{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,24]],"date-time":"2026-01-24T02:57:20Z","timestamp":1769223440653,"version":"3.49.0"},"reference-count":43,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,2,10]],"date-time":"2025-02-10T00:00:00Z","timestamp":1739145600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Cardiovasc. Med."],"abstract":"<jats:sec><jats:title>Objective<\/jats:title><jats:p>To explore the impact of type 2 diabetes mellitus (T2DM) on exercise tolerance and fat oxidation capacity in patients with heart failure (HF).<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We retrospectively analyzed 108 Chinese patients with HF who were divided into a diabetic group (T2DM group, <jats:italic>n<\/jats:italic>\u2009=\u200947) and a non-diabetic group (non-T2DM group, <jats:italic>n<\/jats:italic>\u2009=\u200961). All subjects completed cardiopulmonary exercise testing (CPX). We determined their fat oxidation (FATox) by indirect calorimetry.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>In the HF patients, the peak oxygen uptake (VO<jats:sub>2<\/jats:sub>) value was 14.76\u2009\u00b1\u20093.27\u2005ml\/kg\/min in the T2DM group and 17.76\u2009\u00b1\u20094.64\u2005ml\/kg\/min in the non-T2DM group. After adjusting for age, sex, body mass index (BMI), log N-terminal pro-B type natriuretic peptide (log NT-proBNP), left ventricular ejection fraction (LVEF), hemoglobin, renal function, coronary heart disease and hypertension, the peak VO<jats:sub>2<\/jats:sub> was lower in the T2DM group compared to the non-T2DM group with a mean difference (MD) of \u22122.0\u2005ml\/kg\/min [95% confidence interval (CI), \u22123.18 to \u22120.82, <jats:italic>P<\/jats:italic>\u2009&amp;lt;\u20090.01]. The VO<jats:sub>2<\/jats:sub> at anaerobic threshold (AT VO<jats:sub>2<\/jats:sub>) was also lower in the T2DM group than in the non-T2DM group, with a MD of \u22121.11\u2005ml\/kg\/min (95% CI \u22122.04 to \u22120.18, <jats:italic>P<\/jats:italic>\u2009&amp;lt;\u20090.05). Regarding the fat oxidation capacity during CPX, the T2DM group's maximal fat oxidation (MFO) was lower than that of the non-T2DM group (0.143\u2009\u00b1\u20090.055 vs. 0.169\u2009\u00b1\u20090.061\u2005g\/min, <jats:italic>P<\/jats:italic>\u2009&amp;lt;\u20090.05). In addition, the T2DM group had lower FATox at exercise intensity levels of 40% (<jats:italic>P<\/jats:italic>\u2009&amp;lt;\u20090.05) and 50% (<jats:italic>P<\/jats:italic>\u2009&amp;lt;\u20090.05) of peak VO<jats:sub>2<\/jats:sub>, compared to the non-T2DM group.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>T2DM is associated with a decrease in exercise tolerance and fat oxidation capacity in patients with heart failure. Thus, it could be useful to develop exercises of appropriate intensity to optimize physical and metabolic health.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fcvm.2025.1485755","type":"journal-article","created":{"date-parts":[[2025,2,10]],"date-time":"2025-02-10T06:49:25Z","timestamp":1739170165000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":2,"title":["Type 2 diabetes mellitus\u2019 impact on heart failure patients\u2019 exercise tolerance: a focus on maximal fat oxidation during 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