Impaired diurnal cardiac autonomic function in subjects with type 2 diabetes.

Yamamoto, Masahiko; Yamasaki, Yoshimitsu; Kodama, Mineo; Matsuhisa, Munehide; Kishimoto, Mitsumasa; Ozaki, Hiroyuki; Tani, Akihiro; Ueda, Nobuyuki; Iwasaki, Midori; Hori, Masaru

doi:10.2337/diacare.22.12.2072

Cited by 22 publications

(15 citation statements)

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“…Sayer et al (39) found that the rhythm of sympathovagal balance was significantly attenuated in patients with diabetes compared with those without diabetes. Similarly, patients with diabetes and symptomatic autonomic neuropathy have been shown to have markedly impaired heart rate variability (40,41). Lower heart rate variability in turn has been shown to be associated with an increased risk of development of coronary heart disease in individuals with diabetes (42).…”

Section: Discussionmentioning

confidence: 99%

Circadian Variation in the Onset of Myocardial Infarction

et al. 2003

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There are conflicting reports regarding circadian variation in the onset of acute myocardial infarction (MI) among patients with diabetes. We therefore, studied the circadian pattern of the incidence of acute MI in patients (n ‫؍‬ 3,882) who were enrolled in the Onset Study stratified by the presence, type, and duration of diabetes. The Onset Study was conducted at 64 U.S. medical centers between August 1989 and September 1996. We used harmonic regression model to evaluate the circadian variation of MI symptom onset in patients with and without diabetes. Subgroup analysis was performed according to the presence, type, and duration of diabetes by the 2 test (dividing the day into four 6-h intervals). Patients without diabetes exhibited a prominent morning peak in the incidence of acute MI symptom onset (P < 0.001). In contrast, patients with type 1 diabetes and type 2 diabetes >5 years had a marked attenuation of the morning peak. Patients who had type 2 diabetes diagnosed within the previous 5 years had a pattern of onset of acute MI similar to patients without diabetes. Patients with type 1 diabetes and those with type 2 diabetes >5 years have an attenuation of the morning peak in acute MI. Inconsistency in observation of such an effect in patients with diabetes in the past may well have been due to difference in the duration of diabetes and thus the variable extent of underlying autonomic dysfunction. Diabetes 52:1464 -1468, 2003 T he onset of acute myocardial infarction (MI) varies throughout the day, with a peak in the morning hours and a trough at night (1-3). However, there are conflicting reports regarding circadian variation in the onset of acute MI among patients with diabetes (4 -6). Possible reasons for the inconsistency in the literature might be due to difference in the duration of diabetes and thus the extent of underlying autonomic dysfunction.Diabetes is associated with an abnormal circadian pattern of several physiologic processes, including concentrations of glucose (7) and circulating glucocorticoids (8,9). Furthermore, diabetic neuropathy associated with a longer duration of diabetes may lead to loss of the normal circadian pattern of autonomic nervous system activity (10,11) and altered normal circadian variation in blood pressure with a loss of the nocturnal dip (12,13). Only recently, Liao et al. (14) showed that a lower heart rate variability, a reflection of impaired cardiac autonomic control, was also associated with development of coronary heart disease among individuals with diabetes. Zarich et al. (15) performed autonomic nervous system testing on patients with ambulatory ischemia and showed that patients with moderate to severe autonomic nervous system dysfunction did not experience a morning peak of ischemia. To determine whether duration of diabetes has an impact on the circadian variation of MI onset, we studied the circadian pattern of acute MI symptom onset in patients with diabetes from among patients enrolled in the Determinants of Myocardial Infarction Onset Study (16). RESE...

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Section: Discussionmentioning

confidence: 99%

Circadian Variation in the Onset of Myocardial Infarction

et al. 2003

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“…Evidence is accumulating that SCN functioning is affected in several chronic diseases, such as hypertension, diabetes and depression. For a long time now physiological studies have indicated disturbances in the circadian rhythm in patients suffering from these diseases (Pickering 1990, Yamamoto et al 1999. Recently, we demonstrated the anatomical basis for these disturbances in hypertensive patients: a severe decrease in staining for several SCN neurotransmitters (Goncharuk et al 2001) (Fig.…”

Section: The Human Scnmentioning

confidence: 99%

The biological clock tunes the organs of the body: timing by hormones and the autonomic nervous system

Buijs¹,

Eden²,

Goncharuk³

et al. 2003

Journal of Endocrinology

336

207

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The biological clock, the suprachiasmatic nucleus (SCN), is essential for our daily well-being. It prepares us for the upcoming period of activity by an anticipatory rise in heart rate, glucose and cortisol. At the same time the 'hormone of the darkness', melatonin, decreases. Thus, the time-ofday message penetrates into all tissues, interestingly not only by means of hormones but also by a direct neuronal influence of the SCN on the organs of the body. The axis between the SCN and the paraventricular nucleus of the hypothalamus (PVN) is crucial for the organization/ synchronization of the neuroendocrine and autonomic nervous system with the time of day. This SCNneuroendocrine PVN axis takes care of a timely hormonal secretion. At the same time, the SCN-autonomic PVN axis fine-tunes the organs by means of the autonomic nervous system for the reception of these hormones. Finally, the similar organization of the projections of the human SCN as compared with that in the rodent brain suggests that these basic principles of neuroendocrine autonomic interaction may also be true in the human. The physiological data collected in humans thus far seem to support this hypothesis, while pathological changes in the SCN of humans suffering from depression or hypertension indicate a role for the SCN in the etiology of these diseases.

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“…As shown in Table 1, there was a 4% increase of R-%LF after acute insulin infusion. This may seem a small change, but we previously found that the relative increase of mean %LF between 0800 and 1200 compared with the daily mean %LF (0800-0800) was 4-6%, whereas no significant increase was detected in subjects with diabetic autonomic neuropathy (21). Accordingly, the modest increase of R-%LF observed in the present study may be physiologically meaningful.…”

Section: Discussionmentioning

confidence: 39%

“…Although the LF-to-HF ratio has been suggested as a marker of SNA, we have shown that the LF/(LF ϩ HF) ratio is an alternative marker (22). We have also reported that type 2 diabetics with symptomatic autonomic or peripheral neuropathy, but not diabetics without neuropathy, show a decrease of both the LF and HF components and loss of the normal circadian rhythm of heart variability (21).…”

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confidence: 57%

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Responsiveness of insulin-induced cardiac sympathetic nerve activation associates with blood pressure regulation in diabetics

Takagi

Tanaka

Yamasaki

et al. 2003

American Journal of Physiology-Endocrinology and Metabolism

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. Responsiveness of insulin-induced cardiac sympathetic nerve activation associates with blood pressure regulation in diabetics. Am J Physiol Endocrinol Metab 284: E1022-E1026, 2003. First published February 4, 2003 10.1152/ajpendo.00169.2002To quantitatively evaluate the effect of insulin on cardiac sympathetic nerve activity (SNA) and analyze clinical factors associated with insulin sensitivity for the regulation of SNA in diabetics, 29 Japanese type 2 diabetics without neuropathy were recruited. A 2-h control study and a 2-h hyperinsulinemic euglycemic glucose clamp study were performed. From the power spectral analysis of R-R intervals on ECG during both studies, two major components, the low-frequency (LF) and the highfrequency component (HF), were obtained. Then %LF was calculated as LF/(LF ϩHF), and the ratio of the average %LF during the last 30 min of the clamp or the control to the average %LF for the entire time for clamp or control (R-%LF) was used as a marker of changes in SNA. R-%LF was significantly higher during the clamp than in the control (1.07 Ϯ 0.04 vs. 1.03 Ϯ 0.03, P Ͻ 0.05). High responders (individual R-%LF during clamp Ն mean ϩ 2SD in control) showed a higher basal mean blood pressure (BP) before the clamp (89 Ϯ 3 vs. 82 Ϯ 2, P Ͻ 0.03) but not a higher glucose infusion rate (GIR) compared with low responders (Ͻmean ϩ 2SD). Furthermore, R-%LF showed a positive correlation with basal mean BP (P Ͻ 0.02) but not with GIR. These data demonstrate that an acute insulin load stimulates cardiac SNA, and insulin sensitivity in the regulation of SNA may be associated with BP regulation independently of peripheral insulin sensitivity. insulin action; type 2 diabetes; blood pressure; power spectral analysis INFUSION OF INSULIN during hyperinsulinemic euglycemic glucose clamp studies can enhance sympathetic nerve activity (SNA), as detected by monitoring muscle microelectrodes, but this phenomenon is not observed when glucose or fructose is infused without insulin, suggesting an insulin-specific effect on SNA (20). Although the mechanism of this insulin-induced increase in SNA remains unclear, insulin receptors are expressed in the hypothalamus (7, 11), and direct intraventricular infusion of insulin increases SNA in rats (12). Thus it has been hypothesized that insulin may physiologically enhance SNA, at least partly, via hypothalamic regulation (16). Previous studies have shown that the action of insulin on SNA, as monitored by plasma catecholamine levels or muscle SNA, is not correlated with the glucose infusion rate (GIR), a marker of insulin sensitivity for peripheral glucose uptake during hyperinsulinemic euglycemic glucose clamp studies (14,19). These results suggest that compensatory hyperinsulinemia secondary to peripheral insulin resistance may decrease the GIR and enhance SNA, which in turn may be a possible cause of hypertension through an increment of cardiovascular SNA (16). However, there was no increase of plasma catecholamines during euglycemic hyperinsulinemic clamping, according to...

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Impaired diurnal cardiac autonomic function in subjects with type 2 diabetes.

Cited by 22 publications

References 0 publications

Circadian Variation in the Onset of Myocardial Infarction

Circadian Variation in the Onset of Myocardial Infarction

The biological clock tunes the organs of the body: timing by hormones and the autonomic nervous system

Responsiveness of insulin-induced cardiac sympathetic nerve activation associates with blood pressure regulation in diabetics

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