Abstract
Cardiovascular disease (CVD) is the leading cause of mortality in patients with type 1 diabetes (T1D). The cardiovascular autonomic neuropathy (CAN), although considered as an independent risk factor for CVD, remains underdiagnosed. The aim of this paper was to determine the prevalence, predictors of CAN in patients with T1D and its association with other chronic complications of diabetes. Patients with T1D underwent a clinical-epidemiological survey, had blood and urinary samples collected, performed ophthalmoscopic and clinical neurological examination and cardiovascular reflex tests. One hundred and fifty one patients with T1D, 53.6% female, 45.7% Caucasian, mean age of 33.4 ± 13 years, diabetes duration of 16.3 ± 9.5 years, and glycated hemoglobin levels of 9.1 ± 2% were evaluated. The prevalence of CAN in the studied population was 30.5%. CAN was associated with age (p = 0.01), diabetes duration (p = 0.036), hypertension (p = 0.001), resting heart rate (HR) (p = 0.000), HbA1c (p = 0.048), urea (p = 0.000), creatinine (p = 0.008), glomerular filtration rate (p = 0.000), urinary albumin concentration (p = 0.000), LDL (p = 0.048), free T4 (p = 0.023), hemoglobin (p = 0.01) and presence of retinopathy (p = 0.000), nephropathy (p = 0.000) and diabetic neuropathy (p = 0.000), the following symptoms syncope (p = 0.000), post prandial nausea (p = 0.042), early satiety (p = 0.031), sexual dysfunction (p = 0.049), and gustatory sweating (p = 0.018). In logistic regression model, it was observed that only resting HR, diabetic neuropathy, and retinopathy were independent associated with CAN. In conclusion, CAN is a common chronic complication of T1D affecting about 30% of the studied population and is associated with the presence of other chronic complications. Indicators of CAN included age, diabetes duration, hypertension, resting HR, diabetic neuropathy and retinopathy, and symptoms suggestive of autonomic neuropathy. This study confirms the importance of systematic and early screening for CAN.
Highlights
Type 1 diabetes (T1D) is the most common endocrine disorder of childhood and adolescence affecting about 10–20 million people worldwide [1]
After logistic regression model using diagnosis of Cardiovascular autonomic neuropathy (CAN) by cardiovascular reflex testes as a dependent variable and sex, age, diabetes duration, pulse pressure, resting heart rate (HR), BMI, hypertension, albuminuria, presence of diabetic neuropathy and retinopathy, HbA1c, urea, creatinine, low-density lipoprotein (LDL), and hemoglobin as independent variables, it was observed that only resting HR, presence of diabetic neuropathy and retinopathy were significantly independent variables associated with the diagnosis of CAN (Table 6)
The prevalence of CAN assessed by cardiovascular reflex tests was lower than the prevalence reported in the literature (11.3 versus 25%), but quite similar when using cardiovascular reflex tests associated with the heart rate variability (HRV) parameters (25.8 versus 25%)
Summary
Type 1 diabetes (T1D) is the most common endocrine disorder of childhood and adolescence affecting about 10–20 million people worldwide [1]. Poor glycemic control is associated with the development of micro and macrovascular chronic complications leading to a major impact on morbidity and mortality [2]. Cardiovascular autonomic neuropathy (CAN) considered a common diabetic chronic complication [6] and associated with increased cardiovascular morbidity and mortality, remains underdiagnosed [6, 7]. Depending on the methodology and diagnostic criteria, the prevalence of CAN ranges from 2.6 to 90% among patients with diabetes and its prevalence increases with age, diabetes duration, and inappropriate glycemic control [8, 9] and may be associated with peripheral neuropathy (up to 62.5% of cases) and the presence of other cardiovascular risk factors, such as hypertension, dyslipidemia, diabetic nephropathy and retinopathy, arterial stiffness, left ventricular hypertrophy, and diastolic dysfunction [9, 10]. Cardiovascular autonomic neuropathy has been identified as a strong predictor of CVD in both patients with T1D and type 2 diabetes (T2D). Patients with diabetes and CAN have 5year mortality rates ranging from 16 to 53%, depending on its severity [8]
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