Abstract
Background People with diabetic cardiovascular autonomic neuropathy (CAN) have increased cardiovascular mortality. However, the association between distal symmetric polyneuropathy (DSPN) or CAN with all-cause mortality is much less investigated. Thus, we set out to examine the effect of CAN and DSPN on all-cause mortality in a well-phenotyped cohort. Methods All diabetes cases (n = 1,347) from the catchment area of a secondary diabetes care centre who had medical examination including neuropathy assessment between 1997 and 2016 were followed up for all-cause mortality in the NHS Hungary reimbursement database until 2018. We investigated the association of CAN (Ewing tests) and DSPN (Neurometer) with all-cause mortality using Cox models stratified by diabetes type. Results Altogether, n = 131/1,011 persons with type 1/type 2 diabetes were included. Of the participants, 53%/43% were male, mean age was 46 ± 12/64 ± 10 years, diabetes duration was 13 ± 10/7 ± 8 years, 42%/29% had CAN, and 39%/37% had DSPN. During the 9 ± 5/8 ± 5-year follow-up, n = 28/494 participants died. In fully adjusted models, participants with type 1 diabetes patients with versus without DSPN had an increased mortality (HR 2.99, 95% CI 1.4-8.63), while no association with CAN was observed. In type 2 diabetes, both DSPN and CAN independently increased mortality (HR 1.32, 95% CI: 1.07-1.64, and HR 1.44, 95% CI: 1.17-1.76). Conclusions Our results are compatible with an increased risk of mortality in people with type 1 diabetes and DSPN. Furthermore, we report a similarly strong association between DSPN and CAN and all-cause mortality in type 2 diabetes mellitus.
Highlights
Compared to the general population, both type 1 and type 2 diabetes (T1DM, T2DM) confer a higher risk of cardiovascular complications and all-cause mortality
While distal symmetric polyneuropathy (DSPN) was less frequent among survivors, the frequency of cardiovascular autonomic neuropathy (CAN) was similar in the groups (Table 1)
According to a model adjusted for potential confounders and mutually including CAN and DSPN among T2DM persons, we found that CAN and DSPN were independent predictors of all-cause mortality
Summary
Compared to the general population, both type 1 and type 2 diabetes (T1DM, T2DM) confer a higher risk of cardiovascular complications and all-cause mortality. People with diabetic cardiovascular autonomic neuropathy (CAN) have increased cardiovascular mortality. We investigated the association of CAN (Ewing tests) and DSPN (Neurometer) with all-cause mortality using Cox models stratified by diabetes type. Participants with type 1 diabetes patients with versus without DSPN had an increased mortality (HR 2.99, 95% CI 1.4-8.63), while no association with CAN was observed. Our results are compatible with an increased risk of mortality in people with type 1 diabetes and DSPN. We report a strong association between DSPN and CAN and all-cause mortality in type 2 diabetes mellitus
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