Dissociation of local and global skeletal muscle oxygen transport metrics in type 2 diabetes

- Muscle oxygenation is impaired in type 2 diabetes despite normal limb blood flow and local microvascular recruitment.
- Correlations between local oxygen transport metrics and VO2peak are abolished in type 2 diabetes.
- The correlation between blood flow and VO2peak is abolished in type 2 diabetes.
- The correlation between blood flow and local microvascular recruitment is abolished in type 2 diabetes.

AimsExercise capacity is impaired in type 2 diabetes, and this impairment predicts excess morbidity and mortality. This defect appears to involve excess skeletal muscle deoxygenation, but the underlying mechanisms remain unclear. We hypothesized that reduced blood flow, reduced local recruitment of blood volume/hematocrit, or both contribute to excess skeletal muscle deoxygenation in type 2 diabetes.MethodsIn patients with (n = 23) and without (n = 18) type 2 diabetes, we recorded maximal reactive hyperemic leg blood flow, peak oxygen utilization during cycling ergometer exercise (VO2peak), and near-infrared spectroscopy-derived measures of exercise-induced changes in skeletal muscle oxygenation and blood volume/hematocrit.ResultsWe observed a significant increase (p < 0.05) in skeletal muscle deoxygenation in type 2 diabetes despite similar blood flow and recruitment of local blood volume/hematocrit. Within the control group skeletal muscle deoxygenation, local recruitment of microvascular blood volume/hematocrit, blood flow, and VO2peak are all mutually correlated. None of these correlations were preserved in type 2 diabetes.ConclusionsThese results suggest that in type 2 diabetes 1) skeletal muscle oxygenation is impaired, 2) this impairment may occur independently of bulk blood flow or local recruitment of blood volume/hematocrit, and 3) local and global metrics of oxygen transport are dissociated.