Does the Relationship of the Autonomic Symptoms Questionnaire COMPASS 31 with Cardiovascular Autonomic Tests Differ between Type 1 and Type 2 Diabetes Mellitus?

Abstract

Background:The aim was to investigate if autonomic symptoms questionnaire Composite Autonomic Symptom Score (COM-PASS) 31 has different association with cardiovascular autonomic neuropathy (CAN) and diagnostic performance between type 1 diabetes mellitus (T1DM) and type 2 diabetes mellitus (T2DM). Methods: Seventy-nine participants with T1DM and 140 with T2DM completed COMPASS 31 before cardiovascular reflex tests (CARTs) for CAN, and assessment of symptoms, signs, vibration, and thermal perception thresholds for diabetic polyneuropathy (DPN) diagnosis. Results: COMPASS 31 total weighted score (TWS) was similar in the two groups, but significantly associated with confirmed CAN only in T1DM (P=0.0056) and not T2DM group (P=0.1768) and correlated with CARTs score more strongly in T1DM (rho=0.356, P=0.0016) than in T2DM group (rho=0.084, P=0.3218) (P=0.016). Only in T1DM and not T2DM group, the area under the receiver operating characteristic curve (AUC) reached a fair diagnostic accuracy (>0.7) for confirmed CAN (0.73±0.07 vs. 0.61±0.08) and DPN (0.75±0.06 vs. 0.68±0.05), although without a significant difference. COMPASS 31 TWS (cut-off 16.44) reached acceptable diagnostic performance in T1DM, with sensitivity for confirmed CAN 81.2% and sensitivity and specificity for DPN 76.3% and 78%, compared to T2DM group (all <70%). AUC for DPN of orthostatic intolerance domain was higher in T1DM compared to T2DM group (0.73±0.05 vs. 0.58±0.04, P=0.027). Conclusion: COMPASS 31 is more weakly related to CAN in T2DM than in T1DM, with a fair diagnostic accuracy for confirmed CAN only in T1DM. This difference supports a multifactorial origin of symptoms and should be considered when using COM-PASS 31.

Frequency and severity of autonomic dysfunction assessed by objective hemodynamic responses and patient-reported symptoms in individuals with myasthenia gravis

“…Similarly, earlier studies on patients with diabetes showed an overall weak correlation between CASS scores and autonomic symptoms using the Autonomic Symptom Profile questionnaire ( Low et al, 2004 ). In another study ( D’Ippolito et al, 2024 ), COMPASS-31 exhibited a weak association with CAN in type 1 diabetes mellitus and type 2 diabetes mellitus indicating a multifactorial origin of symptoms. In our study, patient-reported autonomic symptoms (total COMPASS-31 score and OI score) were correlated with hemodynamic changes (ΔBP and ΔTPR) induced by AFTs.…”

“…There are conflicting findings regarding the relationship between autonomic questionnaires and autonomic function tests (AFTs) or CASS. Studies have shown a lack of or weak correlations in diabetic and mixed neurological patient groups ( Low et al, 2004 ; D’Ippolito et al, 2024 ; Novak et al, 2024 ). Currently, there is a scarcity of comprehensive assessments of the prevalence and severity of autonomic dysfunction in MG, including subjective and objective measures as well as investigating its relationship with disease outcomes.…”