Characteristics of cardiopulmonary function during exercise in type 2 diabetes patients with obesity

doi:10.3877/cma.j.issn.2095-9605.2022.01.005

Abstract

Abstract:

Objective

To investigate the characteristics of cardiopulmonary function during exercise in patients with type 2 diabetes mellitus (T2DM) and obesity by cardiopulmonary exercise test (CPET).

Methods

Retrospectively analyze patients with T2DM who underwent CPET in Tianjin Third Central Hospital from June 2020 to March 2021. A total of 124 subjects were divided into non-obese group (group A, BMI<28 kg/m², n=60) and obese group (group B, BMI≥28 kg/m², n=64) by body mass index (BMI). Independent sample T test and chi-square test were used to compare the differences of baseline and cardiopulmonary indexes between the two groups.Hierarchical analysis was used to adjust the effects of age on peak oxygen uptake (VO_2peak/kg).

Results

Baseline: The age of group B was lower than that of group A (P<0.01). Metabolic/cardiovascular indicators: There was no statistical difference in age-adjusted VO_2peak/kg between obese and non-obese patients. The percentage of predicted VO_2peak/kg in group B was lower than that in group A (P<0.01). The oxygen uptake at anaerobic threshold (AT) in group B was higher (P<0.01) while the VO_2peak/kg at AT was lower (P<0.05), and the percentage of predicted oxygen pulse was higher than that in group A (P<0.05). No obvious differences in gas exchange indexes were found between the two groups. Ventilation function indicators: The maximum minute ventilation (VE_max) and the percentage of predicted VE_max in group B were higher than those in group A (P<0.01), while the respiratory reserve, ratio of physiological dead space to tidal volume VD/VT_rest , %VD/VT_rest , VD/VT_peak , %VD/VT_peak were lower than those in group A (P<0.01).

Conclusions

T2DM patients will experience a relative decline in cardiopulmonary fitness compared to themselves before the absolute decline, and this relative decline was more obvious in obese individuals than in non-obese individuals. During exercise, obese patients need to first use the breathing reserve and to reduce ineffective cavity ventilation to increase ventilation, thereby increasing oxygen uptake in order to maintain their cardiopulmonary fitness.

Key words: Type 2 diabetes mellitus, Obesity, Exercise, Cardiopulmonary function

Ling Yang, Hongyan Yu, Jie Zhang, Guoyu Jia, Ying Li, Fusheng Di. Characteristics of cardiopulmonary function during exercise in type 2 diabetes patients with obesity[J]. Chinese Journal of Obesity and Metabolic Diseases(Electronic Edition), 2022, 08(01): 30-35.

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References 19

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指标		A组（非肥胖n=60）	B组（肥胖n=64）	P值
临床指标
	性别^*（男/女）	41/19	47/17	0.531
	吸烟史^*（有/无）	35/25	42/22	0.403
	高血压史^*（有/无）	40/20	46/18	0.530
	年龄（岁）	50.75±12.27	42.77±11.95	0.000
	BMI（kg/m²）	24.97±2.16	31.41±3.17	0.000
	血红蛋白（g/L）	147.72±18.68	148.20±13.91	0.874
生化指标
	LDL-C（mmol/L）	2.94±0.97	2.84±0.79	0.547
	HOMA-IR	5.57±7.56	5.74±5.12	0.887
	HbA1c（%）	8.66±2.29	8.08±2.14	0.165
心脏结构及功能指标
	LVMI（g/m²）	88.74±19.43	91.93±17.72	0.341
	LVEF（%）	59.28±1.80	59.16±1.73	0.690
	E/A	0.95±0.31	1.01±0.29	0.242
静态肺功能指标
	FVC（L）	3.22±0.89	3.49±0.80	0.074
	%FVC	84.58±14.86	83.64±12.67	0.704
	FEV1（L）	2.75±0.73	3.00±0.71	0.056
	%FEV1	87.93±13.62	86.52±12.63	0.553
	MVV（L）	107.37±31.01	112.75±28.74	0.320
	%MVV	103.88±22.70	97.87±20.12	0.122

指标		A组（非肥胖n=60）	B组（肥胖n=64）	P值
临床指标
	性别^*（男/女）	41/19	47/17	0.531
	吸烟史^*（有/无）	35/25	42/22	0.403
	高血压史^*（有/无）	40/20	46/18	0.530
	年龄（岁）	50.75±12.27	42.77±11.95	0.000
	BMI（kg/m²）	24.97±2.16	31.41±3.17	0.000
	血红蛋白（g/L）	147.72±18.68	148.20±13.91	0.874
生化指标
	LDL-C（mmol/L）	2.94±0.97	2.84±0.79	0.547
	HOMA-IR	5.57±7.56	5.74±5.12	0.887
	HbA1c（%）	8.66±2.29	8.08±2.14	0.165
心脏结构及功能指标
	LVMI（g/m²）	88.74±19.43	91.93±17.72	0.341
	LVEF（%）	59.28±1.80	59.16±1.73	0.690
	E/A	0.95±0.31	1.01±0.29	0.242
静态肺功能指标
	FVC（L）	3.22±0.89	3.49±0.80	0.074
	%FVC	84.58±14.86	83.64±12.67	0.704
	FEV1（L）	2.75±0.73	3.00±0.71	0.056
	%FEV1	87.93±13.62	86.52±12.63	0.553
	MVV（L）	107.37±31.01	112.75±28.74	0.320
	%MVV	103.88±22.70	97.87±20.12	0.122

指标		A组（非肥胖n=60）	B组（肥胖n=64）	P值
代谢/心血管指标
	VO_2peak [mL/(kg·min)]	23.15±5.95	22.81±5.87	0.745
	% VO_2peak	75.13±19.11	65.17±18.29	0.004
	O₂ pulse（mL/beat）	13.57±11.67	24.63±6.38	0.411
	% O₂ pulse	95.3±28.34	109.78±32.19	0.011
	AT % of VO_2max	42.42±8.62	45.11±11.14	0.137
	AT（L/min）	1.00±0.24	1.17±0.28	0.000
	VO₂/kg@AT [mL/(kg·min)]	13.96±2.88	12.76±2.78	0.020
	HRR（%）	28.38±12.60	30.94±16.57	0.338
	HR/VO₂ [bpm/(kg·min)]	2.96±0.72	3.10±0.92	0.364
气体交换指标
	VE/VO₂ slope	20.65±3.93	20.85±5.80	0.823
	VE/VCO₂ slope	25.90±3.09	26.13±2.64	0.661
	PetO₂@AT mmHg	104.92±5.36	103.22±4.49	0.078
	PetCO₂@AT mmHg	40.09±3.86	39.89±3.33	0.772
	VE/VO₂@AT	27.98±3.99	26.66±2.90	0.052
	VE/VCO₂@AT	31.35±3.50	30.91±3.03	0.487
通气功能指标
	VE_max [L/(kg·min)]	0.81±0.22	0.77±0.17	0.190
	% VE_max	60.20±14.95	68.02±13.88	0.003
	BR（%）	43.45±16.24	35.36±16.94	0.008
	VD/VT_rest	0.33±0.06	0.29±0.06	0.001
	% VD/VT_rest	109.77±21.33	96.67±20.47	0.001
	VD/VT_peak	0.18±0.04	0.15±0.05	0.009
	% VD/VT_peak	97.77±23.92	85.80±25.62	0.008
其他指标：
	Work（watts/kg）	1.64±0.46	1.52±0.31	0.097
	VO₂/Work [mL/(kg·watt)]	9.46±1.63	9.97±1.63	0.088
	MET_peak	5.71±1.49	5.70±1.12	0.967
	SPO_2peak（%）	96.30±1.95	96.13±2.09	0.642

指标		A组（非肥胖n=60）	B组（肥胖n=64）	P值
代谢/心血管指标
	VO_2peak [mL/(kg·min)]	23.15±5.95	22.81±5.87	0.745
	% VO_2peak	75.13±19.11	65.17±18.29	0.004
	O₂ pulse（mL/beat）	13.57±11.67	24.63±6.38	0.411
	% O₂ pulse	95.3±28.34	109.78±32.19	0.011
	AT % of VO_2max	42.42±8.62	45.11±11.14	0.137
	AT（L/min）	1.00±0.24	1.17±0.28	0.000
	VO₂/kg@AT [mL/(kg·min)]	13.96±2.88	12.76±2.78	0.020
	HRR（%）	28.38±12.60	30.94±16.57	0.338
	HR/VO₂ [bpm/(kg·min)]	2.96±0.72	3.10±0.92	0.364
气体交换指标
	VE/VO₂ slope	20.65±3.93	20.85±5.80	0.823
	VE/VCO₂ slope	25.90±3.09	26.13±2.64	0.661
	PetO₂@AT mmHg	104.92±5.36	103.22±4.49	0.078
	PetCO₂@AT mmHg	40.09±3.86	39.89±3.33	0.772
	VE/VO₂@AT	27.98±3.99	26.66±2.90	0.052
	VE/VCO₂@AT	31.35±3.50	30.91±3.03	0.487
通气功能指标
	VE_max [L/(kg·min)]	0.81±0.22	0.77±0.17	0.190
	% VE_max	60.20±14.95	68.02±13.88	0.003
	BR（%）	43.45±16.24	35.36±16.94	0.008
	VD/VT_rest	0.33±0.06	0.29±0.06	0.001
	% VD/VT_rest	109.77±21.33	96.67±20.47	0.001
	VD/VT_peak	0.18±0.04	0.15±0.05	0.009
	% VD/VT_peak	97.77±23.92	85.80±25.62	0.008
其他指标：
	Work（watts/kg）	1.64±0.46	1.52±0.31	0.097
	VO₂/Work [mL/(kg·watt)]	9.46±1.63	9.97±1.63	0.088
	MET_peak	5.71±1.49	5.70±1.12	0.967
	SPO_2peak（%）	96.30±1.95	96.13±2.09	0.642

指标	A1组（n=17）	B1组（n=40）	P值	A2组（n=43）	B2组（n=24）	P值
年龄（岁）	34.35±7.41	34.90±5.43	0.757	57.23±6.23	55.87±7.36	0.426
VO_2peak/kg [mL/(kg·min)]	26.68±6.84	23.78±4.96	0.077	21.75±4.99	21.18±6.94	0.697

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