Metabolic and hormonal adaptation and dysfunction in active patients with Type 1 Diabetes (T1D) : from childhood to adulthood

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1 The Future of Research in Sport Participation in the Lifespan (EW10 Rome, Italy - September 14-17, 17, 2011 Convened by: : Laura Capranica, Jan Cabri and Romain Meeusen Metabolic and hormonal adaptation and dysfunction in active patients with Type 1 Diabetes (T1D) : from childhood to adulthood (Sport Physiology) Dr. Elsa Heyman EA4488 Physical activity, Muscle, Health, University of Lille, France European Science Foundation 1 quai Lezay Marnésia BP90015 FR Strasbourg Cedex Tel: +33 (0) or 46 Fax: +33 (0) ew-office@esf.org

2 Educational Opportunities for Young Researchers Faculty of Sport Science & Physical Education University of Lille 2 The PhD program: Master 1 st year STAPS with Research specialty (1 year 100 ECTS credits among which 40 are dedicated to research) (BAC +4y) Master 2 nd year STAPS with Research specialty (1 year 120 ECTS credits among which 60 are dedicated to research) (BAC +5y) PhD in Physical Activity - Biology & Health Doctoral School of Lille (3years with 100h of formation) (BAC +8y) The Future of Research in Sport Participation in the Lifespan (EW10

3 Educational Opportunities for Young Researchers Faculty of Sport Science & Physical Education University of Lille 2 Main research in the area of sport : EA4488 Physical activity, Muscle, Health Director: Pr. Serge Berthoin Physiological limiting factors of exercise performance Health benefices of physical activity (diabetes, metabolic syndrome, cystic fibrosis, children & elderly) Adaptations & Dysfunctions of the neuromuscular function In humans and animals The Future of Research in Sport Participation in the Lifespan (EW10

4 Educational Opportunities for Young Researchers Faculty of Sport Science & Physical Education University of Lille 2 Inter-University Cooperation Department of Human Physiology & Sports Medicine, Vrije Universiteit Brussel, Pr Romain Meeusen: Visiting Professor on Exercise and Brain (Lille, 2010) Department of Human Kinsesiology, University of Montreal, Pr François Péronnet: Symposium on Substrate utilisation during exercise (Lille, 2011) Future plans / developments The Future of Research in Sport Participation in the Lifespan (EW10

5 Main Topic of the Presentation In children, adolescents & adults with Type 1 diabetes (T1D) Barriers to physical activity Management of exercise-induced hypoglycaemia Mechanisms underlying impairment of aerobic fitness

6 Background Open questions Exercise training beneficial effects in T1D patients - on quality-of-life, physical fitness, body composition, lipid profile, insulin sensitivity - in children, adolescents & adults Heyman et al. Pediatr Exerc Sci, 2007; Riddell & Iscoe. Pediatr Diab 2006; Rigla et al. Metab 2000 Problems of sport adherence in somet1d patients Valerio et al. Nutr Metab Cardiovasc Dis, 2007 Heyman et Berthon, review, Salud(i)Ciencia, 2008 P<0.05 vs. Healthy : * P <0.05 vs. Prepubertal : Club-organised physical activity (h.wk -1 ) Healthy T1D Prepubertal girls (n=12) Healthy * T1D Post-pubertal girls (n=52)

7 Background Open questions Barriers to physical activity? In T1D adults Brazeau et al. Diabetes Care, 2008 In T1D children & adolescents? The risk of hypoglycaemia A low fitness level

8 Background Open questions In T1D adults Barriers to physical activity? The risk of hypoglycaemia Brazeau et al. Diabetes Care, 2008 A low fitness level Management with the modality/intensity of exercise? 2 studies in T1D adults Guelfi et al. Diabetes Care, 2005 Iscoe & Riddell. Diabet Med, exercises of similar total amount of work no difference in glycaemic change during exercise Continuous moderate-intensity : 45min at 50% VO 2 peak Intermittent high-intensity : 45min at 50% VO 2 peak + 9*15sec at 100%VO 2 peak? Use of a greater proportion of high intensity bouts In healthy children: In T1D children & adolescents? Bailey et al. Med Sci Sports Exerc, 1995

9 Background Open questions Barriers to physical activity? The risk of hypoglycaemia A low fitness level

10 Background Open questions Barriers to physical activity? The risk of hypoglycaemia A low fitness level Biological factors? Low maximal oxygen uptake? Michaliszyn et al. Pediatr Diab, 2009 Effect of HbA 1c on O 2 availibility and utilisation by muscle? - Ongoing study in University of Lille (EA4488) (funded by Roche lab. and a PHRC) - T1D adults with HbA 1c >8% or <7% and healthy subjects Arterial blood gases Muscle, cerebral HHb (NIRS) Mitochondrial respiration (vastus lateralis biopsies)

11 Background Open questions Barriers to physical activity? The risk of hypoglycaemia A low fitness level Biological factors? Low maximal oxygen uptake? Michaliszyn et al. Pediatr Diab, 2009 Metabolic/hormonal dysfunction : Catecholamines NA < and A < in T1D adults NA < but A > in T1D adolescent girls Bottini et al. Diabetologia, 1995 Heyman et al. Diabetes Metab, 2007

12 Background Open questions Barriers to physical activity? The risk of hypoglycaemia A low fitness level Biological factors? Low maximal oxygen uptake? Michaliszyn et al. Pediatr Diab, 2009 Metabolic/hormonal dysfunction : Catecholamines Endocannabinoid System Overactivity in Type 2 diabetes Involvement in metabolic and psychologic adaptations to exercise? In Type 1 diabetes Di Marzo. Diabetologia, 2008 Heyman et al. Psychoneuroendocrinology, in revision?

13 Actual Forms of Interplay The risk of hypoglycaemia Continuous moderate exercise vs. Intermittent very high intensity exercise with similar total amount of work University of Lille (E. Heyman) In T1D children Vrije Universiteit Brussel (R. Meeusen) In well-trained T1D adults Exercise-induced glycaemic variations Harmful to cognitive function? But chronic exercise beneficial effects on cognition? Vrije Universiteit Brussel (C. Tonoli, L. Buyse, R. Meeusen) University of Lille (E. Heyman, S. Berthoin) Codirection PhD (C. Tonoli)

14 Actual Forms of Interplay A low fitness level Metabolic/hormonal dysfunction : Endocannabinoid System Institute of Biomolecular Chemistry, Napoli (V. DiMarzo) AEA, 2-AG AEA, 2-AG CB1 proteins, CB1,CB2 mrna FAAH, DAG

15 Enhancing Synergies Barriers to physical activity in T1D? - Children/adolescents/adults - Male/female - Differences between countries, cultures in Europe? - Psychology / Sociology / Physiology Role of the endocannabinoid system in exercise-induced metabolic adaptations and fatigue? - Administration of CB1 agonists/antagonists (crossing or not the BBB) in humans Ethics Committee in other European countries?

16 Guelfi et al. Diabetes Care % VO 2 max 30min 40% VO 2 max 30min + 16 Sprints of 4 sec (ev. 2min) catecholamines No glucagon, insulin glucose hepatic production