Exercise Intolerance in Type 2 Diabetes: A Systematic Review and Meta-Analysis
Kara C Anderson1, Nathan R Weeldreyer2, Zachary S Leicht2
1Division of Endocrinology and Metabolism, Department of Medicine University of Virginia Health System Charlottesville VA.
Journal of the American Heart Association
|March 3, 2025
Summary
Type 2 diabetes (T2D) significantly reduces cardiorespiratory fitness, impacting exercise capacity. Early markers of cardiac function and time since diagnosis may explain this exercise intolerance in T2D patients.
Area of Science:
- Cardiology
- Endocrinology
- Exercise Physiology
Background:
- Type 2 diabetes (T2D) is a growing global health concern.
- Cardiorespiratory fitness is a key indicator of overall health and predictor of mortality.
- The impact of T2D on cardiorespiratory fitness requires further investigation.
Purpose of the Study:
- To analyze the effect of type 2 diabetes (T2D) on cardiorespiratory fitness.
- To identify factors that may influence exercise intolerance in individuals with T2D.
Main Methods:
- Pooled analysis of existing data using a multilevel model.
- Inclusion criteria: adults >18 years, diagnosed T2D vs. control without insulin resistance, reported peak oxygen uptake, no prior exercise training, and absence of major comorbidities.
- Moderators assessed included demographics and cardiovascular outcomes.
Main Results:
- Both absolute and relative peak oxygen uptake were significantly reduced in the T2D group compared to controls.
- Time since T2D diagnosis moderated absolute peak oxygen uptake.
- Cardiac diastolic function markers (early mitral inflow velocity/early mitral annulus velocity and left atrial volume index) significantly moderated relative peak oxygen uptake.
Conclusions:
- Reduced cardiorespiratory fitness in T2D is associated with cardiac diastolic dysfunction and time since diagnosis.
- These findings highlight potential contributors to exercise intolerance in T2D.
- Further research is needed in diverse age groups and newly diagnosed individuals to fully understand T2D's impact on fitness.
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