Past Practice of Sports and Type 2 Diabetes in Later Life

Abstract

Introduction: Type 2 diabetes mellitus (T2DM) results from 2 combined abnormalities (insulin resistance and pancreatic β-cell dysfunction), which are present in variable proportion. Regular practice of sports improves insulin sensitivity, decreases atherogenic markers, and may even delay the onset of impaired glucose tolerance in at-risk individuals. Since known duration of type 2 diabetes often underestimates the true exposure to hyperglycaemia and to other atherogenic abnormalities, it is plausible to expect that regular practice of sports prior to T2DM diagnosis might favourably modify the spectrum of diabetes-related complications after diagnosis. Methods: We compared 60 male subjects who reported having practised sports on a regular basis prior to being diagnosed with T2DM (EX-group) with 96 control T2DM subjects who never practised sports, and matched for age and known diabetes duration (NEVER-group). Micro- and macro-angiopathic complications were analysed, alongside diabetic and cardiovascular drug use, prevalence of hypertension, and lipid profile. Results: Age (mean ± 1SD) was 59.5 ± 11.0 years, and known diabetes duration 10.4 ± 7.0 years. EX-subjects were aged 40 ± 14 years at the time they interrupted their sports practice, the interval between interruption and T2DM diagnosis amounting to 12 ± 10 years. There were no difference in present-day BMI (29 ± 5 kg.m−2), nor in waist diameter (103 ± 11 cm) or percent body fat (30 ± 7%) between the EX- and NEVER-groups. Metabolic control, assessed by HbA1c, was similar in both groups (8.3 ± 2.0 (EX-) vs. 8.1 ± 2.1% (NEVER-; NS)). High blood pressure (BP) was present in 53 and 58% respectively. There was no difference between groups for BP- or lipid-lowering drug(s) and drug class(es) usage. Systolic and diastolic BP were identical in both groups (145 and 85 mm Hg). Insulin sensitivity (IS) and β-cell function (β) assessed by the HOMA model (1) were similar in both groups. Thus, IS was (median [perc. 25–75]) 36 [27–58] and 37 [28–48]%, while β was 60 [32–90] and 64 [36–109]% respectively in EX- and NEVER-subjects (NS). Prevalence of micro- and macro-angiopathy, including coronary artery disease (CAD) were lower, though not significantly, in EX-subjects: 22 vs. 29% (retinopathy); 18 vs. 26% (microalbuminuria); 26 vs. 40% (peripheral neuropathy); 27 vs. 35% (macro-angiopathy); 15 vs. 25% (CAD). Total cholesterol.HDL-C−1, fasting- and inter-prandial TG were not significantly different between groups, nor was the absolute 10 year CAD excess risk estimated from Coronary Risk Chart: 12 ± 10%. Discussion: Past regular practice of sports in male subjects did not result in a significantly less severe spectrum of diabetes-related complications after a known duration of type 2 diabetes mellitus of 10 years, when compared with subjects matched for age and for diabetes duration. Nevertheless, a non-significant lesser prevalence of micro- and macro-angiopathic manifestations was found associated with past practice of sports prior to diabetes diagnosis.