Cardiovascular autonomic neuropathy (expiration and inspiration ratio) in type 1 diabetes. Incidence and predictors.

The pathogenesis of diabetic neuropathy is poorly understood. In this prospective study, we investigated the incidence rate and potential predictors for cardiovascular autonomic neuropathy (CAN) in a cohort of childhood-onset type 1 diabetic patients. Subjects from the Epidemiology of Diabetes Complications Study were examined at baseline and then biennially. CAN was diagnosed by abnormal (</=1. 1) expiration/inspiration ratio during deep breathing. During the 4. 7-year mean follow-up period, CAN developed in 104 patients from the 373 subjects who were free of CAN at baseline and provided follow-up data, an incidence-density of 5.9 cases/100 person-years. Cox proportional hazard modeling showed age (relative risk [RR]=2.15, p=0.0001), HbA1 (RR=1.50, p=0.0002) and nephropathy (albumin excretion >200 ug/min) (RR=2.46, p=0.0001) to be significant independent predictors. Hypertension was, however, predictive if nephropathy was not included in the model. We conclude that beyond age and poor glycemic control, nephropathy is a significant risk factor for CAN and this association may explain some of the increased mortality seen in CAN.

[1]  G Bucolo,et al.  Quantitative determination of serum triglycerides by the use of enzymes. , 1973, Clinical chemistry.

[2]  E. Avner,et al.  Choice of urine sample predictive of microalbuminuria in patients with insulin-dependent diabetes mellitus. , 1989, American journal of kidney diseases : the official journal of the National Kidney Foundation.

[3]  S. Smith.  Reduced sinus arrhythmia in diabetic autonomic neuropathy: diagnostic value of an age-related normal range. , 1982, British medical journal.

[4]  P. Fu,et al.  Enzymatic determination of total serum cholesterol. , 1974, Clinical chemistry.

[5]  J. Albers,et al.  Heparin--Mn2+ quantitation of high-density-lipoprotein cholesterol: an ultrafiltration procedure for lipemic samples. , 1978, Clinical chemistry.

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

[7]  R. Levy,et al.  Estimation of the concentration of low-density lipoprotein cholesterol in plasma, without use of the preparative ultracentrifuge. , 1972, Clinical chemistry.

[8]  G. Sundkvist,et al.  Autonomic Neuropathy Predicts Deterioration in Glomerular Filtration Rate in Patients With IDDM , 1993, Diabetes Care.

[9]  W. Rathmann,et al.  Mortality in Diabetic Patients with Cardiovascular Autonomic Neuropathy , 1993, Diabetic medicine : a journal of the British Diabetic Association.

[10]  Phyllis K. Stein,et al.  Association of depression witk reduced heart rate variability in coronary artery disease , 1995 .

[11]  W. Litchy,et al.  Longitudinal assessment of diabetic polyneuropathy using a composite score in the Rochester Diabetic Neuropathy Study cohort , 1997, Neurology.

[12]  A. Vaag,et al.  Local Skin-Fold Thickness as a Clinical Predictor of Depot Size During Basal Rate Infusion of Insulin , 1993, Diabetes Care.

[13]  Langford Hg.  The hypertension detection and follow-up program. , 1984 .

[14]  K. Forrest,et al.  Hypertension as a Risk Factor for Diabetic Neuropathy: A Prospective Study , 1997, Diabetes.

[15]  Sundkvist Göran.  Autonomic Nervous Function in Asymptomatic Diabetic Patients with Signs of Peripheral Neuropathy , 1981, Diabetes Care.

[16]  O. Pahlm,et al.  The association between diabetic nephropathy and autonomic nerve function in type 1 diabetic patients. , 1997, Scandinavian journal of clinical and laboratory investigation.

[17]  J. Mann,et al.  Diabetic Autonomic Neuropathy: the Prevalence of Impaired Heart Rate Variability in a Geographically Defined Population , 1989, Diabetic medicine : a journal of the British Diabetic Association.

[18]  J. Pirart.  Diabetes Mellitus and Its Degenerative Complications: A Prospective Study of 4,400 Patients Observed Between 1947 and 1973 , 1978, Diabetes Care.

[19]  D. Ewing,et al.  The natural history of diabetic autonomic neuropathy. , 1980, The Quarterly journal of medicine.

[20]  F. A. Gries,et al.  The Epidemiology of Diabetic Neuropathy , 1993 .

[21]  L. Kuller,et al.  Predictors of Microalbuminuria in Individuals with IDDM: Pittsburgh Epidemiology of Diabetes Complications Study , 1993, Diabetes Care.

[22]  edited by debrae Haire-joshu.  Management of diabetes mellitus : perspectives of care across the life span , 1992 .

[23]  L. Kuller,et al.  Prevalence of Complications in IDDM by Sex and Duration: Pittsburgh Epidemiology of Diabetes Complications Study II , 1990, Diabetes.

[24]  V. Spallone,et al.  Relationship Between Autonomic Neuropathy, 24-h Blood Pressure Profile, and Nephropathy in Normotensive IDDM Patients , 1994, Diabetes Care.

[25]  L. Kuller,et al.  Factors Associated With Avoidance of Severe Complications After 25 Yr of IDDM: Pittsburgh Epidemiology of Diabetes Complications Study I , 1990, Diabetes Care.

[26]  Roger A. Renfrew,et al.  Lipid Research Clinics Program. , 1984, JAMA.

[27]  L. Kuller,et al.  Why does diabetic autonomic neuropathy predict IDDM mortality? An analysis from the Pittsburgh Epidemiology of Diabetes Complications Study. , 1996, Diabetes research and clinical practice.

[28]  P. Poulsen,et al.  24-h blood pressure and autonomic function is related to albumin excretion within the normoalbuminuric range in IDDM patients , 1997, Diabetologia.

[29]  A. Beck,et al.  Psychometric properties of the Beck Depression Inventory: Twenty-five years of evaluation , 1988 .

[30]  L. Kuller,et al.  Diabetic autonomic neuropathy and cardiovascular risk. Pittsburgh Epidemiology of Diabetes Complications Study III. , 1990, Archives of internal medicine.