Importance of Cardiovascular Autonomic Dysfunction in IDDM Subjects With Diabetic Nephropathy

Zander, E; Schulz, B; Heinke, P.; Grimmberger, E; Zander, G; Hd, Gottschling

doi:10.2337/diacare.12.4.259

Cited by 53 publications

(32 citation statements)

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“…Nitric oxide overproduction has been demonstrated in early diabetic nephropathy (28), and increased urinary 8-iso-PGF2␣ (38), increased renal NTY (39), and suppressed serum uric acid (40) have been documented in patients with more advanced disease. Previous reports of an association between autonomic dysfunction and nephropathy (41,42) may therefore reflect the fact that both of these complications are linked to overproduction of reactive oxygen species and nitric oxide.…”

Section: Discussionmentioning

confidence: 96%

Nitrosative Stress, Uric Acid, and Peripheral Nerve Function in Early Type 1 Diabetes

et al. 2002

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The present study was performed to determine whether nitric oxide overproduction is associated with deterioration in peripheral nerve function in type 1 diabetes. We measured peripheral nerve function and biochemical indicators of nitrosative stress annually for 3 years in 37 patients with type 1 diabetes. Plasma nitrite and nitrate (collectively NO x ) were 34.0 ؎ 4.9 mol/l in the control subjects and 52.4 ؎ 5.1, 50.0 ؎ 5.1, and 49.0 ؎ 5.2 in the diabetic patients at the first, second, and third evaluations, respectively (P < 0.01). Nitrotyrosine (NTY) was 13.3 ؎ 2.0 mol/l in the control subjects and 26.8 ؎ 4.4, 26.1 ؎ 4.3, and 32.7 ؎ 4.3 in the diabetic patients (P < 0.01). Uric acid was suppressed by 20% in the diabetic patients (P < 0.001). Composite motor nerve conduction velocity for the median, ulnar, and peroneal nerves was decreased in patients with high versus low NTY (mean Z score ؊0.522 ؎ 0.25 versus 0.273 ؎ 0.22; P < 0.025). Patients with high NO x had decreased sweating, and those with suppressed uric acid had decreased autonomic function. In conclusion, nitrosative stress in early diabetes is associated with suppressed uric acid and deterioration in peripheral nerve function.

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Section: Discussionmentioning

confidence: 96%

Nitrosative Stress, Uric Acid, and Peripheral Nerve Function in Early Type 1 Diabetes

et al. 2002

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“…Autonomic dysfunction was related to the severity of retinopathy and nephropathy, as in several previous cross-sectional studies (32,(40)(41)(42)(43)(44)(45)(46). Regarding the prospective data, we calculated glycemic exposure as suggested by Orchard et al (9).…”

Section: Mäkimattila and Associatesmentioning

confidence: 99%

Predictors of abnormal cardiovascular autonomic function measured by frequence domain analysis of heart rate variability and conventional tests in patients with type 1 diabetes.

et al. 2000

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. S.M. and A.S. contributed equally to this article. Abbreviations: DCCT, Diabetes Control and Complications Trial; E/I ratio, ratio of length of R-R intervals during expiration to inspiration; ETDRS, Early Treatment of Diabetic Retinopathy Study; HF, high frequency; HFnorm, normalized high frequency component; HRV, heart rate variability; LF, low frequency; LFnorm, normalized low frequency component; RMSSD, square root of the mean square of R-R interval differences; TP, total power; UAER, urinary albumin excretion rate; VLF, very low frequency.A OBJECTIVE -Frequency domain analysis of heart rate variability (HRV) is used to assess cardiovascular autonomic function. There are no prospective data on the sensitivity of its various components to glycemia or other diabetes-related risk factors compared with conventional tests and with other complications of diabetes. RESEARCH DESIGN AND METHODS -In 1985, possible risk factors of future complications were determined in 115 children with type 1 diabetes. In 1996, the presence of complications (HRV analysis, conventional tests of autonomic function, urinary albumin excretion rate [UAER], and retinopathy) were assessed in 83 of these patients (age 32 ± 1 years, duration of diabetes 22 ± 1 years). RESULTS -Poor glycemic control (measured as lifetime glycemic exposure or HbA 1c in 1985)was the most important independent predictor of decreases in all measures of absolute power of HRV (total power [TP] and very low frequency, low frequency [LF], and high frequency [HF] power) and square root of the mean square of R-R interval differences but not of changes of normalized measures or ratios (normalized HF and LF, LF/HF). Other significant independent predictors of autonomic dysfunction were late age of onset of diabetes, female sex, and high BMI. To examine the sensitivity of the various tests to glycemia, the patients were divided into tertiles based on lifetime glycemic exposure (A 1c months). Glycemic exposure in the tertiles averaged 194 ± 25 A 1c months (20 years of HbA 1c 0.8% above normal), 556 ± 19 A 1c months(20 years of HbA 1c 2.3% above normal), and 963 ± 30 A 1c months (20 years of HbA 1c 4% above normal). Tests of complications that were significantly abnormal in patients already in the lowest tertile and were correlated with glycemia were TP and severity of retinopathy. Of conventional tests, only the ratio of length of R-R intervals during expiration to inspiration (E/I ratio) was significantly related to glycemic exposure, but it required high glycemic exposure (20 years of HbA 1c 4% above normal) to be abnormal. UAER was significantly increased only in the highest tertile of glycemic exposure.CONCLUSIONS -TP and retinopathy score were much more sensitive to antecedent glycemia than conventional tests of autonomic function or UAER and were significantly abnor-

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“…The present series did not include patients with advanced nephropathy. Patients with this condition seem to have a higher fre quency of CAD than diabetic controls matched for dis ease duration [19]. In view of our findings and a recent study from Pittsburgh [20] the coexistent hypertension is likely to contribute to this association.…”

Section: Methodsmentioning

confidence: 28%

Abnormalities in Cardiovascular Autonomic Reflexes in Type 1 Diabetes: Clinical Correlates

Airaksinen¹,

Salmela²,

Linnaluoto³

et al. 1992

Am J Noninvas Cardiol

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Cardiac autonomic function was investigated by noninvasive tests in 159 type 1 diabetic women aged 15-40 years. Abnormal cardiovascular reflexes were found in 46 women (29%). Inadequate heart rate variation during deep breathing was the most common abnormality found in 42 women (26%). Heart rate response to standing was abnormal in 15 women (9%), and 3 (2%) women had postural hypotension. Eleven women (7%) had at least 2 abnormal test results. Duration of diabetes was a strong predictor of abnormal cardiovascular reflexes in stepwise logistic regression analysis (p < 0.01). After adjusting for its effect the strongest association was observed between systolic and diastolic blood pressure and autonomic dysfunction (p < 0.001, respectively). Glycohemoglobin level, body mass index and insulin dose showed also an association to autonomic dysfunction at this step (p < 0.05), but after entering systolic blood pressure in the model, only the association of insulin dose remained nearly significant (p = 0.07). Presence of nephropathy and retinopathy, age or smoking had no independent effect on the prevalence of abnormal cardiovascular tests. In conclusion, duration of disease and blood pressure are the major predictors of cardiac autonomic dysfunction in young women with type 1 diabetes.

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Importance of Cardiovascular Autonomic Dysfunction in IDDM Subjects With Diabetic Nephropathy

Cited by 53 publications

References 0 publications

Nitrosative Stress, Uric Acid, and Peripheral Nerve Function in Early Type 1 Diabetes

Nitrosative Stress, Uric Acid, and Peripheral Nerve Function in Early Type 1 Diabetes

Predictors of abnormal cardiovascular autonomic function measured by frequence domain analysis of heart rate variability and conventional tests in patients with type 1 diabetes.

Abnormalities in Cardiovascular Autonomic Reflexes in Type 1 Diabetes: Clinical Correlates

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