Impact of cardiovascular autonomic neuropathy on cardiopulmonary, sympathoadrenal and metabolic responses to physical exercise in adults with type 1 diabetes – Published online 09/12/2025

Olivia M. McCarthy, Rasmus B. Brødsgaard, Sandra Tawfik, Sissel Banner Lundemose, Emilie B. Lindkvist, Sara H. Naaman, Christian Stevns Hansen, Richard M. Bracken, Kirsten Nørgaard

Despite the recognised value of cardiorespiratory fitness as a barometer of cardiovascular health, its integration in clinical practice for those with type 1 diabetes, particularly with known cardiovascular complications like cardiovascular autonomic neuropathy (CAN), is limited. The lack of information on this patient cohort makes it difficult to generalise prudent exercise prescription that takes into account their pathophysiological characteristics. To address this gap, in this issue, McCarthy et al (https://doi.org/10.1007/s00125-025-06619-9) present a comprehensive insight into the physiological responses to graded exercise in adults with type 1 diabetes with the concomitant condition of CAN compared with an age- and sex-matched cohort without CAN. The data highlight functional deficits in various physiological parameters in adults with type 1 diabetes superimposed with CAN, reinforcing the prognostic value of exercise testing to quantify the magnitude of exercise intolerance in already ‘at risk’ cohorts. The authors conclude that, from a clinical perspective, CAN may represent an additional factor that contributes to reduced exercise capacity in individuals with type 1 diabetes, and should therefore be considered when developing personalised physical training plans.

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