Impact of Disease Duration on Cardiovascular and Pupillary Autonomic Nervous Function in IDDM and NIDDM Patients

Straub, Rainer H.; Zietz, B.; Palitzsch, K. D.; Schölmerich, Jürgen

doi:10.2337/diacare.19.9.960

Cited by 21 publications

(15 citation statements)

References 0 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Because central nervous system involvement is common in patients with HIV, [2] the high prevalence of pupillary autonomic disorders may be a sign of central nervous system alterations. By means of the same standardized techniques, the 15% prevalence of CANP was found to be in the range known for other diseases such as systemic lupus erythematosus (10%) [29] and systemic sclerosis (16%) [29], but it was significantly higher than the prevalence known in Crohn disease (0%) [30] and ulcerative colitis (5%) [30] and significantly lower than the prevalence known in diabetes mellitus (approximately 25%) [31]. The afferent part of the reflex loop consists of the retina, the optic nerve, and the central visual pathways, which are often altered in patients with HIV [2,4].…”

Section: Discussionmentioning

confidence: 89%

Autonomic neuropathy in patients with HIV: Course, impact of disease stage, and medication

Glück

Degenhardt

Schölmerich

et al. 2000

Clinical Autonomic Research

Self Cite

View full text Add to dashboard Cite

The purpose of this article is to examine the prevalence, degree, and natural course of pupillary neuropathy (PANP), cardiovascular autonomic neuropathy (CANP), and sensorimotor neuropathy (SNP) and to study the impact of disease stage and medication on neuropathy in 61 consecutive patients with HIV. PANP, CANP, and SNP were assessed by standardized test procedures. Overall prevalence of PANP, CANP, and SNP were 66%, 15%, and 15%, respectively. The maximal pupillary area (pupillary measure, p <0.0001) and the lying-to-standing ratio (cardiovascular measure, p <0.0001) were abnormal as compared with control subjects. The changes in CD4+ T-lymphocytes and respiratory sinus arrhythmia percentile during 2 years of follow-up correlated significantly (r = 0.758, p = 0.007). Patients with CANP were more often in an advanced disease stage than patients without CANP (p = 0.004). SNP, but not PANP or CANP, was associated with the intake of the neuropathogenic drugs dideoxycytidine, dideoxyinosine, and 2',3' didehydro-2',3' dideoxythymidine (p <0.05). Autonomic and sensorimotor neuropathy are frequent in patients with HIV, and progression of CANP may put patients at risk for unexpected cardiorespiratory arrest.

show abstract

Section: Discussionmentioning

confidence: 89%

Autonomic neuropathy in patients with HIV: Course, impact of disease stage, and medication

Glück

Degenhardt

Schölmerich

et al. 2000

Clinical Autonomic Research

Self Cite

View full text Add to dashboard Cite

show abstract

“…It is questionable whether the impairment of cardiac regulation in young diabetics, especially when newly diagnosed, is a true disease-related complication 15 . We are in agreement with this opinion of Straub and co-workers, who found no correlation between disease duration and cardiovascular autonomic nervous function.…”

Section: Discussionmentioning

confidence: 99%

“…Thirty-two children, adolescents and young adults (14 M, 18 F) with type 1 diabetes mellitus (IDDM), average age 16.1 ± 0.7 (range 8-25) years, mean duration of IDDM 6.3 ± 0.8 (range [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17] years, body mass index 21.3 ± 0.9 (15-31), were studied. All patients were being treated with a combination of short and intermediate acting human insulin injected three or four times daily.…”

Section: Subjectsmentioning

confidence: 99%

Heart Rate Variability and Cardiovascular Tests in Young Patients with Diabetes Mellitus Type 1

Javorka¹,

Javorková²,

Petraskova³

et al. 1999

Journal of Pediatric Endocrinology and Metabolism

View full text Add to dashboard Cite

The aim of this study was to obtain information about parameters of heart rate variability (HRV) in three frequency bands (high frequency - HF, low frequency - LF and very low frequency - VLF), the sensitivity of cardiovascular tests, and subjective feelings depending on autonomic nervous system balance in a group of young patients with diabetes mellitus type 1 (IDDM). Sixty-four subjects were examined: 32 patients with diabetes with a mean age of 16.1 +/- 0.7 years and a mean duration of IDDM of 6.3 +/- 0.8 years, and 32 healthy controls matched for age, sex and BMI. Shorter R-R intervals and abnormal values reflecting HRV were found in the diabetic group. In particular, parameters of total power, and HF and LF bands were reduced. The ratio VLF/HF power revealed predominance of sympathetic tone in the diabetic subjects. Although relative power VLF was increased in the supine position, the reactive rise of the VLF band activity in orthostasis was lower in the IDDM group. Using cardiovascular tests (deep breathing, Valsalva, orthostasis), significant differences in reactions were found only in the deep breathing test. Evaluation of sympathetic:parasympathetic:indifferent subjective feelings by questionnaire did not reveal any differences between the diabetic and healthy groups.

show abstract

“…It is well known that diabetic autonomic neuropathy develops within a short duration of diabetes even when somatic neuropathy is not apparent (3,4). Furthermore, the abnormalities in pupillary functions can be detected earlier than those in cardiovascular autonomic functions and are considered the earliest signs of diabetic autonomic neuropathy (5)(6)(7)(8)(9)(10).…”

mentioning

confidence: 99%

Aldose Reductase Inhibition Ameliorates Pupillary Light Reflex and F-Wave Latency in Patients With Mild Diabetic Neuropathy

et al. 2001

View full text Add to dashboard Cite

OBJECTIVE -The present study was conducted to investigate the effect of an aldose reductase inhibitor, epalrestat, on autonomic and somatic neuropathy at an early stage in type 2 diabetic patients by assessing the pupillary light reflex and minimum latency of the F-wave. RESEARCH DESIGN AND METHODS-A total of 30 diabetic patients with subclinical or mild diabetic neuropathy were randomly allocated to a control group (n ϭ 15) and epalrestat (150 mg/day) group (n ϭ 15). After 24 weeks, the pupillary light reflex test, cardiovascular autonomic function tests, and nerve conduction study were performed.RESULTS -The beneficial effect of epalrestat on the pupillary light reflex was observed in the minimum diameter after light stimuli (P ϭ 0.044), constriction ratio (P ϭ 0.014), and maximum velocity of constriction (P ϭ 0.008). Among cardiovascular autonomic nerve functions, the ratio of the longest expiratory R-R interval to the shortest inspiratory R-R interval during deep breathing was significantly improved by epalrestat (P ϭ 0.037). Minimum latencies of F-wave of median and tibial motor nerves were significantly shortened by epalrestat (P ϭ 0.002 and P ϭ 0.001, respectively); however, no significant effects were observed in motor or sensory nerve conduction velocity.CONCLUSIONS -These observations suggest that epalrestat may have therapeutic value at the early stage of diabetic neuropathy and that the pupillary light reflex and minimum latency of F-wave may be useful indicators of diabetic neuropathy. Diabetes Care 24:1093-1098, 2001D iabetic neuropathy is generally classified into somatic and autonomic neuropathy. Although somatic neuropathy can be characterized by symptoms such as numbness, paresthesia, and abnormal sensation, the symptoms of autonomic neuropathy do not appear until the advanced stage.Diabetic autonomic neuropathy causes functional disorders of many organs, such as cardiovascular, gastrointestinal, genitourinary, metabolic, and pupillary dysfunctions. Among these, cardiovascular autonomic neuropathy may increase the risk of sudden death and affects the mortality of diabetic patients (1,2). Therefore, the diagnosis and treatment of autonomic neuropathy at an early stage is important for the management of diabetic patients.It is well known that diabetic autonomic neuropathy develops within a short duration of diabetes even when somatic neuropathy is not apparent (3,4). Furthermore, the abnormalities in pupillary functions can be detected earlier than those in cardiovascular autonomic functions and are considered the earliest signs of diabetic autonomic neuropathy (5-10). Therefore, the pupillary light reflex test has been used for evaluating diabetic autonomic neuropathy.It has been demonstrated that strict glycemic control can decrease the incidence of diabetic complications, including autonomic neuropathy (11). However, it is impossible to completely prevent the development of diabetic complications by glycemic control alone, except by performing a pancreas transplantation. Therefore, different t...

show abstract

Impact of Disease Duration on Cardiovascular and Pupillary Autonomic Nervous Function in IDDM and NIDDM Patients

Cited by 21 publications

References 0 publications

Autonomic neuropathy in patients with HIV: Course, impact of disease stage, and medication

Autonomic neuropathy in patients with HIV: Course, impact of disease stage, and medication

Heart Rate Variability and Cardiovascular Tests in Young Patients with Diabetes Mellitus Type 1

Aldose Reductase Inhibition Ameliorates Pupillary Light Reflex and F-Wave Latency in Patients With Mild Diabetic Neuropathy

Contact Info

Product

Resources

About