F158. Diagnostic accuracy of composite autonomic symptom scale 31 (COMPASS-31) in early detection of autonomic dysfunction in type 2 diabetes mellitus

Abstract

Introduction Diabetes mellitus (DM) has become a global epidemic with an increasing prevalence due to rapid modernization and socioeconomic development. One in six people with diabetes are at a risk of developing diabetes related complications. Diabetic autonomic neuropathy (DAN) is one of the most overlooked complications despite its significant negative impact on survival and quality of life. Damage to autonomic nerve fibres that innervate the heart and blood vessels leads to cardiac autonomic neuropathy (CAN) which has a deleterious effect on cardiovascular dynamics. A useful autonomic functions screening instrument which can be used in DM patients for their autonomic symptoms is the need of the hour. Composite autonomic symptom scale 31 (COMPASS-31), derived from original COMPASS (86 questions), has been validated in patients of small fibre polyneuropathy but its use in patients of DM has not been explored. Present study was done to assess the use of this tool for an early detection of autonomic neuropathy in the patients of type 2 DM. Methods Sixty consecutive patients of type 2 DM of both gender and ages more than 18 years were enrolled from the medicine/neurology outpatient department according to the criteria laid by American Diabetic Association 2016. All patients were evaluated for fasting and postprandial blood glucose level,HbA1c, urine routine and microscopy, serum ceatinine, fundus examination, nerve conduction studies by Nihon kohden (Neuropack) electrophysiological apparatus, autonomic function testing by ewing’s battery of tests and heart rate variability measures (HRV). Basic clinicoepidemiologic data and COMPASS-31 Questionnaire were also collected from the participants. Results Of the 60 patients enrolled 6 patients could not get evaluated for the entire battery of tests and thus 54 patients with complete data were finally considered for analysis. There were 29 (53.7%) males and 25(46.3%) females. The median duration of illness was 7 yrs (minimum 2 months to maximum 24 years). None of the autonomic tests including SSR could show statistically significant association with COMPASS-31 scores. Individual domains of COMPASS-31 also did not show any association with objective autonomic tests. HRV parameters did not show any correlation with COMPASS-31 scores. Conclusion Standard autonomic function test are very time consuming and exhaustive to be performed on routine basis in outpatient department. Present study was planned to assess COMPASS-31 in diabetic patients to detect early autonomic dysfunction. To make it objective, standard autonomic function test was also done in all the patients. Although COMPASS-31 Scales has been validated in patients with small fibre polyneuropathy for assessing autonomic dysfunction, we could not get a significant association between COMPASS-31 and any of the objective tests. Probably COMPASS-31 scores alone is not a very sensitive screening tool for assessment of autonomic dysfunction among the patients of type 2 DM.