Exercise-induced ischemia in newly diagnosed asymptomatic type 2 diabetes mellitus patients: a prospective observational study

Abstract

Background: Cardiovascular disease remains the leading cause of morbidity and mortality in patients with type 2 diabetes mellitus (T2DM). Coronary artery disease in diabetes may remain clinically silent until advanced stages because of autonomic dysfunction, altered pain perception, and diffuse atherosclerosis. Early recognition of occult ischemia may permit timely preventive intervention.

Objective: To determine the prevalence of exercise-induced ischemia using treadmill exercise testing in newly diagnosed asymptomatic T2DM patients and to identify associated clinical predictors.

Methods: This prospective observational study enrolled 200 newly diagnosed asymptomatic T2DM patients with normal resting electrocardiograms and no known coronary artery disease. All patients underwent detailed clinical evaluation, biochemical investigations, lipid profile assessment, and treadmill stress testing using the Bruce protocol.

Results: Of the 100 participants, 63% were male and 37% were female. The majority belonged to the 41–50 year age group. Mean body mass index was 24.71 ± 3.42 kg/m². Mean fasting blood glucose was 181.74 ± 33.80 mg/dL, postprandial blood glucose 229.35 ± 57.92 mg/dL, and HbA1c 8.63 ± 1.22%. Positive treadmill stress testing suggestive of exercise-induced ischemia was observed in 2% patients. HbA1c was significantly higher in treadmill-positive patients compared with treadmill-negative patients.

Conclusion: Exercise-induced ischemia was uncommon in newly diagnosed asymptomatic T2DM patients. Poor glycemic control was significantly associated with positive stress testing. Selective rather than universal screening may be more appropriate in this population.