Correlation of staging and risk factors with cardiovascular autonomic neuropathy in patients with type II diabetes mellitus

Abstract

The impairment of cardiovascular autonomic control among the underdiagnosed complication of diabetes mellitus (DM) with a high prevalence rate of up to 60% in type 2 DM (T2DM). Cardiac autonomic neuropathy (CAN) is an independent risk factor for cardiovascular mortality, arrhythmia, silent ischemia, any major cardiovascular event, and heart failure. We aimed to evaluate cardiovascular autonomic activity by different physiological maneuvers, study risk factors for diabetic CAN including age, gender, duration of diabetes, body mass index (BMI), and glycemic control, and correlate CAN stage with risk factors. One hundred and forty-two T2DM patients consisted of 62 males and 80 females and 100 volunteers as a control sample. Cardiac autonomic functions were assessed by Ewing's tests. Glycated hemoglobin (HbA1c), body weight, height, body mass index (BMI), and waist-hip ratio (WHR) were also measured. Cardiovascular autonomic functions and Ewing scores were significantly different in people with diabetes when compared with control healthy subjects. Ewings test values and Ewing scores were significantly different between diabetics with and without CAN and within patients with different CAN staging. People with diabetes with CAN have a significantly longer duration of disease when compared to those without CAN. A strong association has been found between CAN severity and patient age, duration of disease, HbA1c severity, and the WHR (P < 0.001) but not with BMI. The duration of disease and HbA1c level appear to be associated with the development of CAN (P = 0.001 and P = 0.008, respectively). The poorer glycemic control and the longer the duration of the disease, the higher the prevalence of CAN in T2DM. Age, duration of disease, WHR, and HbA1c are well correlated with the severity of CAN. Parasympathetic impairment is more sensitive to the detection of autonomic dysfunctions than do sympathetic impairment.

Cardiovascular autonomic neuropathy in people with type 2 diabetes mellitus; investigation of its association with classical cardiovascular risk factors using cardiovascular autonomic reflex tests: a cross-sectional study

“…Among the traditional CVD risk factors, BMI was one of the reported factors associated with CAN. In the current study, the absence of association between BMI or body fats percentage with CAN is perhaps due to the smaller sample size from other studies, which reported an inverse association [29,31,40]. This also applies to other CVD risk factors such as age and body fats percentage.…”

Device for Controlling Stimulus Self-Application During Autonomic Nervous System Tests

“…Despite the passage of time, the performing of state-ofthe-art ANS tests has not changed. In the latest papers using Ewing's tests [17][18][19][20][21][22] we found the same problems as mentioned previously: varying protocols, different stimulus level or tests' order. However, it is satisfactory that in almost every paper (besides one 17 ) level and duration of stimulus are mentioned.…”

“…However, it is satisfactory that in almost every paper (besides one 17 ) level and duration of stimulus are mentioned. Only in a few papers [18][19][20] were types of device used to control stimulus mentioned in general terms, eg, aneroid manometer. None of these papers mention method of controlling stimulus.…”

Age and Disease Duration Independent Cardiac Autonomic Neuropathy in Patients with Diabetic Foot Complications

“…Overall, the prevalence of CAN has been variably reported from 10%–80%. [ 6 7 8 9 10 ] Most of the studies are consistent regarding close association of diabetic peripheral neuropathy and CAN. There is being an increasingly recognized association between peripheral neuropathy and CAN in patients of type 2 DM.…”