Cardiovascular control in diabetes mellitus.

Bennett, T.; Hosking, David J.; Hampton, John R.

doi:10.1136/bmj.2.5971.585

Cited by 86 publications

(38 citation statements)

References 13 publications

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“…Our study shows that the impaired rise in heart rate is a late phenomenon preceded by peripheral sympathetic lesions and cardiac vagal neuropathy. This concept has support from earlier studies showing that diabetics with orthostatic symptoms often have tachycardia [1,16,17]. Furthermore, none of our patients developed orthostatic symptoms, not even those with significant systolic pressure reductions.…”

Section: Discussionsupporting

confidence: 75%

Abnormal diastolic blood pressure and heart rate reactions to tilting in diabetes mellitus

1980

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Summary. The orthostatic reaction to tilting was studied in 46 diabetics without symptoms of autonomic neuropathy and in 31 age-matched healthy control subjects. After tilting, the diastolic blood pressure rose in the control subjects but was unchanged or tended to fall in the diabetics, except in those of short duration without retinopathy. After tilting, the control subjects showed an immediate increase in heart rate with the highest value at 8.4 + 1.0 s (mean _+ SEM), followed by a transient decrease with lowest value at 21.2 _+ 0.9 s. The acceleration and brake index measured the changes in heart rate.

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Section: Discussionsupporting

confidence: 75%

Abnormal diastolic blood pressure and heart rate reactions to tilting in diabetes mellitus

1980

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“…In this regard, our results provide a new perspective of the natural history of diabetic autonomic neuropathy. Although it is a common belief that parasympathetic abnormalities develop early in diabetes and that sympathetic dysfunction develops late (31), this dogma may be invalid because it is based on comparisons of sensitive tests of parasympathetic function, such as the heart rate variability with deep breathing, and insensitive tests of sympathetic function, such as the hemodynamic response to orthostatic stress or isometric hand grip. However, the QSART, a much more sensitive test of postganglionic sympathetic neurons than older methods (32,33), has made it possible to demonstrate that sympathetic involvement occurs very early in poorly controlled type 1 diabetes and may be the first detectable feature of peripheral neuropathy.…”

Section: Figmentioning

confidence: 99%

Redistribution of Sudomotor Responses Is an Early Sign of Sympathetic Dysfunction in Type 1 Diabetes

et al. 2001

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Patients with diabetic neuropathy typically have decreased sweating in the feet but excessive sweating in the upper body. Previous studies of sudomotor function in diabetes have included patients with longstanding disease. The present study was designed to test for the early presence of sudomotor dysfunction and to characterize its relation to glycemic control and other aspects of peripheral nerve function. A total of 37 patients (10 males, 27 females) enrolled in a longitudinal study, in which autonomic function was evaluated annually for 3 years. Patients enrolled 2-22 months after the diagnosis of type 1 diabetes. Forty-one ageand sex-matched healthy control subjects were also studied. Sweat production in response to acetylcholine stimulation was dramatically increased in the forearm at the time of the first evaluation (1.67 ± 0.24 µl/cm 2 in the diabetic patients vs. 1.04 ± 0.14 µl/cm 2 in the control subjects, P < 0.05). Likewise, the ratio of sweating in the forearm to sweating below the waist was higher in the diabetic patients (0.553 ± 0.07 µl/cm 2 ) than in the control subjects (0.385 ± 0.04 µl/cm 2 , P < 0.05). Forearm sweat was negatively associated with the renin-toprorenin ratio and vanillylmandelic acid (VMA) excretion (P < 0.025), tests of sympathetic nerve function. The ratio of sweating in the forearm to sweating in the foot was likewise increased in diabetic patients with poor glycemic control. We interpret this redistribution of sudomotor responses to be indicative of sympathetic nerve injury and conclude 1) that the sympathetic nervous system is especially vulnerable to the adverse effects of chronic hyperglycemia and 2) that sympathetic dysfunction can be detected very early in type 1 diabetes. Diabetes 50: [436][437][438][439][440][441][442][443] 2001

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“…Severe peripheral polyneuropathy can lead to autonomic symptoms including orthostatic hypotension (2). It has been reported that postural hypotension might be a consequenceof damageto sympathetic postganglionic innervation of resistance vessels mainly in the lower extremities with loss of reflex vasoconstriction (3)(4)(5)(6)(7). Although the Schellong test is a well-known test estimating orthostatic hypotension (OH) defined as a fall in systolic blood pressure of 30 mmHg or more when changing from lying to standing position (8), diabetic patients suffering from OHoften have severe subjective symptoms including postural weakness, faintness, visual impairment and syncope.…”

Section: Introductionmentioning

confidence: 99%

Early Detection of Orthostatic Hypotension by Quantitative Sudomotor Axon Reflex Test (QSART) in Type 2 Diabetic Patients

et al. 2003

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Objective Orthostatic hypotension is caused by autonomic nerve dysfunction, mainly by severe sympathetic nerve dysfunction in diabetic patients. Diabetes affects the peripheral nerves in a length-dependent manner.Quantitative sudomotor axon reflex test (QSART)is one of the sensitive tests for detecting sympathetic nerve function. Weexamined the relation between orthostatic hypotension and QSARTat the foot and hand in type 2 diabetic patients.Methods Thirty-eight type 2 diabetic patients (age, 48.9±11.9 years; duration of diabetes, 13.4±8.6 years) and 13 age-matched non-diabetic controls were evaluated. All subjects aged under 65 years old were recruited. All subjects underwent Schellong tests and quantitative sudomotor axon reflex tests (QSART)at the back of the hand and dorsum of the foot. Results The sweating volume at the foot dorsum, but not the back of the hand, during the first 10 minutes of QSART was significantly related to the orthostatic hypotension on the Schellong test. In patients with normal, borderline and abnormal blood pressure response to standing, 6 out of 17 (35.3%), 9 out of 12 (75.0%) and 9 out of 9 (100%) had decreased sweating volume of the foot dorsum, respectively. Conclusions Our results suggest that orthostatic hypotension may be detected early by QSART at the dorsum of the foot in type 2 diabetic patients. (Internal Medicine 42: 560-564, 2003)

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Cardiovascular control in diabetes mellitus.

Cited by 86 publications

References 13 publications

Abnormal diastolic blood pressure and heart rate reactions to tilting in diabetes mellitus

Abnormal diastolic blood pressure and heart rate reactions to tilting in diabetes mellitus

Redistribution of Sudomotor Responses Is an Early Sign of Sympathetic Dysfunction in Type 1 Diabetes

Early Detection of Orthostatic Hypotension by Quantitative Sudomotor Axon Reflex Test (QSART) in Type 2 Diabetic Patients

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