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Impact of cardiovascular autonomic neuropathy on cardiopulmonary, sympathoadrenal and metabolic responses to physical exercise in adults with type 1 diabetes

Olivia McCarthy, Rasmus B. Brødsgaard, Sandra Tawfik, Sissel Banner Lundemose, Emilie B. Lindkvist, Sara H. Naaman, Christian Stevns Hansen, Richard Bracken Orcid Logo, Kirsten Nørgaard

Diabetologia, Volume: 69, Issue: 3, Pages: 618 - 630

Swansea University Authors: Olivia McCarthy, Richard Bracken Orcid Logo

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DOI (Published version): 10.1007/s00125-025-06619-9

Abstract

Aims/hypothesis: The aim of this work was to compare the cardiopulmonary, sympathoadrenal and metabolic responses to physical exercise in adults with type 1 diabetes with or without cardiovascular autonomic neuropathy (CAN). Methods: Data collected during a graded maximal exercise test (GXT) from 24...

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Published in: Diabetologia
ISSN: 0012-186X 1432-0428
Published: Springer Nature 2026
Online Access: Check full text

URI: https://cronfa.swan.ac.uk/Record/cronfa70235
Abstract: Aims/hypothesis: The aim of this work was to compare the cardiopulmonary, sympathoadrenal and metabolic responses to physical exercise in adults with type 1 diabetes with or without cardiovascular autonomic neuropathy (CAN). Methods: Data collected during a graded maximal exercise test (GXT) from 24 participants with type 1 diabetes and CAN were compared against 24 matched control individuals without CAN (NO CAN). Throughout exercise, integrated cardiopulmonary variables were obtained continuously via spiroergometry. Plasma concentrations of adrenaline (epinephrine), noradrenaline (norepinephrine), glucose (PG) and lactate (PLa) were measured in 3 min intervals during exercise as well as at the peak workload. Data were assessed via independent t tests and two-factor ANOVAs with significance accepted at p≤0.05. Results: Participants with CAN displayed a reduced (CAN 19.6 ± 5.4 vs NO CAN 27.5 ± 7.8 ml kg−1 min−1) as well as attenuations in several other cardiopulmonary, lactate and exercise performance variables during GXT. Peak catecholamine concentrations were lower in CAN vs NO CAN (AD 0.17 ± 0.12 vs 0.38 ± 0.27 ng/ml, p=0.002; NAD 1.86 ± 1.04 vs 2.85 ± 1.23 ng/ml, p=0.007) as were the magnitudes of change in hormonal concentrations from rest to peak workloads (adrenaline Δ +0.13 ± 0.12 vs Δ +0.32 ± 0.24 ng/ml, p=0.005; noradrenaline Δ +1.33 ± 0.89 vs Δ +2.33 ± 1.30 ng/ml, p=0.005). PG concentrations throughout exercise were similar between groups and remained unchanged from rested values irrespective of CAN status. Conclusions/interpretation: In adults with type 1 diabetes, CAN was associated with exercise intolerance characterised by impairments in various cardiopulmonary, sympathoadrenal system and metabolic responses to GXT. These data support uncovering the presence of CAN when prescribing a personalised physical training plan.
Keywords: Cardiopulmonary exercise testing; Cardiovascular autonomic neuropathy; Exercise; Graded exercise testing; Type 1 diabetes
College: Faculty of Science and Engineering
Issue: 3
Start Page: 618
End Page: 630

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