Physical Activity Level Could Influence Polyneuropathy Risk in Type 1 Diabetes

Luigi Uccioli, MD
Credit: LuigiUccioli.It

Results of a new study in people with type 1 diabetes are underlining the importance of emphasizing healthy lifestyles and physical activity among this patient population.

The cross-sectional study, which included 90 adult patients with type 1 diabetes, suggests patients achieving 600 metabolic equivalent of task (MET) minutes or more per week saw a significant reduction in risk of diabetic neuropathy relative to their counterparts with reduced fitness levels.¹

“There’s evidence that low levels of [physical activity] are associated with the onset of diabetic neuropathy, but to date it has been shown that frequent structured physical activity does not correlate with a reduction in the prevalence of the disease, although it does help to improve neuropathic symptoms, balance and both motor and sensory neuromuscular parameters,” investigators wrote.¹

In recent decades, public health systems have witnessed a steady rise in the prevalence of type 1 diabetes.² As a result of this increasing prevalence and a renewed emphasis on lifestyle intervention in management of chronic disease, the current study was launched by Luigi Uccioli, MD, and investigators at the University of Rome with the intent of exploring how physical activity might influence the appearance of diabetic polyneuropathy in people with type 1 diabetes. With this in mind, the research endeavor was designed as a cross-sectional study of patients with well-controlled type 1 diabetes receiving care at the Diabetes and Endocrinology Department of the CTO Hospital in Rome, Italy from September to June 2023.¹

For inclusion in the study, patients were required to be 18-75 years of age, be using diabetes technology, and . All participants included in the study had biometrics parameters, anthropometric paramedics, physiological anamnesis, pathological history, and clinical data collected.¹

The primary outcome of interest for the study was the association between physical activity levels and risk of diabetic polyneuropathy. For the purpose of analysis, diabetic polyneuropathy was assessed through the Michigan Neuropathy Screening Instrument questionnaire, a neurological examination focused on the lower extremities, and a nerve conduction study of the sural, motor peroneal, and tibial nerves of the lower extremities. Investigators noted physical activity was assessed using the International Physical Activity Questionnaire (IPAQ).¹

A total of 90 patients were identified for inclusion. This cohort had a median age of 49 (41.0-55.8) years, 47.8% were female, a mean disease duration of 21 (14.3-34.0) years, and a mean BMI was 23.6 (21.8-25.9) kg/m2. Among the cohort, 64.4% were either using an insulin pump or insulin with a basal bolus schedule and 35.6% were using a continuous glucose monitor.¹

Investigators pointed out 56.7% of participants had an HbA1c of less than 7.5% at the time of their visit, with 43.3% having an HbA1c of 7.6% or greater. Of the 90 patients included in the study, 26.7% had hypertension and 45.6% had diabetic complications, including retinopathy (28.9%), nephropathy (11.1%), and neuropathy (36.7%).¹

Analysis of IPAQ data revealed low, moderate, and high physical activity levels were observed in 21.1%, 41.1%, and 37.8%, respectively. Further analysis indicated there was no differences between the study groups in age (P =.125), gender (P =.122), BMI (P =.053), smoking (P =.475), alcohol consumption (P =.798), educational level (P =.549), diabetes duration (P =.250), therapy (P =.404), retinopathy (p = 0.251), nephropathy (p = 0.382), carotid atherosclerosis (P =.508) and hypertension (P =.125).¹

When estimating the association between diabetic polyneuropathy and physical activity, an x2-test between physical activity groups and diabetic polyneuropathy demonstrated a statistically significant difference (P < .001), with the statistically significant relationship between physical activity and diabetic polyneuropathy maintained in all groups when stratified by age, duration of disease, HbA1c, gender, and hypertension. Using binomial logistic regression, investigators found exposure to at least 600 MET minutes per week was associated with a significant reduction in the likelihood of diabetic polyneuropathy (Odds Ratio, 0.221; Confidence interval, 0.068–0.720; P =.012).¹

“Patients with type 1 diabetes mellitus should be educated to begin physical activity early, as well as insulin therapy, as part of their treatment plan and to prevent complications that may be associated with a long duration of the disease,” investigators added.¹

References:

1. Zaccaria S, Di Perna P, Giurato L, et al. Diabetic Polyneuropathy and Physical Activity in Type 1 Diabetes Mellitus: A Cross-Sectional Study. J Clin Med. 2023;12(20):6597. Published 2023 Oct 18. doi:10.3390/jcm12206597
2. Lawrence JM, Divers J, Isom S, et al. Trends in Prevalence of Type 1 and Type 2 Diabetes in Children and Adolescents in the US, 2001-2017. JAMA. 2021;326(8):717–727. doi:10.1001/jama.2021.11165