PREVALENCE OF CARDIAC AUTONOMIC NEUROPATHY IN DIABETIC PATIENTS
Main Article Content
Keywords
Cardiac Autonomic Neuropathy, Diabetes, Bedside Tests
Abstract
Background: Diabetic autonomic neuropathy is a stealthy complication of diabetes. CAN is usually detected at a subclinical stage by various tests of autonomic reflexes. Patients with diabetic autonomic neuropathy have three times higher mortality rates than diabetics without autonomic neuropathy. The purpose of this study was to determine the prevalence of cardiac autonomic neuropathy in type 2 diabetes mellitus patients, its early detection with simple bedside tests, and its association with the duration of diabetes.
Methods: 50 patients with diabetes without any complications presenting to the OPD over a period of one year were included in the study. Presence of cardiac autonomic neuropathy was assessed by doing the following tests: Heart rate variations during deep breathing, Heart rate changes from supine to standing, heart rate changes during Valsalva maneuver, presence of postural hypotension and diastolic BP in response to sustained hand grip.
Results: 12 (24%) of the patients had cardiac autonomic neuropathy, and 38 (76%) of the patients had either 1 or no tests positive while testing for cardiac autonomic neuropathy. Out of 17 patients with diabetes of duration >5 years, 9 (52.94%) had evidence of CAN, while of the remaining 33 patients with diabetes of duration <5 years, 3 (9%) had CAN. Postural dizziness was found in 16 (32%) and was the most common of all the autonomic symptoms. Other symptoms were gastroparesis 12 (24%), nocturnal diarrhea 4 (8%), sudomotor disturbances 11 (24%), neurogenic bladder 9 (18%), and weak erection. Out of 34 patients with BMI <25, only 3 (8%) had CAN, and out of 16 patients with BMI >25, 9 (56%) had CAN. Out of 12 patients with CAN, 6 (50%) had albuminuria, and out of 38 patients without CAN, 8 (21%) had albuminuria. Based on the tests conducted, 9 out of 27 (28.57%) of the patients with type 2 diabetes had CAN, whereas only 3 out of 13 (13.63%) of the type 1 diabetics had CAN.
Conclusion: The prevalence of cardiac autonomic neuropathy was increased with the increase in duration of diabetes. Patients who were overweight had higher incidence of cardiac autonomic neuropathy. There was no corelation between the sex of the patient and the prevalence of cardiac autonomic neuropathy.
Methods: 50 patients with diabetes without any complications presenting to the OPD over a period of one year were included in the study. Presence of cardiac autonomic neuropathy was assessed by doing the following tests: Heart rate variations during deep breathing, Heart rate changes from supine to standing, heart rate changes during Valsalva maneuver, presence of postural hypotension and diastolic BP in response to sustained hand grip.
Results: 12 (24%) of the patients had cardiac autonomic neuropathy, and 38 (76%) of the patients had either 1 or no tests positive while testing for cardiac autonomic neuropathy. Out of 17 patients with diabetes of duration >5 years, 9 (52.94%) had evidence of CAN, while of the remaining 33 patients with diabetes of duration <5 years, 3 (9%) had CAN. Postural dizziness was found in 16 (32%) and was the most common of all the autonomic symptoms. Other symptoms were gastroparesis 12 (24%), nocturnal diarrhea 4 (8%), sudomotor disturbances 11 (24%), neurogenic bladder 9 (18%), and weak erection. Out of 34 patients with BMI <25, only 3 (8%) had CAN, and out of 16 patients with BMI >25, 9 (56%) had CAN. Out of 12 patients with CAN, 6 (50%) had albuminuria, and out of 38 patients without CAN, 8 (21%) had albuminuria. Based on the tests conducted, 9 out of 27 (28.57%) of the patients with type 2 diabetes had CAN, whereas only 3 out of 13 (13.63%) of the type 1 diabetics had CAN.
Conclusion: The prevalence of cardiac autonomic neuropathy was increased with the increase in duration of diabetes. Patients who were overweight had higher incidence of cardiac autonomic neuropathy. There was no corelation between the sex of the patient and the prevalence of cardiac autonomic neuropathy.
References
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[2] Ewing DJ, Clarke BF. Diagnosis and management of diabetic autonomic neuropathy. Br Med J 1982;285:916-18.
[3] Boulton AJM, Vinik AI, Arezzo JC, Bril V, Feldman EL, Freeman R, et al. Diabetic neuropathies: a statement by the American Diabetes Association. Diabetes Care 2005;28(4):956-62.
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[8] Balcıoğlu AS, Müderrisoğlu H. Diabetes and cardiac autonomic neuropathy: clinical manifestations, cardiovascular consequences, diagnosis and treatment. Diabetes Care 2010;33(2):434-41.
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[10] Thakuria B, Deka BP. Prevalence of cardiovascular autonomic neuropathy among type 2 diabetes mellitus patients. International Journal of Medical Science in Clinical Research and Review 2023;6(2):384-91.
[11] Murthy ANLN, Lakshmaiah V, Aswathanarayana A. Study of cardiac autonomic neuropathy in type 2 diabetes mellitus. J Clin Biomed Sci 2018;8(2):49-56.
[12] Karupasamy G, Karthick K. Autonomic dysfunction in cardiovascular system of type 2 diabetic mellitus – a bedside evaluation. IAIM 2018;5(3):30-3.
[13] Mohan V, Sastry NG, Premalatha G. Autonomic Neuropathy in NIDDM and fibrocalculus pancreatic diabetes in south India, Diabet Med 1996;13(12):1038-43.
[14] Surendran SA. A Study on Prevalence of Cardiac Autonomic Neuropathy in Type 2 Diabetes Mellitus and use of QTc interval in its prediction. Medicine 2017.
[15] Hage FG, Iskandrian AE. Cardiovascular imaging in diabetes mellitus. J Nucl Cardiol 2011;18:959–65.
[16] Popović-Pejičić S, Todorović-Đilas L, Pantelinac P. The role of autonomic cardiovascular neuropathy in pathogenesis of ischemic heart disease in patients with diabetes mellitus. Med Pregl 2006;59(3-4):118-23.
[17] Spallone V, Bellavere F, Scionti L, Maule S, Quadri R, Bax G, et al. Recommendations for the use of cardiovascular tests in diagnosing diabetic autonomic neuropathy. Nutr Metab Cardiovasc Dis 2011;21(1):69-78.
[18] Beijers HJ, Ferreira I, Bravenboer B, Dekker JM, Nijpels G, Heine RJ, et al. Microalbuminuria and cardiovascular autonomic dysfunction are independently associated with cardiovascular mortality: evidence for distinct pathways: the Hoorn Study. Diabetes Care 2009;32(9):1698-703.
[19] Ziegler D. Cardiovascular autonomic neuropathy: clinical manifestations and measurement. Diabetes Rev 1999;7:342-57.
[20] Pappachan JM, Sebastian J, Bino BC, Jayaprakash K, Vijayakumar K, Sujathan P, et al. Cardiac autonomic neuropathy in diabetes mellitus: prevalence, risk factors and utility of corrected QT interval in the ECG for its diagnosis. Postgraduate Medical Journal 2008;84(990):205-10.
[2] Ewing DJ, Clarke BF. Diagnosis and management of diabetic autonomic neuropathy. Br Med J 1982;285:916-18.
[3] Boulton AJM, Vinik AI, Arezzo JC, Bril V, Feldman EL, Freeman R, et al. Diabetic neuropathies: a statement by the American Diabetes Association. Diabetes Care 2005;28(4):956-62.
[4] Larsen PR, Kronenberg HM, Melmed S, Polonsky KS. Williams’s textbook of endocrinology. 10th edn. Saunders 2002.
[5] Agashe S, Petak S. Cardiac autonomic neuropathy in diabetes mellitus. Methodist Debakey Cardiovasc J 2018;14(4):251-6.
[6] Vinik AI, Ziegler D. Diabetic cardiovascular autonomic neuropathy. Circulation 2007;115(3):387-97.
[7] Dimitropoulos G, Tahrani AA, Stevens MJ. Cardiac autonomic neuropathy in patients with diabetes mellitus. World J Diabetes 2014;5(1):17-39.
[8] Balcıoğlu AS, Müderrisoğlu H. Diabetes and cardiac autonomic neuropathy: clinical manifestations, cardiovascular consequences, diagnosis and treatment. Diabetes Care 2010;33(2):434-41.
[9] Ziegler D. Diabetic cardiovascular autonomic neuropathy: prognosis, diagnosis and treatment. Diabetes Metab Rev 1994;10:339-83.
[10] Thakuria B, Deka BP. Prevalence of cardiovascular autonomic neuropathy among type 2 diabetes mellitus patients. International Journal of Medical Science in Clinical Research and Review 2023;6(2):384-91.
[11] Murthy ANLN, Lakshmaiah V, Aswathanarayana A. Study of cardiac autonomic neuropathy in type 2 diabetes mellitus. J Clin Biomed Sci 2018;8(2):49-56.
[12] Karupasamy G, Karthick K. Autonomic dysfunction in cardiovascular system of type 2 diabetic mellitus – a bedside evaluation. IAIM 2018;5(3):30-3.
[13] Mohan V, Sastry NG, Premalatha G. Autonomic Neuropathy in NIDDM and fibrocalculus pancreatic diabetes in south India, Diabet Med 1996;13(12):1038-43.
[14] Surendran SA. A Study on Prevalence of Cardiac Autonomic Neuropathy in Type 2 Diabetes Mellitus and use of QTc interval in its prediction. Medicine 2017.
[15] Hage FG, Iskandrian AE. Cardiovascular imaging in diabetes mellitus. J Nucl Cardiol 2011;18:959–65.
[16] Popović-Pejičić S, Todorović-Đilas L, Pantelinac P. The role of autonomic cardiovascular neuropathy in pathogenesis of ischemic heart disease in patients with diabetes mellitus. Med Pregl 2006;59(3-4):118-23.
[17] Spallone V, Bellavere F, Scionti L, Maule S, Quadri R, Bax G, et al. Recommendations for the use of cardiovascular tests in diagnosing diabetic autonomic neuropathy. Nutr Metab Cardiovasc Dis 2011;21(1):69-78.
[18] Beijers HJ, Ferreira I, Bravenboer B, Dekker JM, Nijpels G, Heine RJ, et al. Microalbuminuria and cardiovascular autonomic dysfunction are independently associated with cardiovascular mortality: evidence for distinct pathways: the Hoorn Study. Diabetes Care 2009;32(9):1698-703.
[19] Ziegler D. Cardiovascular autonomic neuropathy: clinical manifestations and measurement. Diabetes Rev 1999;7:342-57.
[20] Pappachan JM, Sebastian J, Bino BC, Jayaprakash K, Vijayakumar K, Sujathan P, et al. Cardiac autonomic neuropathy in diabetes mellitus: prevalence, risk factors and utility of corrected QT interval in the ECG for its diagnosis. Postgraduate Medical Journal 2008;84(990):205-10.
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Jun 03, 2023
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Dr. Usham Dharmaraja Meetei, & Dr. Leisangthem Tarinita Devi. (2023). PREVALENCE OF CARDIAC AUTONOMIC NEUROPATHY IN DIABETIC PATIENTS. Journal of Population Therapeutics and Clinical Pharmacology, 30(6), 624-631. https://doi.org/10.53555/r6923396
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Author Biographies
Dr. Usham Dharmaraja Meetei
Associate Professor, Department of Pharmacology, Regional Institute of Medical Sciences, Imphal, Manipur, India.
Dr. Leisangthem Tarinita Devi
Associate Professor, Department of Pharmacology, Regional Institute of Medical Sciences, Imphal, Manipur, India.
How to Cite
Dr. Usham Dharmaraja Meetei, & Dr. Leisangthem Tarinita Devi. (2023). PREVALENCE OF CARDIAC AUTONOMIC NEUROPATHY IN DIABETIC PATIENTS. Journal of Population Therapeutics and Clinical Pharmacology, 30(6), 624-631. https://doi.org/10.53555/r6923396