Prevalence of Cardiovascular Autonomic Neuropathy and Gastroparesis Symptoms among Adults with Type 2 Diabetes Who Attend a Primary Health Care Center

Abstract

Introduction: Cardiovascular autonomic neuropathy (CAN) and gastroparesis are two forms of diabetic autonomic neuropathy that could affect the quality of life of the patients and carry significant morbidity and mortality outcomes. This study aimed to estimate the prevalence and risk factors of both CAN and gastroparesis symptoms (GPS) among patients with type 2 diabetes (T2D). Methods: A cross-sectional study was conducted among 347 adults (≥ 18 years) with T2D from April 1- December 15, 2017. CAN was defined by the presence of any of the followings: resting tachycardia (RT); resting heart rate > 100 bpm, orthostatic hypotension OH (a fall in systolic blood pressure (SBP) by ≥ 20 mmHg or a fall in diastolic blood pressure by ≥ 10 mmHg within 3 minutes of standing) or prolonged corrected QT interval (QTc) in the electrocardiogram (> 0.47 seconds in females, and > 0.45 seconds in males). The GPS were assessed using a validated questionnaire: Gastroparesis Cardinal Symptom Index (GCSI). GCSI score ≥ 1.9 signified definite GPS. Results: The mean age was 55.6 ± 10 years. The mean HbA1c and T2D duration was 8 ± 1.6% and 10.6 ± 6.9 years, respectively. CAN was present in 15.6%: 2.9% with OH, 5.8% with RT and 8.4% with prolonged QTc. Antihypertensive agents (anti-HTN), body mass index (BMI), SBP, triglycerides and HbA1c were significantly higher in patients with CAN, P<0.05. Prolonged T2D duration (OR= 1.07, 95% CI 1-1.14; p= 0.04) and anti-HTN (OR= 5.2, 95% CI 1.2-23; p= 0.03) were independently associated with CAN. GPS were present in 3.2% and were significantly associated with higher BMI, P<0.05. Metformin use emerged as the single significant independent predictor of the presence of at least one GPS (OR= 5.2, 95% CI 1.8- 14.7; p= 0.002). Conclusion: The prevalence of CAN among T2D subjects was 15.5%. Prolonged T2D duration and anti-HTN emerged as significant predictors of CAN. The prevalence of GPS was 3.2% and was independently associated with metformin use. Disclosure L. AlOlaiwi: None. T. Alharbi: None. A. Tourkmani: None.