Association between cardiorespiratory fitness and impaired vascular function in type 2 diabetes

doi:10.4239/wjd.v16.i11.111472

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Publication Name

World Journal of Diabetes

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1948-9358

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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

Observational Study

World J Diabetes. Nov 15, 2025; 16(11): 111472
Published online Nov 15, 2025. doi: 10.4239/wjd.v16.i11.111472

Association between cardiorespiratory fitness and impaired vascular function in type 2 diabetes

Shi-Ting Zhao, Yi-Ming Zhu, Ying-Ying Chen, Zi-Lin Sun, Shan-Hu Qiu

Shi-Ting Zhao, Shan-Hu Qiu, Department of General Practice, Zhongda Hospital, Institute of Diabetes, School of Medicine, Southeast University, Nanjing 210009, Jiangsu Province, China

Shi-Ting Zhao, Shan-Hu Qiu, Research and Education Centre of General Practice, Zhongda Hospital, Southeast University, Nanjing 210009, Jiangsu Province, China

Yi-Ming Zhu, Zi-Lin Sun, Department of Endocrinology, Zhongda Hospital, Institute of Diabetes, School of Medicine, Southeast University, Nanjing 210009, Jiangsu Province, China

Ying-Ying Chen, Department of General Practice, The First People’s Hospital of Lianyungang, Lianyungang 222001, Jiangsu Province, China

Author contributions: Qiu SH had full access to all the data in the study and took responsibility for the integrity of the data and the accuracy of the data analysis; Zhao ST, Zhu YM, Chen YY, Sun ZL and Qiu SH developed the study concept and design; Zhao ST and Qiu SH acquired, analyzed, or interpreted the data; Zhao ST and Qiu SH drafted the manuscript; all authors critically revised the manuscript; Zhao ST, Zhu YM and Qiu SH conducted the statistical analysis; Sun ZL and Qiu SH obtained funding; Sun ZL and Qiu SH supervised the study.

Supported by the Noncommunicable Chronic Diseases-National Science and Technology Major Project, No. 2024ZD0523303; the Funding for Pairing Support to Jiangsu High-Level Hospitals-Zhongda Hospital, No. ZDLYG19; and the Key Research and Development Program in Jiangsu Province, No. BE2022828.

Institutional review board statement: This cross-sectional study protocol was approved by the Ethics Review Committee of Zhongda Hospital (approval No. 2019ZDSYLL119-P01).

Informed consent statement: Written informed consent was waived as the data analyzed in the present study were retrospectively collected.

Conflict-of-interest statement: The authors declare no competing interests.

STROBE statement: The authors have read the STROBE Statement—checklist of items, and the manuscript was prepared and revised according to the STROBE Statement—checklist of items.

Data sharing statement: Data will be made available on request.

Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/

Corresponding author: Shan-Hu Qiu, MD, Department of General Practice, Zhongda Hospital, Institute of Diabetes, School of Medicine, Southeast University, No. 87 Dingjiaqiao, Nanjing 210009, Jiangsu Province, China. tigershanhu@126.com

Received: July 1, 2025
Revised: July 22, 2025
Accepted: September 22, 2025
Published online: November 15, 2025
Processing time: 136 Days and 20 Hours

Abstract

BACKGROUND

Cardiorespiratory fitness (CRF) is inversely associated with the risk of cardiovascular disease, which is related to impaired vascular function. However, its relationship with vascular function remains unknown in patients with type 2 diabetes.

AIM

To assess the relationship of CRF with vascular function in type 2 diabetes.

METHODS

Patients with type 2 diabetes who were aged ≥ 18 years and underwent an incremental and symptom-limited exercise test were included. Vascular function was assessed by the construction of the vascular health index (VHI), which is defined as a composite score of ankle-brachial index, transcutaneous oxygen pressure, pulse wave velocity, and carotid intima-media thickness. Impaired vascular function is defined as a VHI of < 8 points. Linear and logistic regression analyses were used to assess the associations.

RESULTS

We included 343 patients with type 2 diabetes. CRF was positively correlated with VHI (β = 0.10, P = 0.047), particularly with ankle-brachial index and pulse wave velocity. The odds ratio (OR) of impaired vascular function was 0.44 [95% confidence interval (CI): 0.20-0.96] for the highest vs the lowest CRF category. For each one metabolic equivalent increase in CRF, the OR of impaired vascular function was 0.73 (95%CI: 0.57-0.93).

CONCLUSION

Higher CRF was associated with better vascular function and lower odds of impaired vascular function in patients with type 2 diabetes.

Keywords: Cardiorespiratory fitness; Type 2 diabetes; Vascular function; Ankle-brachial index; Pulse wave velocity

Core Tip: This study developed for the first time a new index for the assessment of vascular function, which incorporates measures related to microvascular function, macrovascular function, arterial stiffness, and vascular morphology. We found that higher cardiorespiratory fitness (CRF) was associated with better vascular health in type 2 diabetes, particularly with better macrovascular function. Our study provides evidence in support of the beneficial effect of exercise training, which is associated with improved CRF, in the management of cardiovascular diseases in patients with type 2 diabetes.