Early autonomic dysfunction in type 1 diabetes: a reversible disorder? (original) (raw)
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Autonomic Neuropathic Changes in Diabetes: Early marker of Impending Complications
IOSR Journals , 2019
Background: Cardiac autonomic neuropathy (CAN) is a critical intricacy of diabetes mellitus. Autonomic neuropathy is postulated to be an indicator of impending demise. It is not very easy to detect the diabetic autonomic neuropathy at an earlier stage. The objective of this study was to weigh up the affiliation between autonomic neuropathy and the heart rate variability (HRV) in Type 2 Diabetics. HRV can indicate early subclinical manifestation of autonomic dysfunction, and this could be of value from clinical perspective to understand the risk associated with the subject and further management. In other words, having HRV insight may influence the aggressiveness of the intervention and the choice of therapy when dealing with hyperglycaemia and the complications and also for identifying potential risks, which are not obvious (e.g., CAN). Methods: The present study was conducted on 50 type 2 Diabetics attending the diabetic clinic and 25 healthy attendants served as controls.The patients were divided into two major groups, i.e. (<5 years of duration, >5 years of duration), Autonomic nervous system activity was evaluated. HRV was measured by Standing to lying ratio (S/L ratio), 30/15 ratio, Valsalva ratio and Deep breathing test (DBT). The results were statistically analysed. Results: Significant changes in parasympathetic activity (30:15 ratio, DBT, S/L ratio) were observed in diabetics as compared to normal which progressed with duration of disease (<5 years vs >5 years, p<0.05). Conclusion: With early detection of autonomic neuropathy, use of aggressive approach in management of Diabetes Mellitus would reduce mortality and morbidity in these patients.
A Comparative Study of Autonomic Function Sensitivity Testing in Type 2 Diabetes
International Journal of Science and Research (IJSR)
Autonomic neuropathy is the most common complication of diabetes. Various studies showed that cardiac autonomic neuropathy (CAN) in diabetes is strongly associated with microvascular complications. Cardiac autonomic neuropathy in Type 2 diabetics is detected by various autonomic function tests. The scope of the present study is to compare the sensitivity of sympathetic and parasympathetic function tests in the early detection of autonomic dysfunction in Type 2 diabetics. The Autonomic function tests which are used to test the parasympathetic activity are deep breathing i.e., E: I ratio, valsalva ratio and Heart rate response to standing. The Sympathetic activity can be tested by using simple tests like blood pressure responses to standing, isometric handgrip test and cold pressure test. All the tests are capable for early detection of cardiovascular autonomic dysfunction. Results in our study showed that both Parasympathetic and sympathetic neuropathy was found in diabetics but para...
European Journal of General Medicine
The aim of this study was to emphasize two different points in our work: 1) The well known importance of (subclinical) postural hypotension and reduced heart rate variability as (early) markers of autonomic neuropathy; 2) and the more controversial influence of diabetic control in their worsening. Methods: Two standard cardiovascular response tests (heart rate variability by respiration and orthostatic blood pressure changes) were carried out on 93 diabetic patients with prolonged QT interval in order to determine cardiac dysautonomy. QT segment duration was measured on electrocardiography recordings. Patients with HbA1c levels below 7 were considered as wellcontrolled diabetics. A cut off of 5 years was selected for the known duration of diabetes. The relations between cardiac autonomic neuropathy and diabetic control and the known duration of diabetes were determined. Results: The mean values for the known duration of diabetes and HbA1c level were 10±7.23 years and 9.5±2.3 mg/dl respectively. Median QTc differences, postural change in the systolic blood pressure, and changes of heart rate by respiration were 0.62 sec, 20 mmHg, and 6 beat/min, respectively. There was no difference in QTc values with respect to diabetes control but QTc values were significantly different with regard to the known duration of diabetes. Blood pressure variations with standing were significantly related to control as well as the known duration of diabetes. Variability of hearth rate with respiration on the other hand was significantly related to the duration but not to the control of diabetes. QTc showed a significant correlation with the known duration of diabetes, postural blood pressure changes, and heart rate variability with respiration. Conclusion: Clinician's should be more alert for the signs of autonomic neuropathy, especially in patients with a history of diabetes for more than five years. Special attention should be given to postural blood pressure changes and heart rate variability with respiration.
International Journal of Advances in Medicine, 2017
Background: Neuropathy is a common complication of diabetes mellitus and it may affect both the peripheral nerves and autonomic nervous system. It’s prevalence ranges from 1% to 90%. The present study is therefore designed to investigate autonomic nervous system involvement in diabetes mellitus by using simple bedside tests and to study its association with other diabetic angiopathies.Methods: 100 patients of diabetes mellitus were selected in the study. In Autonomic function tests for evaluating parasympathetic damage E: I ratio, 30:75 ratio and Valsalva ratio test was performed. Sympathetic damage was diagnosed by Blood pressure response to standing test and Blood pressure response to sustained handgrip test.Results: Abnormal E:I ratio was noticed in only 24 patients. The 30:15 ratio was found to be abnormal in 38 patients while the Valsalva Ratio was abnormal in 34 patients. Postural hypotension was observed in only 8% patients. The sustained hand grip test was abnormal in 10 pat...
Assessment of autonomic dysfunction between type I and type II diabetes mellitus
ip innovative publication pvt. ltd , 2019
Abstract Introduction: The diabetes is the most common disease in the present world and India is country with highest incidence of Diabetes Mellitus in the world. The autonomic nervous dysfunction due to diabetes is the common complication of the diabetes. In this study autonomic dysfunction in pateints with type I and type 2 DM and its correlation with the duration of diseases is studied. Materials and Methods: The study was conducted on 30 type I diabetic patients and 40 type II diabetic pateints. All the diabetic patients were questioned about the presence of symptoms reported to be related to autonomic neuropathy. The conventional autonomic function tests were performed on all the subjects inclusive of sympathetic and parasympathetic tests. The scoring of positive and negative for autonmomic dysfuntion was done. Results: The duration of disease in type 1 diabetes, was 6 to 15 years and in type 2 diabetes it was 8 to 18 years with mean duration of 8.5 and 14 years respectively. The mean HbA1C in type 1 DM was 6.21±2.09 and it was 7.50±2.45 in type 2 DM. Comparison of autonomic function tests in the form of heart rate and BP response in subjects with type 1 and type 2 showed that there no significant statistical difference between the groups. Conclusion: It can be concluded the presence of autonomic dysfunction in type 1 and type 2 diabetes mellitus might be due to nerve damage. The duration of diabetes is directly related to such autonomic dysfunction. Keywords: Diabetes Mellitus type 1, Diabetes Mellitus type 2, Autonomic Functions Tests.
CARDIOVASCULAR AUTONOMIC NEUROPATHY IN PATIENTS WITH DIABETES MELLITUS
International Journal of Pharma and Bio Sciences, 2010
The cardioautonomic reflexes of 82 diabetic subjects and 40 age and sex matched healthy controls were studied using blood pressure and heart rate variation in response to standing, deep breathing, isometric exercise, cold pressor test and determination of QTc interval. Among the 82 patients, 68 patients were found to have cardiac autonomic neuropathy (CAN). Results showed that diabetics had significantly impaired cardioautonomic reflexes compared to non-diabetics, which increases with the duration of diabetes. Out of 68 patients with CAN, QTc prolongation was observed in 64 patients. In conclusion the autonomic nervous system integrity is appeared to be greatly affected by diabetes mellitus and the degree of impairment was dependent on duration of the disease.
Aim: The aim of this study was to emphasize two different points in our work: 1) The well known importance of (subclinical) postural hypotension and reduced heart rate variability as (early) markers of autonomic neuropathy; 2) and the more controversial influence of diabetic control in their worsening. Methods: Two standard cardiovascular response tests (heart rate variability by respiration and orthostatic blood pressure changes) were carried out on 93 diabetic patients with prolonged QT interval in order to determine cardiac dysautonomy. QT segment duration was measured on electrocardiography recordings. Patients with HbA1c levels below 7 were considered as well- controlled diabetics. A cut off of 5 years was selected for the known duration of diabetes. The relations between cardiac autonomic neuropathy and diabetic control and the known duration of diabetes were determined. Results: The mean values for the known duration of diabetes and HbA1c level were 10±7.23 years and 9.5±2.3 ...