Original Article

Continuous, non-invasive measurement of the haemodynamic response to submaximal exercise in patients with diabetes mellitus. Evidence of impaired cardiac reserve and peripheral vascular response

Deepa Joshi¹, Ajay Shiwalkar¹, Maurice Cross², Sanjay Sharma³, Ashish vachhani¹, Chaitanya Dutt^1,*

¹ Torrent Research Centre, India;
² Veeda, UK, India;
³ Veeda, India, United Kingdom

Correspondence to: Chaitanya Dutt, Torrent, Bhat, Gandhinagar, 382424, India; cdutt{at}torrentpharma.com

Accepted 29 September 2009

Background: Reduced exercise capacity in diabetics has been attributed to limitations in cardiac function and microvascular dysfunction leading to impaired supply and nutritive perfusion to exercising muscles.

Objective: To study changes in cardiac function, and microvascular utilization during exercise, in diabetic individuals compared to age-matched controls.

Methods: Diabetics with HbA1c<8 (n=31), diabetics with HbA1c>=8 (n=38), and age-matched non diabetic controls (n=32) performed exercise at 50W for 10 minutes followed by recovery, with continuous monitoring of cardiac function by impedance cardiography and regional flow and oxygen saturation by laser Doppler and white light spectroscopy.

Results: In the diabetics, cardiac reserve during exercise and cardiac overshoot during recovery are significantly reduced due to reduction in capacity to increase stroke volume. Regional flow to the exercising muscle is reduced and there is disproportionately greater desaturation of the regional flow as well. Abnormalities in cardiac function and regional perfusion are related to the severity of diabetes.

Conclusion: This study shows that cardiac response to exercise is attenuated significantly in diabetic individuals. Simultaneously, there is impairment in the regional distribution. These changes could be the harbinger of reduced exercise capacity in diabetics.

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