scholarly journals Cerebral vs. Cardiovascular Responses to Exercise in Type 2 Diabetic Patients

2021 ◽  
Vol 11 ◽  
Author(s):  
Yu-Sok Kim ◽  
Björn J. P. van der Ster ◽  
Patrice Brassard ◽  
Niels H. Secher ◽  
Johannes J. van Lieshout
Keyword(s):  
Cardiac Output ◽  
Cerebral Oxygenation ◽  
Central Fatigue ◽  
Cardiovascular Responses ◽  
Exhaustive Exercise ◽  
Diabetic Patients ◽  
Type 2 Diabetic Patients ◽  
The Brain ◽  
Type 2 Diabetic

The human brain is constantly active and even small limitations to cerebral blood flow (CBF) may be critical for preserving oxygen and substrate supply, e.g., during exercise and hypoxia. Exhaustive exercise evokes a competition for the supply of oxygenated blood between the brain and the working muscles, and inability to increase cardiac output sufficiently during exercise may jeopardize cerebral perfusion of relevance for diabetic patients. The challenge in diabetes care is to optimize metabolic control to slow progression of vascular disease, but likely because of a limited ability to increase cardiac output, these patients perceive aerobic exercise to be more strenuous than healthy subjects and that limits the possibility to apply physical activity as a preventive lifestyle intervention. In this review, we consider the effects of functional activation by exercise on the brain and how it contributes to understanding the control of CBF with the limited exercise tolerance experienced by type 2 diabetic patients. Whether a decline in cerebral oxygenation and thereby reduced neural drive to working muscles plays a role for “central” fatigue during exhaustive exercise is addressed in relation to brain’s attenuated vascular response to exercise in type 2 diabetic subjects.

scholarly journals Nitric oxide modulation of renal and cardiac hemodynamics in type 2 diabetes

2002 ◽  
pp. 687-694 ◽  
Author(s):  
M Dalla Vestra ◽  
D Sacerdoti ◽  
G Bombonato ◽  
P Fioretto ◽  
G Finucci ◽  
...  
Keyword(s):  
Nitric Oxide ◽  
Type 2 Diabetes ◽  
Cardiac Output ◽  
Diabetic Nephropathy ◽  
Renal Plasma Flow ◽  
Diabetic Patients ◽  
Type 2 Diabetic Patients ◽  
Control Subjects ◽  
Type 2 Diabetic

OBJECTIVE: To evaluate endothelial function in type 2 diabetic patients with and without diabetic nephropathy. METHODS: We studied the effects of systemic infusion of the nitric oxide (NO) synthase inhibitor NG-monomethyl-l-arginine (L-NMMA) on cardiovascular and renal hemodynamics in six type 2 diabetic patients with microalbuminuria (D2-MA), six type 2 diabetic patients with normoalbuminuria (D2-NA) and five control subjects. Both type 2 diabetic patients and control subjects had mild arterial hypertension. RESULTS: L-NMMA infusion decreased the cardiac index in all groups. A reduction in glomerular filtration rate (GFR) and an increase in filtration fraction were observed only in controls. Renal plasma flow decreased in controls and D2-NA patients and renal vascular resistance increased in all groups. CONCLUSIONS: The effect of L-NMMA on cardiac output was similar in controls and type 2 diabetic patients with and without diabetic nephropathy. In contrast, the effect on GFR was impaired in both diabetic groups, suggesting that glomerular NO homeostasis is altered in type 2 diabetes. Moreover the discrepancy, in diabetic patients, between cardiac and renal effects during L-NMMA infusion suggests that the modulation of glomerular hemodynamics is independent from NO-regulated cardiac output.

scholarly journals Cardiovascular responses to tilting in Type 2 Diabetic patients

2020 ◽  
Vol 15 (2) ◽  
pp. 78-84
Author(s):  
Iffat Rejwana ◽  
Sadia Afrin Rimi ◽  
Shamima Sultana ◽  
Sultana Ferdousi
Keyword(s):  
Autonomic Function ◽  
Cardiovascular Response ◽  
Test Group ◽  
Cardiovascular Responses ◽  
Diabetic Patients ◽  
Tilt Table ◽  
Type 2 Diabetic Patients ◽  
Function Test ◽  
Type 2 Diabetic

Background: Diabetes mellitus (DM) is a disorder with a debilitating effects on cardiac autonomic control. Multiple major cardiovascular risk factors associated with DM led diabetic patients at high risk of Cardiovascular Disease. Objective: To assess cardiovascular responses to tilting in Type 2 Diabetic patients (T2DM) with normal and abnormal autonomic function test. Methods: This experimental study was conducted on 60 patients of T2DM. Among them, 30 patients were with normal cardiovascular reflex test (group DN) and 30 patients were with abnormal test (group DA). Thirty(30) apparently healthy subjects with similar age and sex without any physical illness were enrolled as control. Tilt table test of all subjects was done by tilting at 60° for 10 min by using a motorized tilt table. Cardiovascular response to tilt test was assessed by calculating D Heart rate (Acceleration index and Brake index); DSBP (SBP 30s-0 and SBP1 min -0), DDBP (DBP 30s-0 and DBP1 min -0) after tilting. For statistical analysis, one-way ANOVA followed by Bonferroni post hoc was used. Results: In this study, the Acceleration index was significantly higher in patient group DN compared to control and DA(p<0.001). But the Brake index was significantly (p<0.01, p<0.05) lower in both group of patients compared to control. In addition, SBP 30sec-0 and SBP1 min-0 were significantly higher in DA than those of control and DN.DBP 30sec-0 and DBP1min-0 were significantly (p<0.001) lower in DA patients compared to DN and control. Conclusion: This study concluded that cardiovascular response to tilting was weak in T2DM patients and it was greatly affected in T2DM patients with abnormal autonomic function test. J Bangladesh Soc Physiol. 2020, December; 15(2): 78-84

Reduced exercise arteriovenous O2 difference in Type 2 diabetes

2003 ◽  
Vol 94 (3) ◽  
pp. 1033-1038 ◽  
Author(s):  
James C. Baldi ◽  
James L. Aoina ◽  
Helen C. Oxenham ◽  
Warwick Bagg ◽  
Robert N. Doughty
Keyword(s):  
Type 2 Diabetes ◽  
Cardiac Output ◽  
Bicycle Ergometer ◽  
Diabetic Patients ◽  
Type 2 Diabetic Patients ◽  
Ergometer Exercise ◽  
Maximal Cardiac Output ◽  
Type 2 Diabetic ◽  
Bicycle Ergometer Exercise

Maximal O2 consumption (V˙o 2 max) is lower in individuals with Type 2 diabetes than in sedentary nondiabetic individuals. This study aimed to determine whether the lowerV˙o 2 max in diabetic patients was due to a reduction in maximal cardiac output (Q˙max) and/or peripheral O2 extraction. After 11 Type 2 diabetic patients and 12 nondiabetic subjects, matched for age and body composition, who had not exercised for 2 yr, performed a bicycle ergometer exercise test to determine V˙o 2 max, submaximal cardiac output, Q˙max, and arterial-mixed venous O2 (a-v̄ O2) difference were assessed. Maximal workload, V˙o 2 max, and maximal a-v̄ O2 difference were lower in Type 2 diabetic patients ( P < 0.05). Q˙max was low in both groups but not significantly different: 11.2 and 10.0 l/min for controls and diabetic patients, respectively ( P > 0.05). Submaximal O2 uptake and heart rate were lower at several workloads in diabetic patients; respiratory exchange ratio was similar between groups at all workloads.V˙o 2 max was linearly correlated with a-v̄ O2 difference, but not Q˙max in diabetic patients. These data suggest that a reduction in maximal a-v̄ O2 difference contributes to a decreasedV˙o 2 max in Type 2 diabetic patients.

Vitamin D3 supplementation improves glycemic control in type 2 diabetic patients: Results from an Italian clinical trial

2020 ◽  
pp. 1-10
Author(s):  
Giuseppe Derosa ◽  
Angela D’Angelo ◽  
Chiara Martinotti ◽  
Maria Chiara Valentino ◽  
Sergio Di Matteo ◽  
...  
Keyword(s):  
Vitamin D ◽  
Vitamin D Deficiency ◽  
Metabolic Control ◽  
Vitamin D3 ◽  
Therapy Group ◽  
Hypoglycemic Agents ◽  
Diabetic Patients ◽  
Type 2 Diabetic Patients ◽  
Type 2 Diabetic

Abstract. Background: to evaluate the effects of Vitamin D3 on glyco-metabolic control in type 2 diabetic patients with Vitamin D deficiency. Methods: one hundred and seventeen patients were randomized to placebo and 122 patients to Vitamin D3. We evaluated anthropometric parameters, glyco-metabolic control, and parathormone (PTH) value at baseline, after 3, and 6 months. Results: a significant reduction of fasting, and post-prandial glucose was recorded in Vitamin D3 group after 6 months. A significant HbA1c decrease was observed in Vitamin D3 (from 7.6% or 60 mmol/mol to 7.1% or 54 mmol) at 6 months compared to baseline, and to placebo (p < 0.05 for both). At the end of the study period, we noticed a change in the amount in doses of oral or subcutaneous hypoglycemic agents and insulin, respectively. The use of metformin, acarbose, and pioglitazone was significantly lower (p = 0.037, p = 0.048, and p = 0.042, respectively) than at the beginning of the study in the Vitamin D3 therapy group. The units of Lispro, Aspart, and Glargine insulin were lower in the Vitamin D3 group at the end of the study (p = 0.031, p = 0.037, and p = 0.035, respectively) than in the placebo group. Conclusions: in type 2 diabetic patients with Vitamin D deficiency, the restoration of value in the Vitamin D standard has led not only to an improvement in the glyco-metabolic compensation, but also to a reduced posology of some oral hypoglycemic agents and some types of insulin used.

Evaluation of aortic arch calcification in type 2 diabetic patients

VASA ◽  
2005 ◽  
Vol 34 (2) ◽  
pp. 113-117 ◽  
Author(s):  
Papanas ◽  
Symeonidis ◽  
Maltezos ◽  
Giannakis ◽  
Mavridis ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Aortic Arch ◽  
Diabetic Patients ◽  
Type 2 Diabetic Patients ◽  
Insulin Dependence ◽  
Artery Disease ◽  
Type 2 Diabetic ◽  
Aortic Arch Calcification

Background: The purpose of this study is to evaluate the severity of aortic arch calcification among type 2 diabetic patients in association with diabetes duration, diabetic complications, coronary artery disease and presence of cardiovascular risk factors. Patients and methods: This study included 207 type 2 diabetic patients (101 men) with a mean age of 61.5 ± 8.1 years and a mean diabetes duration of 13.9 ± 6.4 years. Aortic arch calcification was assessed by means of posteroanterior chest X-rays. Severity of calcification was graded as follows: grade 0 (no visible calcification), grade 1 (small spots of calcification or single thin calcification of the aortic knob), grade 2 (one or more areas of thick calcification), grade 3 (circular calcification of the aortic knob). Results: Severity of calcification was grade 0 in 84 patients (40.58%), grade 1 in 64 patients (30.92%), grade 2 in 43 patients (20.77%) and grade 3 in 16 patients (7.73%). In simple regression analysis severity of aortic arch calcification was associated with age (p = 0.032), duration of diabetes (p = 0.026), insulin dependence (p = 0.042) and presence of coronary artery disease (p = 0.039), hypertension (p = 0.019), dyslipidaemia (p = 0.029), retinopathy (p = 0.012) and microalbuminuria (p = 0.01). In multiple regression analysis severity of aortic arch calcification was associated with age (p = 0.04), duration of diabetes (p = 0.032) and presence of hypertension (p = 0.024), dyslipidaemia (p = 0.031) and coronary artery disease (p = 0.04), while the association with retinopathy, microalbuminuria and insulin dependence was no longer significant. Conclusions: Severity of aortic arch calcification is associated with age, diabetes duration, diabetic complications (retinopathy, microalbuminuria), coronary artery disease, insulin dependence, and presence of hypertension and dyslipidaemia.

The Effect of Insulin Treatment on the Balance between Tissue Plasminogen Activator and Plasminogen Activator Inhibitor-1 in Type 2 Diabetic Patients

1992 ◽  
Vol 68 (03) ◽  
pp. 253-256 ◽  
Author(s):  
Thomas Vukovich ◽  
Sylvia Proidl ◽  
Paul Knöbl ◽  
Harald Teufelsbauer ◽  
Christoph Schnack ◽  
...  
Keyword(s):  
Plasminogen Activator ◽  
Insulin Treatment ◽  
Plasminogen Activator Inhibitor ◽  
Diabetic Patients ◽  
Plasminogen Activator Inhibitor 1 ◽  
Type 2 Diabetic Patients ◽  
Glycemic Regulation ◽  
Type 2 Diabetic ◽  
Pai 1

SummaryBeside hypercoagulation and hyperactivated platelets disturbances of the fibrinolytic system towards hypofibrinolysis have been reported to be associated with both glycemic and lipidemic derangement in diabetic patients. In the present prospective follow-up study the effect of 16 weeks insulin treatment and glycemic regulation on plasma levels of tissue plasminogen activator (tPA) and plasminogen activator inhibitor-1 (PAI-1), the main regulators of fibrinolysis, was investigated in 19 type-2 diabetic patients with secondary failure to sulphonylureas. A similar glycemic regulation was obtained in a control group of 10 type 2 diabetic patients with sufficient metabolic response to strict dietary treatment and continuation of sulphonylurea treatment. Compared to 27 healthy subjects levels of tPA and PAI-1 were not significantly increased in type 2 diabetic patients before metabolic intervention. Although a hypofibrinolytic state due to an increase of PAI-1 levels was previously reported in obese hyperinsulinemic patients, no effect of insulin treatment on both tPA- and PAI-1 levels was observed in the present study including patients with only slightly increased body mass index (median 26.0 kg/m2). By correlation analysis PAI-1 levels were significantly related to serum cholesterol (R = 0.52) and glycemic control (glucose R = 0.41) in the whole group of diabetic patients at entry and in both subgroups after 16 weeks of treatment (insulin group: cholesterol R = 0.46, HbA1c R = 0.51; sulphonylurea group: cholesterol R = 0.59, HbA1c R = 0.58). In healthy subjects tPA and PAI-1 was correlated to serum insulin (R = 0.54, R = 0.56) and triglycerides (R = 0.46, R = 0.40). In conclusion, our results indicate that insulin treatment associated with metabolic improvement has no adverse effect to fibrinolysis in type 2 diabetic patients.

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