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J Am Coll Cardiol. 2009 Jun 9;53(23):2175-83. doi: 10.1016/j.jacc.2009.02.042.

Abnormal skeletal muscle capillary recruitment during exercise in patients with type 2 diabetes mellitus and microvascular complications.

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General Clinical Research Center, University of Virginia, Charlottesville, USA.



We sought to determine whether skeletal muscle capillary recruitment is impaired in type 2 diabetes mellitus (DM) with and without microvascular complications (MC).


Insulin and exercise each stimulate recruitment of skeletal muscle capillaries. Insulin-mediated recruitment is impaired in insulin-resistant humans and animals, but exercise-mediated recruitment has not been studied.


We studied 20 control subjects, 22 patients with DM, and 8 patients with DM + MC. With the patients under fasting conditions, contrast-enhanced ultrasound perfusion imaging of the forearm flexor muscles was performed to evaluate capillary blood flow and blood volume at rest and during low- or high-intensity contractile exercise (25% and 80% maximal handgrip). Rheologic parameters of erythrocyte deformability and plasma viscosity were measured.


Muscle capillary responses to exercise were similar between the control and DM groups, but were reduced (p < 0.05) in those with DM + MC. The DM + MC group had a approximately 50% reduction in capillary recruitment and a approximately 60% to 70% reduction in capillary blood flow during both low- and high-intensity exercise compared with the control group. These abnormalities were independent of disease duration. Patients with DM + MC were more insulin resistant than DM patients and had an elevated whole blood viscosity that correlated with plasma glucose (p = 0.001) and C-reactive protein (p = 0.003).


Capillary recruitment during low- and high-intensity exercise is normal in uncomplicated type 2 DM but is impaired in those with microvascular complications. Abnormalities in capillary recruitment may be related to abnormal hemorheology, although larger trials are needed to establish this relation.

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