Abnormal Cardiac and Skeletal Muscle Energy Metabolism in Patients With Type 2 Diabetes

TLDR

Patients with type 2 diabetes are at higher cardiovascular risk, yet it is unclear whether they have abnormal cardiac or skeletal muscle high‑energy phosphate metabolism. The study compared 21 type 2 diabetic patients without coronary disease to 15 matched controls, measuring cardiac and skeletal muscle high‑energy phosphate metabolites, pH, and oxygenation at rest and during exercise using 31P MRS and near‑infrared spectroscopy. Diabetic patients exhibited reduced cardiac PCr/ATP ratios and faster skeletal muscle PCr depletion and pH decline during exercise, with slower PCr recovery and exercise tolerance linked to higher HbA1c and altered oxygenation dynamics.

Abstract

Background— It is well known that patients with type 2 diabetes have increased risk of cardiovascular disease, but it is not known whether they have underlying abnormalities in cardiac or skeletal muscle high-energy phosphate metabolism. Methods and Results— We studied 21 patients with type 2 diabetes with no evidence of coronary artery disease or impaired cardiac function, as determined by echocardiography, and 15 age-, sex-, and body mass index-matched control subjects. Cardiac high-energy phosphate metabolites were measured at rest using 31 P nuclear magnetic resonance spectroscopy (MRS). Skeletal muscle high-energy phosphate metabolites, intracellular pH, and oxygenation were measured using 31 P MRS and near infrared spectrophotometry, respectively, before, during, and after exercise. Although their cardiac morphology, mass, and function appeared to be normal, the patients with diabetes had significantly lower phosphocreatine (PCr)/ATP ratios, at 1.50±0.11, than the healthy volunteers, at 2.30±0.12. The cardiac PCr/ATP ratios correlated negatively with the fasting plasma free fatty acid concentrations. Although skeletal muscle energetics and pH were normal at rest, PCr loss and pH decrease were significantly faster during exercise in the patients with diabetes, who had lower exercise tolerance. After exercise, PCr recovery was slower in the patients with diabetes and correlated with tissue reoxygenation times. The exercise times correlated negatively with the deoxygenation rates and the hemoglobin (Hb)A 1c levels and the reoxygenation times correlated positively with the HbA 1c levels. Conclusions— Type 2 diabetic patients with apparently normal cardiac function have impaired myocardial and skeletal muscle energy metabolism related to changes in circulating metabolic substrates.