Michielsen Matthijs, Bekhuis Youri, Claes Jomme, Decorte Elise, De Wilde Camille, Gojevic Tin, Costalunga Louise, Amyay Sara, Lazarou Varvara, Daraki Daphni, Kounalaki Eleftheria, Chatzinikolaou Panagiotis, Goetschalckx Kaatje, Hansen Dominique, Claessen Guido, De Craemer Marieke, Cornelissen Véronique
Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium.
Department of Rehabilitation Sciences, Ghent University, Gent, Belgium.
PLoS One. 2025 Sep 9;20(9):e0331737. doi: 10.1371/journal.pone.0331737. eCollection 2025.
This study investigates the mechanisms behind exercise capacity in adults with type 2 diabetes mellitus (T2DM), focusing on central and peripheral components, as described by the Fick equation.
A cross-sectional study of 141 adults with T2DM was conducted, using cardiopulmonary exercise testing, near-infrared spectroscopy (NIRS) and exercise echocardiography. Participants with sufficient-quality NIRS data were stratified into tertiles based on percentage predicted VO₂peak. Group comparisons and stepwise regression were used to examine the contributions of central and peripheral components to VO₂peak.
Sixty-seven participants had insufficient quality NIRS data. Those with lower-quality data were more likely to be female (p < 0.001) and had a lower exercise capacity (p < 0.001). Among participants with good-quality NIRS data, those in the lowest fitness tertile were older (p < 0.01), had a longer diabetes duration (p = 0.04), lower eGFR (p < 0.001) and more frequent use of beta-blockers (p = 0.02) and diuretics (p = 0.04). Significant differences were observed in peak cardiac output (p < 0.001) and NIRS-derived parameters across fitness groups. Multivariate regression identified cardiac output as the strongest predictor of VO₂peak, while peripheral oxygen extraction did not improve model performance.
Cardiac output is the primary determinant of exercise capacity in adults with T2DM. This suggests that muscle perfusion may be the main limiting factor in relatively fit individuals with T2DM. However, cardiac output and local muscle perfusion are not directly equivalent, as mechanical factors, such as intramuscular pressure during high-intensity exercise, may prevent maximal perfusion.
本研究调查2型糖尿病（T2DM）成年患者运动能力背后的机制，重点关注菲克方程所描述的中心和外周组成部分。
对141名T2DM成年患者进行了一项横断面研究，采用心肺运动试验、近红外光谱（NIRS）和运动超声心动图。根据预测的VO₂峰值百分比，将具有足够质量NIRS数据的参与者分层为三分位数。采用组间比较和逐步回归来检验中心和外周组成部分对VO₂峰值的贡献。
67名参与者的NIRS数据质量不足。数据质量较低的参与者更可能为女性（p<0.001），且运动能力较低（p<0.001）。在具有高质量NIRS数据的参与者中，体能最低三分位数的参与者年龄较大（p<0.01），糖尿病病程较长（p=0.04），估算肾小球滤过率（eGFR）较低（p<0.001），更频繁使用β受体阻滞剂（p=0.02）和利尿剂（p=0.04）。在各体能组之间，观察到峰值心输出量（p<0.001）和NIRS衍生参数存在显著差异。多变量回归确定心输出量是VO₂峰值的最强预测因子，而外周氧摄取并未改善模型性能。
心输出量是T2DM成年患者运动能力的主要决定因素。这表明肌肉灌注可能是相对健康的T2DM患者的主要限制因素。然而，心输出量和局部肌肉灌注并不直接等同，因为机械因素，如高强度运动期间的肌肉内压力，可能会阻止最大灌注。
