Association between physical activity level and cardiovascular risk factors in adolescents living with type 1 diabetes mellitus: a cross-sectional study
Authors: Wu Nana , Bredin Shannon S. D. , Jamnik Veronica K. , Koehle Michael S. , Guan Yanfei , Shellington Erin M. , Li Yongfeng , Li Jun , Warburton Darren E. R. 
Published: March 2021

Background

Type 1 diabetes mellitus (T1DM) is associated with an increased risk for cardiovascular disease (CVD) related morbidity and premature mortality. Regular physical activity plays an important role in the primary and secondary prevention of CVD, improving overall health and wellbeing. Previous observational studies have examined the associations between self-reported physical activity and CVD risk factors in largely adult Caucasian populations. However, limited work has evaluated the relationship between objectively measured physical activity and CVD risk factors in other ethnicities, particularly Chinese youth living with T1DM.

Methods

This cross-sectional study assessed CVD risk factors, physical activity, and aerobic fitness (and their associations) in Chinese youth living with T1DM (n = 48) and peers (n = 19) without T1DM. Primary outcomes included blood pressure, lipid profiles, and physical activity (accelerometry). Statistical differences between groups were determined with chi-square, independent-samples t-tests, or analysis of covariance. The associations between aerobic fitness, daily physical activity variables, and CVD risk factors were assessed with univariate and multivariate linear regression analyses.

Results

Results were summarized using means and standard deviation (SD) for normally distributed variables and medians and 25–75th quartile for non-normally distributed variables. In comparison to peers without diabetes, youth living with T1DM showed higher levels of total cholesterol (3.14 ± 0.67 vs. 4.03 ± 0.81 mmol·L-1,p= 0.001), low-density lipoprotein cholesterol (1.74 ± 0.38 vs. 2.31 ± 0.72 mmol·L-1,p= 0.005), and triglycerides (0.60 ± 0.40 vs. 0.89 ± 0.31 mmol·L-1p= 0.012), and lower maximal oxygen power (44.43 ± 8.29 vs. 35.48 ± 8.72 mL·kg-1·min-1,p= 0.003), total physical activity counts (451.01 ± 133.52 vs. 346.87 ± 101.97 counts·min-1,p= 0.004), metabolic equivalents (METs) (2.41 ± 0.60 vs. 2.09 ± 0.41 METs,p= 0.033), moderate-to-vigorous intensity physical activity [MVPA: 89.57 (61.00–124.14) vs (53.19 (35.68–63.16) min,p = 0.001], and the percentage of time spent in MVPA [11.91 (7.74–16.22) vs 8.56 (6.18–10.12) %,p = 0.038]. The level of high-density lipoprotein cholesterol was positively associated with METs (β = 0.29,p = 0.030, model R2 = 0.168), and the level of triglycerides was negatively associated with physical activity counts (β = − 0.001,p= 0.018, model R2= 0.205) and METs (β = − 0.359,p= 0.015, model R2= 0.208), and positively associated with time spent in sedentary behaviour (β = 0.002,p = 0.041, model R2 = 0.156) in persons living with T1DM.

Conclusions

Chinese youth with T1DM, despite their young age and short duration of diabetes, present early signs of CVD risk, as well as low physical activity levels and cardiorespiratory fitness compared to apparently healthy peers without diabetes. Regular physical activity is associated with a beneficial cardiovascular profile in T1DM, including improvements in lipid profile. Thus, physical activity participation should be widely promoted in youth living with T1DM.