Inter-relações entre a aptidão cardiorrespiratória, composição corporal, perfil lipídico e controle glicêmico de adolescentes com Diabetes Mellitus Tipo 1

Abstract

Introduction: Type 1 Diabetes Mellitus (T1DM) is a chronic disease characterized by the non-production or insufficient production of insulin. The period of highest concentration and onset is adolescence. Maintaining good levels of cardiorespiratory fitness, body composition, and lipid profile is of great importance for the treatment of the disease. However, adolescents have greater difficulty in adhering to the treatment of DM1, reflecting in inadequate glycemic control. Objective: To verify the relationship between cardiorespiratory fitness, body composition, lipid profile and glycemic control of adolescents with T1DM and to verify the moderating role of cardiorespiratory fitness in the relationship between glycated hemoglobin and glycemic variability with the components of the lipid profile in children and adolescents with T1DM. Methodology: The cross-sectional descriptive study includes 34 adolescents with T1DM (13.0±1.9 years, time of diagnosis = 5.9±3.6 years), in two stages: 1st - evaluation of lipid profile and glycated hemoglobin (HbA1c), anthropometric and maturational evaluation; 2nd - evaluation of body composition (DXA), cardiorespiratory fitness test (VO2max) and implantation of the continuous glucose monitoring (CGM) sensor. To verify the relationship between the study variables, Pearson correlation test was used, to verify the moderating role of cardiorespiratory fitness in the relationship between glycemic control and lipid profile the moderation analysis was performed by different linear regression models. In all analyses the alpha error of 5% was considered. Results: Article 1. The boys presented better VO2max in comparison to the girls (p=0.01), the girls presented high values in the percentage of total fat (32.8±8.1). Most participants showed adequate values of total cholesterol (61.8%), HDL-C (73.5%), LDL-C (70.6%) and triglycerides (82.4%). The glycemic control was considered inadequate, with HbA1c values above recommendations (HbA1c=9.7±1.5), high glycemic variability (CV>36%) and time in range (TIR) below 70%. It was found inverse relationship of VO2max with fat percentage (p=0.0001), BMI-z (p=0.008), total cholesterol (p=0.050) and LDL-C (p=0.007). There was also a direct relationship of total fat with BMI-z (p=0.001) and LDL-C (p=0.033). Total cholesterol had inverse relationship with TIR (p=0.046). In addition, inverse relationship of blood glucose coefficient of variation with total cholesterol (p<0.001), HDL-C (p=0.004) and LDL-C (p=0.004) was also found. Article 2. Moderation analysis demonstrated significant interaction between VO2max versus HbA1c with total cholesterol (p=0.029) and triglycerides (p=0.047) only in those with low and medium VO2max, but this association ceased to exist in those with high VO2max. The interaction between VO2max versus coefficient of variation of glycemia with total cholesterol was significant (p=0.039) and also ceased to exist in higher VO2max values. Conclusion: Cardiorespiratory fitness is inversely related to body composition and lipid profile of adolescents with T1DM. Higher levels of VO2max attenuate the influence of HbA1c and glycemic variability on the relationship with the lipid profile.