Eckstein Max L, Aberer Felix, Dobler Florian J R, Aziz Faisal, Heise Tim, Sourij Harald, Moser Othmar
BaySpo-Bayreuth Center of Sport Science, Research Group Exercise Physiology and Metabolism, University Bayreuth, 95447 Bayreuth, Germany.
Division of Endocrinology and Diabetology, Medical University of Graz, 8036 Graz, Austria.
Metabolites. 2022 Oct 24;12(11):1017. doi: 10.3390/metabo12111017.
The aim of this systematic review and meta-analysis was to evaluate the association between glycemic control (HbA1c) and functional capacity (VO2max) in individuals with type 1 diabetes (T1DM). A systematic literature search was conducted in EMBASE, PubMed, Cochrane Central Register of Controlled Trials, and ISI Web of Knowledge for publications from January 1950 until July 2020. Randomized and observational controlled trials with a minimum number of three participants were included if cardio-pulmonary exercise tests to determine VO2max and HbA1c measurement has been performed. Pooled mean values were estimated for VO2max and HbA1c and weighted Pearson correlation and meta-regression were performed to assess the association between these parameters. We included 187 studies with a total of 3278 individuals with T1DM. The pooled mean HbA1c value was 8.1% (95%CI; 7.9−8.3%), and relative VO2max was 38.5 mL/min/kg (37.3−39.6). The pooled mean VO2max was significantly lower (36.9 vs. 40.7, p = 0.001) in studies reporting a mean HbA1c > 7.5% compared to studies with a mean HbA1c ≤ 7.5%. Weighted Pearson correlation coefficient was r = −0.19 (p < 0.001) between VO2max and HbA1c. Meta-regression adjusted for age and sex showed a significant decrease of −0.94 mL/min/kg in VO2max per HbA1c increase of 1% (p = 0.024). In conclusion, we were able to determine a statistically significant correlation between HbA1c and VO2max in individuals with T1DM. However, as the correlation was only weak, the association of HbA1c and VO2max might not be of clinical relevance in individuals with T1DM.
本系统评价和荟萃分析的目的是评估1型糖尿病（T1DM）患者血糖控制（糖化血红蛋白[HbA1c]）与功能能力（最大摄氧量[VO2max]）之间的关联。在EMBASE、PubMed、Cochrane对照试验中央注册库和ISI科学网中进行了系统的文献检索，以查找1950年1月至2020年7月期间发表的文献。如果进行了用于测定VO2max的心肺运动试验和HbA1c测量，则纳入至少有三名参与者的随机和观察性对照试验。估计VO2max和HbA1c的合并平均值，并进行加权Pearson相关性分析和荟萃回归，以评估这些参数之间的关联。我们纳入了187项研究，共3278例T1DM患者。HbA1c的合并平均值为8.1%（95%置信区间[CI]：7.9−8.3%），相对VO2max为38.5毫升/分钟/千克（37.3−39.6）。与平均HbA1c≤7.5%的研究相比，报告平均HbA1c>7.5%的研究中，合并平均VO2max显著更低（36.9对40.7，p = 0.001）。VO2max与HbA1c之间的加权Pearson相关系数为r = -0.19（p < 0.001）。针对年龄和性别进行调整的荟萃回归显示，HbA1c每增加1%，VO2max显著降低-0.94毫升/分钟/千克（p = 0.024）。总之，我们能够确定T1DM患者中HbA1c与VO2max之间存在统计学显著相关性。然而，由于相关性较弱，HbA1c与VO2max之间的关联在T1DM患者中可能不具有临床相关性。
