Perissiou, M, Saynor, ZL, Feka, K, Edwards, C, James, TJ, Corbett, J, Mayes, H, Shute, J, Cummings, M, Black, MI, Strain, WD, Little, JP and Shepherd, AI (2025) Ketone monoester ingestion improves cardiac function in adults with type 2 diabetes: a double-blind, placebo-controlled, randomized, crossover trial. Journal of Applied Physiology, 138 (2). pp. 546-558. ISSN 8750-7587

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Abstract

Type 2 diabetes (T2D) is a metabolic disease associated with cardiovascular dysfunction. The myocardium preferentially uses ketones over free fatty acids as a more energy-efficient substrate. The primary aim was to assess the effects of ketone monoester (Kme) ingestion on cardiac output index ([Formula: see text]i). The secondary aims were to assess the effects of Kme ingestion on markers of cardiac hemodynamics, muscle oxygenation, and vascular function at rest, during and following step-incremental cycling. We undertook a double-blind, randomized, crossover design study in 13 adults [age, 66 ± 10 yr; body mass index (BMI), 31.3 ± 7.0 kg·m-2] with T2D. Participants completed two conditions, where they ingested a Kme (0.115 g·kg-1) or a placebo taste-matched drink. Cardiac function was measured using thoracic impedance cardiography, and muscle oxygenation of the calf was determined via near-infrared spectroscopy. Macrovascular endothelial function was measured by flow-mediated dilation (FMD), and microvascular endothelial function was measured via transdermal delivery of acetylcholine (ACh) and insulin. Circulating β-hydroxybutyrate [β-Hb] was measured throughout. Kme ingestion raised circulating β-Hb throughout the protocol (peak 1.9 mM; P = 0.001 vs. placebo). Kme ingestion increased [Formula: see text]i by 0.75 ± 0.5 L·min-1·m-2 (P = 0.003), stroke volume index by 7.2 ± 4.5 mL·m-2 (P = 0.001), and peripheral muscle oxygenation by 9.9 ± 7.1% (P = 0.001) and reduced systemic vascular resistance index by -420 ± -225 dyn·s-1·cm-5·m-2 (P = 0.031) compared with the placebo condition. There were no differences between Kme and placebo in heart rate (P = 0.995), FMD (P = 0.542), ACh max (P = 0.800), and insulin max (P = 0.242). Ingestion of Kme improved [Formula: see text], stroke volume index, and peripheral muscle oxygenation but did not alter macro- or microvascular endothelial function in people with T2D.NEW & NOTEWORTHY For the first time, we show that acute ketone monoester ingestion (Kme) can increase cardiac output and stroke volume and reduce systemic vascular resistance at rest and during exercise in sodium glucose transporter inhibitors naïve (i.e. no drug-induced ketosis) people with type 2 diabetes. Acute Kme ingestion improves peripheral skeletal muscle oxygenation during moderate intensity and maximal exercise. Kme has no effect on macro- or microvascular endothelial function in people with type 2 diabetes.

Item Type:	Article
Uncontrolled Keywords:	Muscle, Skeletal; Endothelium, Vascular; Heart; Humans; Diabetes Mellitus, Type 2; Ketones; Cardiac Output; Cross-Over Studies; Double-Blind Method; Oxygen Consumption; Aged; Middle Aged; Female; Male; Hemodynamics; cardiovascular hemodynamics; diabetes; exercise; muscle oxygenation; β-hydroxybutyrate; Humans; Cross-Over Studies; Male; Diabetes Mellitus, Type 2; Double-Blind Method; Aged; Female; Middle Aged; Ketones; Cardiac Output; Muscle, Skeletal; Heart; Oxygen Consumption; Hemodynamics; Endothelium, Vascular; 32 Biomedical and Clinical Sciences; 3201 Cardiovascular Medicine and Haematology; Clinical Trials and Supportive Activities; Cardiovascular; Clinical Research; Heart Disease; Nutrition; Physical Activity; Diabetes; 6.1 Pharmaceuticals; Cardiovascular; Metabolic and endocrine; Humans; Cross-Over Studies; Male; Diabetes Mellitus, Type 2; Double-Blind Method; Aged; Female; Middle Aged; Ketones; Cardiac Output; Muscle, Skeletal; Heart; Oxygen Consumption; Hemodynamics; Endothelium, Vascular; 06 Biological Sciences; 11 Medical and Health Sciences; Physiology; 31 Biological sciences; 32 Biomedical and clinical sciences; 42 Health sciences
Subjects:	R Medicine > RC Internal medicine > RC1200 Sports Medicine
Divisions:	Sport and Exercise Sciences
Publisher:	American Physiological Society
SWORD Depositor:	A Symplectic
Date Deposited:	02 Apr 2025 15:40
Last Modified:	02 Apr 2025 15:45
DOI or ID number:	10.1152/japplphysiol.00800.2024
URI:	https://researchonline.ljmu.ac.uk/id/eprint/26081

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