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Abstract

Background: Patients with type 2 diabetes (T2D) develop vascular complications due to arginine deficiency-induced microvascular endothelial dysfunction, which is related to the loss of muscle strength (MS) associated with aging. Thus, increased nitric oxide (NO)-mediated vasodilation may improve MS. We investigated the impact of the NO precursor citrulline on microvascular function (endothelial and muscle reactivity) and MS in T2D patients. Methods: Sixteen participants with T2D (53–72 years, nine females) were randomized to citrulline supplementation (CITS, 6 g/day) or placebo for 4 weeks prior to an 8-week washout period, followed by the opposite supplement for 4 weeks in a crossover trial. Endothelial function (log-transformed reactive hyperemia index, LnRHI), forearm muscle reactivity (near-infrared spectroscopy-derived tissue oxygen index (TOI) reperfusion indices), plasma arginine levels (ARG), and handgrip strength (HGSrel) and calf MS (CMSrel) adjusted for body weight were measured at baseline and 4 weeks for each condition. Results: CITS increased the LnRHI (∆0.11 ± 0.16 vs. ∆−0.08 ± 0.24, p < 0.05), TOI range (∆2.6 ± 3.3 vs. ∆−1.5 ± 4.8%, p < 0.01), TOI hyperemic response (∆1.2 ± 1.4 vs. ∆−0.6 ± 2.8%, p < 0.05), TOI 2 min area under the curve (∆154 ± 187 vs. ∆−41 ± 194%/s, p < 0.01), ARG (∆43 ± 28 vs. ∆1 ± 16μM/L, p < 0.001), CMS (∆1.5 ± 2.8 vs. ∆−0.3 ± 1.2 kg, p < 0.05), and CMSrel (∆0.02 ± 0.03 vs. ∆−0.01 ± 0.02 kg/kg, p < 0.01) compared to placebo. The improvements in LnRHI and CMSrel were correlated (r = 0.37, p < 0.05). Conclusions: This study showed that CITS improves microvascular endothelial function, muscle microvascular reactivity, and calf muscle strength in middle-aged and older patients with T2D.