Abstract
Autonomic nervous system (ANS) imbalance manifesting as cardiac autonomic neuropathy in the diabetic population is an important predictor of cardiovascular events. Symptoms and signs of ANS dysfunction, such as resting heart rate elevations, diminished blood pressure responses to standing, and altered time and frequency domain measures of heart rate variability in response to deep breathing, standing, and the Valsalva maneuver, should be elicited from all patients with diabetes and prediabetes. With the recognition of the presence of ANS imbalance or for its prevention, a rigorous regime should be implemented with lifestyle modification, physical activity, and cautious use of medications that lower blood glucose. Rather than intensifying diabetes control, a regimen tailored to the individual risk of autonomic imbalance should be implemented. New agents that may improve autonomic function, such as SGLT2 inhibitors, should be considered and the use of incretins monitored. One of the central mechanisms of dysfunction is disturbance of the hypothalamic cardiac clock, a consequence of dopamine deficiency that leads to sympathetic dominance, insulin resistance, and features of the metabolic syndrome. An improvement in ANS balance may be critical to reducing cardiovascular events, cardiac failure, and early mortality in the diabetic population.
Highlights
Repository CitationAaron I.; Casellini, Carolina; Parson, Henri K.; Colberg, Sheri R.; and Nevoret, Marie-laure, "Cardiac Autonomic Neuropathy in Diabetes: A Predictor of Cardiometabolic Events" (2018)
As the United States population grows older and more obese, fully one third of people over the age of 65 will develop diabetes (Cowie et al, 2009; Boyle et al, 2010) and a host of comorbidities; and almost two thirds of these patients will experience cardiometabolic events
The authors hypothesize that the chronotropic effect of liraglutide, which may be mediated through the GLP1 receptor on the sinoatrial node, cannot explain the worsening of heart rate variability (HRV) measures; instead, the impaired HRV may be due to a direct influence on sympathovagal balance, as reflected by the increase in night-time heart rate (HR) in conjunction with the significant decrease in standard deviation of all normal R–R intervals (sdNN) and rMSSD suggesting an impairment of parasympathetic activity
Summary
Aaron I.; Casellini, Carolina; Parson, Henri K.; Colberg, Sheri R.; and Nevoret, Marie-laure, "Cardiac Autonomic Neuropathy in Diabetes: A Predictor of Cardiometabolic Events" (2018). Human Movement Sciences Faculty Publications. 76. https://digitalcommons.odu.edu/hms_fac_pubs/76
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