Predictors of the maximal oxygen consumption in adult patients with type 1 diabetes treated with personal insulin pumps

Abstract

Aims/Introduction Regular physical activity for adults with type 1 diabetes mellitus improves cardiorespiratory fitness (CF) and quality of life. The aim of our study was to evaluate clinical and biochemical features that might be associated with CF in a homogenous group of adults with type 1 diabetes mellitus who are all treated with a personal insulin pump (continuous subcutaneous insulin infusion). Materials and Methods We assessed CF in 62 patients (74.2% of whom were men) who fulfilled the eligibility criteria. To determine maximal oxygen consumption, the march‐running test on the treadmill was carried out. Two hours before the test, the patients consumed a defined meal covered by a dose of rapid acting insulin analog that was reduced by 25% from their regular dose. Basal insulin infusion was reduced by 50% for an hour. Additionally, the Perceived Stress Scale‐10 questionnaire was used to measure the perception of stress. Results There was no episode of severe hypoglycemia during or after the test. In the final model, independent predictors of maximal oxygen consumption were sex, body fat percentage, lactate at 20 min after CF test and Perceived Stress Scale‐10 score. Of interest, neither short‐term (continuous glucose monitoring) nor long‐term (glycosylated hemoglobin) metabolic control parameters were predictors of CF. Conclusions In our selected homogenous group of patients with type 1 diabetes mellitus treated with personal insulin pumps, higher CF was associated with a lower percentage of body fat, male sex, higher lactate level after the CF test and the Perceived Stress Scale‐10 score. The proposed protocol in our cohort proved to be safe with regard to glycemic control.

Metabolic and physiological responses to graded exercise testing in individuals with type 1 diabetes using insulin pump therapy

“…Nevertheless, although minimal, the directional change in glycaemia in our study was not 'fixed' with a proportional amount of people experiencing a rise as a decline (57% vs. 42%). Furthermore, similar to others, 16,19,24 we observed no hypoglycaemic events during the test despite pronounced swings in glucose between participants [range (min to max): 5.2 mmol/L (À2.1 to +3.2 mmol/L)].…”

“…Indeed, we observed a non-significant change in PG of Δ +0.3 mmol/L, the magnitude of which is in keeping with our findings in those with multiple daily injections (MDI) (Δ -0.3 mmol/L), albeit directional diametric. The minimal change in PG over GXT in our present and previously published studies is markedly lower than the +1.6 mmol/L increase observed by Matejko et al, 19 during their investigation of predictors of V ̇O2peak in adult patients with T1D using the insulin pump. A possible explanation for the pronouncement of this gap is their incorporation of reductions in both basal (50% 30 min before to 60 min after) and bolus (25%) insulin dosing alongside the provision of a fixed carbohydrate-based meal (50 g total from high glycaemic index foods) 2 h before GXT.…”

“…Although not ubiquitous, 5 , 6 , 7 the majority of evidence points to an attenuated maximal aerobic rate in adults with type 1 diabetes (T1D) 8 , 9 , 10 , 11 concomitant with altered cardiovascular 12 , 13 and pulmonary 6 , 9 , 13 , 14 responses to GXT. Some, 12 , 14 , 15 , 16 , 17 but not all studies, 18 , 19 have indicated that glycaemic control plays a seminal role determining the physiological responses to GXT. However, compiled analysis on these studies shows that such conclusions have been drawn from rather homogeneous cohorts who are relatively young (age 34 ± 5 years), reasonably fit (V̇O 2peak 36 ± 7 ml/min/kg), modestly well controlled [haemoglobin A1c (HbA1c) 7.4 ± 0.8%] and have a medium length of diabetes duration (13 ± 6 years).…”

Exercise Self-Efficacy and patient global assessment were associated with 6-min walk test distance in persons with rheumatoid arthritis

“…Perceived stress was not associated with the 6MWD in the present study. This was surprising as perceived stress has been negatively associated with PA in the general population and CRF in persons with diabetes [ 38 , 39 ]. Maybe the association with stress would have been stronger in a sample with less variation in age.…”

Assessment of dietary intake by self-report in adult patients with type 1 diabetes treated with a personal insulin pump

“…In our subgroups, carbohydrates constituted 52.3% ± 5.0% vs. 50.2% ± 8.2%, p=0.32 respectively. The intake of carbohydrates was about 250 grams per day in each subgroup, therefore it can be classified as a high carbohydrate diet [27]. This type of diet is meant for subjects who are very physically active, otherwise, it could be responsible for increases in glycemic variability, time spent in hypoglycemia, and gaining weight [28].…”