Risk factors for cardiac autonomic neuropathy in type 1 diabetes mellitus

Abstract

Aims/hypothesis: Cardiac autonomic neuropathy (CAN) is associated with increased morbidity and mortality in type 1 diabetes. Apart from glycaemic control, risk factors for CAN have not been extensively studied. Methods: As part of the EURODIAB Prospective Complications Study, CAN-defined as either a loss of heart rate variability or postural hypotension on standing-was assessed at baseline and follow-up (7.3±0.6 years from baseline) in patients with type 1 diabetes. Results: Follow-up measurements were available for 956 participants without CAN at baseline (age at baseline 31.3±8.9 years, duration of diabetes 13.5±8.3 years). During followup, 163 (17%) subjects developed CAN, yielding an incidence of 23.4 per 1,000 person-years. Blood pressure, weight, the presence of cardiovascular disease, albuminuria, distal symmetrical polyneuropathy (DSP) and retinopathy at baseline were associated with the incidence of CAN after adjustment for sex, duration of diabetes and HbA 1 c. In a multivariate regression model, baseline factors associated with an increased risk of developing CAN were age [odds ratio (OR)=1.3 per decade, 95% CI 1.1-1.7], HbA 1 c (OR=1.2 per percentage point, 95% CI 1.1-1.4), systolic blood pressure (OR=1.1 per 10 mmHg, 95% CI 1.0-1.3), feeling faint on standing (OR=2.0, 95% CI 1.2-3.2), DSP (OR=1.9, 95% CI 1.2-3.0) and retinopathy (OR=1.7, 95% CI 1.1-2.6). Conclusion/interpretation: This study confirms the importance of exposure to hyperglycaemia as a risk factor for CAN. A small set of variables, including HbA 1 c, hypertension, DSP and retinopathy, predict the risk of CAN. Clinical trials are needed to address the impact of intensive antihypertensive treatment on CAN in type 1 diabetes.

Impact of early detection and treatment of diabetes on the 6-year prevalence of cardiac autonomic neuropathy in people with screen-detected diabetes: ADDITION-Denmark, a cluster-randomised study

“…This confirms that diabetic neuropathy is indeed prevalent among patients in the early stages of type 2 diabetes. Several risk factors for the development of neuropathy exist [1,18,[21][22][23]. However, trial evidence of treatment to prevent the development of CAN in people with type 2 diabetes is sparse [1,12,24].…”

Haemodynamic changes during a squat test, pulsatile stress and indices of cardiovascular autonomic neuropathy in patients with long-duration type 1 diabetes

“…There may also be links between PP and CAN [24], between aortic stiffness and CAN [13,14], and between arterial stiffness, cardiovagal baroreflex sensitivity and postural BP changes [35]. Increased SBP was identified as a factor associated with an increased risk of developing CAN in the cohort of T1DM patients in the EURODIAB Prospective Complications Study [16]. Also, we previously reported a significant inverse relationship between pulsatile stress and baroreflex gain as a marker of CAN in middle-aged patients with T1DM [26].…”

“…Both CAN [10] and increased PP [11,12] are considered to be independent risk factors of cardiovascular disease and total mortality in T1DM patients. Furthermore, CAN may be linked to aortic stiffness [13,14], endothelial dysfunction [15] and increased SBP [16] or PP [17] in T1DMpatients. Moreover, CAN is known to be associated with a greater risk of orthostatic hypotension [18,19].…”

Frequency of Autonomic Neuropathy Occurrence among Diabetic Patients

“…This may be responsible for certain disabling symptoms, painless myocardial infarction, and sudden deaths 4,5,[14][15][16][17] . In our study, 43% of the patients showed the involvement of the cardiovascular system.…”