Frontiers in cardiovascular medicine · 2025
Type 2 diabetes mellitus' impact on heart failure patients' exercise tolerance: a focus on maximal fat oxidation during exercise.
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Zhu Huiying, Pan Jianchao, Wen Jianxuan, Dang Xiaojing, Chen Xiankun, Fan Yunxiang, Lu Weihui, Jiang Wei
Аннотация
OBJECTIVE: To explore the impact of type 2 diabetes mellitus (T2DM) on exercise tolerance and fat oxidation capacity in patients with heart failure (HF).
METHODS: We retrospectively analyzed 108 Chinese patients with HF who were divided into a diabetic group (T2DM group, n = 47) and a non-diabetic group (non-T2DM group, n = 61). All subjects completed cardiopulmonary exercise testing (CPX). We determined their fat oxidation (FATox) by indirect calorimetry.
RESULTS: In the HF patients, the peak oxygen uptake (VO2) value was 14.76 ± 3.27 ml/kg/min in the T2DM group and 17.76 ± 4.64 ml/kg/min in the non-T2DM group. After adjusting for age, sex, body mass index (BMI), log N-terminal pro-B type natriuretic peptide (log NT-proBNP), left ventricular ejection fraction (LVEF), hemoglobin, renal function, coronary heart disease and hypertension, the peak VO2 was lower in the T2DM group compared to the non-T2DM group with a mean difference (MD) of -2.0 ml/kg/min [95% confidence interval (CI), -3.18 to -0.82, P < 0.01]. The VO2 at anaerobic threshold (AT VO2) was also lower in the T2DM group than in the non-T2DM group, with a MD of -1.11 ml/kg/min (95% CI -2.04 to -0.18, P < 0.05). Regarding the fat oxidation capacity during CPX, the T2DM group's maximal fat oxidation (MFO) was lower than that of the non-T2DM group (0.143 ± 0.055 vs. 0.169 ± 0.061 g/min, P < 0.05). In addition, the T2DM group had lower FATox at exercise intensity levels of 40% (P < 0.05) and 50% (P < 0.05) of peak VO2, compared to the non-T2DM group.
CONCLUSIONS: T2DM is associated with a decrease in exercise tolerance and fat oxidation capacity in patients with heart failure. Thus, it could be useful to develop exercises of appropriate intensity to optimize physical and metabolic health.
METHODS: We retrospectively analyzed 108 Chinese patients with HF who were divided into a diabetic group (T2DM group, n = 47) and a non-diabetic group (non-T2DM group, n = 61). All subjects completed cardiopulmonary exercise testing (CPX). We determined their fat oxidation (FATox) by indirect calorimetry.
RESULTS: In the HF patients, the peak oxygen uptake (VO2) value was 14.76 ± 3.27 ml/kg/min in the T2DM group and 17.76 ± 4.64 ml/kg/min in the non-T2DM group. After adjusting for age, sex, body mass index (BMI), log N-terminal pro-B type natriuretic peptide (log NT-proBNP), left ventricular ejection fraction (LVEF), hemoglobin, renal function, coronary heart disease and hypertension, the peak VO2 was lower in the T2DM group compared to the non-T2DM group with a mean difference (MD) of -2.0 ml/kg/min [95% confidence interval (CI), -3.18 to -0.82, P < 0.01]. The VO2 at anaerobic threshold (AT VO2) was also lower in the T2DM group than in the non-T2DM group, with a MD of -1.11 ml/kg/min (95% CI -2.04 to -0.18, P < 0.05). Regarding the fat oxidation capacity during CPX, the T2DM group's maximal fat oxidation (MFO) was lower than that of the non-T2DM group (0.143 ± 0.055 vs. 0.169 ± 0.061 g/min, P < 0.05). In addition, the T2DM group had lower FATox at exercise intensity levels of 40% (P < 0.05) and 50% (P < 0.05) of peak VO2, compared to the non-T2DM group.
CONCLUSIONS: T2DM is associated with a decrease in exercise tolerance and fat oxidation capacity in patients with heart failure. Thus, it could be useful to develop exercises of appropriate intensity to optimize physical and metabolic health.