Diabetic Neuropathy Is a More Important Determinant of Baroreflex Sensitivity Than Carotid Elasticity in Type 2 Diabetes

Abstract

Abstract-The object of this study was to evaluate the contribution of carotid distensibilty on baroreflex sensitivity in patients with type 2 diabetes mellitus with at least 2 additional cardiovascular risk factors. Carotid distensibility was measured bilaterally at the common carotid artery in 79 consecutive diabetic patients and 60 matched subjects without diabetes. Spontaneous baroreflex sensitivity assessment was obtained using time and frequency methods. Baroreflex sensitivity was lower in diabetic subjects as compared with nondiabetic control subjects (5.25Ϯ2.80 ms/mm Hg versus 7.55Ϯ3.79 ms/mm Hg; PϽ0.01, respectively). Contrary to nondiabetic subjects, diabetic subjects showed no significant correlation between carotid distensibility and baroreflex sensitivity (r 2 ϭ0.08, Pϭ0.04 and r 2 ϭ0.04, Pϭ0.13, respectively). In diabetic subjects, baroreflex sensitivity was significantly lower in subjects with peripheral neuropathy than in those with preserved vibration sensation (4.1Ϯ0.5 versus 6.1Ϯ0.4 ms/mm Hg, respectively; Pϭ0.005). Age in nondiabetic subjects, diabetes duration, systolic blood pressure, peripheral or sensitive neuropathy, and carotid distensibility were introduced in a stepwise multivariate analysis to identify the determinants of baroreflex sensitivity. In diabetic patients, neuropathy is a more sensitive determinant of baroreflex sensitivity than the reduced carotid distensibility (stepwise analysis; F ratioϭ5.1, Pϭ0.028 versus F ratioϭ1.9, Pϭ0.16, respectively). In diabetic subjects with 2 additional cardiovascular risk factors, spontaneous baroreflex sensitivity is not related to carotid distensibility. Diabetic subjects represent a particular population within the spectrum of cardiovascular risk situations because of the marked neuropathy associated with their metabolic disorder. Therefore, neuropathy is a more significant determinant of baroreflex sensitivity than carotid artery elasticity in patients with type 2 diabetes.

Early Progression of the Autonomic Dysfunction Observed in Pediatric Type 1 Diabetes Mellitus

“…9 This suggests that the impairment of the cardiac baroreflex might represent a sensitive, early quantitative indicator of diabetic autonomic impairment of the cardiac vagal regulation in children as well. Baroreflex gain is also selectively reduced in older patients affected by disturbances of glycemic metabolism, such as the metabolic syndrome, 13 or in patients with type 2 diabetes mellitus 14 and their offspring. 15 In this study, the repeat observations after 1 year suggest that the reduction in baroreflex gain is also accompanied by signs of progressive increase of sympathetic modulation to AP and of the autonomic balance to the sinoatrial node.…”

Baroreflex analysis in diabetes mellitus: linear and nonlinear approaches

“…Decreased BRS was found in both Type 1 and Type 2 DM patients, using time domain (sequence method) and frequency domain (cross-spectral method) analyses [5,15,29]. Several studies have shown that BRS measures have a higher sensitivity to detect the cardiovascular dysregulation in DM than HRV measures [4,15,19].…”

Changes in heart rate in patients with type 2 diabetes mellitus after treatment with luseogliflozin: Subanalysis of placebo‐controlled, double‐blind clinical trials

“…It is suggested that luseogliflozin can effectively decrease the HR in patients with higher baseline HR. Some patients with type 2 diabetes mellitus have elevated central sympathetic activity, which is exacerbated by a malfunction of the negative feedback mechanism as a result of decreased sensitivity of baroreceptor reflexes5, 6. This results in elevation of peripheral sympathetic activity in the heart, leading to an increase in resting HR.…”