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

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

doi:10.1007/s00125-025-06619-9

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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

, Kirsten Nørgaard

Diabetologia

Swansea University Authors: Olivia McCarthy, Richard Bracken

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

Abstract

Aims/hypothesisThe 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).MethodsData collected during a graded maximal exercise test (GXT) from 24 part...

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Published in:	Diabetologia
ISSN:	0012-186X 1432-0428
Published:	Springer Science and Business Media LLC 2025
Online Access:	Check full text
URI:	https://cronfa.swan.ac.uk/Record/cronfa70235

first_indexed	2025-08-27T16:01:47Z
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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.ResultsParticipants 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/interpretationIn adults with type 1 diabetes, CAN was associated with exercise intolerance characterised by impairments in various cardiopulmonary, sympathoadrenal system and metabolic responses to GXT. 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spelling	2026-01-07T15:22:46.8421233 v2 70235 2025-08-27 Impact of cardiovascular autonomic neuropathy on cardiopulmonary, sympathoadrenal and metabolic responses to physical exercise in adults with type 1 diabetes 4fea3e19b39712dea1d051d317614572 Olivia McCarthy Olivia McCarthy true false f5da81cd18adfdedb2ccb845bddc12f7 0000-0002-6986-6449 Richard Bracken Richard Bracken true false 2025-08-27 EAAS Aims/hypothesisThe 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).MethodsData 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.ResultsParticipants 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/interpretationIn 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. Journal Article Diabetologia 0 Springer Science and Business Media LLC 0012-186X 1432-0428 Cardiopulmonary exercise testing; Cardiovascular autonomic neuropathy; Exercise; Graded exercise testing; Type 1 diabetes 9 12 2025 2025-12-09 10.1007/s00125-025-06619-9 COLLEGE NANME Engineering and Applied Sciences School COLLEGE CODE EAAS Swansea University 2026-01-07T15:22:46.8421233 2025-08-27T11:35:27.1412682 Faculty of Science and Engineering School of Engineering and Applied Sciences - Sport and Exercise Sciences Olivia McCarthy 1 Rasmus B. Brødsgaard 2 Sandra Tawfik 3 Sissel Banner Lundemose 4 Emilie B. Lindkvist 5 Sara H. Naaman 6 Christian Stevns Hansen 7 Richard Bracken 0000-0002-6986-6449 8 Kirsten Nørgaard 9 70235__35910__00937a0eccec484585f45f2842ba8976.pdf 70235.VoR.pdf 2026-01-07T15:19:59.9953535 Output 1417685 application/pdf Version of Record true © The Author(s) 2025. This article is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License. true eng http://creativecommons.org/licenses/by-nc-nd/4.0/
title	Impact of cardiovascular autonomic neuropathy on cardiopulmonary, sympathoadrenal and metabolic responses to physical exercise in adults with type 1 diabetes
spellingShingle	Impact of cardiovascular autonomic neuropathy on cardiopulmonary, sympathoadrenal and metabolic responses to physical exercise in adults with type 1 diabetes Olivia McCarthy Richard Bracken
title_short	Impact of cardiovascular autonomic neuropathy on cardiopulmonary, sympathoadrenal and metabolic responses to physical exercise in adults with type 1 diabetes
title_full	Impact of cardiovascular autonomic neuropathy on cardiopulmonary, sympathoadrenal and metabolic responses to physical exercise in adults with type 1 diabetes
title_fullStr	Impact of cardiovascular autonomic neuropathy on cardiopulmonary, sympathoadrenal and metabolic responses to physical exercise in adults with type 1 diabetes
title_full_unstemmed	Impact of cardiovascular autonomic neuropathy on cardiopulmonary, sympathoadrenal and metabolic responses to physical exercise in adults with type 1 diabetes
title_sort	Impact of cardiovascular autonomic neuropathy on cardiopulmonary, sympathoadrenal and metabolic responses to physical exercise in adults with type 1 diabetes
author_id_str_mv	4fea3e19b39712dea1d051d317614572 f5da81cd18adfdedb2ccb845bddc12f7
author_id_fullname_str_mv	4fea3e19b39712dea1d051d317614572_*_Olivia McCarthy f5da81cd18adfdedb2ccb845bddc12f7_*_Richard Bracken
author	Olivia McCarthy Richard Bracken
author2	Olivia McCarthy Rasmus B. Brødsgaard Sandra Tawfik Sissel Banner Lundemose Emilie B. Lindkvist Sara H. Naaman Christian Stevns Hansen Richard Bracken Kirsten Nørgaard
format	Journal article
container_title	Diabetologia
container_volume	0
publishDate	2025
institution	Swansea University
issn	0012-186X 1432-0428
doi_str_mv	10.1007/s00125-025-06619-9
publisher	Springer Science and Business Media LLC
college_str	Faculty of Science and Engineering
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hierarchy_top_title	Faculty of Science and Engineering
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hierarchy_parent_title	Faculty of Science and Engineering
department_str	School of Engineering and Applied Sciences - Sport and Exercise Sciences{{{_:::_}}}Faculty of Science and Engineering{{{_:::_}}}School of Engineering and Applied Sciences - Sport and Exercise Sciences
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description	Aims/hypothesisThe 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).MethodsData 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.ResultsParticipants 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/interpretationIn 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.
published_date	2025-12-09T05:32:22Z
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Impact of cardiovascular autonomic neuropathy on cardiopulmonary, sympathoadrenal and metabolic responses to physical exercise in adults with type 1 diabetes

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