In the JournalsPerspective

Physical activity reduced all-cause mortality risk in type 1 diabetes, CKD

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Exercise was associated with a decreased risks for both cardiovascular and all-cause mortality in patients with type 1 diabetes, researchers in Finland reported.

Mortality was also reduced in patients with type 1 diabetes and chronic kidney disease.

“A high level of leisure-time physical activity or fitness is associated with a reduced risk of premature mortality in the general population and in individuals with type 2 diabetes, but whether this is true for patients with type 1 diabetes has not yet been determined because the available evidence is limited,” Per-Henrik Groop, MD, professor of internal medicine at the University of Helsinki, and colleagues wrote. “Only a few prospective studies have explored the association of [leisure-time physical activity] and mortality in type 1 diabetes, and none have been performed in patients with type 1 diabetes and chronic kidney disease.”

Groop and colleagues conducted a prospective, observational study of 2,639 patients with type 1 diabetes enrolled in the Finnish Diabetic Nephropathy Study, an ongoing national study in Finland. Mean follow-up was 11.4 years, and researchers used a validated self-reporting questionnaire to assess patients’ exercise habits.

Of the total cohort, 310 patients (11.7%) had CKD. Slightly less than half were men (48.5%), and the patients’ mean age was 40.1 years.

Two hundred-seventy patients died during follow-up, Groop and colleagues reported. Of these, 27.8% (n = 75) were CV-related deaths. Leisure-time physical activity was associated with all-cause mortality even after the researchers adjusted for diabetic nephropathy, sex, age at onset of diabetes, duration of diabetes, systolic blood pressure, BMI, triglycerides and HbA1c.

Patients classified as having low leisure-time physical activity levels had a higher 10-year cumulative CV mortality rate (4.7%; 95% CI, 3.2%-6.2%), compared with the rate among those with moderate physical activity (1.9%; 95% CI, 1.1%-2.7%) and high levels of physical activity (1.8%; 95% CI, 0.4%-3.1%), Groop and colleagues wrote.

The same was true for the intensity of the exercise: Patients who participated in low-intensity exercise had a 6.7% 10-year CV mortality rate (95% CI, 4.7%-8.7%), whereas those who participated in high-intensity exercise had a 0.2% CV mortality rate (95% CI, 0%-0.6%), the researchers reported.

In patients with CKD, 127 died during follow-up. The amount of physical activity and frequency of exercise were both independently associated with a lower risk for all-cause mortality, according to Groop and colleagues.

“The findings indicate that physical activity is associated with reduced all-cause and cardiovascular mortality in patients with type 1 diabetes,” Groop and colleagues wrote. “In addition, we show an association between physical activity and reduced all-cause mortality in patients with type 1 diabetes and CKD. Thus, exercise can be recommended to all patients with type 1 diabetes, including those with CKD.” – by Andy Polhamus

Disclosures: Groop reports he received research grants from Eli Lilly and Roche; has advisory roles with AbbVie, AstraZeneca, Boehringer Ingelheim, Eli Lilly, Janssen, Medscape, MSD, Novartis and Sanofi; and received lecture fees from AstraZeneca, Boehringer Ingelheim, Eli Lilly, Genzyme, Novartis, NovoNordisk, MSD and Sanofi.

Test.docx

Exercise was associated with a decreased risks for both cardiovascular and all-cause mortality in patients with type 1 diabetes, researchers in Finland reported.

Mortality was also reduced in patients with type 1 diabetes and chronic kidney disease.

“A high level of leisure-time physical activity or fitness is associated with a reduced risk of premature mortality in the general population and in individuals with type 2 diabetes, but whether this is true for patients with type 1 diabetes has not yet been determined because the available evidence is limited,” Per-Henrik Groop, MD, professor of internal medicine at the University of Helsinki, and colleagues wrote. “Only a few prospective studies have explored the association of [leisure-time physical activity] and mortality in type 1 diabetes, and none have been performed in patients with type 1 diabetes and chronic kidney disease.”

Groop and colleagues conducted a prospective, observational study of 2,639 patients with type 1 diabetes enrolled in the Finnish Diabetic Nephropathy Study, an ongoing national study in Finland. Mean follow-up was 11.4 years, and researchers used a validated self-reporting questionnaire to assess patients’ exercise habits.

Of the total cohort, 310 patients (11.7%) had CKD. Slightly less than half were men (48.5%), and the patients’ mean age was 40.1 years.

Two hundred-seventy patients died during follow-up, Groop and colleagues reported. Of these, 27.8% (n = 75) were CV-related deaths. Leisure-time physical activity was associated with all-cause mortality even after the researchers adjusted for diabetic nephropathy, sex, age at onset of diabetes, duration of diabetes, systolic blood pressure, BMI, triglycerides and HbA1c.

Patients classified as having low leisure-time physical activity levels had a higher 10-year cumulative CV mortality rate (4.7%; 95% CI, 3.2%-6.2%), compared with the rate among those with moderate physical activity (1.9%; 95% CI, 1.1%-2.7%) and high levels of physical activity (1.8%; 95% CI, 0.4%-3.1%), Groop and colleagues wrote.

The same was true for the intensity of the exercise: Patients who participated in low-intensity exercise had a 6.7% 10-year CV mortality rate (95% CI, 4.7%-8.7%), whereas those who participated in high-intensity exercise had a 0.2% CV mortality rate (95% CI, 0%-0.6%), the researchers reported.

In patients with CKD, 127 died during follow-up. The amount of physical activity and frequency of exercise were both independently associated with a lower risk for all-cause mortality, according to Groop and colleagues.

“The findings indicate that physical activity is associated with reduced all-cause and cardiovascular mortality in patients with type 1 diabetes,” Groop and colleagues wrote. “In addition, we show an association between physical activity and reduced all-cause mortality in patients with type 1 diabetes and CKD. Thus, exercise can be recommended to all patients with type 1 diabetes, including those with CKD.” – by Andy Polhamus

Disclosures: Groop reports he received research grants from Eli Lilly and Roche; has advisory roles with AbbVie, AstraZeneca, Boehringer Ingelheim, Eli Lilly, Janssen, Medscape, MSD, Novartis and Sanofi; and received lecture fees from AstraZeneca, Boehringer Ingelheim, Eli Lilly, Genzyme, Novartis, NovoNordisk, MSD and Sanofi.

    Perspective

    Sheri Colberg

    It has already been proven that people with type 2 diabetes have a lower risk for premature death when they are physically active; this is true for the population in general. However, not as many studies have looked specifically at the association between physical activity and lowered mortality risk in adults with type 1 diabetes. This matters because, although it has been changing over time, type 1 diabetes has previously been associated with a shorter lifespan in many adults with it.

    Earlier studies, such as the DCCT, have shown that keeping blood glucose levels in a more normal range can help lower the risk of diabetes-related complications in people with type 1 diabetes. Most deaths in this population are related to either cardiovascular events or chronic kidney disease (and failure). Exercise has an innate ability to lower oxidative stress, which has been implicated in the development of many of these complications. Habitual physical activity has already been associated with a lower risk for mortality in adults with and without type 2 diabetes. This study specifically examines a population with type 1 diabetes, which is novel.

    Being physically active on a regular basis is critical to living long and well with type 1 diabetes. While the exact amount of exercise needed to lower the risk for cardiovascular events is unknown, doing any is better than remaining sedentary. As in people without diabetes, intense activity likely is even more cardioprotective than moderate or light activity, but since the exercise in this study was self-reported and only collected at the start of the study, it is hard to draw definitive conclusions about how much exercise is needed and how intense it should be to reduce mortality risk.

    Sheri Colberg, PhD, FACSM

    Professor Emerita of Exercise Science, Old Dominion University

    2016 American Diabetes Association Outstanding Educator in Diabetes

    Disclosure: Colberg reports no relevant financial disclosures.