Relationship between cardiovascular autonomic (dys)function and microalbuminuria in type 2 Diabetes Mellitus

Abstract

Background: Diabetic autonomic neuropathy is a serious and common complication of diabetes mellitus and in fact it is one of the most overlooked complications, thus very limited clinical and research data are available on early renal and cardiovascular autonomic complications in type 2 diabetes mellitus. Aims & Objective: To determine the possible association of elevated albumin excretion rate with cardiovascular autonomic activity in type 2 diabetes mellitus. Materials and methods: A cross-sectional study was conducted with one hundred and fifteen patients of type 2 diabetes mellitus. Microalbuminuria was defined as Albumin Excretion Rate (AER) > 30 mg/24 hr in an early morning urine sample. Nine parameters reflecting different aspects of cardiovascular autonomic function were measured and were summarized in a single cardiovascular autonomic function score (CAFS).The association between cardiovascular autonomic dysfunction and microalbuminuria was estimated by multiple linear regressions. Results: Patients with microalbuminuria had low levels of the autonomic function parameters i.e. mean CAFS, indicating impaired autonomic function. This association was consistent with increasing AER, and remained significant after multivariate adjustment for other clinical factors predictive of microalbuminuria. In additional analysis, we examined the autonomic function tests combined on the part of autonomic nervous system they predominantly represent. The results of these alternative combinations were comparable to those of the CAFS score. Conclusion: Cardiovascular autonomic dysfunction was independently associated with microalbuminuria in patients with type 2 diabetes mellitus, and that this association is independent of other previously identified determinants of albuminuria in type 2 diabetes mellitus. Therefore cardiovascular autonomic function tests should be monitored to pay attention to major potential cardiovascular complications even in asymptomatic patients, but especially among those with microalbuminuria.

Cardiovascular Autonomic Dysfunction in Type-2 Diabetes patients with Microalbuminuria in a Tertiary Level Hospital

“…Present study showed that, 40 (80%) patients had parasympathetic dysfunction (at least one of the three tests of parasympathetic function being abnormal) and 43 (86%) patients had sympathetic dysfunction (at least one of the two tests of sympathetic function being abnormal) which is consistent to the study done by Basu AK in which parasympathetic and sympathetic abnormality were 52% and 20% respectively. 2 In this study, common risk factors were HTN, smoking, obesity and dyslipidaemia and it is consistent with the study done by Deepak N Parchwani et al 7 in which age, triglycerides, blood pressure and HbA1c were significantly related to the presence of microalbuminuria.…”

Cardio Vascular Autonomic Dysfunction in Type 2 Diabetes Patients with Microalbuminuria

“…In the Deepak N study Parchwani et al were significantly involved in the existence of microalbuminuria in the age, triglycerides, blood pressure and HbA1c. [16] Microalbuminuria evaluation is included in the paradigm based on studies which suggest that microalbuminuria is related. [17][18][19] 126 T-2DM patients were compared to 152 aging and sex-matched healthy controls in a research in a rural region in southern India.…”

Diabetic nephropathy: Progression and pathophysiology

“…Several factors, such as hyperglycemia, hyperlipidemia, hypertension & cardiovascular autonomic dysfunction contribute to the progression of renal damage. [54] However, they are supported by a specific genetic background because only a subset of people with diabetes develops microalbuminuria, irrespective of glycemic control. Evidence supporting this includes the increased risk for microalbuminuria in diabetic siblings of a type 1 diabetic proband with microalbuminuria [55] and familial clustering of nephropathy in both type 1 and type 2 diabetes.…”