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Heart rate dynamics during cardio-pulmonary exercise testing are associated with glycemic control in individuals with
Othmar Moser1,2, Max L Eckstein1,2, Olivia McCarthy1,2
1Diabetes Research Group, Medical School, Swansea University, Swansea, United Kingdom.
Insights
Heart rate response during exercise testing in type 1 diabetes is linked to blood sugar control. Poor glycemic control may lead to atypical heart rate performance curves in T1DM patients.
Area of Science:
- Cardiology
- Endocrinology
- Exercise Physiology
Background:
- Type 1 diabetes (T1DM) affects cardiovascular function.
- Understanding exercise response in T1DM is crucial for management.
Purpose of the Study:
- Investigate the heart rate to performance curve (HRPC) in T1DM.
- Explore associations between HRPC, glycemic control, and physiological markers.
Main Methods:
- Sixty-four T1DM patients underwent maximal cardio-pulmonary exercise (CPX) testing.
- Heart rate to performance curve (kHR) calculated using polynomial regression.
- Linear regression and ROC curve analysis performed to assess associations.
Main Results:
- kHR significantly correlated with HbA1c, age, and diabetes duration.
- kHR associated with heart rate at turn point and power output relative to bodyweight.
- ROC analysis identified an HbA1c threshold of 7.9% (62 mmol.mol-1).
Conclusions:
- Atypical HRPC observed in T1DM patients.
- Glycemic control is a primary determinant of HRPC in T1DM.
- kHR may serve as a marker for glycemic control during exercise.
Introduction:
This study investigated the degree and direction (kHR) of the heart rate to performance curve (HRPC) during cardio-pulmonary exercise (CPX) testing and explored the relationship with diabetes markers, anthropometry and exercise physiological markers in type 1 diabetes (T1DM).
Material And Methods:
Sixty-four people with T1DM (13 females; age: 34 ± 8 years; HbA1c: 7.8 ± 1% (62 ± 13 mmol.mol-1) performed a CPX test until maximum exhaustion. kHR was calculated by a second-degree polynomial representation between post-warm up and maximum power output. Adjusted stepwise linear regression analysis was performed to investigate kHR and its associations. Receiver operating characteristic (ROC) curve was performed based on kHR for groups kHR < 0.20 vs. > 0.20 in relation to HbA1c.
Results:
We found significant relationships between kHR and HbA1c (β = -0.70, P < 0.0001), age (β = -0.23, P = 0.03) and duration of diabetes (β = 0.20, P = 0.04). Stepwise linear regression resulted in an overall adjusted R2 of 0.57 (R = 0.79, P < 0.0001). Our data revealed also significant associations between kHR and percentage of heart rate at heart rate turn point from maximum heart rate (β = 0.43, P < 0.0001) and maximum power output relativized to bodyweight (β = 0.44, P = 0.001) (overall adjusted R2 of 0.44 (R = 0.53, P < 0.0001)). ROC curve analysis based on kHR resulted in a HbA1c threshold of 7.9% (62 mmol.mol-1).
Conclusion:
Our data demonstrate atypical HRPC during CPX testing that were mainly related to glycemic control in people with T1DM.
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