Autonomic neuropathy and survival in diabetes mellitus: effects of pancreas transplantation

Abstract

Summary. Cardiorespiratory reflexes were studied during slow breathing and a Valsalva maneuver in 232 Type 1 (insulin-dependent) diabetic subjects. At 1 to 7 years follow-up, death occurred in 23.4% of 175 patients with abnormal reflexes and in 3.5% of 57 patients with normal reflexes. The mortality rates of diabetic subjects with abnormal reflexes were 17% at 2.5 years, 33% at 5 years and 40% at 7 years, significantly higher than for patients with normal reflexes (4.6%, 4.6% and 13.8%). Among patients with abnormal reflexes, patients with a functioning pancreas transplantation had better survival rates than patients with a failed transplantation, and in long-term follow-up better than patients without transplantation. A functioning transplantation prevented the progressive decline of cardiorespiratory reflex function that occurred over time in control patients.

Impact of liver transplantation on autonomic neuropathy in familial amyloidotic polyneuropathy: an evaluation by spectral analysis of heart rate variability

“…Conflicting results have been reported from renal and pancreatic-transplanted diabetic patients [21][22][23][24], however, improvement has been found after a follow-up period of 4ϩ years [22,23] therefore the follow-up of 17 months in the present investigation may be too short.…”

Effects of cyclooxygenase-2 gene inactivation on cardiac autonomic and left ventricular function in experimental diabetes

“…Cardiac autonomic neuropathy (CAN) is a serious complication of diabetes, which also associates with increased CVD risk and mortality (38). The loss of heart rate (HR) variability, an index of CAN, is an independent predictor of mortality after an acute myocardial infarction in nondiabetic (ND) subjects (3) and in patients with type 1 and type 2 diabetes (60).…”

Diabetic neuropathy in patients with "Latent Autoimmune Diabetes of the Adults" (LADA) compared with patients with type 1 and type 2 diabetes

“…This is an important finding since patients with autonomic neuropathy frequently have hypoglycaemia unawareness. In addition, many authors showed that abnormalities in autonomic testing frequently are associated with high rates of mortality in diabetic patients [3,15,16,18]. Interestingly, another study showed that thinly myelinated and unmyelinated nerve fibres in patients with diabetic neuropathy seem to improve less or at least at a slower rate than myelinated fibres after pancreas transplantation [11,17,25].…”