Background:
Exercise capacity has been shown to predict outcomes in the general population. However, the prognostic value of Exercise capacity in patients with insulin dependent diabetes mellitus (IDDM) and non insulin dependent diabetes mellitus (NIDDM) has not been extensively evaluated.
Methods:
We included 10768 consecutive diabetic patients (3600 (33%) IDDM and 7168 NIDDM (67%)) who underwent exercise testing between 1991 and 2008. Baseline characteristics and exercise data were collected prospectively at the time of testing including Metabolic Equivalents (METS). The primary endpoint is all cause mortality confirmed by the social security death index.
Results:
Patents with IDDM were older, more often females (46% vs. 41%) with higher prevalence of hypertension (83% vs. 77%) and prior coronary disease (21% vs. 17%). Patients with NIDDM achieved more than 10 METS more often (36% vs. 30%, p<0.0001). After a median follow-up duration of 6.4 years (Range 1-18 years), 2143 patients (20%) died. Kaplan Meier survival curves are shown below. Using Multivariable Cox Hazard Proportional Analysis, IDDM (Hazard ratio 1.45, 95% CI 1.3 -1.6, p<0.0001 (in comaprison to NIDDM)) and METS achieved (HR 0.82, 95% CI 0.80-0.83, p<0.0001 per METS achieved) were associated with decreased survival.
Conclusions:
In this large cohort of diabetic patients, decreased Exercise capacity is independently associated with decreased survival over long follow-up duration.
Follow-up of anti-beta-lactoglobulin antibodies in children with Type 1 (insulin-dependent) diabetes mellitus
