Prevalence and Diagnosis of Diabetic Cardiovascular Autonomic Neuropathy in Beijing, China: A Retrospective Multicenter Clinical Study

Abstract

Cardiovascular autonomic neuropathy (CAN) is a debilitating condition occurring among diabetic patients especially those with long duration of disease. Whereas incidences and treatment of CAN has been well described for Western populations, fewer studies have been conducted among the Chinese. This study, therefore, aimed to assess the prevalence of CAN among sampled Chinese diabetic patients. Accordingly, 2,048 participants with a history of type 1 diabetes mellitus (T1DM, 73) and type 2 diabetes mellitus (T2DM, 1975) were randomly sampled from 13 hospitals. Patients’ biodata were recorded, and autonomic nervous system function tests performed to aid in the preliminary diagnosis of CAN. The final CAN diagnosis was based on the Ewing’s test in which heart rate variation (HRV) values were evaluated through deep-breathing (DB), lying-to-standing (LS), and Valsalva (V) tests. Systolic blood pressure (SBP) variation values were also evaluated through LS. In the T1DM group, 61.6% patients were diagnosed with CAN and no differences were observed in the baseline and clinical data between this group and those without CAN (P > 0.05). In the T2DM group, 62.6% patients were diagnosed with CAN and statistically significant differences were found between the CAN and non- CAN group with regards to age, duration of diabetes, metformin treatment, retinopathy, and hypertension history (P < 0.05). The most common manifestations of CAN included weakness (28.6%), dizziness (23.4%), frequent urination (19.6%), upper body sweating (18.3%), and nocturia (15.9%). Additionally, duration of disease and age were independent risk factors for CAN in T1DM and T2DM, respectively. On diagnosis, a combination of the V test + LS test provided the highest sensitivity of detecting CAN among T1DM group (sensitivity = 97.6%, AUC = 0.887) while for T2DM category, DB test had the highest sensitivity (83.6%), and maximal AUC (0.856) was found with V test + DB test. The overall prevalence of diabetes with CAN in the study was up to 63%.

Differences and Similarities in Neuropathy in Type 1 and 2 Diabetes: A Systematic Review

“…Heart rate variability was the most extensively investigated parameter in those studies, comparing type 1 and type 2 cardiac dysautonomy [ 29 , 36 , 37 ]. Autonomic cardiac neuropathy is diagnosed when there are two or more abnormal results of autonomic function tests [ 38 ] and its prevalence is high in diabetic patients, ranging between 20 and 60% [ 28 , 29 , 31 , 39 ]. The prevalence of cardiac autonomous neuropathy has been reported either to be higher in type 2 diabetic patients [ 29 , 40 , 41 ] or similar in both types of diabetes in other reports [ 31 , 32 , 35 , 42 ].…”

“…In contrast, heart rate variability in response to the Valsalva maneuver and the dispersion of QTc interval (QT interval corrected for heart rate) in the electrocardiogram was more impaired in type 2 diabetic patients [ 17 , 33 ]. A combination of the Valsalva and lying-to-standing tests provided the highest sensitivity for detecting cardiac autonomous neuropathy in type 1 diabetic patients (sensitivity = 97.6%, AUC = 0.887) while for type 2 diabetes patients, the deep-breathing and Valsalva test had the highest values (sensitivity = 83.6%, AUC = 0.856) [ 28 ]. There were associations between cardiac autonomic neuropathy and long-term complications of diabetes [ 31 , 32 , 35 ].…”

“…The study of the influence of age and gender as independent risk factors in the development of neuropathy in type 1 and type 2 diabetic patients has rarely been addressed by the scientific community. Only six articles [ 21 , 23 , 24 , 28 , 32 , 55 ] have assessed the contribution of age and gender variables in the development of sensory, motor or autonomous neuropathy by type of diabetes. An advanced age better fits in statistical models for neuropathy severity in type 2 diabetic patients [ 21 , 23 , 24 , 28 , 32 ].…”

“…Only six articles [ 21 , 23 , 24 , 28 , 32 , 55 ] have assessed the contribution of age and gender variables in the development of sensory, motor or autonomous neuropathy by type of diabetes. An advanced age better fits in statistical models for neuropathy severity in type 2 diabetic patients [ 21 , 23 , 24 , 28 , 32 ]. In research conducted by Pan et al 2019 [ 28 ], neither age nor gender were independent factors for the development of cardiac autonomic neuropathy in type 1 diabetic patients.…”

“…An advanced age better fits in statistical models for neuropathy severity in type 2 diabetic patients [ 21 , 23 , 24 , 28 , 32 ]. In research conducted by Pan et al 2019 [ 28 ], neither age nor gender were independent factors for the development of cardiac autonomic neuropathy in type 1 diabetic patients. However, an older age was a significant risk factor in the type 2 group.…”