Leisure-time physical activity and development and progression of diabetic nephropathy in type 1 diabetes: the FinnDiane Study

Wadén, Johan; Tikkanen, H; Forsblom, Carol; Thorn, Lena M.; Saraheimo, Markku; Tolonen, Nina; Rosengård-Bärlund, Milla; Gordin, Daniel; Tikkanen, Heikki; Groop, Per‐Henrik

doi:10.1007/s00125-015-3499-6

Cited by 53 publications

(37 citation statements)

References 26 publications

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“…115 In addition, in patients with type 1 diabetes, higher levels of leisure-time physical activity were associated with less progression to renal failure (on the basis of urinary albumin excretion rate) and less incidence of microalbuminuria over 6 years of follow up. 116…”

Section: Low Birth Weightmentioning

confidence: 99%

Assessing Microvascular Function in Humans from a Chronic Disease Perspective

Houben

Martens

Stehouwer

2017

JASN

113

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Microvascular dysfunction (MVD) is considered a crucial pathway in the development and progression of cardiometabolic and renal disease and is associated with increased cardiovascular mortality. MVD often coexists with or even precedes macrovascular disease, possibly due to shared mechanisms of vascular damage, such as inflammatory processes and oxidative stress. One of the first events in MVD is endothelial dysfunction. With the use of different physiologic or pharmacologic stimuli, endothelium-dependent (micro)vascular reactivity can be studied. This reactivity depends on the balance between various mediators, including nitric oxide, endothelin, and prostanoids, among others. The measurement of microvascular (endothelial) function is important to understand the pathophysiologic mechanisms that contribute to MVD and the role of MVD in the development and progression of cardiometabolic/renal disease. Here, we review a selection of direct, noninvasive techniques for measuring human microcirculation, with a focus on methods, interpretation, and limitations from the perspective of chronic cardiometabolic and renal disease.

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Section: Low Birth Weightmentioning

confidence: 99%

Assessing Microvascular Function in Humans from a Chronic Disease Perspective

Houben

Martens

Stehouwer

2017

JASN

113

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“…In a separate analysis, exercise intensity also had a borderline effect on recurrencefree time in patients with a major CVD event at baseline. We previously showed that the intensity of exercise, rather than the total amount of LTPA, predicts the progression and development of diabetic nephropathy in type 1 diabetes [7]. We have also shown that lower intensity is associated with prevalent CVD in a cross-sectional setting [2].…”

Section: Discussionmentioning

confidence: 93%

“…We recently reported that the intensity of physical activity might have an impact on the incidence and progression of diabetic nephropathy [7]. In addition, an increasing body of evidence suggests that the complications of type 1 diabetes, namely CVD and diabetic nephropathy, share risk factors and develop in parallel [8].…”

Section: Iqrmentioning

confidence: 99%

Frequent and intensive physical activity reduces risk of cardiovascular events in type 1 diabetes

et al. 2016

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Aims/hypothesis Cardiovascular disease (CVD) is the most common cause of premature death and disability among patients with type 1 diabetes. Diabetic nephropathy accounts for the increased cardiovascular morbidity and mortality of these patients. We recently showed that the intensity of exercise predicts the incidence and progression of diabetic nephropathy in patients with type 1 diabetes. Little is known about the relationship between physical activity and CVD. Therefore, we studied how physical activity affects the risk of CVD events in patients with type 1 diabetes. Methods A 10 year follow-up study including 2180 type 1 diabetes patients from the nationwide multicentre Finnish Diabetic Nephropathy Study (FinnDiane). Leisure time physical activity (LTPA) was assessed by a previously validated self-report questionnaire. A CVD event was defined as a verified myocardial infarction, coronary procedure or stroke. Patients were analysed separately for the risk of developing a first ever CVD event and for the risk of a recurrent CVD event following a baseline event.Results A total of 206 patients had an incident CVD event during follow-up. A higher total LTPA and higher intensity, frequency and duration of activity were associated with a lower risk of incident CVD events. The observed association between exercise frequency and incident CVD remained significant when adjusted for classic risk factors. Exercise intensity also had a borderline effect on the recurrence-free time in patients with a major CVD event at baseline. Conclusions/interpretation This study suggests that exercise, particularly high frequency and high intensity exercise, may reduce the risk of CVD events in patients with type 1 diabetes.

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“…Possible mechanisms that link PA to the prevention of the progression and remission of microvascular complications in patients with type 2 diabetes reportedly include the following: reduction of blood pressure, improvements in lipid profile, glycemic control, insulin sensitivity, and endothelial function [34–38]. However, our results show that the association is robust after adjusting for sBP, dBP, BMI, and HbA1c level as time-varying variables, suggesting that PA could lower the risk of developing DR via pathways other than blood pressure, BMI, and glycemic control.…”

Section: Discussionmentioning

confidence: 99%

Higher levels of physical activity are independently associated with a lower incidence of diabetic retinopathy in Japanese patients with type 2 diabetes: A prospective cohort study, Diabetes Distress and Care Registry at Tenri (DDCRT15)

et al. 2017

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We assessed the prospective association between baseline levels of physical activity (PA) and the incidence of newly developed diabetic retinopathy (DR) in patients with type 2 diabetes. Data from 1,814 patients with type 2 diabetes without DR were obtained from a Japanese diabetes registry at Tenri Hospital, Nara, Japan. To assess the independent correlations between baseline PA levels and newly developed DR, the participants were divided into five categories based on their PA levels. A Cox proportional hazards model with time-varying exposure information was used and adjusted for potential confounders to assess the independent correlations. At baseline, the mean age, BMI, and hemoglobin A1c levels of the patients were 65.5 years, 24.5 kg/m2, and 7.2% (54 mmol/mol), respectively. After 2 years, newly developed DR was confirmed in 184 patients (10.1%). Patients with newly developed DR had longer duration of type 2 diabetes (14.7 versus 11.0 years, p < 0.0001), higher systolic blood pressure (139.2 versus 135.1 mmHg, p = 0.0012), lower estimated glomerular filtration rate (74.0 versus 77.1 mL/min/1.73 m2, p = 0.0382), greater urinary albumin–creatinine ratio (4.00 versus 2.45 mg/mmol, p < 0.0039), and higher HbA1c levels (7.5 versus 7.2%, p = 0.0006) than those without newly developed DR. The multivariable-adjusted hazard ratios for DR development were 0.87 (95% CI, 0.53–1.40; p = 0.557), 0.83 (95% CI, 0.52–1.31; p = 0.421), 0.58 (95% CI, 0.35–0.94; p = 0.027), and 0.63 (95% CI, 0.42–0.94; p = 0.025)for the second, third, fourth, and fifth PA categories, respectively, compared with the reference category of patients with a mean PA of 0 metabolic equivalent of task-hours/week). Higher PA levels are independently associated with a lower incidence of DR in Japanese patients with type 2 diabetes.

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Leisure-time physical activity and development and progression of diabetic nephropathy in type 1 diabetes: the FinnDiane Study

Cited by 53 publications

References 26 publications

Assessing Microvascular Function in Humans from a Chronic Disease Perspective

Assessing Microvascular Function in Humans from a Chronic Disease Perspective

Frequent and intensive physical activity reduces risk of cardiovascular events in type 1 diabetes

Higher levels of physical activity are independently associated with a lower incidence of diabetic retinopathy in Japanese patients with type 2 diabetes: A prospective cohort study, Diabetes Distress and Care Registry at Tenri (DDCRT15)

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