Correlation of cardiac autonomic functions with uroflowmetry parameters in Type 2 diabetes mellitus patients – Analytical cross-sectional study

Abstract

Background: Diabetic autonomic neuropathy can affect the autonomic nervous system (ANS) as a whole and result in a detrimental impact on cardiovascular, gastrointestinal, and genitourinary systems. However, urinary bladder dysfunction is one of the most important complications of long-standing and poorly controlled diabetes mellitus (DM) and often impairs the quality of life presenting as an under-recognized complication of diabetes. Cardiac autonomic functions are also severely affected in DM, leading to cardiovascular autonomic neuropathy (CAN). Hence, the present study aimed at correlating the urinary bladder functions with cardiac autonomic functions in Type 2 diabetic patients. Aims and Objectives: The aim of the study was to assess the cardiac autonomic functions using a cardiac ANS study (CANS study) and correlate it with the urinary bladder functions using uroflowmetry studies in Type 2 DM patients. Materials and Methods: This is an analytical cross-sectional study, with a sample size of 31 Type 2 DM patients recruited from the diabetology ward of Rajiv Gandhi Government General Hospital, Madras Medical College, Chennai. The patients were clinically examined and the history was collected. The Uroflowmetry test was done in the Department of Urology and the CANS study was done in the Department of Diabetology and the parameters were recorded in Microsoft Excel and analyzed using Statistical Package for the Social Sciences software. Results: A majority of subjects had significant severe and definite sympathetic involvement and early and definite cardiac autonomic neuropathy in the CANS study. Subjects with cardiac autonomic neuropathy had a negative correlation with voided volume, maximum flow rate, and average flow rate and a positive correlation with voiding time, and post-voided residual urine volume. Conclusion: According to this study, subjects with uncontrolled diabetes had predominant sympathetic nervous system dysfunction and also early, definite cardiac autonomic neuropathy. Subjects with early cardiac autonomic neuropathy had significant alterations in the uroflowmetry parameters indicating bladder voiding dysfunction in them. Hence, CANS study and uroflowmetry can be used to determine early ANS dysfunction in DM.