Cardiac Autonomic Neuropathy In Patients Research Articles

Artificial intelligence-enhanced electrocardiogram analysis for identifying cardiac autonomic neuropathy in patients with diabetes.

To develop and employ machine learning (ML) algorithms to analyse electrocardiograms (ECGs) for the diagnosis of cardiac autonomic neuropathy (CAN). We used motif and discord extraction techniques, alongside long short-term memory networks, to analyse 12-lead, 10-s ECG tracings to detect CAN in patients with diabetes. The performance of these methods with the support vector machine classification model was evaluated using 10-fold cross validation with the following metrics: accuracy, precision, recall, F1 score, and area under the receiver-operating characteristic curve (AUC). Among 205 patients (mean age 54 ± 17 years, 54% female), 100 were diagnosed with CAN, including 38 with definite or severe CAN (dsCAN) and 62 with early CAN (eCAN). The best model performance for dsCAN classification was achieved using both motifs and discords, with an accuracy of 0.92, an F1 score of 0.92, a recall at 0.94, a precision of 0.91, and an excellent AUC of 0.93 (95% confidence interval [CI] 0.91-0.94). For the detection of any stage of CAN, the approach combining motifs and discords yielded the best results, with an accuracy of 0.65, F1 score of 0.68, a recall of 0.75, a precision of 0.68, and an AUC of 0.68 (95% CI 0.54-0.81). Our study highlights the potential of using ML techniques, particularly motifs and discords, to effectively detect dsCAN in patients with diabetes. This approach could be applied in large-scale screening of CAN, particularly to identify definite/severe CAN where cardiovascular risk factor modification may be initiated.

The Incidence of Cardiac Autonomic Neuropathy in Patients with Amyotrophic Lateral Sclerosis – A Systematic Review (P5-3.006)

The Incidence of Cardiac Autonomic Neuropathy in Patients with Amyotrophic Lateral Sclerosis – A Systematic Review (P5-3.006)

FREQUENCY OF CARDIAC AUTONOMIC NEUROPATHY IN TYPE 2 DIABETES MELLITUS PATIENTS PRESENTING TO KHYBER TEACHING HOSPITAL PESHAWAR

This study aimed to determine the frequency of cardiac autonomic neuropathy in patients with type 2 diabetes. A cross-sectional study was conducted at the Department of Medicine, Khyber Teaching Hospital Peshawar, Pakistan, from June 2022 to June 2023. The study included 285 individuals aged 40-60 diagnosed with type 2 diabetes for at least 5 to 10 years. The study aimed to evaluate the frequency of cardiac autonomic neuropathy in type 2 diabetics. Chi-square was applied for statistical analysis with a significance level of p≤0.05. Of 285 type 2 diabetic patients, 199 (69.82%) were male, and 86 (30.18%) were female. 26.31% of the participants were diagnosed with cardiac autonomic neuropathy, of which 26.67% were male and 73.33% were female. This difference was statistically significant. 37.35% of the patients with cardiac autonomic neuropathy were smokers, while 62.65% were non-smokers. All the patients with CAN were either overweight or obese. This study found that prolonged diabetes is directly related to the development of cardiac autonomic neuropathy, and there was a statistically significant association between diabetes and gender, as well as smoking.

Interest of the SUDOSCAN in the screening of cardiac autonomic neuropathy in type 2 diabetics

Introduction: Cardiac autonomic neuropathy (CAN) is one of the first complications of type 2 diabetes (T2DM) and a silent cause of cardiovascular morbidity and mortality. SUDOSCAN, a digital chronoamperometric analysis device, has appeared in recent years and allows a rapid and non-invasive quantitative assessment of sudomotor function, which will allow the measurement of sympathetic cholinergic function in the assessment of CAN by reflecting the state of the autonomic nervous system. The main purpose of the present study is to evaluate the usefulness of SUDOSCAN in the detection of cardiac autonomic neuropathy in type 2 diabetic patients. Patients and methods: In this study we recruited 85 patients with type 2 diabetes. The study data were collected by questionnaire, clinical examination and SUDOSCAN. Results: The 85 patients had a mean age of 58.32 ± 10.89 years, with a large female predominance, and a sex ratio of 0.28. 67% of our patients had diabetes for less than 10 years. The SUDOSCAN measurement noted 54.1% with a moderate risk of having CAN, 45.9% with a low risk, and a zero percentage with a high risk of having CAN. Conclusion: The risk score for cardiac autonomic neuropathy assessed by SUDOSCAN, and its ease of use and interpretation, make it a good screening test for cardiac autonomic neuropathy in patients with type 2 diabetes.

Cardiac Autonomic Neuropathy in Patients with Newly Diagnosed Carbohydrate Disturbances.

Cardiac autonomic neuropathy (CAN) is a serious complication of diabetes mellitus that can predispose patients to higher risk for cardiovascular death. The aim of the present study was to evaluate the presence of cardiac autonomic neuropathy and sudomotor dysfunction in patients with newly diagnosed carbohydrate disturbances (prediabetes or diabetes) and to assess their relationship to metabolic disturbances and cardiovascular risk. In the present study, we included 160 patients -78 with obesity without carbohydrate disturbances, 52 with prediabetes, and 30 with newly diagnosed diabetes. CAN was diagnosed using cardiovascular reflex tests and sudomotor function was evaluated by SUDOSCAN. Cardiovascular risk was calculated using SCORE and FRMINGHAM risk scores. The prevalence of cardiac autonomic neuropathy was significantly higher in patients with newly diagnosed diabetes. Independently of their glycemic status, the patients who had blood glucose on the 60th-minute of OGTT>8.5 mmol/l had significantly higher prevalence of cardiac autonomic neuropathy (30.2% vs 15.6%, р=0.044). Patients with high cardiovascular risk according to FRAMINGHAM and SCORE had worse heart rate variability scores. Autonomic neuropathy risk assessed by SUDOSCAN was a good predictor for the presence of CAN. In conclusion, CAN has a higher prevalence on patients with newly diagnosed diabetes compared to prediabetic and normoglycemic subjects, while the patients with blood glucose>8.5 mmol/l on the 60th-minute of OGTT have higher prevalence of CAN independently of their glycemic status. SUDOSCAN testing can be used to assess the risk of CAN and to select patients that should undergo further testing.

Thermal quantitative sensory testing as a screening tool for cardiac autonomic neuropathy in patients with diabetes mellitus.

IntroductionElectrophysiological diagnosis of cardiac autonomic neuropathy (CAN) is based on the evaluation of cardiovascular autonomic reflex tests (CARTs). CARTs are relatively time consuming and must be performed under standardized conditions. This study aimed to determine whether thermal quantitative sensory testing (TQST) can be used as a screening tool to identify patients with diabetes at a higher risk of CAN.MethodsEighty‐five patients with diabetes and 49 healthy controls were included in the study. Neurological examination, CARTs, TQST, biochemical analyses, and neuropathy symptom questionnaires were performed.ResultsCAN was diagnosed in 46 patients with diabetes (54%). CAN‐positive patients with diabetes had significantly higher warm detection thresholds (WDT) and significantly lower cold detection thresholds (CDT) in all tested regions (thenar, tibia, and the dorsum of the foot). CDT on the dorsum < 21.8°C in combination with CDT on the tibia < 23.15°C showed the best diagnostic ability in CAN prediction, with 97.4 % specificity, 60.9% sensitivity, 96.6% positive predictive value, and 67.3% negative predictive value.ConclusionTQST can be used as a screening tool for CAN before CART.

Age and Disease Duration Independent Cardiac Autonomic Neuropathy in Patients with Diabetic Foot Complications: Case-Control Study.

Introduction:Cardiac autonomic neuropathy (CAN) in people with diabetes is associated with high mortality. We aimed to study age and disease duration, independent prevalence of CAN in people with diabetic foot complications.Methods:530 patients with diabetes were screened to undergo CAN assessment (automated CANS-analyser). CAN was defined as “early”, “definite,” or “severe” according to the Toronto consensus. History pertaining to autonomic symptoms, prior cardiovascular events (CVE), and assessment for peripheral neuropathy was done. Participants were grouped into those with diabetic foot complication (group A, n = 82) [Charcot foot (n = 42), diabetic foot ulcer (n = 40)]; with DPN without foot complications (group B, n = 82); and without DPN or foot complications (group C, n = 82).Results:Symptoms of autonomic dysfunction were prominent in people with foot complications than the other groups. Resting heart rate was significantly greater in those with foot complications [99.89 ± 26.71 (group A) vs. 86.99 ± 22.24 (group B) vs. 88.32 ± 17.08 (group C); P = 0.001]. The prevalence of CAN was 75.6% in group A (51.2% early, 12.2% definite, 12.2% severe), 57.2% in group B (45.1% early, 12.2% severe) and 58.5% in group C (43.9% early, 1.2% definite, 13.4% severe) (P = 0.002). Patients with foot complications were more likely to have CAN (75.6% vs. 57.9%, P < 0.001). Charcot foot had higher prevalence of CAN (78.6%) as compared with those with DFU (72.5%) or without DFU or DPN (57.9%), P < 0.001.Conclusion:CAN is present in more than two-third of patients with diabetes and foot complications with highest prevalence in Charcot neuroarthropathy.

The association between diabetic retinopathy and cardiac autonomic neuropathy in patients with type 2 diabetes

The association between diabetic retinopathy and cardiac autonomic neuropathy in patients with type 2 diabetes

Relationship between Pancreas Exocrine Insufficiency and Cardiac Autonomic Neuropathy in Patients with Type 2 Diabetes Mellitus.

The exocrine function of the pancreas is controlled by the autonomic nervous system (ANS), and autonomic neuropathy is a common and serious complication of diabetes. There are many factors contributing to the development of autonomic neuropathy in diabetic patients. Cardiovascular tests have been developed to evaluate the function of the ANS. This study investigated the relationship between cardiovascular autonomic neuropathy (CAN) and pancreas exocrine insufficiency (PEI) in diabetic patients. This study evaluated 110 individuals with type 2 diabetes mellitus (T2DM) and 40 healthy volunteers. Autonomous neuropathy tests were utilized to diagnose patients, and Ewing and Clarke's criteria were employed to assess the severity of autonomous dysfunction. Stool samples were also collected from patients to measure fecal elastase-1 (FE-1). A 65.5% incidence of PEI was observed in DM patients. There was no significant correlation among the duration of disease, C-peptide, HbA1c, and PEI, respectively (P = .782, P = .521, P = .580). However, a significant difference between DM patients and controls in terms of cardiac dysautonomia (P = .001) was seen. Moreover, a statistically significant correlation between the degree of cardiac dysautonomia and FE-1 level was observed within the patient group (P =.001). It is possible that the disruption of exocrine hormone secretion in the pancreas due to the impairment of enteropancreatic reflexes is secondary to diabetic autonomic neuropathy and resulting in PEI. This study also showed that autonomic neuropathy might develop and cause PEI in diabetic patients without known added confounding factors.

Association of serum CTRP9 levels with cardiac autonomic neuropathy in patients with type 2 diabetes mellitus.

AimsCardiac autonomic neuropathy (CAN) is a serious complication of diabetes and is associated with adipokines. The C1q tumor necrosis factor‐related protein 9 (CTRP9) is a newly discovered adipokine. This study aimed to evaluate the association of serum CTRP9 levels with the prevalence and severity of CAN in patients with type 2 diabetes mellitus.Materials and MethodsWe enrolled 262 patients (aged ≥18 years) with type 2 diabetes mellitus into this study. Standard cardiovascular autonomic reflex tests (CARTs) were used to assess CAN and patients were divided into three groups accordingly: a non‐CAN group, an early CAN group, and a definite CAN group. Serum CTRP9 levels were measured by enzyme‐linked immunosorbent assay, and the tertiles were calculated.ResultsSerum CTRP9 levels decreased significantly in the early CAN and definite CAN groups (P < 0.05). The percentage of definite CAN was the highest at the minimum tertile of serum CTRP9 level (T1; P < 0.05). Additionally, serum CTRP9 levels were negatively correlated with age, DM duration, hemoglobin A1c (HbA1c), and fasting plasma glucose (FPG) while positively correlated with high‐density lipoprotein cholesterol (HDL; P < 0.05). The level of CTRP9 was also significantly associated with the four indexes of CARTs (P < 0.05). Furthermore, CTRP9 was a protective factor for definite CAN (P < 0.05). Compared with the maximum tertile (T3) of the serum CTRP9 levels, a decreased level of serum CTRP9 in T1 significantly increased the prevalence ratio of definite CAN in patients with type 2 diabetes mellitus (P < 0.05).ConclusionSerum CTRP9 levels were independently associated with definite CAN. CTRP9 represents a reliable biomarker for exploring CAN in patients with type 2 diabetes mellitus.

Effect of HMG-Co-A reductase inhibitors on cardiac autonomic neuropathy in diabetic patients

Objective: To observe the effect of statins on cardiac autonomic neuropathy in patients with diabetes and to study the correlation between cardiac autonomic neuropathy as assessed by cardiac autonomic reflex tests (CARTs) and by Composite Autonomic Symptom Scale (COMPASS)-31. Materials and Methods: A cross-sectional observational study was conducted on 62 patients having Type 2 diabetes mellitus for more than 5 years. Patients were randomized into two groups, one group received standard antidiabetic therapy and other group received standard antidiabetic along with statin medication at least for more than 1 year. Each patient underwent CART and heart rate variability to assess autonomic dysfunction. In addition, COMPASS 31 questionnaire was used to evaluate symptoms subjectively. Statin Experience Assessment Questionnaire was used to note adverse effects of statins. Chi-square test, Spearman correlation test, and Mann–Whitney U-test were used for statistical analysis. Results: A significant difference in severity of cardiac autonomic dysfunction was observed between two groups as measured by CART (P = 0.016) and COMPASS-31 questionnaire (P = 0.008). Moreover, COMPASS score of >16 was observed in patients with advanced cardiac autonomic neuropathy. A significant correlation was found between COMPASS 31 score and CART results (r = 0.29, P = 0.02). Conclusion: Our study highlights the potential utility of statins in curbing progression of cardiac autonomic neuropathy and can be safely administered in patients with Type 2 diabetes mellitus. COMPASS 31 questionnaire can be used as an effective screening tool for CART referral, facilitating the early detection of cardiac autonomic neuropathy.

Cardiac autonomic neuropathy in patients with type 2 diabetes mellitus having peripheral neuropathy: A cross-sectional study

AimsThe aim was to see the frequency of CAN in type 2 diabetes mellitus patients with peripheral neuropathy, and its association with peripheral nerve conduction abnormalities. MethodsA cross-sectional study at BIRDEM was conducted in 62 patients with type 2 diabetes mellitus having electrophysiologically diagnosed peripheral neuropathy. CAN was detected by four clinical tests - heart rate response to deep breathing and valsalva maneuver, blood pressure response to standing and sustained handgrip. ResultThe study showed that all patients had CAN – 14.52% had early, 26.67% had definitive and 59.68% had severe CAN. Patients with severe CAN had significantly reduced nerve conduction velocity and amplitude of peripheral nerves (sural 4.36 ± 12.77 vs 9.65 ± 17.77 m/s, p = 0.009; 2.23 ± 1.89 vs 3.01 ± 2.76 mV, p = 0.001; peroneal 7 ± 4.23 vs 8.53 ± 5.99 mV, p = 0.047; tibial 0.008 ± 0.03 vs 0.026 ± 0.05 mV, p = 0.009) and higher serum triglyceride levels (221.17 ± 120.61 vs 197.76 ± 68.43 mg/dl, p = 0.033). ConclusionDiabetic patients with peripheral neuropathy have CAN, the severity of which increases with worsening neuropathy.

A Study of Cardiac Autonomic Neuropathy in Patients with Type 2 Diabetes Mellitus: A Northeast India Experience.

Aim:To investigate the prevalence and the risk factors for cardiac autonomic neuropathy (CAN) in type 2 diabetes mellitus (DM) patients.Study Design:Cross-sectional cohort study.Place and Duration of Study:This study was conducted in the Department of Endocrinology, Gauhati Medical College and Hospital, Assam, India between December 2016 to March 2018.Methodology:We included 100 patients (60 males and 40 females; age range: 36–72 years) with type 2 DM. Their clinical, biochemical, and metabolic parameters were analyzed and assessment of CAN were done based on the Ewing's criteria.Results:Out of 100 patients, 60 were males and 40 were females. The mean age of the patients was 53.3 ± 10.37 years (36–72 years) and the mean duration of diabetes was 9.03 ± 6.4 years (6 months–25 years). Patients were divided into two groups: “without CAN” (CAN−) and “with CAN” (CAN+). The prevalence of CAN was 70%, with early CAN in 25%, definite CAN in 24%, and severe CAN in 21% cases The patients with CAN were older (P = 0.0005), had longer diabetes duration (11.56 vs. 3.13; P = 0.0001), higher creatinine (P < 0.0001), and lower estimated glomerular filtration rate (eGFR) (P = 0.0001) compared to patients without CAN. Retinopathy, peripheral neuropathy, and nephropathy were common in CAN + patients. On multiple logistic regression analysis, duration of diabetes [odds ratio (OR); 6.7, P < 0.0001), older age (OR; 1.07, P < 0.016), and lower eGFR (OR; 0.97, P < 0.03) were risk factors for CAN.Conclusion:CAN is a common microvascular complication in type 2 DM with duration of diabetes, age, and severity of nephropathy being its significant determinants.

DESCENSO DEL 10% DEL PESO CORPORAL EN PACIENTES CON SÍNDROME METABÓLICO: IMPACTO SOBRE VARIABLES CARDIOMETABÓLICAS Y FUNCIÓN AUTONÓMICA CARDÍACA

Introducción: existe exceso de morbimortalidad asociada con el síndrome metabólico (SM). El descenso de peso demostró efectos beneficiosos sobre distintos componentes del mismo.Objetivos: determinar el impacto del descenso del 10% del peso corporal inicial en variables cardiometabólicas y sobre la función autonómica cardíaca en pacientes con SM.Sujetos de estudio y métodos: se estudiaron 103 pacientes con SM, 69 mujeres (66,9%); edad promedio 51,9 años (23-79). Se evaluó la actividad cardíaca para diagnosticar la presencia de neuropatía autonómica cardíaca (NAC) con los test de Ewing. Se definió la anormalidad de las mismas con la presencia de dos o más pruebas patológicas. El tratamiento indicado fue el plan de alimentación hipocalórico, individualizado. No se modificaron los medicamentos por dislipemia y/o hipertensión arterial que ya venían recibiendo; los pacientes que requirieron fármacos nuevos fueron excluidos. Se realizó la propuesta de descenso del 10% de peso corporal inicial con un límite de un año para conseguir el objetivo. Para el análisis estadístico se utilizaron: promedios, test para muestras apareadas y test de Fisher.

Кардиальная автономная нейропатия у пациентов с сахарным диабетом: факторы риска, диагностика и лечение (обзор литературы).

Кардиальная автономная нейропатия у пациентов с сахарным диабетом: факторы риска, диагностика и лечение (обзор литературы).

Pathogenetic Mechanisms of Outbreak and Development of Cardiac Autonomic Neuropathy in Patients with Metabolic Syndrome.

A cross-sectional study of universe sample of patients (N=135; mean age -49.7±0.8 years) with metabolic syndrome yielded the incidence of cardiac autonomic neuropathy of 37.5%. The pathogenetic peculiarities were revealed for the onset and development of this neuropathy. At the early stages, the progress of cardiac autonomic neuropathy closely correlated with elevation of blood glucose, while endothelial dysfunction progressing at the later period against the background of persistent hyperglycemia is viewed as an extra factor contributing to the development of this disease.

Heart rate variability evaluation in the assessment of cardiac autonomic neuropathy in patients with type 2 diabetes

IntroductionHeart rate variability (HRV) is a respected measure used in the assessment of cardiac autonomic neuropathy (CAN) and it can serve as an independent prognostic indicator of sudden arrhythmic death risk. Despite the importance of early detection, the diagnosis of CAN is often made too late, especially in diabetics. Besides the long subclinical phase of CAN, reasons for this include great diversification of employed diagnostic methods and absence of universally accepted normal values; the latter applies mostly in HRV evaluated using short-term spectral analysis (SAHRV). AimThe aim of this cross-sectional study involving patients with type 2 diabetes was to summarize the real potential of using a testing method for CAN diagnosis by short-term SAHRV, including an autonomic load imposed during an orthoclinostatic test (Supine1–Standing–Supine2, short 5-min recordings). Three different normative approaches to the postprocessing analysis of acquired data described by different authors were employed.Secondary aim of the study was to assess the benefit of rate-controlled breathing. The next aim was to compare the HRV data measured with the selected clinical and laboratory indices in patient examined. Materials and methodsThe study included 43 patients with type 2 diabetes (12 women, 31 men, mean age 51.1±10.7 y) and no history of manifest CAN or serious cardiovascular illness, except uncomplicated hypertension. Using a diagnostic system DiANS PF8 with telemetric transfer of ECG and respiratory rate, series of reflex tests according to Ewing and SAHRV (Fourier tachogram analysis, window 256) during autonomic load imposed by Supine1–Standing–Supine2 test (SSS test) and during 5min of rate-controlled, non-deepened breathing (PB, 12cycles/min) were performed. Acquired spectral indices were analyzed and compared with normatives of 3 authors using the same recording algorithm, SSS test, but different data postprocessing analysis. These were (1) so called “functional age” of autonomic nervous system (ANS), (2) assessment of CAN severity according to age-stratified medians and percentiles, (3) assessment of CAN severity according to cumulative spectral power during the entire test (cumLFHF). ResultsAccording to the total Ewing score (ETS), 11.6% patients were categorized as CAN-free (ETS=0), 32.6% were diagnosed with possible CAN (ETS=1), and 55.8% labeled with manifest CAN (ETS=2–3). Moderate correlation between ETS and individual SAHRV parameters following orthoclinostasis (test SSS) in Supine2 position was described [ms2]: TP (total power, f=0.02–0.5Hz): r=−0.4, p<0.006; LF component (low frequency, 0.05–0.15Hz): r=−0.31, p<0.04; HF component (high frequency, 0.15–0.5Hz): r=−0.45, p<0.003) and the same applied to rate-controlled breathing PB (TP, [ms2]: r=−0.56, p<0.0001; LF: r=−0.38, p<0.018; HF: r=−0.52, p<0.001). Moderate correlation was also found between ETS and HRV assessment using a complex indicator – “functional age of ANS” (r=0.37, p<0.015), ETS and cumLFHF [ms2, lnms2]: r=−0.46, p<0.002). In most patients, significant difference between functional age of ANS and calendar age was confirmed (mean 21.8±12.9 y, median 23.5 years, p<0.0001). An attempt to assess the severity CAN using age-stratified medians and percentiles of TP, LF, HF, and LF/HF was not successful.As for SAHRV and clinical indices (anthropometric, echocardiographic, QTc, laboratory), moderate correlation between the glycated hemoglobin on one side and basic SAHRV indices (TP, LF, HF, LF/HF), functional age of ANS and cumLFHF on the other side was prominent (r=0.36–0.53, p<0.0004 to p<0.02). ConclusionAssessment of CAN using evaluation of HRV can optimally be performed (and simply realized in clinical practice) using SAHRV based on short ECG recordings during autonomic load imposed by orthoclinostatic test (Supine1–Standing–Supine2) and on postprocessing data analysis using complex indicator called “functional age of ANS”. In the detailed evaluation of sympathovagal balance, it complements the screening assessment with cardiovascular reflex tests (Ewing's battery). Besides the orthoclinostatic load, pronounced vagal provocation using rate-controlled, non-deepened breathing (12cycles/min) represents a recommended facultative load option increasing the yield of the SAHRV method.The detection and assessment of CAN severity while applying the cumulative indicator of HRV (cumLFHF) showed a good discrimination power in the frontline screening for CAN, albeit without the possibility to distinguish between the sympathetic and vagal branch of ANS.Presented cross-sectional study in type 2 diabetes mellitus demonstrated a significant autonomic dysfunction in majority patients examined, independently of diabetes duration. It supports the recommendation to assess the ANS integrity in type 2 diabetes already at diagnosis, within the initial staging of the illness. The severity of CAN correlates well with metabolic control of diabetes as evaluated by glycated hemoglobin.

INNOVATIONS IN THE DIAGNOSIS OF CARDIAC AUTONOMIC NEUROPATHY IN PATIENTS WITH DIABETES MELLITUS TYPE 2

Diabetic neuropathy is a multifaceted problem and requires joint efforts of endocrinologists to early diagnose the recognition and treatment of this complication. Diabetic autonomic cardiac neuropathy is one of the manifestations of nerve fiber damage in diabetes mellitus. Cardiac neuropathy is one of the variants of heart failure in conditions of hyperglycemia. The proposed article discusses new methods for diagnosis cardiac autonomic neuropathy in patients with type 2 diabetes mellitus.

Cardiac Autonomic Neuropathy in Patients with Type 2 Diabetes Mellitus at High Risk for Foot Ulcers.

Aim:To study the prevalence of cardiac autonomic neuropathy (CAN) in patients with Type 2 diabetes mellitus at high risk for foot ulcers.Materials and Methods:We screened patients attending diabetic clinic for identifying patients at high risk for foot ulcers. Those with foot risk category 1, 2 and 3 as per criteria of Foot Care Interest Group were subjected to battery of cardiovascular autonomic reflex tests. Those with one abnormal test were termed as probable CAN and those with two abnormal tests as definite CAN. Those with postural fall in blood pressure with one other abnormal test were termed to have advanced CAN.Results:A total of 74 patients were recruited in the study. The prevalence of abnormal cardiovascular autonomic reflex test was sustained hand grip 81%, E/I ratio 66.2%, 30:15 ratio 28.3% and orthostatic hypotension 13.5%. The prevalence of possible CAN was 31.0% (23/74) and definite CAN was 66.2% (49/74). Ten patients had advanced CAN. There was no observable difference in presence of probable or definite CAN in three risk category for foot ulcers.Conclusion:We found a high prevalence of CAN in subgroup of diabetic patients at increased risk for foot ulcer.

Risk factors of diabetic cardiac autonomic neuropathy in patients with type 1 diabetes mellitus: a meta-analysis.

ObjectivesWe aimed to stratify the possible risk factors for diabetic cardiac autonomic neuropathy (CAN).MethodsWe did a meta-analysis of risk factors of CAN. We did a web-based search for literature in MEDLINE/PubMed, Scopus database and CENTRAL database up to August 2015. We included clinical trials or cohort studies that provide data about relationship between CAN and variables of interest. Our risk factors of interest were age, sex, duration of diabetes, body mass index (BMI), systolic blood pressure (sBP) and diastolic blood pressure (dBP), glycated haemoglobin (HbA1c), high-density lipoprotein and low-density lipoprotein (HDL and LDL), triglycerides, retinopathy and nephropathy. We generated Forest plots, χ2 test and I2 as tests for heterogeneity, risk ratio (RR), mean difference (MD), CIs and p values by ReVMan V.5.3 software.ResultsWe found a total of 882 related items. We excluded 873 studies from the title and abstract and 4 studies after review of full reports. Four studies were included. Our meta-analysis showed significant association between CAN and age (MD=4.94 (3.46 to 6.42)), duration of diabetes (MD=4.51 (2.51 to 6.52)), HbA1c (MD=0.48 (0.28 to 0.67)), BMI (MD=0.55 (0.08 to 1.01)), serum triglycerides (MD=0.09 (0.01 to 0.17)), proliferative retinopathy (RR=3.69 (1.20 to 11.34)), microalbuminuria (RR=2.47 (1.43 to 4.29)), hypertension (RR=4.18 (2.52 to 6.91)) and sBP (MD=4.10 (2.20 to 6.00)). We neither discovered the absence of significant association between the development of CAN and male sex (RR=1.57 (0.45 to 5.39)), dBP (MD=0.89 (−0.36 to 2.14)), cholesterol level (MD=1.19 (−0.99 to 3.36)), LDL (MD=0.12 (−0.15 to 0.39)), nor HDL level (MD=−0.28 (−0.58 to 0.03)).ConclusionsAge, duration of diabetes, HbA1c, BMI, serum triglycerides, proliferative retinopathy, microalbuminuria, hypertension and sBP are directly related to the risk of development of diabetic CAN.