Advertisement

Decreased Diastolic Blood Pressure and Average Grip Strength in Adults With Type 1 Diabetes Compared With Controls: An Analysis of Data From the Canadian Longitudinal Study on Aging

      Abstract

      Objectives

      Our aim in this study was to determine whether aging individuals with type 1 diabetes (T1D) have differences in cardiovascular health, assessed by blood pressure, and skeletal muscle function, assessed by grip strength, compared with matched nondiabetic controls (CON).

      Methods

      This investigation was a retrospective cohort analysis using baseline and 3-year follow-up data from the Canadian Longitudinal Study on Aging. Bivariate and multivariate regression analyses were used to examine the association between sociodemographic, health, behavioural and T1D-specific variables on blood pressure and grip strength in T1D and CON groups. Generalized estimating equations were used to model the average population changes in blood pressure and grip strength from baseline to follow up.

      Results

      The sample included 126 individuals (63 T1D and 63 CON). Systolic blood pressure was not significantly different between groups at baseline or follow up (p>0.05). However, compared with CON, diastolic blood pressure was significantly lower at both time-points in the T1D group (p<0.001). Grip strength was consistently lower among persons with T1D (p=0.03). In the multivariate regression model, body mass index, age and sex were significantly associated with diastolic blood pressure and grip strength in both groups. In the T1D group, disease duration accounted for a large proportion of the variance in diastolic blood pressure and grip strength (17% and 9%, respectively). The rate of decline in diastolic blood pressure and grip strength did not differ between groups (p>0.05).

      Conclusions

      Diastolic blood pressure and grip strength appear to be consistently lower and differentially regulated in individuals with T1D vs CON. Aging individuals with T1D may be at risk of premature morbidity and mortality.

      Résumé

      Objectifs

      L’objectif de notre étude était de déterminer si les personnes vieillissantes atteintes du diabète de type 1 (DT1) montraient des différences dans la santé cardiovasculaire, évaluée par la pression artérielle, et le fonctionnement des muscles squelettiques, évalué par la force de préhension, par rapport aux témoins (TÉM) non diabétiques appariés.

      Méthodes

      Il s’agissait d’une étude de cohorte rétrospective réalisée à partir des données initiales et du suivi après 3 ans de l’Étude longitudinale canadienne sur le vieillissement (ÉLCV). Nous avons utilisé les analyses de régression bivariées et multivariées pour examiner l’association entre les variables sociodémographiques, de santé, comportementales et relatives au DT1, et la pression artérielle et la force de préhension des groupes DT1 et TÉM. Nous avons utilisé les équations d’estimation généralisées pour modéliser les variations moyennes populationnelles de la pression artérielle et de la force de préhension du début jusqu’au suivi.

      Résultats

      L’échantillon regroupait 126 personnes (63 DT1 et 63 TÉM). La pression artérielle systolique n’était pas significativement différente entre les groupes au début ou au suivi (p > 0,05). Toutefois, par rapport aux TÉM, la pression artérielle diastolique du groupe DT1 était significativement plus faible à ces deux moments (p < 0,001). La force de préhension était systématiquement plus faible chez les personnes DT1 (p = 0,03). Dans le modèle de régression multivarié, l’indice de masse corporelle, l’âge et le sexe étaient associés de façon significative à la pression artérielle diastolique et à la force de préhension dans les 2 groupes. Dans le groupe DT1, la durée de la maladie expliquait en grande partie la variance de la pression artérielle diastolique et de la force de préhension (17 % et 9 %, respectivement). Le taux de déclin de la pression artérielle diastolique et de la force de préhension ne différait pas entre les groupes (p > 0,05).

      Conclusions

      La pression artérielle diastolique et la force de préhension semblent être systématiquement plus faibles et régulées différemment chez les personnes DT1 vs les personnes TÉM. Les personnes vieillissantes atteintes du DT1 peuvent être prématurément exposées au risque de morbidité et de mortalité.

      Keywords

      Mots clés

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Canadian Journal of Diabetes
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Diamond Project Group
        Incidence and trends of childhood type 1 diabetes worldwide 1990–1999.
        Diabet Med. 2006; 23: 857-866
        • Lung T.W.C.
        • Hayes A.J.
        • Herman W.H.
        • Si L.
        • Palmer A.J.
        • Clarke P.M.
        A meta-analysis of the relative risk of mortality for type 1 diabetes patients compared to the general population: Exploring temporal changes in relative mortality.
        PLoS One. 2014; 9: e113635
        • Foster N.C.
        • Beck R.W.
        • Miller K.M.
        • et al.
        State of type 1 diabetes management and outcomes from the T1D exchange in 2016–2018.
        Diabetes Technol Ther. 2019; 21: 66-72
        • Pelletier C.
        • Dai S.
        • Roberts K.C.
        • Bienek A.
        • Onysko J.
        • Pelletier L.
        Report summary. Diabetes in Canada: Facts and figures from a public health perspective.
        Chron Dis Inj Can. 2012; 33: 53-54
        • Gordin D.
        • Rönnback M.
        • Forsblom C.
        • Mäkinen V.
        • Saraheimo M.
        • Groop P.H.
        Glucose variability, blood pressure and arterial stiffness in type 1 diabetes.
        Diabetes Res Clin Pract. 2008; 80: e4-e7
        • Monaco C.M.F.
        • Hughes M.C.
        • Ramos S.V.
        • et al.
        Altered mitochondrial bioenergetics and ultrastructure in the skeletal muscle of young adults with type 1 diabetes.
        Diabetologia. 2018; 61: 1411-1423
        • Wadwa R.P.
        • Urbina E.M.
        • Anderson A.M.
        • et al.
        Measures of arterial stiffness in youth with type 1 and type 2 diabetes.
        Diabetes Care. 2010; 33: 881-886
        • Rӧnnback M.
        • Fagerudd J.
        • Forsblom C.
        • et al.
        Altered age-related blood pressure pattern in type 1 diabetes.
        Circulation. 2004; 110: 1076-1082
        • Ortega F.B.
        • Silventoinen K.
        • Tynelius P.
        • Rasmussen F.
        Muscular strength in male adolescents and premature death: Cohort study of one million participants.
        BMJ. 2012; 345e7279
        • Lee S.I.
        • Patel M.
        • Jones C.M.
        • Narendran P.
        Cardiovascular disease and type 1 diabetes: Prevalence, prediction and management in an ageing population.
        Ther Adv Chronic Dis. 2015; 6: 347-374
        • Mayhew A.J.
        • Phillips S.M.
        • Sohel N.
        • et al.
        The impact of different diagnostic criteria on the association of sarcopenia with injurious falls in the CLSA.
        J Cachexia Sarcopenia Muscle. 2020; 11: 1603-1613
        • Monaco C.M.F.
        • Perry C.G.R.
        • Hawke T.J.
        Alterations in mitochondrial functions and morphology in muscle and non-muscle tissues in type 1 diabetes: Implications for metabolic health.
        Exp Physiol. 2020; 105: 565-570
        • Mori H.
        • Kuroda A.
        • Yoshida S.
        • et al.
        High prevalence and clinical impact of dynapenia and sarcopenia in Japanese patients with type 1 and type 2 diabetes: Findings from the Impact of Diabetes Mellitus on Dynapenia study.
        J Diabetes Invest. 2021; 12: 1050-1059
        • Gutefeldt K.
        • Lundstedt S.
        • Thyberg I.S.M.
        • Bachrach-Lindström M.
        • Arnqvist H.J.
        • Spångeus A.
        Clinical examination and self-reported upper extremity impairments in patients with long-standing type 1 diabetes mellitus.
        J Diabetes Res. 2020; 20204172635
        • Raina P.
        • Wolfson C.
        • Kirkland S.
        • et al.
        Cohort profile: The Canadian Longitudinal Study on Aging (CLSA).
        Int J Epidemiol. 2019; 48 (1752–3j)
        • Raina P.S.
        • Wolfson C.
        • Kirkland S.A.
        • et al.
        The Canadian Longitudinal Study on Aging (CLSA).
        Can J Aging La Revue Can Du Vieillissement. 2009; 28: 221-229
        • Diabetes Canada Clinical Practice Guidelines Expert Committee
        Definition, classification and diagnosis of diabetes, prediabetes and metabolic syndrome.
        Can J Diabetes. 2018; 42: S10-S15
      1. Canadian Longitudinal Study on Aging. Physical assessments.
        • Bahat G.
        • Tufan A.
        • Tufan F.
        • et al.
        Cut-off points to identify sarcopenia according to European Working Group on Sarcopenia in Older People (EWGSOP) definition.
        Clin Nutr. 2016; 35: 1557-1563
        • Landi F.
        • Calvani R.
        • Picca A.
        • et al.
        Body mass index is strongly associated with hypertension: Results from the Longevity Check-Up 7+ Study.
        Nutrients. 2018; 10: 1976
        • Hemelrijck M.V.
        • Ulmer H.
        • Nagel G.
        • et al.
        Longitudinal study of body mass index, dyslipidemia, hyperglycemia, and hypertension in 60,000 men and women in Sweden and Austria.
        PLoS One. 2018; 13e0197830
        • Cheung B.M.Y.
        • Wat N.M.S.
        • Tso A.W.K.
        • et al.
        Association between raised blood pressure and dysglycemia in Hong Kong Chinese.
        Diabetes Care. 2008; 31: 1889-1891
        • Wallymahmed M.E.
        • Morgan C.
        • Gill G.V.
        • MacFarlane I.A.
        Aerobic fitness and hand grip strength in type 1 diabetes: Relationship to glycaemic control and body composition.
        Diabet Med. 2007; 24: 1296-1299
        • Abe T.
        • Thiebaud R.S.
        • Loenneke J.P.
        Age-related change in handgrip strength in men and women: Is muscle quality a contributing factor?.
        Age. 2016; 38: 28
        • Haider S.
        • Luger E.
        • Kapan A.
        • et al.
        Associations between daily physical activity, handgrip strength, muscle mass, physical performance and quality of life in prefrail and frail community-dwelling older adults.
        Qual Life Res. 2016; 25: 3129-3138
        • Taekema D.G.
        • Maier A.B.
        • Westendorp R.G.J.
        • de Craen A.J.M.
        Higher blood pressure is associated with higher handgrip strength in the oldest old.
        Am J Hypertens. 2011; 24: 83-89
        • de Lima T.R.
        • Silva D.A.S.
        • de Castro J.A.C.
        • Christofaro D.G.D.
        Handgrip strength and associated sociodemographic and lifestyle factors: A systematic review of the adult population.
        J Bodyw Mov Ther. 2017; 21: 401-413
        • Washburn R.A.
        • Smith K.W.
        • Jette A.M.
        • Janney C.A.
        The Physical Activity Scale for the Elderly (PASE): Development and evaluation.
        J Clin Epidemiol. 1993; 46: 153-162
        • Zheng B.
        Summarizing the goodness of fit of generalized linear models for longitudinal data.
        Stat Med. 2000; 19: 1265-1275
        • Nathan D.M.
        Realising the long-term promise of insulin therapy: The DCCT/EDIC study.
        Diabetologia. 2021; 64: 1049-1058
        • Tran-Duy A.
        • Knight J.
        • Clarke P.M.
        • Svensson A.M.
        • Eliasson B.
        • Palmer A.J.
        Development of a life expectancy table for individuals with type 1 diabetes.
        Diabetologia. 2021; 64: 2228-2236
        • Dial A.G.
        • Monaco C.M.F.
        • Grafham G.K.
        • Patel T.P.
        • Tarnopolsky M.A.
        • Hawke T.J.
        Impaired function and altered morphology in the skeletal muscles of adult men and women with type 1 diabetes.
        J Clin Endocrinol Metab. 2021; 106: 2405-2422
        • Vinik A.I.
        • Maser R.E.
        • Mitchell B.D.
        • Freeman R.
        Diabetic autonomic neuropathy.
        Diabetes Care. 2003; 26: 1553-1579
        • Pop-Busui R.
        Cardiac autonomic neuropathy in diabetes.
        Diabetes Care. 2010; 33: 434-441
        • Tielemans S.M.A.J.
        • Soedamah-Muthu S.S.
        • Neve M.D.
        • et al.
        Association of physical activity with all-cause mortality and incident and prevalent cardiovascular disease among patients with type 1 diabetes: The EURODIAB Prospective Complications Study.
        Diabetologia. 2013; 56: 82-91
        • Cameron J.D.
        • Bulpitt C.J.
        • Pinto E.S.
        • Rajkumar C.
        The aging of elastic and muscular arteries.
        Diabetes Care. 2003; 26: 2133-2138
        • King D.E.
        • Mainous A.G.
        • Buchanan T.A.
        • Pearson W.S.
        C-reactive protein and glycemic control in adults with diabetes.
        Diabetes Care. 2003; 26: 1535-1539
        • Park S.
        • Lakatta E.G.
        Role of inflammation in the pathogenesis of arterial stiffness.
        Yonsei Med J. 2012; 53: 258-261
        • Kalyani R.R.
        • Metter E.J.
        • Egan J.
        • Golden S.H.
        • Ferrucci L.
        Hyperglycemia predicts persistently lower muscle strength with aging.
        Diabetes Care. 2015; 38: 82-90
        • Monaco C.M.F.
        • Perry C.G.R.
        • Hawke T.J.
        Diabetic myopathy.
        Curr Opin Neurol. 2017; 30: 545-552
        • Franklin S.S.
        • Gustin W.
        • Wong N.D.
        • et al.
        Hemodynamic patterns of age-related changes in blood pressure: The Framingham Heart Study.
        Circulation. 1997; 96: 308-315
        • Protogerou A.D.
        • Safar M.E.
        • Iaria P.
        • et al.
        Diastolic blood pressure and mortality in the elderly with cardiovascular disease.
        Hypertension. 2007; 50: 172-180
        • Franklin S.S.
        • Gokhale S.S.
        • Chow V.H.
        • et al.
        Does low diastolic blood pressure contribute to the risk of recurrent hypertensive cardiovascular disease events?.
        Hypertension. 2018; 65: 299-305
        • Diabetes Canada Clinical Practice Guidelines Expert Committee
        Treatment of hypertension.
        Can J Diabetes. 2018; 42: S186-S189
        • Bohannon R.W.
        Hand-grip dynamometry predicts future outcomes in aging adults.
        J Geriatr Phys Ther. 2008; 31: 3
        • Labott B.K.
        • Bucht H.
        • Morat M.
        • Morat T.
        • Donath L.
        Effects of exercise training on handgrip strength in older adults: A meta-analytical review.
        Gerontology. 2019; 65: 686-698