Cardiovascular Autonomic Neuropathy in Context of Other Complications of Type 2 Diabetes Mellitus

The aim of this study was to investigate the relationship between cardiac autonomic neuropathy (CAN) and other micro- and macrovascular complications and risk factors for type 2 diabetes. We included, in this study, 149 patients with type 2 diabetes. We evaluated their cardiovascular risk factors, demographic data, and any major micro- and macrovascular complications of their diabetes. Assessments of CAN were based upon Ewing's battery. Results. CAN was present in 38.9% of patients. In the CAN group, the duration of diabetes, BMI, systolic blood pressure, lipid levels, and HBA1c were all significantly higher than those in the other group. A significant association was found between CAN and retinopathy, peripheral neuropathy, ABI, and IMT. Multivariate logistic regression demonstrated that, in type 2 diabetes, the odds of CAN (OR (95% confidence intervals)) increase with the age of the patients (1.68 (1,4129–2.0025)), the average diabetes duration (0.57 (0.47–0.67)), cholesterol (1.009 (1.00-1.01)), HbA1c levels (1.88 (1.31–2.72)), peripheral neuropathy (15.47 (5.16–46.38)), BMI (1.12 (1.05–1.21)), and smoking (2.21 (1.08–4.53)). Conclusions. This study shows that CAN in type 2 diabetes is significantly associated with other macro- and microvascular complications and that there are important modifiable risk factors for its development.

[1]  C. Jf,et al.  [Diabetic autonomic neuropathy]. , 1989, Atencion primaria.

[2]  Oluf Pedersen,et al.  Multifactorial intervention and cardiovascular disease in patients with type 2 diabetes. , 2003, The New England journal of medicine.

[3]  S. Haffner,et al.  Effects of Diabetes and Level of Glycemia on All-Cause and Cardiovascular Mortality: The San Antonio Heart Study , 1998, Diabetes Care.

[4]  Jun Kimura,et al.  Principles of Nerve Conduction Studies , 2013 .

[5]  Matthias W. Lorenz,et al.  Prediction of Clinical Cardiovascular Events With Carotid Intima-Media Thickness: A Systematic Review and Meta-Analysis , 2007, Circulation.

[6]  P. Valensi,et al.  Cardiac autonomic neuropathy in diabetic patients: influence of diabetes duration, obesity, and microangiopathic complications--the French multicenter study. , 2003, Metabolism: clinical and experimental.

[7]  N. Katsilambros,et al.  The association between cardiac autonomic neuropathy with metabolic and other factors in subjects with type 1 and type 2 diabetes. , 2011, Journal of diabetes and its complications.

[8]  G. Sundkvist,et al.  Autonomic neuropathy in non‐insulin dependent (type II) diabetes mellitus. Possible influence of obesity , 1990, Journal of internal medicine.

[9]  Rayaz A. Malik,et al.  Diabetic Neuropathies: Update on Definitions, Diagnostic Criteria, Estimation of Severity, and Treatments , 2010, Diabetes Care.

[10]  L. Melton,et al.  Risk factors for severity of diabetic polyneuropathy: intensive longitudinal assessment of the Rochester Diabetic Neuropathy Study cohort. , 1999, Diabetes care.

[11]  M. Horowitz,et al.  Diabetic neuropathies: Update on definitions, diagnostic criteria, estimation of severity, and treatments(Diabetes Care (2010) 33, (2285-2293)) , 2010 .

[12]  P. Dyck.  Detection, characterization, and staging of polyneuropathy: Assessed in diabetics , 1988, Muscle & nerve.

[13]  W H Eisma,et al.  Symptom scoring systems to diagnose distal polyneuropathy in diabetes: the Diabetic Neuropathy Symptom score , 2002, Diabetic medicine : a journal of the British Diabetic Association.

[14]  D. Ewing,et al.  The Value of Cardiovascular Autonomic Function Tests: 10 Years Experience in Diabetes , 1985, Diabetes Care.

[15]  Ambady Ramachandran,et al.  High prevalence and early onset of cardiac autonomic neuropathy among South Indian type 2 diabetic patients with nephropathy. , 2000, Diabetes research and clinical practice.

[16]  T Gustavsson,et al.  Ultrasound measurement of wall thickness in the carotid artery: fundamental principles and description of a computerized analysing system. , 1991, Clinical physiology.

[17]  J. Schölmerich,et al.  Impact of Obesity on Neuropathic Late Complications in NIDDM , 1994, Diabetes Care.

[18]  A. Folsom,et al.  Relation of Carotid Artery Wall Thickness to Diabetes Mellitus, Fasting Glucose and Insulin, Body Size, and Physical Activity , 1994, Stroke.

[19]  N. Tentolouris,et al.  Peripheral neuropathy does not invariably coexist with autonomic neuropathy in diabetes mellitus. , 2001, European journal of internal medicine.

[20]  R. Freeman,et al.  Cardiovascular autonomic neuropathy in diabetes: clinical impact, assessment, diagnosis, and management , 2011, Diabetes/metabolism research and reviews.

[21]  F. Rubino,et al.  The effects of intensive glycemic control on neuropathy in the VA cooperative study on type II diabetes mellitus (VA CSDM). , 1999, Journal of diabetes and its complications.

[22]  J. Eriksson,et al.  Cardiovascular autonomic dysfunction is associated with central obesity in persons with impaired glucose tolerance , 2011, Diabetic medicine : a journal of the British Diabetic Association.

[23]  Uk-Prospective-Diabetes-Study-Group.  Intensive blood-glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes (UKPDS 33) , 1998, The Lancet.

[24]  M. Uusitupa,et al.  Divergent development of autonomic and peripheral somatic neuropathies in NIDDM , 1997, Diabetologia.

[25]  R. Holman,et al.  Association of glycaemia with macrovascular and microvascular complications of type 2 diabetes (UKPDS 35): prospective observational study , 2000, BMJ : British Medical Journal.

[26]  R. Freeman,et al.  A cross-sectional study of the relationships among tests of neurophysiology , 2010 .

[27]  M. Lenhard,et al.  Cardiovascular autonomic neuropathy due to diabetes mellitus: clinical manifestations, consequences, and treatment. , 2005, The Journal of clinical endocrinology and metabolism.

[28]  G. Eknoyan,et al.  Definition and classification of chronic kidney disease: a position statement from Kidney Disease: Improving Global Outcomes (KDIGO). , 2005, Kidney international.

[29]  Consensus statement: Report and recommendations of the San Antonio conference on diabetic neuropathy. American Diabetes Association American Academy of Neurology. , 1988, Diabetes care.

[30]  Dan Ziegler,et al.  Assessment of Cardiovascular Autonomic Function: Age‐related Normal Ranges and Reproducibility of Spectral Analysis, Vector Analysis, and Standard Tests of Heart Rate Variation and Blood Pressure Responses , 1992, Diabetic medicine : a journal of the British Diabetic Association.

[31]  E. Feldman,et al.  Elevated Triglycerides Correlate With Progression of Diabetic Neuropathy , 2009, Diabetes.

[32]  J. Satoh,et al.  [Epidemiology of diabetic neuropathy]. , 2012, Nihon rinsho. Japanese journal of clinical medicine.

[33]  Braxton D Mitchell,et al.  The association between cardiovascular autonomic neuropathy and mortality in individuals with diabetes: a meta-analysis. , 2003, Diabetes care.