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The metabolome as a diagnostic for maximal aerobic capacity during exercise in type 1 diabetes – published online 25/04/2024

Taylor graphical abstract

Guy S. Taylor, Kieran Smith, Jadine Scragg, Timothy J. McDonald, James A. Shaw, Daniel J. West, Lee D. Roberts

Despite the health benefits of exercise, uptake in people with type 1 diabetes is lower than in the general population, in part due to the heterogeneous metabolic responses to exercise that can lead to hypoglycaemia. Metabolomics measures the metabolites in a biofluid or tissue and is used in precision medicine to understand an individual’s molecular phenotype in response to disease. In this issue, Taylor et al (https://doi.org/10.1007/s00125-024-06153-0) use metabolomics to identify a unique metabolic response to aerobic exercise in the blood of individuals with type 1 diabetes. The authors show that this response differed depending on whether an individual’s beta cells retained the capacity to produce insulin. Two metabolites in blood, malic acid and pyruvate, were found to reciprocally correlate with VO2peak, a metric of aerobic capacity in exercise, in individuals with type 1 diabetes. The authors conclude that the ratio of malic acid to pyruvate, key metabolites in cellular energy production, may have diagnostic potential in identifying people with type 1 diabetes with low aerobic capacity in exercise.

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