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Table 2 Physiological meaning of the alterations observed in type 2 diabetes, and clinical usefulness of various cardiopulmonary exercise test indices in the management of diabetic patients

From: Type 2 diabetes and reduced exercise tolerance: a review of the literature through an integrated physiology approach

CPET variable

Alterations seen in T2D

Pathophysiologic mechanisms

Clinical value

Heart rate kinetics

Chronotropic insufficiency, Attenuated heart rate recovery

Autonomic neuropathy

Prognostic

Exercise ECG

Eventual inducible ischemia

Epicardial vessel disease

Screening

Exercise capacity

Reduced

Physical deconditioning?

Unknown

Peak oxygen uptake (VO2max)

Reduced

Primary myocardial impairment

Prognostic

Oxygen kinetics

Slower

Primary myocardial impairment

Unknown

Oxygen pulse (VO2/HR)

Reduced

Primary myocardial impairment

Prognostic

Ventilatoy response (VE/VCO2)

Augmented

Primary ventilatory impairment

Unknown

Peripheral oxygen extraction (a-v O2)

Reduced

Skeletal muscle microcirculation impairment

Unknown

Anaerobic threshold (AT)

Unaltered, even in the presence of autonomic dysfunction

Aerobic/anaerobic metabolism

Unknown

VO2 at the anaerobic threshold (AT)

Possibly reduced

Unknown

Unknown