{"id":1563,"date":"2023-03-30T09:43:12","date_gmt":"2023-03-30T13:43:12","guid":{"rendered":"https:\/\/med.virginia.edu\/exercise-physiology-core-laboratory\/?p=1563"},"modified":"2026-06-27T20:28:23","modified_gmt":"2026-06-28T00:28:23","slug":"better-than-any-drug","status":"publish","type":"post","link":"https:\/\/med.virginia.edu\/exercise-physiology-core-laboratory\/2023\/03\/30\/better-than-any-drug\/","title":{"rendered":"Better than Any Drug"},"content":{"rendered":"

By Lisa Farr, M.Ed, Director, Exercise Physiology Core Lab <\/strong><\/p>\n

Interview with: Katie Love, MD<\/strong><\/p>\n

\"Katie<\/p>\n

Type 1 diabetes occurs when the insulin-producing beta cells of the pancreas are damaged through an
\nauto-immune process. This process happens in genetically susceptible individuals and is probably
\ntriggered by one or more environmental factors, such as viral infection. Over time, once enough of the
\nbeta cells are destroyed, blood glucose begins to rise, and the diagnosis of type 1 diabetes is established.
\nMost people are diagnosed as children, teens, or young adults.<\/p>\n

Mortality is three times higher in people with type 1 diabetes than the general population, and the main
\ndriver of this is cardiovascular disease. Individuals with type 1 diabetes are at a 3-10 fold increased risk
\nof cardiovascular disease compared to the general population, and they tend to develop it at younger
\nages. This risk increases with poor control of blood glucose, referred to as \u201cglycemic control.\u201d<\/p>\n

Best estimates indicate that over 75% of adults living with type 1 diabetes are not achieving optimal
\nglucose control.<\/p>\n

Most people with type 1 diabetes develop insulin resistance. Insulin resistance means that cells in
\nmultiple parts of the body, including the muscles, liver, heart, and brain, don\u2019t respond well to insulin.
\nThe vascular system takes a hit in diabetes, in part related to insulin resistance.<\/p>\n

We know that insulin resistance and poor vascular health are more common when people don\u2019t
\nexercise. We also know that blood sugar is harder to control under these conditions.<\/p>\n

Exercise is an extremely potent intervention for improving vascular health and blood glucose regulation.
\nSome, but not all, studies show that people with type 1 diabetes who exercise spend more time \u201cin
\nrange\u201d (ie at goal glucose levels) on days they exercise when compared to days they don\u2019t. So a person
\nwith type 1 diabetes could see a daily benefit of being an exerciser. But there are also important long
\nterm benefits of exercise\u2014exercise has been shown to decrease cardiovascular disease event rate, and
\nimprove all-cause mortality in type 1 diabetes.<\/p>\n

Unfortunately, people with type 1 diabetes are less likely to exercise than the general population.<\/p>\n

One of the questions this study will seek to answer is—what happens to vascular health and insulin
\nresistance if a person with type 1 diabetes does begin an exercise program? And sticks to it? What
\nhappens to blood glucose control?<\/p>\n

It will also examine these same questions in individuals who are prescribed a medication called
\ndulaglutide. Dulaglutide also potentially has positive effects on insulin resistance and the vascular
\nsystem. Perhaps it could be cardioprotective in type 1 diabetes?<\/p>\n

Thus, the overarching goals of this study are to better understand how and in what ways exercise or this
\nmedication might help people with type 1 diabetes.<\/p>\n

Another goal is to better understand the barriers people with type 1 diabetes face when beginning or
\nsticking with an exercise program.<\/p>\n

Questions and Answers with Katie Love, MD, a UVA Endocrinologist and Principal Investigator for
\nHSR210198-Therapeutic Strategies for Microvascular Dysfunction in Type 1 Diabetes<\/p>\n

Question<\/strong>
\nWhy did you want to study this issue?<\/p>\n

Answer<\/strong>
\nI\u2019m an endocrinologist. But I\u2019m also someone living with type 1 diabetes. I was diagnosed at the age of 4.
\nSo in addition to the scientific interest, and the clinical interest in learning more to provide better care
\nfor my patients, I have a personal interest.<\/p>\n

There are a few studies that show that people with type 1 diabetes live longer, healthier lives if they
\nexercise. And that individuals with diabetes can better control blood sugar and reduce their risk of
\ncardiovascular disease if they exercise. But overall I\u2019ve been surprised by the lack of research—most of it
\nhas been in type 2 diabetes.<\/p>\n

People living with type 1 diabetes are at a much higher risk for cardiovascular disease than the general
\npopulation. It\u2019s the leading cause of death in type 1 diabetes. And we know the risk is highest when
\nglucose control is poor. Yet about 75% of adults with type 1 diabetes are not meeting goals for glucose
\ncontrol.<\/p>\n

We know that poor glucose control increases the incidence of diabetes complications, and results in an
\nunhealthy vascular system. We know that type 1 diabetics develop something called insulin resistance,
\nand that insulin resistance predicts many of the complications we see in diabetes, including
\ncardiovascular disease. Exercise and certain medications have both been shown to improve insulin
\nresistance and cardiovascular disease in type 2 diabetes. The hope is that this will be similar in type 1
\ndiabetes.<\/p>\n

We think we can improve vascular health and reduce risk of cardiovascular disease and other diabetesrelated complications with exercise, and perhaps also with a certain class of drugs called glucagon-likepeptide-1-receptor agonists (GLP-1 RA\u2019s). This study will examine both (as well as placebo) by doing a
\nvariety of tests at baseline and again after 14 weeks of intervention. In addition, we\u2019ll do a number of
\nsurveys to get a sense of what people\u2019s barriers to exercise are. We\u2019ll also do these 3 months after the
\nstudy has ended, as we are very interested in who continues to exercise and who doesn\u2019t and why.<\/p>\n

Question<\/strong>
\nSo what do you think is the real-life application of your study?<\/p>\n

Answer<\/strong>
\nI think research like this ultimately helps us provide better care for our patients. It drives us to do more
\nresearch—to better understand the mechanisms involved, which can allow us to develop better
\ntherapies to prevent the cardiovascular conditions so common in type 1 diabetes.
\nI think the surveys we are doing will also be very important. As health care clinicians we sometimes
\nassume we know why people don\u2019t exercise, but we\u2019re not always correct. For example, most clinicians
\nthink people with type 1 diabetes exercise less than the non-diabetic population because of fear of
\nhypoglycemia. But some small surveys have not borne that out. It appears that people with type 1
\ndiabetes don\u2019t exercise enough for the same reasons as most people- things like time and motivation.
\nWe\u2019re hoping to gain more insight into that question with this study—particularly because we\u2019ll track
\ntheir exercise during the study period and after it has ended.<\/p>\n

Question<\/strong>
\nCan you describe the basics of the study procedure?<\/p>\n

Answer<\/strong>
\nWe are recruiting people with type 1 diabetes between the ages of 18 and 40 who are not regular
\nexercisers but are otherwise healthy. Enrolled subjects will be randomized to one of three groups—
\nexercise, medication, or placebo. The exercise intervention is 14 weeks of supervised high intensity
\ninterval training on a stationary bike. We chose high intensity interval training because previous studies
\nhave shown it is more effective while also being less likely to cause hypoglycemia. The medication and
\nplacebo groups will receive weekly injections.
\nWe\u2019ll do a variety of tests on the subjects at baseline and repeat these 14 weeks later after they\u2019ve been
\nexercising or taking the medication\/placebo. We\u2019ll measure fitness with a VO2 peak test; body
\ncomposition with a Bod Pod, and we\u2019ll do a number of different labs. Some labs are specific to diabetes,
\nsuch as tests to determine how well the pancreas is working (C-peptide level and blood sugar control),
\nand others are related to cardiovascular risk and overall health. Subjects will wear a continuous glucose
\nmonitor for 10 days at the beginning of the study and again at the end—this provides information about
\nglycemic variability. We\u2019ll do a test called an insulin clamp which allows us to measure insulin sensitivity.
\nWe\u2019ll study blood flow by performing ultrasounds of the heart and the leg muscles. We\u2019ll look at how
\nwell the vessels dilate and respond to insulin. And we\u2019ll look at the relationships between vascular
\nperfusion, fitness, insulin resistance, and glucose variability.
\nWe will get a lot of useful information from this study and we do share results with our subjects, so they
\nwill get a lot of useful information too. And for those randomized to the exercise program—well, 14
\nweeks of supervised exercise is a great jump start!
\nWhile catching up with Dr. Love we took the time to get a little personal too.<\/p>\n

Question<\/strong>
\nAre you an exerciser Dr. Love?<\/p>\n

Answer<\/strong>
\nI am! My parents pushed this my entire child hood as they believed in the health benefits. I spent my
\nchildhood dancing\u2014hip hop!\u2014and then became a runner in my teens. I ran all through high school,
\nmedical school, and residency—it was great stress relief. I\u2019m still a runner but now that I have 2 little
\nones in addition to being a Doc it is harder to make time. My husband and I try to support each other\u2019s
\nexercise and we\u2019ve purchased a home treadmill to make it easier. We try to do outdoorsy active things
\nwith our kids to set a good example.<\/p>\n

Question<\/strong>
\nWhat advice do you give your patients about exercise?<\/p>\n

Answer<\/strong>
\nI share that I have type 1 diabetes too\u2026and that for me too it can be challenging some days to fit it
\nin\u2026but that my glucose control is so much better regulated if I exercise every day. Exercise really allows
\nyou to live your best life. If there is one thing I would encourage everyone to do\u2014people with type 1
\ndiabetes or not– it would be exercise. There is not a drug I could give that would mean more to health.<\/p>\n

\"Katie<\/p>\n","protected":false},"excerpt":{"rendered":"

By Lisa Farr, M.Ed, Director, Exercise Physiology Core Lab Interview with: Katie Love, MD Type 1 diabetes occurs when the insulin-producing beta cells of the pancreas are damaged through an auto-immune process. This process happens in genetically susceptible individuals and is probably triggered by one or more environmental factors, such as viral infection. Over time, […]<\/p>\n","protected":false},"author":1673,"featured_media":0,"comment_status":"closed","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"inline_featured_image":false,"footnotes":"","_members_access_role":[],"_members_access_error":"","_links_to":"","_links_to_target":""},"categories":[4],"tags":[7],"class_list":["post-1563","post","type-post","status-publish","format-standard","hentry","category-news","tag-department-news"],"acf":false,"yoast_head":"\nBetter than Any Drug - Exercise Physiology Core Laboratory<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/med.virginia.edu\/exercise-physiology-core-laboratory\/2023\/03\/30\/better-than-any-drug\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Better than Any Drug - Exercise Physiology Core Laboratory\" \/>\n<meta property=\"og:description\" content=\"By Lisa Farr, M.Ed, Director, Exercise Physiology Core Lab Interview with: Katie Love, MD Type 1 diabetes occurs when the insulin-producing beta cells of the pancreas are damaged through an auto-immune process. This process happens in genetically susceptible individuals and is probably triggered by one or more environmental factors, such as viral infection. 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