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

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.