Международный эндокринологический журнал 2 (74) 2016
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Comparative Analyses of the Cardiac Autonomic Neuropathy in Patients with Diabetes Mellitus Type 1 and 2
Авторы: Shuper V.A., Shuper S.V. - Higher State Educational Establishment of Ukraine «Bukovinian State Medical University», Chernivtsi, Ukraine
Рубрики: Эндокринология
Разделы: Медицинские форумы
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The article was published on p. 183-184
Cardiac autonomic neuropathy (CAN) is a very common diabetes-related complication that has a major effect on mortality and morbidity in patients with diabetes mellitus (DM). Based on the CAN Subcommittee of the Toronto Consensus Panel on Diabetic Neuropathy, CAN is defined as the impairment of cardiovascular autonomic control in patients with established DM following the exclusion of other causes. The prevalence of CAN varies between 1–90 % in patients with type 1 DM (DM 1) and 20–73 % in patients with type 2 DM (DM 2). Careful and timely testing of CAN with easy standard bedside tests in patients with DM 1 and 2 is critically important for early diagnoses and prophylaxes of further cardio-vascular complications.
The aim of the study was to establish and compare the clinical and diagnostic characteristic of CAN among the DM 1 and DM 2 patients.
Material and methods. 75 patients with DM (DM 1 — 30 patients, DM 2 — 45 patients) were examined in the endocrinology department while they had been hospitalized for treatment. All patients were investigated routinely — complains, anamnestic data, objective examination, additional examination (blood test, sugar test, GTT, HbA1, urine test, ECG, other standard tests). For defining of CAN following five classical tests were done (cardiac autonomic reflex testing (CART)): Evaluating of the Resting tachycardia; Heart rate response to deep breathing; Valsalva maneuver; Systolic blood pressure response to standing; Diastolic blood pressure response to sustained handgrip with calculation of the score.
Results. Clinically 20 % of DM 1 and 17.8 % of DM 2 patients had palpitation, resting tachycardia, 10 % of DM 1 and 11.1 % of DM 2 patients felt dyspnea in physical exertions, 10 % of DM 1 and 15 % of DM 2 patients had weakness, dizziness, visual impairment from a lying to a standing posture (orthostatic hypotension). Clinical signs of CVD were defined in all firstly diagnosed DM 2 patients and in half of DM 1 patients. After providing 5 examination tests for diagnosis of CAN we received next results: Resting tachycardia — 20 % DM 1 and 2, Standing tests for orthostatic hypotension — 30 % DM 1 and 33 % DM 2, Valsalva maneuver — 30 % DM 1 and 35.5 % DM 2, Heart rate response to deep breathing — 20 % DM 1 and 17.8 % DM 2, Diastolic blood pressure response to sustained handgrip — 37 % DM 1 and 44.4 % DM 2.
Absence of CAN, according to proposed score, was defined in those patients without clinical features of cardiovascular problems — 43.3 % of patients with DM 1 and 40 % of patients with DM 2. Near half of all patients were diagnosed with early and definite CAN (23.3 % and 23.3 % relatively in patients with DM 1), at that higher prevalence of definite CAN was shown in DM 2 patients (17.8 % — early CAN, 28.9 % — definite CAN). Severe CAN was confirmed more often in DM 2 patients as well (13.3 %).
It was seen, that history of DM 1 and DM 2 more than 10 years strongly correlated with high prevalence of CAN. But in cases of DM 1, 76.5 % of patients suffering from disease longer than 10 years had clinically diagnosed CAN and only 11.8 % of those had the disease shorter than 10 years. Besides, 55.6 % of patients with DM 2, who had CAN, suffered from DM longer than 10 years, and 25.9 % had this disease less than 10 years. All firstly diagnosed DM 2 patients were characterized with CAN presence, while half of the same DM 1 patients had not CAN in period of observation. Nobody of DM 2 patients with duration of the disease longer than 10 years was free of CAN sings.
Conclusions:
1. Near 60 % of investigated patients with diabetes mellitus type 1 and 2 were suffering from cardiovascular autonomic neuropathy, affirming, that CAN becomes a very common diabetic complication. Definite and severe CAN was closer associated with diabetes mellitus type 2 and could be explained by long undiagnosed period of the disease in those patients.
2. Development and progression of CAN is strongly correlated with prolongation of diabetes mellitus. However, presence of diabetes mellitus type 1 longer than 10 years is associated with CAN more often, than in cases of shorter disease. In patients with history of diabetes mellitus type 2 for less than 10 years, CAN was diagnosed more often than in the same category of patients with diabetes mellitus type 1. All newly diagnosed patients with diabetes mellitus type 2 showed presence of CAN.
3. Careful and easy revealing of CAN with usage of proposed standard tests could help in proper diagnosis of diabetic complications for the effective treatment and prevention of the adverse cardiovascular and cerebrovascular events in patients with diabetes mellitus type 1 and 2.