Differences in Physiological Responses to Cardiopulmonary Exercise Testing in Adults With and Without Type 1 Diabetes: A Pooled Analysis

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

doi:10.2337/dc20-1496

Differences in Physiological Responses to Cardiopulmonary Exercise Testing in Adults With and Without Type 1 Diabetes: A Pooled Analysis

Diabetes Care. 2021 Jan;44(1):240-247. doi: 10.2337/dc20-1496. Epub 2020 Nov 12.

Authors

Max L Eckstein^{1

2}, Juliano Boufleur Farinha³, Olivia McCarthy⁴, Daniel J West⁵, Jane E Yardley^{6

7}, Lia Bally⁸, Thomas Zueger⁸, Christoph Stettler⁸, Winston Boff⁹, Alvaro Reischak-Oliveira³, Michael C Riddell¹⁰, Dessi P Zaharieva¹¹, Thomas R Pieber¹, Alexander Müller^{1

12}, Philipp Birnbaumer¹², Faisal Aziz¹, Laura Brugnara¹³, Hanne Haahr¹⁴, Eric Zijlstra¹⁵, Tim Heise¹⁵, Harald Sourij¹, Michael Roden^{16

17}, Peter Hofmann¹², Richard M Bracken⁴, Dominik Pesta^{16

18}, Othmar Moser^{19

2}

Affiliations

¹ Cardiovascular Diabetology Research Group, Division of Endocrinology and Diabetology, Department of Internal Medicine, Medical University of Graz, Graz, Austria.
² Division of Exercise Physiology and Metabolism, Department of Sport Science, University of Bayreuth, Bayreuth, Germany.
³ School of Physical Education, Physiotherapy and Dance, Federal University of Rio Grande do Sul, Porto Alegre, Brazil.
⁴ Applied Sport, Technology, Exercise and Medicine Research Centre, College of Engineering, Swansea University, Swansea, U.K.
⁵ Population Health Science Institute, Faculty of Medical Science, Newcastle University, Newcastle upon Tyne, U.K.
⁶ Alberta Diabetes Institute, Edmonton, Alberta, Canada.
⁷ Augustana Faculty, University of Alberta, Camrose, Alberta, Canada.
⁸ Department of Diabetes, Endocrinology, Nutritional Medicine and Metabolism, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland.
⁹ Institute for Children with Diabetes, Conceição Hospital Group, Porto Alegre, Brazil.
¹⁰ School of Kinesiology and Health Science, York University, Toronto, Ontario, Canada.
¹¹ Department of Pediatric Endocrinology and Diabetes, Stanford University School of Medicine, Stanford, CA.
¹² Exercise Physiology, Training & Training Therapy Research Group, Institute of Sports Science, University of Graz, Graz, Austria.
¹³ CIBERDEM-Spanish Biomedical Research Centre in Diabetes and Associated Metabolic Disorders and IDIBAPS-August Pi i Sunyer Biomedical Research Institute/Hospital Clínic de Barcelona, Barcelona, Spain.
¹⁴ Novo Nordisk A/S, Søborg, Denmark.
¹⁵ Profil, Neuss, Germany.
¹⁶ Institute for Clinical Diabetology, German Diabetes Centre, Leibniz Institute for Diabetes Research, Düsseldorf, Germany.
¹⁷ Division of Endocrinology and Diabetology, Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf, Germany.
¹⁸ German Center for Diabetes Research, München-Neuherberg, Germany.
¹⁹ Cardiovascular Diabetology Research Group, Division of Endocrinology and Diabetology, Department of Internal Medicine, Medical University of Graz, Graz, Austria othmar.moser@medunigraz.at.

PMID: 33184152
DOI: 10.2337/dc20-1496

Abstract

Objective: To investigate physiological responses to cardiopulmonary exercise (CPX) testing in adults with type 1 diabetes compared with age-, sex-, and BMI-matched control participants 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 control participants without type 1 diabetes. Parameters were peak and threshold variables of VO₂, heart rate, and power output. Differences between groups were investigated through restricted maximum likelihood modeling 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 [interquartile range 22; 43] years, 93 females, BMI 23.6 [22; 26] kg/m², HbA_1c 6.9% [6.2; 7.7%] [52 (44; 61) mmol/mol]), VO_2peak (32.55 [26.49; 38.72] vs. 42.67 ± 10.44 mL/kg/min), peak heart rate (179 [170; 187] vs. 184 [175; 191] beats/min), and peak power (216 [171; 253] vs. 245 [200; 300] W) were lower compared with 308 control participants 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 with control participants 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 HbA_1c in individuals with type 1 diabetes.

Conclusions: Individuals with type 1 diabetes show altered responses to CPX testing, which cannot be explained by HbA_1c. Intriguingly, the participants in our cohort were people with recent-onset type 1 diabetes; heart rate dynamics were altered during CPX testing.

Trial registration: ClinicalTrials.gov NCT01704417 NCT01055093 NCT02068638 NCT03451201 NCT02939768.

Publication types

Meta-Analysis
Research Support, Non-U.S. Gov't

MeSH terms

Adult
Diabetes Mellitus, Type 1*
Exercise
Exercise Test*
Exercise Tolerance
Female
Humans
Oxygen Consumption
Young Adult

Associated data

figshare/10.2337/figshare.13103585
ClinicalTrials.gov/NCT01704417
ClinicalTrials.gov/NCT01055093
ClinicalTrials.gov/NCT02068638
ClinicalTrials.gov/NCT03451201
ClinicalTrials.gov/NCT02939768