A 14‐year prospective study of autonomic nerve function in Type 1 diabetic patients: association with nephropathy

Abstract

A 14-year prospective study of autonomic nerve function in Type 1 diabetic patients: association with nephropathy. Link to publication Citation for published version (APA): Forsén, A., Kangro, M., Sterner, G., Norrgren, K., Thorsson, O., Wollmer, P., & Sundkvist, G. (2004). A 14-year prospective study of autonomic nerve function in Type 1 diabetic patients: association with nephropathy. Diabetic Medicine, 21(8), 852-858. DOI: 10.1111/j.1464-5491.2004 General rights Copyright and moral rights for the publications made accessible in the public portal are retained by the authors and/or other copyright owners and it is a condition of accessing publications that users recognise and abide by the legal requirements associated with these rights.• Users may download and print one copy of any publication from the public portal for the purpose of private study or research.• You may not further distribute the material or use it for any profit-making activity or commercial gain • You may freely distribute the URL identifying the publication in the public portal AbstractAims Prospective studies of autonomic nerve function are rare. We have followed the progression of autonomic dysfunction in relation to nephropathy over 14 years in Type 1 diabetic patients.Methods Autonomic nerve function was assessed by heart-rate responses to deep breathing (E / I ratio) and tilting (acceleration and brake indices) and by the postural blood pressure reaction in 58 patients, 43 of whom were reassessed after 14 years. Nephropathy was evaluated by the degree of albuminuria (albuminuria > 20 µ g/ min or > 0.03 g /24 h) and glomerular filtration rate ( 51 Cr-EDTA plasma clearance). The acceleration index had deteriorated after 7 years ( P = 0.0155), whereas the E/I ratio ( P = 0.0070) and the diastolic postural blood pressure reaction ( P = 0.0054) had deteriorated 14 years after the baseline examination (age-corrected values). All those with albuminuria at the third examination showed signs of autonomic neuropathy at baseline (10 of 10) compared with only nine of 22 without ( P = 0.0016). Multiple regression analysis showed that the association between autonomic dysfunction and future albuminuria was due to the E / I ratio. In addition, individuals with an abnormal postural diastolic blood pressure fall ( n = 7) at baseline showed a greater fall in glomerular filtration rate more than others 7-14 years later [29 (16.5) ml/min/1.72 m 2 vs. 11 (9) ml/min/1.72 m 2 ; P = 0.0074].Conclusion Autonomic nerve function had deteriorated after 14 years. Autonomic neuropathy and abnormal postural diastolic blood pressure falls at baseline were associated with future renal complications.Diabet. Med. 21, 852-858 (2004)

Enteric ganglioneuritis and abnormal interstitial cells of Cajal

“…To match for age, all test results were expressed in age-related values-that is, SD-as previously described (17). An age-related value below -1.64 SD was considered abnormal and signified autonomic neuropathy (18).…”

Oesophageal dysmotility, delayed gastric emptying and autonomic neuropathy correlate to disturbed glucose homeostasis

“…RR interval variation during deep breathing (expiration/inspiration [E/I] ratio) was used as a test of autonomic nerve function and an age-related E/I below -1.64 SD was considered abnormal [7].…”

Haemodynamic changes during a squat test, pulsatile stress and indices of cardiovascular autonomic neuropathy in patients with long-duration type 1 diabetes

“…In a recent statement by the Toronto Diabetic Neuropathy Expert Group [4], it was suggested that the presence of one abnormal cardiovagal test identifies possible or early CAN, and that at least two abnormal HR tests are required for a definite or confirmed diagnosis of CAN. Nevertheless, several studies have pointed out that the RR E/I ratio is a simple, but especially informative, marker of CAN [6,38], and has the greatest specificity [4]. In addition, orthostatic hypotension (asymptomatic or symptomatic) along with HR test abnormalities (resulting in a decreased baroreflex gain in the present study) indicate more severe or advanced CAN [4].…”

“…In the present study, a strong relationship was observed between the decreased baroreflex gain (but with no decreased RR E/I ratios) assessed during the squat test and the presence of microalbuminuria. In one prospective study, the progression of autonomic dysfunction in relation to nephropathy was followed for 14 years in T1DM patients [38]. Multiple regression analyses showed that the association between autonomic dysfunction and future albuminuria was due to the RR E/I ratio, supporting a role for this simple marker in routine clinical practice.…”