abbott, Astra-Zeneca, Bayer, Boehringer I, Dexcom, E Lilly, HLS therapeutics, INESSS, Insulet, Janssen, Medtronic, Merck, Novo- Nordisk, Pfizer, Sanofi-Aventis. 3. Honoraria for conferences: Abbott, Astra-Zeneca, Boehringer I, CPD Network, Dexcom, CMS Canadian Medical & Surgical Knowledge Translation Research group, E Lilly, Janssen, Medtronic, Merck, Novo-Nordisk, Sanofi-Aventis, Tandem, Vertex Pharmaceutical. 4. Consumable gift (in kind): E Lilly, Medtronic. 5. Unrestricted grants for clinical and educational activities: Abbott, E Lilly, Medtronic, Merck, Novo Nordisk, Sanofi-Aventis. 6. Patent: T2D risk biomarkers, catheter life. 7. Purchase fees: E Lilly (artificial pancreas).

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Ethics approval was obtained by the Centre Hospitalier de l'Université de Montréal ethics committee (2024-11786 (23.156)) in November 2023. Written consent was obtained from all participants.

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