Abstract
Objectives:To determine the prevalence of asymptomatic cardiac autonomic neuropathy and its association with risk factors among patients with Type-2 diabetes mellitus (T2DM)Methods:The present case-control study was conducted at Department of Medicine, Civil Hospital, Dow University of Health Sciences (DUHS), Karachi, Pakistan during the period September` 2016 to May` 2017. After taking informed consent, subjects from both genders, 72 healthy controls and 72 clinically diagnosed T2DM diabetic patients, age between 30-65 years were selected by non-probability sampling technique. After taking medical history and demographics, Cardiac Autonomic Neuropathy (CAN) was identified by using Ewing`s cardiac autonomic reflex tests (CARTs) and association of risk factors was also investigated.Results:Severe CAN was identified in 13.9% of T2DM patients while in none of the healthy controls. HR response to deep breathing test was most sensitive (sensitivity= 90%) among all tests. The most common symptoms were Numbness (75.9%) and constipation (69%), resting heart rate and diabetes duration was significantly associated with DCAN.Conclusions:CAN was highly prevalent in diabetic population that may lead to nephropathy and retinopathy in future. It is highly recommended to use sensitive and simple CARTs in clinics for early detection and early treatment of CAN.
Highlights
Diabetes mellitus (DM) is characterized by a high blood sugar level over a prolonged period and its mystifying nature led to pathophysiological alteration in almost all body systems, that causes economic, social and healthcare burden
Diabetic cardiac autonomic neuropathy (DCAN) is an independent predictor of heart associated mortality and nephropathy, it is recommended to perform Cardiac autonomic reflex tests (CARTs) for assessment of subclinical DCAN at first time diagnosis of diabetes and every five years thereafter.[6,7]
As no routine test is implemented for early detection of Cardiac Autonomic Neuropathy (CAN) in Pakistan, we and few other researchers are working on this comorbidity of diabetes to highlight its importance
Summary
Diabetes mellitus (DM) is characterized by a high blood sugar level over a prolonged period and its mystifying nature led to pathophysiological alteration in almost all body systems, that causes economic, social and healthcare burden. “Ewing’s CARTs” are Gold standard tests to identify subclinical DCAN that have been used consistently for several decades.[6,8,9] It consists of five autonomic reflex tests three of them are based on heart rate changes, and two of them are based on BP changes.[9] Karachi is among the most populated city in the world, with 9.4% diabetes burden[10] along with its underlying complications Literature on this subject is insufficient from Pakistan and this is high time to consider the importance of this devastating complication
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