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Differences in physiological responses to cardio-pulmonary exercise testing in adults with type 1 diabetes and controls without type 1 diabetes – a pooled analysis

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posted on 12.11.2020, 19:37 by Max L. Eckstein, Juliano Boufleur Farinha, Olivia McCarthy, Daniel J. West, Jane E. Yardley, Lia Bally, Thomas Zueger, Christoph Stettler, Winston Boff, Alvaro Reischak-Oliveira, Michael C. Riddell, Dessi P. Zaharieva, Thomas R. Pieber, Alexander Müller, Philipp Birnbaumer, Faisal Aziz, Laura Brugnara, Hanne Haahr, Eric Zijlstra, Tim Heise, Harald Sourij, Michael Roden, Peter Hofmann, Richard M. Bracken, Dominik Pesta, Othmar Moser
OBJECTIVE

To investigate physiological responses to cardio-pulmonary exercise (CPX) testing in adults with type 1 diabetes compared to age-, sex- and body mass index- (BMI) matched controls without type 1 diabetes.

RESEARCH DESIGN AND METHODS

We compared results from CPX tests on a cycle ergometer in individuals with type 1 diabetes and controls without type 1 diabetes. Parameters were peak and threshold variables of oxygen uptake, heart rate and power output. Differences between groups were investigated via restricted maximum likelihood modelling and post-hoc tests. Differences between groups were explained by stepwise linear regressions (p<0.05).

RESULTS

Among 303 individuals with type 1 diabetes (age 33 [22; 43] years, 93 females, BMI 23.6 [22; 26] kg/m2, HbA1c 6.9 [6.2; 7.7]%; 52 [44; 61] mmol/mol), peak oxygen uptake (32.55 [26.49; 38.72] vs. 42.67 ± 10.44) (mL/kg/min), peak heart rate (179 [170; 187] vs. 184 [175; 191]) (bpm) and peak power (216 [171; 253] vs. 245 [200; 300]) (Watt) were lower in comparison to 308 controls without type 1 diabetes (all p<0.001). Individuals with type 1 diabetes displayed an impaired degree and direction of the heart rate to performance curve compared against controls without type 1 diabetes (0.07 [-0.75; 1.09] vs. 0.66 [-0.28; 1.45] (p<0.001)). None of the exercise physiological responses were associated with HbA1c in individuals with type 1 diabetes.

CONCLUSIONS

Individuals with type 1 diabetes show altered responses to CPX testing, which cannot be explained by HbA1c. Intriguingly, the participants in our cohort consisted of people with recent-onset type 1 diabetes, heart rate dynamics were altered during CPX testing.

Funding

Data were extracted from clinical trials funded by Novo Nordisk A/S (NCT01704417 and DRKS00013509) and Novo Nordisk Austria (EudraCT: 2017-000922-37). From the prospective observational German Diabetes Study (ClinicalTrial.gov registration no: NCT01055093) by the German Diabetes Center (DDZ), which is funded by the Ministry of Culture and Science of the State of North Rhine-Westphalia (MIWF NRW) and the German Federal Ministry of Health (BMG) and in part by a grant of the Federal Ministry of Education and Research (BMBF) to the German Center for Diabetes Research (DZD e.V.). The Swiss National Science Foundation (NCT02068638), the Fundo de Incentivo à Pesquisa – Hospital de Clínicas de Porto Alegre (NCT03451201), Brazilian National Council for Research and Technological Development (NCT02939768).

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