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TableĀ 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