Association of physical activity with all-cause mortality and incident and prevalent cardiovascular disease among patients with type 1 diabetes: the EURODIAB Prospective Complications Study

Tielemans, S.M.A.J.; Soedamah‐Muthu, Sabita S.; Neve, Myriam De; Toeller, M.; Chaturvedi, Nish; Fuller, John; Stamatakis, Emmanuel

doi:10.1007/s00125-012-2743-6

Cited by 73 publications

(62 citation statements)

References 45 publications

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“…Meanwhile, studies have clearly shown that people with type 1 diabetes do not undertake sufficient exercise [64], and that exercise is not actively promoted or supported at the time of diagnosis with type 1 diabetes (unpublished work from our group, N. Lascar, S. Greenfield). The reasons for this are multi-factorial and complex, and include patient anxieties relating to hypoglycaemia and loss of control over their diabetes [65].…”

Section: Discussionmentioning

confidence: 99%

The time has come to test the beta cell preserving effects of exercise in patients with new onset type 1 diabetes

et al. 2014

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Type 1 diabetes is characterised by immunemediated destruction of insulin-producing beta cells. Significant beta cell function is usually present at the time of diagnosis with type 1 diabetes, and preservation of this function has important clinical benefits. The last 30 years have seen a number of largely unsuccessful trials for beta cell preservation, some of which have been of therapies that have potential for significant harm. There is a need to explore new, more tolerable approaches to preserving beta cell function that can be implemented on a large clinical scale. Here we review the evidence for physical exercise as a therapy for the preservation of beta cell function in patients with newly diagnosed type 1 diabetes. We highlight possible mechanisms by which exercise could preserve beta cell function and then present evidence from other models of diabetes that demonstrate that exercise preserves beta cell function. We conclude by proposing that there is now a need for studies to explore whether exercise can preserve beta cell in patients newly diagnosed with type 1 diabetes.

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Section: Discussionmentioning

confidence: 99%

The time has come to test the beta cell preserving effects of exercise in patients with new onset type 1 diabetes

et al. 2014

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“…Physical activity positively affects health status in different types of populations (1)(2)(3)(4)(5)(6)(7)(8)(9). Previous studies in patients with CKD and patients on maintenance hemodialysis (MHD) have shown associations of physical activity with improved outcomes (10)(11)(12)(13)(14)(15)(16)(17)(18).…”

Section: Introductionmentioning

confidence: 99%

Associations of Self-Reported Physical Activity Types and Levels with Quality of Life, Depression Symptoms, and Mortality in Hemodialysis Patients

Lopes

Lantz

Morgenstern

et al. 2014

Clinical Journal of the American Society of Nephrology

128

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Background and objectives Physical activity has been associated with better health status in diverse populations, but the association in patients on maintenance hemodialysis is less established. Patient-reported physical activities and associations with mortality, health-related quality of life, and depression symptoms in patients on maintenance hemodialysis in 12 countries were examined.Design, setting, participants, & measurements In total, 5763 patients enrolled in phase 4 of the Dialysis Outcomes and Practice Patterns Study (2009)(2010)(2011) were classified into five aerobic physical activity categories (never/ rarely active to very active) and by muscle strength/flexibility activity using the Rapid Assessment of Physical Activity questionnaire. The Kidney Disease Quality of Life scale was used for health-related quality of life. The Center for Epidemiologic Studies Depression scale was used for depression symptoms. Linear regression was used for associations of physical activity with health-related quality of life and depression symptoms scores. Cox regression was used for association of physical activity with mortality.Results The median (interquartile range) of follow-up was 1.6 (0.9-2.5) years; 29% of patients were classified as never/rarely active, 20% of patients were classified as very active, and 20.5% of patients reported strength/ flexibility activities. Percentages of very active patients were greater in clinics offering exercise programs. Aerobic activity, but not strength/flexibility activity, was associated positively with health-related quality of life and inversely with depression symptoms and mortality (adjusted hazard ratio of death for very active versus never/ rarely active, 0.60; 95% confidence interval, 0.47 to 0.77). Similar associations with aerobic activity were observed in strata of age, sex, time on dialysis, and diabetes status. ConclusionsThe findings are consistent with the health benefits of aerobic physical activity for patients on maintenance hemodialysis. Greater physical activity was observed in facilities providing exercise programs, suggesting a possible opportunity for improving patient outcomes.

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“…Despite early planning, they are often compelled to consume additional carbohydrates, which can lead to excess caloric intake and may increase the risk of subsequent hyperglycaemia [29]. Patients with type 1 diabetes thus face many barriers and rarely meet the recommended physical activity levels, despite the proven health and cardiovascular benefits of exercise [2,3]. In this trial, exercise was not preceded by carbohydrate consumption but was announced to the artificial pancreas algorithm 20 min ahead of the session, which is a practical timing for patients.…”

Section: Discussionmentioning

confidence: 99%

“…Exercise is associated with several health benefits for patients with type 1 diabetes such as improved physical fitness, reduced cardiovascular risk factors and reduced insulin requirements [2,3]. Nevertheless, the majority of patients with type 1 diabetes do not meet the recommended physical activity levels mostly because of fear of exerciseinduced hypoglycaemia [4,5].…”

Section: Introductionmentioning

confidence: 99%

Efficacy of single-hormone and dual-hormone artificial pancreas during continuous and interval exercise in adult patients with type 1 diabetes: randomised controlled crossover trial

et al. 2016

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Aims/hypothesis The aim of this study was to assess whether the dual-hormone (insulin and glucagon) artificial pancreas reduces hypoglycaemia compared with the single-hormone (insulin alone) artificial pancreas during two types of exercise. Methods An open-label randomised crossover study comparing both systems in 17 adults with type 1 diabetes (age, 37.2 ± 13.6 years; HbA 1c, 8.0 ± 1.0% [63.9 ± 10.2 mmol/mol]) during two exercise types on an ergocycle and matched for energy expenditure: continuous (60% V : O 2peak for 60 min) and interval (2 min alternating periods at 85% and 50% V : O 2peak for 40 min, with two 10 min periods at 45% V : O 2peak at the start and end of the session). Blocked randomisation (size of four) with a 1:1:1:1 allocation ratio was computer generated. The artificial pancreas was applied from 15:30 hours until 19:30 hours; exercise was started at 18:00 hours and announced 20 min earlier to the systems. The study was conducted at the Institut de recherches cliniques de Montréal. Results During single-hormone control compared with dualhormone control, exercise-induced hypoglycaemia (plasma glucose <3.3 mmol/l with symptoms or <3.0 mmol/l regardless of symptoms) was observed in four (23.5%) vs two (11.8%) interventions (p = 0.5) for continuous exercise and in six (40%) vs one (6.25%) intervention (p = 0.07) for interval exercise. For the pooled analysis (single vs dual hormone), the median (interquartile range) percentage time spent at glucose levels below 4.0 mmol/l was 11% (0.0-46.7%) vs 0% (0-0%; p = 0.0001) and at glucose levels between 4.0 and 10.0 mmol/l was 71.4% (53.2-100%) vs 100% (100-100%; p = 0.003). Higher doses of glucagon were needed during continuous (0.126 ± 0.057 mg) than during interval exercise (0.093 ± 0.068 mg) (p = 0.03), with no reported side-effects in all interventions.A. Haidar and R. Rabasa-Lhoret are joint senior authors.Electronic supplementary material The online version of this article (doi:10.1007/s00125-016-4107-0) contains peer-reviewed but unedited supplementary material, which is available to authorised users.* Rémi Rabasa-Lhoret

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Association of physical activity with all-cause mortality and incident and prevalent cardiovascular disease among patients with type 1 diabetes: the EURODIAB Prospective Complications Study

Cited by 73 publications

References 45 publications

The time has come to test the beta cell preserving effects of exercise in patients with new onset type 1 diabetes

The time has come to test the beta cell preserving effects of exercise in patients with new onset type 1 diabetes

Associations of Self-Reported Physical Activity Types and Levels with Quality of Life, Depression Symptoms, and Mortality in Hemodialysis Patients

Efficacy of single-hormone and dual-hormone artificial pancreas during continuous and interval exercise in adult patients with type 1 diabetes: randomised controlled crossover trial

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