Screening for Diabetic Cardiac Autonomic Neuropathy Using a New Handheld Device

Gulichsen, Elisabeth; Fleischer, Jesper; Ejskjær, Niels; Eldrup, Ebbe; Tarnow, Lise

doi:10.1177/193229681200600430

Cited by 39 publications

(46 citation statements)

References 25 publications

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“…In a feasibility study of the new handheld device used for performing CARTs, we used the same examination guidelines from ADA, but did not use age-dependent cutoff levels. 4 Without adjusting for age we found a lower prevalence of manifest CAN (28% in type 2 and 21% in type 1). Therefore, an age-dependent cutoff should always be used when analyzing CARTs.…”

Section: Discussionmentioning

confidence: 78%

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

Fleischer

Yderstræde

Gulichsen

et al. 2014

J Diabetes Sci Technol

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Neurological and Microvascular Function Autonomic neuropathy affects both the sympathetic and parasympathetic nervous system, which provides a rapidly responding mechanism to control a wide range of functions such as cardiovascular, respiratory, gastrointestinal, renal, endocrine, and other systems. 1,2 The balance/imbalance in the autonomic nervous system can be determined by computerassisted and complex analyses of variations in blood pressure and in electrocardiographic measurements. 2 For clinical use the gold standard tests are heart rate response to (1) change from supine to upright position, (2) deep breathing, and (3) the Valsalva manoeuvre. 3 In the diabetic population abnormal results in 2 or more of the gold standard tests constitutes a surrogate measure and a subclinical diagnostic marker of cardiovascular autonomic neuropathy (CAN). 3 We have recently 528616D STXXX10.

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Section: Discussionmentioning

confidence: 78%

“…4 The prevalence of CAN is estimated to be approximately 20-70%, depending on the test used and the population investigated. 5,6 The prevalence is higher among patient with type 2 as compared to type 1 diabetes.…”

mentioning

confidence: 99%

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

Fleischer

Yderstræde

Gulichsen

et al. 2014

J Diabetes Sci Technol

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“…If a single or combined measure of HRV is able to predict real-time changes in BGL, this could lead to a novel method for noninvasive monitoring of BGL based on HRV parameters. Such novel technology 56 could eliminate the complications and fatalities associated with the daily glucose excursions that occur in diabetes. Inclusion of such HRV as a basis for CGM devices can substantially augment the safety aspects of existing invasive CGMs as well as provide a noninvasive practical alternative.…”

Section: Discussionmentioning

confidence: 99%

Association Between Heart Rate Variability Measures and Blood Glucose Levels: Implications for Noninvasive Glucose Monitoring for Diabetes

Rothberg

Lees

Clifton‐Bligh³

et al. 2016

Diabetes Technology & Therapeutics

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“…Three of five test centers examined CAN using a Vagus device (Medicus Engineering, Aarhus, Denmark) at the 6-year examination, and all test centers did so at the 13-year examination (22,23). The Vagus device automatically records an electrocardiographic signal.…”

Section: Methodsmentioning

confidence: 99%

Risk Factors for the Presence and Progression of Cardiovascular Autonomic Neuropathy in Type 2 Diabetes: ADDITION-Denmark

et al. 2018

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OBJECTIVETo examine the course of cardiovascular autonomic neuropathy (CAN) and related cardiometabolic risk factors in patients with type 2 diabetes. RESEARCH DESIGN AND METHODS CAN and cardiometabolic risk factors were assessed in the Danish arm of the Anglo-Danish-Dutch Study of Intensive Treatment in People With Screen-Detected Diabetes in Primary Care (ADDITION-Denmark) at 6-year (n = 777) and 13-year (n = 443) follow-up examinations. Cardiovascular autonomic reflex tests (CARTs)d that is, lying to standing, deep breathing, and the Valsalva maneuverdand 2-min resting heart rate variability (HRV) indices were obtained as the main measures of CAN. Risk factors related to CAN status, as determined by CARTs, were studied by using multivariate logistic regressions. The effects of risk factors on continuous CARTs and HRV indices, and their changes over time, were estimated in linear mixed models. RESULTSA progressive yet heterogeneous course of CAN occurred between the 6-and 13-year follow-ups. Higher HbA 1c , weight, BMI, and triglycerides were associated with prevalent CAN. No significant effect of risk factors on CARTs was found when they were analyzed as continuous variables. CART indices decreased over time, and a trend of decreasing HRV indices was seen. Higher HbA 1c and BMI were associated with lower HRV index values, but these differences diminished over time. CONCLUSIONSThese data confirm that hyperglycemia, obesity, and hypertriglyceridemia are negatively related to indices of CAN, although these effects diminish over time. The observed heterogeneous course of CAN may challenge the present clinical approach of categorically classifying CARTs to diagnose CAN and the notion of CAN being irreversible.Cardiovascular autonomic neuropathy (CAN) is a common complication of diabetes and is associated with markedly increased morbidity and mortality (1-5). Damage to the parasympathetic and sympathetic autonomic nerve fibers that innervate the heart and blood vessels causes dysfunction of heart rate control and vascular dynamics, and thereby causes CAN (6). CAN poorly correlates with specific symptoms or clinical signs, implying that this condition frequently remains unrecognized until late in the disease

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Screening for Diabetic Cardiac Autonomic Neuropathy Using a New Handheld Device

Abstract: Abbreviations: (ADA) American Diabetes Association, (BMI) body mass index, (CAN) cardiac autonomic neuropathy, (HbA1c) hemoglobin A1c, (HRV) heart rate variability, (T1DM) type 1 diabetes mellitus, (T2DM) type 2 diabetes mellitus

Cited by 39 publications

References 25 publications

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

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

Association Between Heart Rate Variability Measures and Blood Glucose Levels: Implications for Noninvasive Glucose Monitoring for Diabetes

Risk Factors for the Presence and Progression of Cardiovascular Autonomic Neuropathy in Type 2 Diabetes: ADDITION-Denmark

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