The effect of intensive diabetes therapy on measures of autonomic nervous system function in the Diabetes Control and Complications Trial (DCCT)

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doi:10.1007/s001250050924

Cited by 268 publications

(38 citation statements)

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“…In the DCCT trial, intensive glucose control prevented the development of abnormal heart rate variability (5). One previous study has shown abnormal expiration/inspiration ratio ( E / I ratio) in 35% of the studied population of patients with type 2 diabetes (T2D) (6), and a large trial demonstrated that CAN was present in 15% of newly diagnosed T2D cases (7).…”

Section: Introductionmentioning

confidence: 99%

Autonomic Neuropathy—a Prospective Cohort Study of Symptoms and E/I Ratio in Normal Glucose Tolerance, Impaired Glucose Tolerance, and Type 2 Diabetes

et al. 2018

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BackgroundAutonomic neuropathy in diabetes, in addition to causing a range of symptoms originating from the autonomic nervous system, may increase cardiovascular morbidity. Our aim was to study the progression of autonomic neuropathy, based on symptom score and evaluation of an autonomic test, in persons with normal and impaired glucose tolerance and in patients with type 2 diabetes (T2D).MethodsParticipants were recruited in 2003/2004 with a follow-up in 2014. The participants’ glucose tolerance was categorized using oral glucose tolerance tests. Symptoms were evaluated using an autonomic symptom score (ASS), ECG was used to test cardiac autonomic function based on the expiration/inspiration ratio (E/I ratio), and blood samples were taken on both occasions.ResultsASSs were higher at follow-up in the T2D patients than in the normal glucose tolerance group (mean 1.21 ± 1.30 vs. 0.79 ± 0.7; p < 0.05). E/I ratio did not deteriorate more than could be expected as an aging effect in well-controlled T2D. No relationship was found between E/I ratio and HbA1c or ASS.ConclusionThe presence of autonomic symptoms increased over time in T2D patients, but the symptoms did not correlate with the E/I ratio in this metabolically well-controlled cohort. ASSs can be a useful clinical tool when assessing the progression of autonomic dysfunction in patients with abnormal glucose metabolism.

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Section: Introductionmentioning

confidence: 99%

Autonomic Neuropathy—a Prospective Cohort Study of Symptoms and E/I Ratio in Normal Glucose Tolerance, Impaired Glucose Tolerance, and Type 2 Diabetes

et al. 2018

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“…Считается, что ключевую роль в развитии нейропа-тии играет хроническая гипергликемия, это убедительно доказали результаты DCCT [6].…”

Section: патогенезunclassified

“…Осложнения Complications у многих пациентов с СД1 и СД2 могут быть стабильными в течение нескольких лет, несмотря на прогрессирование ДКАН, что подчеркивает необходимость в достоверной и объективной экспертизе методов ранней стратифика-ции риска [6,35].…”

Section: сахарный диабет Diabetes Mellitusunclassified

“…Патологические результаты тестов оценки ВСР выявлены у 7% больных с впервые выявленными СД1 и СД2 [5]. Проведенные исследования указывают на ежегодное увеличение распространенности ДКАН у больных СД2 до 6% и у больных СД1 до 2% соответ-ственно [4,5,6].…”

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“…В 1998 г. исследовательская группа «Diabetes Control and Complications Trial (DCCT)» наблюдала 1441 боль-ного СД1 и продемонстрировала снижение ВСР у 6,2% испытуемых [6], в то время как Kennedy W. с соавт. на-блюдали снижение ВСР во время глубокого дыхания и проведения пробы Вальсальвы у 90% и 88% больных соответственно [7].…”

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Predictors and diagnosis of cardiac autonomic nervous dysfunction in patients with type 1 and type 2 diabetes mellitus

et al. 2017

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ОсложненияComplications нижение вариабельности сердечного ритма (ВСР) является предиктором внезапной сер-дечной смерти, что было известно китайским врачам уже в третьем веке нашей эры: «Если пульс регу-лярен, как стук дятла или капель дождя о крышу, то па-циент умрет в течение четырех дней». В отечественной литературе до последнего времени изменения сердеч-ной мышцы у пациентов с нарушением углеводного об-мена именовали диабетической дистрофией миокарда, что было предложено еще в 1935 г. Лангом Г.Ф. [1]. ЭпидемиологияАнализ результатов эпидемиологических исследова-ний диабетической автономной нейропатии затруднен в связи с различием критериев отбора пациентов и ме-тодов исследования, что ведет к существенной разнице полученных результатов [2].Фактическая распространенность диабетической кардиоваскулярной автономной нейропатии (ДКАН) не установлена. Признается, что она зависит от воз-

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Effect of Intensive Therapy on the Microvascular Complications of Type 1 Diabetes Mellitus

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2002

JAMA: The Journal of the American Medical Association

851

147

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The purpose of this report is to summarize and integrate the findings of the Diabetes Control and Complications Trial (DCCT), a randomized controlled clinical trial, and the succeeding observational follow-up of the DCCT cohort in the Epidemiology of Diabetes Interventions and Complications (EDIC) study, regarding the effects of intensive treatment on the microvascular complications of type 1 diabetes mellitus. The DCCT proved that intensive treatment reduced the risks of retinopathy, nephropathy, and neuropathy by 35% to 90% compared with conventional treatment. The absolute risks of retinopathy and nephropathy were proportional to the mean glycosylated hemoglobin (HbA 1c ) level over the follow-up period preceding each event Intensive treatment was most effective when begun early, before complications were detectable. These risk reductions, achieved at a median HbA 1c level difference of 9

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The effect of intensive diabetes therapy on measures of autonomic nervous system function in the Diabetes Control and Complications Trial (DCCT)

Cited by 268 publications

References 29 publications

Autonomic Neuropathy—a Prospective Cohort Study of Symptoms and E/I Ratio in Normal Glucose Tolerance, Impaired Glucose Tolerance, and Type 2 Diabetes

Autonomic Neuropathy—a Prospective Cohort Study of Symptoms and E/I Ratio in Normal Glucose Tolerance, Impaired Glucose Tolerance, and Type 2 Diabetes

Predictors and diagnosis of cardiac autonomic nervous dysfunction in patients with type 1 and type 2 diabetes mellitus

Effect of Intensive Therapy on the Microvascular Complications of Type 1 Diabetes Mellitus

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