A cross-sectional assessment to detect type 2 diabetes with endothelial and autonomic nervous system markers using a novel system

Abstract

BackgroundType 2 diabetes mellitus is frequently unrecognized until complications appear. Diabetic autonomic neuropathy is one of the early complications of type 2 diabetes mellitus, resulting in autonomic nervous system (ANS) dysfunction. The purpose of this study was to determine the validity of ANS function indicators to screen for type 2 diabetes mellitus, as measured by the TM-Oxi and SudoPath system.MethodsAll enrolled participants completed a basic sociodemographic and medical history questionnaire including current medications. Healthy controls (n = 25) underwent a 2-hour oral glucose tolerance test (OGTT) to evaluate glucose, insulin, and insulin C-peptide. Patients with type 2 diabetes mellitus (n = 24) were assessed with fasting plasma glucose (FPG) and glycosylated hemoglobin. The TM-Oxi and SudoPath system evaluation was completed by all subjects. Data were analyzed using SPSS 22. Frequency and descriptive statistics were calculated on all variables. The criterion for statistical significance was α = 0.05.ResultsThe twenty-five healthy controls had a mean age of 37.0 years. The twenty-four type 2 diabetes mellitus patients currently undergoing standard treatment had a mean age of 48.9 years. Based on the American Diabetes Association guidelines, we detected pre-diabetes in 4 subjects and diabetes in 1 subject, while all other subjects had normal FPG values. At 120 minutes, the correlations between the OGTT and cardiometabolic risk score (CMRS) were: r = 0.56 (p = 0.004) for glucose and r = 0.53 (p = 0.006) for insulin. At 120 minutes, the correlations between the OGTT and photoplethysmography index (PTGi) were: r = -0.56 (p = 0.003) for glucose and r = -0.41 (p = 0.04) for insulin. The CMRS, PTGi, and plethysmography total power index (PTGVLFi) differed significantly between the diabetes patients and healthy participants. The specificity and sensitivity for the CMRS, PTGi, and PTVLFi comparing the diabetes patients with healthy controls were high.ConclusionThe TM-Oxi and SudoPath system shows promise as a valid, convenient, and non-invasive screening method for type 2 diabetes mellitus. The ANS function and CMR indicators measured by this system may be useful in guiding diabetes and cardiovascular health screening, treatment, and monitoring.

Vitamin D Status, Autonomic Nervous System Activity, and Cardiometabolic Risk

“…Recently, a study comparing diabetic and healthy controls showed that the CMRS calculated by this software is significantly correlated with glucose and insulin measured during an oral glucose tolerance test and was significantly higher in participants with diabetes. Also, specificity (92%) and sensitivity (83%) were high for the CMRS in differentiating patients with diabetes from healthy control [21].…”

“…Steps of the procedure are described elsewhere and details of the devices are discussed in previous publications and the manufacturer's website (http://www.ldteck.com) [20] [21]. The Electro-Sensor Body Composition (ES-BC) device uses a single-frequency bioelectrical impedance analyzer to compute percent fat mass (%FM) using accepted peer-reviewed published algorithms tailored to the general and obese population based on gender, height, weight, age, and activity level [20] [22].…”

“…The left ventricle ejection time index (LVETi) is a measurement of the cardiac output adjusted with heart rate, the pre-ejection period (PEP) is the systolic time interval, which has been correlated with left ventricle contractility controlled by the SNS, and the ratio of these (PEP/LVETi) has been correlated with cardiac performance [20] [21].…”

“…The total power (TP) of the FFT is the sum of the areas under the curve covered by the frequency domains, it is a main indicator of ANS activity, and usually decreased in people with chronic stress or diseases. The low frequency to high frequency ratio (LF/HF) is an overall estimate of cardiac ANS balance, with a ratio > 2 meaning SNS predominance and <0.5 indicating PNS predominance [21].…”

“…This instrument combines three devices (ES-BC, TM-Oxi, and SudoPath) that use Open Journal of Internal Medicine bioelectrical impedance, galvanic skin response, spectrophotometry, and an oscillometric blood pressure device [20] [21].…”