Metabolic changers in oxygen transport in patients with diabetes mellitus type 2. Possibilities for correction

Diabetes mellitus type 2 (DM2) - is an independent predictor of development of heart failure (HF). Spiroergometry - is a method for studying blood gas exchange parameters, commonly used for specification of HF. The purpose: 1. To study features of gas exchange at patients with DM2 without cardiovascular diseases in comparison with healthy control. 2. To estimate efficiency of metoprolol for correction of metabolic disturbances in patients with DM2. Materials and methods: 12 patients with DM2, aged 48,4±8, without history of cardiovascular diseases and 15 control subjects, aged 43,6±8 underwent cardio-pulmonary exercise test on treadmill, according to Bruce protocol. Exercise energy, VO2 peak, MET, VE max, VCO2 production were observed. Results: Patients with DM2 had a reduced exercise duration (p<0,001), lower peak oxygen consumption (p<0,001), VCO2 production and MET (p<0,005), than controls, representing the same state of hypoxia as in patients with ischemic heart disease (IHD) of functional class 2. The introduction of metoprolol to patients with DM2 significantly increased exercise duration time and VCO2 production (p<0,005). Conclusions: 1. VO2 consumption in patients with DM2 is decreased to the same levels as in persons without DM2, who have IHD and HF. 2. Changes in oxygen-transport in persons with DM2 may serve as a marker of negative influence of the disease on cardiovascular system status. 3. Metoprolol improves parameters of cardio-respiratory system in patients with DM2.

diabetes mellitus, spiroergometry, oxygen-transport system, cardio-respiratory system, metoprolol

1. Аронов Д.М., Лупанов В.П., Шарфнадель М.Г. Классиикация функционального состояния больных ишемической болезнью сердца по результатам пробы с физической нагрузкой // Tер. арх. - 1980. - №1. - С. 73-80.

2. Аронов Д.М., В.П. Лупанов В.М. Функциональные пробы в кардиологии. - М.: МЕДпресс-информ, 2002. - 296 с.

3. Национальные Рекомендации ВНОК и ОССН по диагностике и лечению ХСН (второй пересмотр). Сердечная недостаточность, том 8, № 2; www.OSSN.ru &lt;http://www.OSSN.ru&gt;

4. Amit S. Tibb, Pierre V. Ennezat Diabetes Lowers Aerobic Capacity in Heart Failure J of the American College of Cardiology, Vol. 46, No. 5, 2005.

5. Вaldi J.C., Aoina J.L., Oxenham H.C., Bagg W., Doughty R.N. Reduced exercise arteriovenous O2 difference in Type 2 diabetes. J Appl Physiol 2003; 94: 1033-1038.

6. Barstow T.J., Mole P.A. Linear and nonlinear characteristics of oxygen uptake kinetics during heavy exercise. J. Appl. Physiol. 1991; 71: 2099-2106.

7. Guidelines on diabetes, pre-diadetes, and cardiovascular diseases / ESC and EASD Guidelines // European Heart Jornal, 1997.

8. Hayat S.A., Patel B., Khattar R.S. and Malik R.A. Diabetic cardiomyopathy: mechanisms and treatment. Clin Sci (Lond) 107: 539-557, 2004.

9. Karlsson J. Muscle exercise, energy metabolism and blood lactate. In: Adv. Cardiol., 1986, 35, p.35-46, Basel.

10. Laukkanen J.A., Kurl S., Lakka T.A., Tuomainen T.P., Rauramaa R., Salonen R., Erдnen J., Salonen J.T. Exercise-induced silent myocardial ischemia and coronary morbidity and mortality in middle-aged men. J Am Coll Cardiol. 2001 Jul; 38(1): 72-9.

11. McVeigh G.E., Brennan G.M., Johnston G.D., McDermott B.J., McGrath L.T., Henry W.R., Andrews J.W., Hayes J.R. Impaired endothelium-dependent and -independent vasodilation in patients with type 2 (non-insulin-dependent) diabetes mellitus. Diabetologia 1992;35: 771-776.

12. Oxenham H.C., Bagg W., Doughty R.N. Reduced exercise arteriovenous O2 difference in Type 2 diabetes. J Appl Physiol 2003; 94: 1033-1038.

13. Piergiuseppe Agostoni, Caia Cattadozi, Maurizio Busstotti. Cardiopulmonary interaction in heart failure. Pulmonary Pharmacology&amp;Therapeutics 20 (2007): 130-134.

14. Poirier P., Bogaty P., Garneau C., Marois L., and Dumesnil J.G. Diastolic dysfunction in normotensive men with well-controlled type 2 diabetes. Diabetes Care 2001; 24: 5-10.

15. Rao S.V., McGuire D.K., Epidemiology of diabetes mellitus and cardiovascular disease. In: Marso S.P., Stern D.M., eds. Diabetes and Cardiovascular Disease: Integrating Sciense and Clinical Medicine. Philadelphia, Pa: Lippincott Williams &amp; Wilkins; 2004: 164-165.

16. Regensteiner J.G., Sippel J., McFarling E.T., Wolfel E.E., Hiatt W.R. Effects of non-insulin-dependent diabetes on oxygen consumption during treadmill exercise. Med Sci Sports Exerc 1995;27: 661-667.

17. Tantucci C., Bottini P., Dottorini M. L., Puxeddu E., Casucci G., Scionti L., Sorbini C. A. Ventilatory response to exercise in diabetic subjects with autonomic neuropathy. J Appl Physiol 1996; 81: 1978-1986.

18. Vanninen E., Uusitupa M., Remes J., Siitonen O., Laitinen J., Ubnsimies E., Relationship between hyperglycaemia and aerobic power in men with newly diagnosed type 2 (non insulin-dependent) diabetes. Clin Physiol. 1992 Nov; 12(6): 667-77.

19. Weber K. T. Concept and applications of cardiopulmonary exercise testing. Chest. 1988. Vol. 93. N.4 - P.843-847.

20. Weber K. T. Concept from exercise testing beyond the detection of myicardial ischemia?. Clin. Cardiol. 1997. V. 20. P. 684-696.

21. Witte K.K.A., Thackray S.D.R., Nikitin N.P., Cleland J.G.F., Clark A.L. The effects of (alpha) and (beta) blockade on ventilatory responses to exercise in chronic heart failure. Heart, oct. 2003, p. 123-128.