Prevalence and Diagnosis of Diabetic Cardiovascular Autonomic Neuropathy in Beijing, China: A Retrospective Multicenter Clinical Study.

Qi Pan,Dong Zhao,Hebin Yao,Xiaofeng Lyu,Wei Huang,Quanmin Li,Hongmei Li,Yufeng Li,Wei Deng,Li Ma,Xiaoyan Xing,Lin Qi,Lixin Guo,Aihong Wang

doi:10.3389/fnins.2019.01144

Abstract

Cardiovascular autonomic neuropathy (CAN) is a debilitating condition occurring among diabetic patients especially those with long duration of disease. Whereas incidences and treatment of CAN has been well described for Western populations, fewer studies have been conducted among the Chinese. This study, therefore, aimed to assess the prevalence of CAN among sampled Chinese diabetic patients. Accordingly, 2,048 participants with a history of type 1 diabetes mellitus (T1DM, 73) and type 2 diabetes mellitus (T2DM, 1975) were randomly sampled from 13 hospitals. Patients’ biodata were recorded, and autonomic nervous system function tests performed to aid in the preliminary diagnosis of CAN. The final CAN diagnosis was based on the Ewing’s test in which heart rate variation (HRV) values were evaluated through deep-breathing (DB), lying-to-standing (LS), and Valsalva (V) tests. Systolic blood pressure (SBP) variation values were also evaluated through LS. In the T1DM group, 61.6% patients were diagnosed with CAN and no differences were observed in the baseline and clinical data between this group and those without CAN (P > 0.05). In the T2DM group, 62.6% patients were diagnosed with CAN and statistically significant differences were found between the CAN and non- CAN group with regards to age, duration of diabetes, metformin treatment, retinopathy, and hypertension history (P < 0.05). The most common manifestations of CAN included weakness (28.6%), dizziness (23.4%), frequent urination (19.6%), upper body sweating (18.3%), and nocturia (15.9%). Additionally, duration of disease and age were independent risk factors for CAN in T1DM and T2DM, respectively. On diagnosis, a combination of the V test + LS test provided the highest sensitivity of detecting CAN among T1DM group (sensitivity = 97.6%, AUC = 0.887) while for T2DM category, DB test had the highest sensitivity (83.6%), and maximal AUC (0.856) was found with V test + DB test. The overall prevalence of diabetes with CAN in the study was up to 63%.

Highlights

Cardiovascular autonomic neuropathy (CAN) is one of the most serious diabetic complications but is often unrecognized by patients and clinicians (Vinik and Ziegler, 2007; Chen et al, 2015)
In contrast to T1DM patients, CAN patients suffering from T2DM had significant differences (P < 0.01), in comparison to patients without CAN, in terms of age, education, childbearing history and medical payment
This study found that for T1DM, the optimal CAN diagnostic method is the use of the V test in combination with the LS test while for T2DM, the DB test had the highest sensitivity with combined V and DB tests giving the maximal AUC

Summary

Introduction

Cardiovascular autonomic neuropathy (CAN) is one of the most serious diabetic complications but is often unrecognized by patients and clinicians (Vinik and Ziegler, 2007; Chen et al, 2015). Varying incidence and prevalence of CAN are reported in different studies among diabetic patients with the rates ranging from as low as 1.6% in patients with well-controlled diabetes to as high as 90% in those awaiting a pancreas transplant (Vinik et al, 2013). The development of CAN is reported to be associated with poor glycemic control, duration of diabetes, old age, female gender, and lifestyle factors such as smoking (Maser and Lenhard, 2005; Pop-Busui, 2012). There is wide heterogeneity in the causes and progression of CAN among diabetics (Pop-Busui, 2012)

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