Heidi Tikkanen-Dolenc1,2,3, Johan Wadén1,2,3, Carol Forsblom1,2,3, Valma Harjutsalo1,2,3,4, Lena M Thorn1,2,3, Markku Saraheimo1,2,3, Nina Elonen1,2,3, Heikki O Tikkanen5,6,7, Per-Henrik Groop8,2,3,9. 1. Folkhälsan Institute of Genetics, Folkhälsan Research Center, Biomedicum Helsinki, Helsinki, Finland. 2. Abdominal Center Nephrology, University of Helsinki, and Helsinki University Hospital, Helsinki, Finland. 3. Research Programs Unit, Diabetes and Obesity, University of Helsinki, Helsinki, Finland. 4. Chronic Disease Prevention Unit, National Institute for Health and Welfare, Helsinki, Finland. 5. Department of Sports and Exercise Medicine, Institute of Clinical Medicine, University of Helsinki, Helsinki, Finland. 6. Foundation for Sports and Exercise Medicine, Clinic for Sports and Exercise Medicine, Helsinki, Finland. 7. School of Medicine, Institute of Biomedicine, University of Eastern Finland, Kuopio, Finland. 8. Folkhälsan Institute of Genetics, Folkhälsan Research Center, Biomedicum Helsinki, Helsinki, Finland per-henrik.groop@helsinki.fi. 9. Department of Diabetes, Central Clinical School, Monash University, Melbourne, Victoria, Australia.
Abstract
OBJECTIVE: The aims of the study were to assess how baseline leisure-time physical activity (LTPA) and its exercise components intensity, duration, and frequency are associated with all-cause and cardiovascular mortality in patients with type 1 diabetes 1) overall, 2) stratified by presence or absence of chronic kidney disease (CKD), and 3) stratified by sex. RESEARCH DESIGN AND METHODS: The study design was prospective and observational and included 2,639 patients with type 1 diabetes from the ongoing nationwide multicenter Finnish Diabetic Nephropathy (FinnDiane) Study. Mean follow-up time was 11.4 ± 3.5 years. LTPA was assessed by using a validated self-report questionnaire. Three hundred ten patients (11.7%) had CKD defined as an estimated glomerular filtration rate of ≤60 mL/min/1.73 m2. RESULTS: During follow-up, 270 deaths occurred. LTPA and all its components were associated with all-cause mortality, even after adjustment for the potential confounders sex, diabetic nephropathy, duration of diabetes, age at onset of diabetes, systolic blood pressure, triglycerides, BMI, and HbA1c. Only exercise intensity was associated with cardiovascular mortality after adjustment for the confounders. Of the patients with CKD, 127 died during follow-up. The total amount of LTPA and exercise frequency were independently associated with lower risk of all-cause mortality when adjusted for covariates. CONCLUSIONS: Exercise is associated with a lower risk of premature all-cause and cardiovascular mortality in patients with type 1 diabetes. This study also demonstrates that physical activity is associated with a lower risk of mortality in patients with type 1 diabetes and CKD.
OBJECTIVE: The aims of the study were to assess how baseline leisure-time physical activity (LTPA) and its exercise components intensity, duration, and frequency are associated with all-cause and cardiovascular mortality in patients with type 1 diabetes 1) overall, 2) stratified by presence or absence of chronic kidney disease (CKD), and 3) stratified by sex. RESEARCH DESIGN AND METHODS: The study design was prospective and observational and included 2,639 patients with type 1 diabetes from the ongoing nationwide multicenter Finnish Diabetic Nephropathy (FinnDiane) Study. Mean follow-up time was 11.4 ± 3.5 years. LTPA was assessed by using a validated self-report questionnaire. Three hundred ten patients (11.7%) had CKD defined as an estimated glomerular filtration rate of ≤60 mL/min/1.73 m2. RESULTS: During follow-up, 270 deaths occurred. LTPA and all its components were associated with all-cause mortality, even after adjustment for the potential confounders sex, diabetic nephropathy, duration of diabetes, age at onset of diabetes, systolic blood pressure, triglycerides, BMI, and HbA1c. Only exercise intensity was associated with cardiovascular mortality after adjustment for the confounders. Of the patients with CKD, 127 died during follow-up. The total amount of LTPA and exercise frequency were independently associated with lower risk of all-cause mortality when adjusted for covariates. CONCLUSIONS: Exercise is associated with a lower risk of premature all-cause and cardiovascular mortality in patients with type 1 diabetes. This study also demonstrates that physical activity is associated with a lower risk of mortality in patients with type 1 diabetes and CKD.
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