Cardiovascular Autonomic Neuropathy Is Associated With Macrovascular Risk Factors in Type 2 Diabetes

Fleischer, Jesper; Yderstræde, Knud Bonnet; Gulichsen, Elisabeth; Jakobsen, Poul Erik; Lervang, Hans-Henrik; Eldrup, Ebbe; Nygaard, Hans; Tarnow, Lise; Ejskjær, Niels

doi:10.1177/1932296814528616

Cited by 23 publications

(33 citation statements)

References 32 publications

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“…This contrasts with previous studies where the association has been in the other direction (7, 8). The effect in this study is, however, very small and may be a chance effect, rather than a true effect, and thus of no clinical significance.…”

Section: Discussioncontrasting

confidence: 99%

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Autonomic Neuropathy—a Prospective Cohort Study of Symptoms and E/I Ratio in Normal Glucose Tolerance, Impaired Glucose Tolerance, and Type 2 Diabetes

et al. 2018

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BackgroundAutonomic neuropathy in diabetes, in addition to causing a range of symptoms originating from the autonomic nervous system, may increase cardiovascular morbidity. Our aim was to study the progression of autonomic neuropathy, based on symptom score and evaluation of an autonomic test, in persons with normal and impaired glucose tolerance and in patients with type 2 diabetes (T2D).MethodsParticipants were recruited in 2003/2004 with a follow-up in 2014. The participants’ glucose tolerance was categorized using oral glucose tolerance tests. Symptoms were evaluated using an autonomic symptom score (ASS), ECG was used to test cardiac autonomic function based on the expiration/inspiration ratio (E/I ratio), and blood samples were taken on both occasions.ResultsASSs were higher at follow-up in the T2D patients than in the normal glucose tolerance group (mean 1.21 ± 1.30 vs. 0.79 ± 0.7; p < 0.05). E/I ratio did not deteriorate more than could be expected as an aging effect in well-controlled T2D. No relationship was found between E/I ratio and HbA1c or ASS.ConclusionThe presence of autonomic symptoms increased over time in T2D patients, but the symptoms did not correlate with the E/I ratio in this metabolically well-controlled cohort. ASSs can be a useful clinical tool when assessing the progression of autonomic dysfunction in patients with abnormal glucose metabolism.

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Section: Discussioncontrasting

confidence: 99%

“…Body mass index (BMI) has been associated with CAN in T2D in some studies (7, 8), but not in all (9). …”

Section: Introductionmentioning

confidence: 99%

Autonomic Neuropathy—a Prospective Cohort Study of Symptoms and E/I Ratio in Normal Glucose Tolerance, Impaired Glucose Tolerance, and Type 2 Diabetes

et al. 2018

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“…The cohort is part of an ongoing study of diabetic autonomic neuropathy. 10 In brief, over a period of 12 months, patients were recruited consecutively from outpatient clinics at the following hospitals: Aalborg University Hospital, Aarhus University Hospital, Odense University Hospital, and Steno Diabetes Centre. None of the subjects demonstrated alcohol abuse (women 14 units per week and men 21 units per week), congestive heart failure (NYHA classification 3 and 4), arrhythmias preventing HRV calculations, or an existing diagnosis of CAN.…”

Section: Methodsmentioning

confidence: 99%

“…Total cholesterol, triglycerides, high-density lipoprotein (HDL), and lowdensity lipoprotein (LDL) cholesterol were measured using an enzymatic method. 10 …”

Section: Laboratory Testsmentioning

confidence: 99%

“…7,10 The heart-rate-based tests were evaluated according to published age-related reference intervals. 14 CAN was defined using the American Diabetes Association criteria and CAN score was defined as followed: "CAN 0": all tests are normal; "CAN 1": 1 test is abnormal indicating the presence of borderline or early stage CAN; "CAN 2-3": 2 or 3 abnormal tests indicating definite or late stage CAN.…”

Section: Laboratory Testsmentioning

confidence: 99%

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The Degree of Autonomic Modulation Is Associated With the Severity of Microvascular Complications in Patients With Type 1 Diabetes

Fleischer

Cichosz

Jakobsen

et al. 2015

J Diabetes Sci Technol

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Neurological and Microvascular FunctionHeart rate variability (HRV) is a widely accepted noninvasive measure of balance/imbalance in the autonomic nervous system, HRV is defined as the variation in heart rate from beat to beat (RR interval) caused by changes in breathing, blood pressure, sympathoadrenal hormones, as well as mental, physical, and certain pathological conditions. In the general population, low HRV has been associated with compromised health and independently predicts all-cause mortality. [1][2][3] Moreover, in diabetes patients, the presence of autonomic dysfunction has been suggested as a prognostic marker of complications 4,5 and the presence of autonomic dysfunction may occur before other late complications. 5Detailed HRV analysis, including both cardiovascular reflex tests and frequency domain analysis, are an important tool to estimate cardiac autonomic nervous activity. 6,7 Several studies indicate that spectral analysis in particular, describing frequency-specific fluctuations in heart rate, may be a more sensitive tool to detect autonomic imbalance compared to active tests. 8,9 However, it is unknown if the cardiovascular reflex tests and frequency domain analysis decrease according to the severity of microvascular complications or are limited to diagnose cardiovascular autonomic neuropathy (CAN).The objective of this study was therefore to elucidate the association between the degree of autonomic modulation, The objective of this study was to elucidate whether the degree of autonomic modulation is associated with the degree of microvascular complications in patients with type 1 diabetes. Methods: A total of 290 type 1 individuals with diabetes were randomly recruited during normal visits to outpatient clinics at 4 Danish hospitals. The degree of autonomic modulations was quantified by measuring heart rate variability (HRV) during passive spectral analysis and active tests (valsalva ratio [VT], response to standing [RT], and deep breathing [E:I]). To describe possible associations between severity of microvascular complications and measures of autonomic modulation, multivariate analysis was performed. Results: After adjusting for diabetes duration, sex, age, pulse pressure, heart rate, and smoking, autonomic dysfunction remained significantly correlated with severity of retinopathy, nephropathy, and peripheral neuropathy in individuals with type 1 diabetes patients. Conclusions: Autonomic dysfunction is present in early stages of retinopathy, nephropathy, and peripheral neuropathy in patients with type 1 diabetes.

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The co-existence of sensory and autonomic neuropathy in type 1 diabetes with and without pain

et al. 2023

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Cardiovascular Autonomic Neuropathy Is Associated With Macrovascular Risk Factors in Type 2 Diabetes

Cited by 23 publications

References 32 publications

Autonomic Neuropathy—a Prospective Cohort Study of Symptoms and E/I Ratio in Normal Glucose Tolerance, Impaired Glucose Tolerance, and Type 2 Diabetes

Autonomic Neuropathy—a Prospective Cohort Study of Symptoms and E/I Ratio in Normal Glucose Tolerance, Impaired Glucose Tolerance, and Type 2 Diabetes

The Degree of Autonomic Modulation Is Associated With the Severity of Microvascular Complications in Patients With Type 1 Diabetes

The co-existence of sensory and autonomic neuropathy in type 1 diabetes with and without pain

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