2098-LB: Cardiopulmonary Fitness in Adults with Type 1 Diabetes

Introduction and Objective: Measurements of cardiovascular fitness obtained during exercise rather than in a resting state are accepted surrogates relevant to heart failure (HF). Data in T1D are limited. In this ongoing study, we examined risk factors for reduced peak VO2, reflecting impaired cardiopulmonary fitness, in adults with type 1 diabetes (T1D) in the Epidemiology of Diabetes Interventions and Complications (EDIC) study. Methods: Peak VO2 was measured in 634 participants using a standardized cardiopulmonary exercise testing protocol. Peak VO2<18 mL/kg/min was the defined threshold for impaired cardiopulmonary fitness. Linear regression models assessed the associations with chronic glycemia (mean HbA1c over ~40 years) and multiple nonglycemic factors. Results: Current mean age was 64 yrs, T1D duration 43 yrs, BMI 29.0 kg/m2, and HbA1c 7.2%; 44% were females. Impaired cardiopulmonary fitness was observed in 41%. Female sex and older age, but not duration of diabetes, were associated with lower peak VO2. Adjusted for age and sex, higher mean BMI (per 1 kg/m2), mean insulin (per 0.2 units/kg/day), and mean HbA1c (per 1%) were associated with lower peak VO2 (-0.54, -1.63, and -2.13 ml/kg/min, respectively; all p<0.0001). The age- and sex-adjusted associations with insulin and HbA1c were independent of BMI (p<0.002). Conclusion: Over 40% of DCCT participants with long-duration T1D had exercise results consistent with impaired cardiopulmonary fitness, a strong predictor of subsequent clinical HF. Independent of age, sex, and BMI, higher glycemic levels over time were associated with lower peak VO2. Controlling glycemia may preserve and improve cardiopulmonary fitness in individuals with T1D. The association with insulin dose requires further study. Disclosure H. Karanchi: None. R. Shah: Stock/Shareholder; Thryv. Consultant; Amgen Inc, Cytokinetics Inc. Other Relationship; National Institutes of Health, Patent disclosures. L. El Ghormli: None. G.M. Lorenzi: None. P.M. Gatcomb: None. B.H. Braffett: None. I. Bebu: None. D.M. Nathan: Advisory Panel; Lexicon Pharmaceuticals, Inc.