ArticleNutrition & metabolism2026
Metabolic inflexibility mediates the association between type 2 diabetes and impaired post-exercise heart rate recovery: a mediation analysis.
Article in Nutrition & metabolism, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
0 citing papers in PubMed.
No citing paper in PubMed yet.
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
7 authors.
Funding
Abstract
backgroundCoronary vascular disease (CVD) is the leading cause of mortality worldwide, while type 2 diabetes mellitus (T2DM) coexists in up to 40% of patients with established CVD and nearly doubles the risk of death. Heart rate recovery (HRR) is a recognized predictor of adverse cardiovascular outcomes, but the specific influence of T2DM on HRR remains incompletely understood. Metabolic inflexibility—reflected by a reduced peak respiratory exchange ratio (RER)—is characteristic of T2DM and may mediate its impact on HRR. We investigated this potential mediation relationship in post-percutaneous coronary intervention (PCI) patients.
methodsWe performed a single-center, retrospective cross-sectional study of 275 post-PCI patients at Beijing Anzhen Hospital from September 2023 to August 2024. Demographics, traditional cardiovascular risk factors, and physical activity status were recorded. Cardiopulmonary exercise testing (CPET) provided peak RER (RERpeak), ΔRER, and first-minute after peak exercise HRR (HRR1). Using multivariate regression, we assessed associations among T2DM, RER parameters, and HRR1, while adjusting for potential confounders. Mediation analysis evaluated whether RER parameters mediated the relationship between T2DM and HRR1. Subgroup analyses were conducted according to β-blocker use.
resultsA total of 275 post-PCI patients were included (198 without T2DM, 77 with T2DM). Compared with non-diabetic participants, those with T2DM exhibited significantly lower RERpeak (1.12 ± 0.07 vs. 1.17 ± 0.08; p < 0.001) and ΔRER (0.27 ± 0.08 vs. 0.31 ± 0.10; p = 0.001). T2DM was independently associated with worse HRR1 (β = − 2.47, 95% CI: − 4.53 to − 0.41, p = 0.0197) after adjustment. Both RERpeak and ΔRER were negatively correlated with T2DM and positively correlated with HRR1. Mediation analysis showed that RERpeak partially mediated 25.06% of T2DM’s adverse effect on HRR1, while ΔRER accounted for 17.62%. Subgroup analyses revealed that in patients not receiving β-blockers, RERpeak mediated 28.46% of the T2DM-HRR1 association, while ΔRER accounted for 13.51%; however, this mediation effect was not evident in β-blocker users.
conclusionIn this post-PCI population, metabolic inflexibility partially mediated the negative association between T2DM and impaired post-exercise HRR. These findings highlight the need to improve metabolic flexibility in diabetic patients as part of risk stratification and targeted therapeutic interventions.
Indexed as
Identifiers
What OpenQuestion holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.