Exercise Responses in Patients With IDDM
- Anne-Marie Nugent, MD, MRCP,
- Ian C Steele, MD, MRCP,
- Firas Al-Modaris, MB, MRCP,
- Stephen Vallely, MD,
- Ann Moore, MD, MRCP,
- Norman P S Campbell, MD, FRCP,
- Patrick M Bell, MD, FRCP,
- Keith D Buchanan, MD, FRCP,
- Elisabeth R Trimble, MD, FRCP, FRCPATH and
- D Paul Nicholls, MD, FRCP, FESC
- Department of Medicine, Royal Victoria Hospital Belfast, Northern Ireland, U.K.
- Regional Medical Cardiology Centre, Royal Victoria Hospital Belfast, Northern Ireland, U.K.
- Sir George E. Clark Metabolic Unit, Royal Victoria Hospital Belfast, Northern Ireland, U.K.
- Department of Clinical Biochemistry, Royal Victoria Hospital Belfast, Northern Ireland, U.K.
- Address correspondence and reprint requests to D.P Nicholls, the Department of Medicine, Royal Victoria Hospital, Belfast BT12 6BA, Northern Ireland, U.K.
Abstract
OBJECTIVE The hemodynamic, respiratory, and metabolic responses to exercise were studied in IDDM patients and control subjects to detect diabetic cardiomyopathy.
RESEARCH DESIGN AND METHODS Eight subjects aged 25–40 years with diabetes of at least 10 years' duration were compared with eight control subjects aged 21–46 years. All subjects underwent a progressive incremental bicycle exercise test with measurement of gas exchange, blood glucose, lactate, fat metabolite, and catecholamine levels and two steady-state exercise tests with measurement of cardiac output by a CO2 rebreathing method. A new first-pass radionuclide method was used to measure cardiac ejection fractions (EFs) at rest, peak exercise, and steady-state exercise.
RESULTS The peak achieved oxygen consumption was similar in the diabetic and control subjects (29.9 [25.1–34.6] and 31.4 [26.9–35.9] ml . min−1 . kg−1, respectively; mean [95% CI]). There were no significant differences in heart rate, double product, ventilation, respiratory exchange ratio, or ventilatory equivalents for oxygen and CO2 during the incremental test. Glucose levels were higher in the diabetic subjects, but there were no significant differences in levels of lactate, catecholamines, free fatty acids, glycerol, or β-hydroxybutyrate. Left ventricular EF fell from rest to peak exercise within the diabetic group (66.0% [59.6–72.4] at rest; 53.6% [45.6–61.6] at peak; P < 0.05) but this did not differ significantly from the control group (58.7% [52.3–65.1] at rest; 60.3% [48.9–71.7] at peak). Right ventricular EFs were similar in each group, and there was no reduction in peak filling rate to suggest diastolic dysfunction. The cardiac output responses to exercise were also similar in the two groups.
CONCLUSIONS There is no evidence of impairment of the exercise response in subjects with long-standing diabetes, and the apparent fall in left ventricular EF at peak exercise could be related to hemodynamic adaptation.
- Received January 23, 1997.
- Revision received May 23, 1997.
- Accepted May 23, 1997.
- Copyright © 1997 by the American Diabetes Association
