Title of project

Importance of cardiorespiratory fitness as a biomarker of cardiovascular disease risk in type 1 diabetes: Survival of the fittest?

Abstract

Low levels of cardiorespiratory fitness (CRF) are associated with a high risk of cardiovascular disease, all-cause mortality, and mortality rates across a spectrum of age, race, and gender. Various epidemiological and clinical trials have demonstrated that CRF is a stronger predictor of mortality than established cardiovascular disease (CVD) risk factors and can significantly improve the reclassification of risk for adverse outcomes. Yet, despite its prognostic utility in evaluating the (patho)physiological mechanisms underpinning exercise intolerance, the integration of CRF testing in clinical practice is uncommon, particularly in those with type 1 diabetes (T1D). This is surprising given the considerably elevated cardiovascular disease risk profile associated with T1D which constitutes the leading cause of premature mortality in those living with the condition.

Though previous work by this research group has repeatedly found attenuated exercise tolerance in those with T1D relative to healthy controls, an assessment of CRF and its association to CVD risk factors in large, heterogenous cohorts of people with T1D is currently missing. Furthermore, our understanding of the importance of physical activity for CVD management and/or prevention stems from data acquired from self-reported physical activity questionnaires with limited exploration of underlying physiological mechanisms.

This ambitious project will incorporate a multifaceted approach, examining previously collected, prospective, and interventional data in a large cohort of people with T1D across the age, fitness, and disease status spectrum. We will establish the first T1D-specific pooled data set of detailed CRF test and physical activity metrics alongside clinical and novel CVD risk biomarkers obtained via registry databases and biochemical techniques, respectively.

Such information will deepen our understanding of the (patho)physiological relationships modulating exercise tolerance in heterogenous T1D patient cohorts and aid in developing targeted interventions based on personalised responses to implementable physical function tests that drive improvements in health-span.