Cardiovascular Autonomic Dysfunction Predicts Severe Hypoglycemia in Patients With Type 2 Diabetes: A 10-Year Follow-up Study

Yun, Jae‐Seung; Kim, Jihyun; Song, Ki‐Ho; Ahn, Yu‐Bae; Yoon, Kun‐Ho; Yoo, Ki‐Dong; Park, Young Jun; Ko, Seung‐Hyun

doi:10.2337/dc13-1164

Cited by 42 publications

(31 citation statements)

References 36 publications

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“…[26] In patients with diabetes, the extent of CAN is inversely related to survival and quality-of-life,[26, 34] and is associated with cardiovascular events, stroke, and other diabetic complications such as severe hypoglycemia and chronic kidney disease. [27, 28, 35] CAN may be detected at the time of diabetes diagnosis; poor glycemic control plays a central role in the development and progression of CAN. [26] In the present study, we used Ewing’s method to determine the extent of CAN.…”

Section: Discussionmentioning

confidence: 99%

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Early inner retinal thinning and cardiovascular autonomic dysfunction in type 2 diabetes

et al. 2017

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BackgroundTo investigate changes in the neural retina according to the presence of retinal nerve fiber layer (RNFL) defects in type 2 diabetes, and to determine the association between inner retina thickness and the severity of diabetic complications.MethodsWe studied non-glaucomatous patients with type 2 diabetes and control subjects Circumpapillary RNFL and macula ganglion cell-inner plexiform layer (GCIPL) thicknesses were measured by spectral-domain optical coherence tomography. In patients with type 2 diabetes, a cardiovascular autonomic function test (AFT) was performed, which included the heart rate parameter of beat-beat variation—with deep breathing, in response to the Valsalva maneuver, and on postural change from lying to standing. The results of each test were scored as 0 for normal and 1 for abnormal. A total AFT score of 1 was defined as early cardiovascular autonomic neuropathy (CAN), and an AFT score≥ 2 as definite CAN.ResultsWe compared control eyes (n = 70), diabetic eyes with RNFL defects (n = 47), and eyes without RNFL defects (n = 30). The average RNFL and GCIPL thicknesses were significantly different among groups (all, P<0.05). On post-hoc testing, diabetic eyes with RNFL defects had a significantly thinner average GCIPL thickness than those without RNFL defects. On multivariate analyses, significantly thinner average GCIPL was seen in early CAN staging (B = -4.32, P = 0.016) and in definite CAN staging (B = -10.33, P<0.001), compared with no CAN involvement, after adjusting for confounding parameters.ConclusionsCardiovascular autonomic dysfunction was associated with early neurodegenerative changes in type 2 diabetes.

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Section: Discussionmentioning

confidence: 99%

“…The CAN stage was defined as follows: 0, normal autonomic function; 1, early CAN; and ≥ 2, definite diagnosis of CAN. [28]…”

Section: Methodsmentioning

confidence: 99%

Early inner retinal thinning and cardiovascular autonomic dysfunction in type 2 diabetes

et al. 2017

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“…A cardiovascular autonomic function test using the Ewing method was performed in all enrolled patients at baseline. At least two abnormal results were defined as definite cardiovascular autonomic neuropathy [22]. Medication utilization was assessed for insulin, angiotensin-converting enzyme (ACE) inhibitor/angiotensin II receptor blocker (ARB), statin, fenofibrate, and aspirin from enrollment to the end of the follow-up period.…”

Section: Methodsmentioning

confidence: 99%

Clinical Course and Risk Factors of Diabetic Retinopathy in Patients with Type 2 Diabetes Mellitus in Korea

et al. 2016

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BackgroundWe investigated clinical course and risk factors for diabetic retinopathy (DR) in patients with type 2 diabetes mellitus (T2DM).MethodsA total of 759 patients with T2DM without DR were included from January 2001 to December 2004. Retinopathy evaluation was performed at least annually by ophthalmologists. The severity of the DR was classified into five categories according to the International Clinical Diabetic Retinopathy Severity Scales.ResultsOf the 759 patients, 523 patients (68.9%) completed the follow-up evaluation. During the follow-up period, 235 patients (44.9%) developed DR, and 32 patients (13.6%) progressed to severe nonproliferative DR (NPDR) or proliferative DR (PDR). The mean duration of diabetes at the first diagnosis of mild NPDR, moderate NPDR, and severe NPDR or PDR were 14.8, 16.7, and 17.3 years, respectively. After adjusting multiple confounding factors, the significant risk factors for the incidence of DR risk in patients with T2DM were old age, longer duration of diabetes, higher mean glycosylated hemoglobin (HbA1c), and albuminuria. Even in the patients who had been diagnosed with diabetes for longer than 10 years at baseline, a decrease in HbA1c led to a significant reduction in the risk of developing DR (hazard ratio, 0.73 per 1% HbA1c decrement; 95% confidence interval, 0.58 to 0.91; P=0.005).ConclusionThis prospective cohort study demonstrates that glycemic control, diabetes duration, age, and albuminuria are important risk factors for the development of DR. More aggressive retinal screening for T2DM patients diagnosed with DR should be required in order to not miss rapid progression of DR.

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“…Furthermore, the presence of autonomic neuropathy attenuates the epinephrine response to hypoglycemia in the patients with diabetes after recent hypoglycemic exposure [14]. Moreover, diabetic cardiovascular autonomic neuropathy is an independent prognostic factor for the development of severe hypoglycemia in the patients with type 2 diabetes [15]. Therefore, we hypothesize that patients who have multiple co-morbidities, including renal impairment, may be more vulnerable to hypoglycemia when receiving SSRIs.…”

Section: Discussionmentioning

confidence: 99%

Paroxetine-induced Hypoglycemia in Type 2 Diabetic Patient

et al. 2016

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Cardiovascular Autonomic Dysfunction Predicts Severe Hypoglycemia in Patients With Type 2 Diabetes: A 10-Year Follow-up Study

Cited by 42 publications

References 36 publications

Early inner retinal thinning and cardiovascular autonomic dysfunction in type 2 diabetes

Early inner retinal thinning and cardiovascular autonomic dysfunction in type 2 diabetes

Clinical Course and Risk Factors of Diabetic Retinopathy in Patients with Type 2 Diabetes Mellitus in Korea

Paroxetine-induced Hypoglycemia in Type 2 Diabetic Patient

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