Abstract
Type 1 diabetes may, in time, cause lung dysfunction including airflow limitation. We hypothesized that ventilatory flow morphology during a cardiopulmonary exercise test (CPET) would be altered in adult men with well-controlled type 1 diabetes. Thirteen men with type 1 diabetes [glycated hemoglobin A1c 59 (9) mmol/mol or 7.5 (0.8)%, duration of diabetes 12 (9) years, and age 33.9 (6.6) years] without diagnosed diabetes-related complications and 13 healthy male controls [age 37.2 (8.6) years] underwent CPET on a cycle ergometer (40 W increments every 3 min until volitional fatigue). We used a principal component analysis based method to quantify ventilatory flow dynamics throughout the CPET protocol. Last minute of each increment, peak exercise, and recovery were examined using linear mixed models, which accounted for relative peak oxygen uptake and minute ventilation. The type 1 diabetes participants had lower expiratory peak flow (P = 0.008) and attenuated slope from expiration onset to expiratory peak flow (P = 0.012) at peak exercise when compared with the healthy controls. Instead, during submaximal exercise and recovery, the type 1 diabetes participants possessed similar ventilatory flow dynamics to that of the healthy controls. In conclusion, men with relatively well-controlled type 1 diabetes and without clinical evidence of diabetes-related complications exhibited attenuated expiratory flow at peak exercise independently of peak oxygen uptake and minute ventilation. This study demonstrates that acute exercise reveals alterations in ventilatory function in men with type 1 diabetes but not until peak exercise.
Highlights
Type 1 diabetes has been linked to pulmonary dysfunction (Kolahian et al, 2019), which is typically absent at the time diabetes is diagnosed but develops over time
Forced expiratory volume in 1 s (FEV1), forced vital capacity (FVC), and forced expiratory volume in 1 s (FEV1)/FVC were similar between the groups
The participants’ efforts during cardiopulmonary exercise test (CPET) were maximal in the DM and controls matched for peak minute ventilation (CON) groups based on respiratory exchange ratio, rating of perceived exertion, and % of age-predicted maximal heart rate at peak exercise
Summary
Type 1 diabetes has been linked to pulmonary dysfunction (Kolahian et al, 2019), which is typically absent at the time diabetes is diagnosed but develops over time. Lower respiratory muscle strength has been linked to diabetes (Fuso et al, 2012) and reduced maximal minute ventilation to type 1 diabetes (Komatsu et al, 2005; Koponen et al, 2013). Patients with type 1 diabetes have exhibited reduced peak pulmonary oxygen uptake (V O2peak) (Komatsu et al, 2005; Peltonen et al, 2012; Rissanen et al, 2015), which is an integrated measure of pulmonary, cardiovascular, and skeletal muscle function (Wagner, 1996) and a strong predictor of respiratory and cardiovascular morbidity and mortality (Steell et al, 2019)
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