University Hospital "Dr. Dragisa Misovic - Dedinje" Department of Cardiology, Heroja Milana Tepica 1, Belgrade, 11000, Serbia.
University of Milan-Bicocca, Milan, Italy.
Heart Fail Rev. 2021 Mar;26(2):301-308. doi: 10.1007/s10741-020-10015-3.
Functional capacity represents an important predictor for cardiovascular and all-cause mortality in patients with diabetes mellitus (DM). Impaired cardiopulmonary fitness is frequently seen in DM patients, and it might partly explain morbidity and mortality in these patients. There are several potential reasons that could explain impaired functional capacity in DM patients: hyperglycemia, insulin resistance, endothelial dysfunction, inflammation, microvascular impairment, myocardial dysfunction, and skeletal muscle changes. These changes are partly reversible, and improvement of any of these components might increase functional capacity in DM patients and improve their outcome. Physical activity is related with decreased cardiovascular disease and all-cause mortality in patients with type 2 DM. Diabetic cardiomyopathy is the most important clinical entity in DM patients that involves left ventricular diastolic dysfunction and cardiac autonomic neuropathy, which potentially induce heart failure with preserved ejection fraction. Development of diabetic cardiomyopathy may slow oxygen uptake kinetics and affect the cardiorespiratory fitness in DM patients, but it can also induce development of heart failure. Improvement of functional capacity in DM patients represents an important therapeutic task, and it can be achieved mainly with exercise training and significantly less with pharmacological treatment. Exercise training reduces body weight and improves glycemic control, as well as left ventricular structure and function. The aim of this review was to summarize current knowledge about importance of functional capacity in DM patients, as well as possible mechanisms that could explain the relationship between DM and oxygen kinetics.
功能能力是糖尿病（DM）患者心血管和全因死亡率的重要预测指标。DM 患者常伴有心肺功能受损，这可能部分解释了这些患者的发病率和死亡率。有几个潜在的原因可以解释 DM 患者的功能能力受损：高血糖、胰岛素抵抗、内皮功能障碍、炎症、微血管损伤、心肌功能障碍和骨骼肌变化。这些变化部分是可逆的，改善任何这些成分都可能增加 DM 患者的功能能力并改善其预后。身体活动与 2 型 DM 患者心血管疾病和全因死亡率降低有关。糖尿病性心肌病是 DM 患者最重要的临床实体，涉及左心室舒张功能障碍和心脏自主神经病变，这可能导致射血分数保留的心力衰竭。糖尿病性心肌病的发展可能会减缓摄氧量动力学，并影响 DM 患者的心肺功能适应性，但它也可能导致心力衰竭的发展。改善 DM 患者的功能能力是一项重要的治疗任务，主要可以通过运动训练来实现，而药物治疗的效果则要小得多。运动训练可减轻体重，改善血糖控制，以及左心室结构和功能。本文综述的目的是总结目前关于 DM 患者功能能力重要性的知识，以及可能解释 DM 与氧动力学之间关系的机制。
