Diabetic cardiovascular autonomic neuropathy: Prognosis, diagnosis and treatment

Ziegler, Dan

doi:10.1002/dmr.5610100403

Cited by 274 publications

(254 citation statements)

References 385 publications

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“…Type 1 diabetic patients with cardiac autonomic neuropathy (CAN) have a greater general risk of sudden death (11), which has been linked to QTc prolongation (12). Advanced CAN is relatively rare in young people with type 1 diabetes, but more subtle autonomic abnormalities such as impaired baroreflex sensitivity (BRS) and reduced heart rate variability are more common (13,14).…”

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confidence: 99%

Influence of Autonomic Neuropathy on QTc Interval Lengthening During Hypoglycemia in Type 1 Diabetes

et al. 2004

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Hypoglycemia produces electrocardiographic QTc lengthening, a predictor of arrhythmia risk and sudden death. This results from both sympatho-adrenal activation and a lowered serum potassium. It has been suggested that cardiac autonomic neuropathy (CAN) might indicate those who are at particular risk. We tested this hypothesis in 28 adults with type 1 diabetes and 8 nondiabetic control subjects. After standard tests of autonomic function and baroreflex sensitivity (BRS) measurement, diabetic participants were divided into three groups: 1) CAN؊ with normal BRS (BRS؉; n ‫؍‬ 10), 2) CAN؊ with impaired BRS (BRS؊; n ‫؍‬ 9), and 3) CAN؉ (n ‫؍‬ 9). QTc was then measured during controlled hypoglycemia (2.5 mmol/l) using a hyperinsulinemic clamp. Mean (؎SE) QTc lengthened from 377 ؎ 9 ms (baseline) to a maximum during hypoglycemia of 439 ؎ 13 ms in BRS؉ subjects and from 378 ؎ 5 to 439 ؎ 10 ms in control subjects. Peak QTc tended to be lower in CAN؉ (baseline, 383 ؎ 6; maximum, 408 ؎ 10) and BRS؊ groups (baseline, 380 ؎ 8; maximum, 421 ؎ 11; F ‫؍‬ 1.7, P ‫؍‬ 0.18). Peak epinephrine concentrations (nmol/l) were 3.1 ؎ 0.8 (BRS؉), 2.6 ؎ 0.5 (BRS؊), 1.4 ؎ 0.3 (CAN؉), and 5.7 ؎ 0.8 (control subjects). These data do not indicate that those with CAN are at particular risk for abnormal cardiac repolarization during hypoglycemia. Indeed, they suggest that such patients may be relatively protected, perhaps as a result of attenuated sympatho-adrenal responses. Diabetes 53: [1535][1536][1537][1538][1539][1540][1541][1542] 2004

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confidence: 99%

Influence of Autonomic Neuropathy on QTc Interval Lengthening During Hypoglycemia in Type 1 Diabetes

et al. 2004

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“…R educed heart rate variation is used as a marker of cardiac autonomic neuropathy (1,2). It is known that type 2 diabetic subjects have increased cardiovascular morbidity and mortality that is associated with microalbuminuria (3-6), hypertension (7)(8)(9), and cardiac autonomic neuropathy detectable by cardiovascular reflex tests (10 -12).…”

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confidence: 99%

Autonomic Neuropathy in Nondiabetic Offspring of Type 2 Diabetic Subjects Is Associated With Urinary Albumin Excretion Rate and 24-h Ambulatory Blood Pressure

Foss

Vestbo

Frøland³

et al. 2001

Diabetes

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The aim of this study was to examine the impact of parental type 2 diabetes on the autonomic nervous system and to determine whether autonomic neuropathy is present and associated with changes in 24-h ambulatory blood pressure (AMBP) and urinary albumin excretion rate (UAER) in nondiabetic subjects with parental type 2 diabetes. We examined 223 nondiabetic offspring of type 2 diabetic subjects and a control group of 258 offspring of nondiabetic subjects. The autonomic nervous system was assessed by three cardiovascular reflex tests, 24-h AMBP was measured with an oscillometric recorder (90207; Spacelabs, Redmond, WA), and UAER was determined through three overnight urine samples. The subjects with parental type 2 diabetes had significantly lower heart rate variation in all three bedside tests (P < 0.01) than subjects without parental diabetes. The prevalence of autonomic neuropathy in the nondiabetic offspring with parental type 2 diabetes (6.7%) was significantly (P < 0.01) higher compared with the control group (1.6%). Autonomic neuropathy was associated with a higher fasting insulin level (P < 0.05), higher UAER (P < 0.001), higher 24-h mean AMBP (P < 0.01), and reduced diurnal blood pressure variation (P < 0.001) after adjustment for age, sex, and BMI. In conclusion, parental type 2 diabetes was found to be associated with alterations in the autonomic nervous system in nondiabetic subjects. The presence of autonomic neuropathy in subjects with parental type 2 diabetes was associated with higher UAER, fasting insulin level, and 24-h AMBP and a reduced diurnal blood pressure variation. This study indicates that parental type 2 diabetes has an impact on the cardiac autonomic function in nondiabetic subjects. Diabetes 50:630 -636, 2001

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“…If we assess the mortality rate in relation to the presence or absence of CAN, we can look at the most cited works in this area, Ziegler et al 2 and Rathmann et al 27 and conclude that there is an increased mortality of patients with CAN. Ziegler et al performed a meta-analysis of 9 studies showing that 29% of diabetics with CAN compared to 6% of diabetics without CAN die within 10 years (Table 6).…”

Section: Discussionmentioning

confidence: 99%

The influence of cardiovascular autonomic neuropathy on mortality in type 1 diabetic patients; 10-year follow-up

Lacigová

Brožová

Cechurová

et al. 2016

Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub

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Aim. The aim of our retrospective study was to answer the question if the presence of cardiovascular autonomic neuropathy (CAN) affects mortality in type 1 diabetic patients during a 10-year follow-up. Methods. Patients with type 1 diabetes mellitus examined for CAN in 2003 were enrolled in this retrospective study. A total of 278 patients were included and divided into two groups according to the presence or absence of CAN (111 CAN+, 167 CAN-). The group characteristics and outcomes were compared at baseline and after ten years (in 2013). Results. In the follow-up period, a total of 18 patients died; CAN+ (14/111; 12.6%) and CAN-(4/167; 2.4%) (P < 0.001). At baseline, the CAN+ patients were older (47 vs. 33 years; P < 0.001), had longer duration of diabetes (20 vs. 12 years; P < 0.05), had worse glycemic control assessed by HbA1c (73 vs. 68 mmol/mol; P < 0.05), higher systolic (130 vs. 120 mmHg; P < 0.001) and diastolic (80 vs. 70 mmHg; P < 0.01) blood pressure and had more diabetic complications. In our analysis we found the strongest predictor of mortality to be the presence of CAN (P < 0.01) and the blood pressure value at baseline (P < 0.05). Other baseline characteristics, including the duration of diabetes, age and the presence of micro-and macrovascular complications were not significant. The statistical analysis was performed using logistic regression step-wise analysis. Conclusions. During the 10-year follow-up, CAN+ patients had a 5-fold higher mortality rate than CAN-patients. The strongest predictor of mortality was the presence of CAN.

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Diabetic cardiovascular autonomic neuropathy: Prognosis, diagnosis and treatment

Cited by 274 publications

References 385 publications

Influence of Autonomic Neuropathy on QTc Interval Lengthening During Hypoglycemia in Type 1 Diabetes

Influence of Autonomic Neuropathy on QTc Interval Lengthening During Hypoglycemia in Type 1 Diabetes

Autonomic Neuropathy in Nondiabetic Offspring of Type 2 Diabetic Subjects Is Associated With Urinary Albumin Excretion Rate and 24-h Ambulatory Blood Pressure

The influence of cardiovascular autonomic neuropathy on mortality in type 1 diabetic patients; 10-year follow-up

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