Modifiable predictors of chronotropic incompetence in male patients with type 2 diabetes.
OBJECTIVE
Type 2 diabetes mellitus (T2DM) is associated with chronotropic incompetence (CI), which may lead to a worse prognosis. It remains uncertain whether CI in T2DM patients is related to patient characteristics that are modifiable by exercise interventions.


METHODS
From 33 male T2DM patients and 18 healthy subjects not taking β-blockers, calcium-antagonists, and/or diuretics, a fasting blood sample was collected, followed by an oral glucose tolerance test, maximal cardiopulmonary exercise test, and body composition analysis. Chronotropic incompetence was defined as the inability to achieve a maximal chronotropic response index (maxCRI) ≥ 0.80 during exercise testing. By univariate correlations and multivariate regression analysis, relationships between exercise tolerance, body composition, glycemic control, and maxCRI were examined.


RESULTS
MaxCRI was significantly lower in T2DM patients (0.85 ± 0.17) vs healthy controls (1.02 ± 0.17, P < .01): Chronotropic incompetence was prevalent in 14 T2DM patients (42%) and 1 healthy subject (6%, P < .05). Significant (P < .05) univariate correlations between maxCRI and body mass index (r = -0.59), blood high-density lipoprotein cholesterol (r = 0.34), HbA1c (r = -0.33) and insulin level (r = -0.48), HOMA-IR index (r = -0.45), trunk adipose tissue mass (r = -0.45), waist circumference (r = -0.58), peak cycling power output (r = 0.42), and oxygen uptake (r = 0.33) were found (P < .05). Independent significant relations were found between maxCRI and waist circumference (P < .01) and peak cycling power output (P < .05).


CONCLUSIONS
Chronotropic incompetence in male T2DM patients is independently related to exercise tolerance and adipose tissue mass. These data provide further insight into the etiology of CI in male T2DM patients and show that exercise interventions might impact predictors of CI.
Biomedical Research Institute, Faculty of Medicine and Life Sciences, Hasselt University, Diepenbeek, Belgium; and Heart Centre Hasselt, Jessa Hospital, Hasselt, Belgium.
Dominique
D
Hansen
Paul
P
Dendale
D001341:Autonomic Nervous System / Q000503:physiopathology*; D050218:Body Fat Distribution; D015992:Body Mass Index; D016022:Case-Control Studies; D008076:Cholesterol, HDL / Q000097:blood; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000503:physiopathology*; D005080:Exercise Test; D017079:Exercise Tolerance / Q000502:physiology; D006442:Glycated Hemoglobin / Q000032:analysis; D006339:Heart Rate / Q000502:physiology*; D006801:Humans; D007328:Insulin / Q000097:blood; D008297:Male; D008875:Middle Aged; D010101:Oxygen Consumption / Q000502:physiology; D055105:Waist Circumference / Q000502:physiology
D008076:Cholesterol, HDL; D006442:Glycated Hemoglobin; D007328:Insulin; C517652:hemoglobin A1c protein, human