EFFECTS OF PHYSICAL EXERCISE AFTER ISLET TRANSPLANTATION: GLICEMIC CONTROL, PERFORMANCE AND AUTOIMMUNITY IN AN HALF MARATHON RUNNER

EFFECTS OF PHYSICAL EXERCISE AFTER ISLET TRANSPLANTATION: GLICEMIC CONTROL, PERFORMANCE AND AUTOIMMUNITY IN AN HALF MARATHON RUNNER Type 1 diabetes mellitus (T1DM) is a chronically progressive autoimmune disease in which the adverse immune response compromises the pancreatic β-cell function, impairing blood glucose control. In the worst case, when exogenous insulin therapy is not sufficient to manage the disorder, Islet transplantation (IT) could be a possible intervention for restoring the glycemic control. Anyway immunosuppressive therapy, autoimmune response and adverse events can lead to the progression of graft dysfunction and to several side effects. Physical activity might influence in a positive way the outcome of this clinical frame. We will discuss the feasibility of physical activity in immunosuppressed patients, its possible helpful contribution to the management of diabetes after IT and its role for mitigating the side effects of chronic pharmacological regime with the mean to report a concrete example of physical training as complementary therapy in the managing of T1DM and graft dysfunction after IT. We have monitored longitudinally a T1 DM amateur half-marathon runner (M, 44yrs) for autoimmunity markers, metabolic profile and physical performance in the 7 years since he received IT. After a sedentary period of insulin independence post-transplantation (HbA1c, 48mmol/mol; 6.5%), he started a classical endurance training, culminated with a half-marathon performance of 1h45’ and accompanied by a reduction of HbA1c (41mmol/mol, 5.9%). Subsequently, because injured, he had to rest and his glycemia and HbA1c worsened (51mmol/mol, 6.8%) so that he had to reintroduce exogenous insulin (4-6U/day). When he could finally resume an ad hoc training (aerobic, anaerobic, interval) his HbA1c levels diminished (34mmol/mol, 5.3%) and he could suspend insulin therapy again. In this ultimate period, his performance time improved by 10.5% (1h34’). The markers of autoimmunity and inflammation were never affected by the training and remained stable during the entire follow up. For this patient physical exercise plausibly act improving the insulin sensitivity and diabetic symptoms, mitigating the side effects of immunosuppression without interfering with the autoimmune profile. Further studies are desirable to better orchestrate an ad hoc exercise regime associated with an optimal management of T1D, graft function and an ameliorated performance.