Cardiac autonomic neuropathy in diabetes mellitus
DOI:
https://doi.org/10.18203/2320-6012.ijrms20175501Keywords:
Autonomic function tests, Cardiac autonomic neuropathy, Diabetes mellitusAbstract
Background: The present study was conducted with an objective to study the prevalence of cardiac autonomic neuropathy (CAN) in patients with diabetes mellitus (DM) and its relation to duration, severity of DM, patient's age and BMI.
Methods: This hospital based prospective study was conducted from August 2015 to September 2017, at M.K.C.G. Medical College Hospital, Berhampur, Odisha, India. Cross sectional study was design. A total number of 100 diagnosed patients of diabetes mellitus who were admitted in hospital or attended on OPD basis were taken for the study. Detailed history, clinical evaluation, laboratory investigations were carried out. The diagnosis of CAN was made by autonomic function tests. The CAN score of each patient was analysed. Database were generated based on age, duration of diabetes, severity of DM and BMI.
Results: Out of 100 diabetic patients, 40 patients (23 males and 17 females) were selected for final analysis after excluding conditions causing cardiac autonomic neuropathy other than diabetes mellitus. All the patients were in the age group 21 to 70years. In the present study it was found that 57.5% of patients with DM had CAN and its incidence increased with severity of hyperglycemia, duration of DM, BMI and age of the patient.
Conclusions: Cardiac autonomic neuropathy is a common and early complication of DM. Proper history taking to identify the symptoms related to CAN and performing simple autonomic tests in all patients of DM can identify cardiac autonomic neuropathy.
References
Töyry JP, Niskanen LK, Mäntysaari MJ, Länsimies EA, Uusitupa MI. Occurrence, predictors, and clinical significance of autonomic neuropathy in NIDDM: ten-year follow-up from the diagnosis. Diabetes. 1996;45(3):308-15.
Sampson MJ, Chambers JB, Sprigings DC, Drury PL. Abnormal diastolic function in patients with type 1 diabetes and early nephropathy. Heart. 1990;64(4):266-71.
O'Brien IA, McFadden JP, Corrall RJ. The influence of autonomic neuropathy on mortality in insulin- dependent diabetes. Q J Med. 1991;71:495-502.
Orchard TJ, Lloyd CE, Maser RE, Kuller LH. Why does diabetic autonomic neuropathy predict IDDM mortality? An analysis from the Pittsburgh Epidemiology of Diabetes Complications Study. Dia Res Clinic Pr. 1996;34:S165-71.
Kreiner G, Wolzt M, Fasching P, Leitha T, Edlmayer A, Korn A, et al. Myocardial m-[123I] iodobenzylguanidine scintigraphy for the assessment of adrenergic cardiac innervation in patients with IDDM:comparison with cardiovascular reflex tests and relationship to left ventricular function. Diabetes. 1995;44(5):543-9.
Hume L, Oakley GP, Boulton AJ, Hardisty C, Ward JD. Asymptomatic myocardial ischemia in diabetes and its relationship to diabetic neuropathy: an exercise electrocardiography study in middle-aged diabetic men. Diab Care. 1986;9(4):384-8.
O'Brien IA, McFadden JP, Corrall RJ. The influence of autonomic neuropathy on mortality in insulin- dependent diabetes.Q J Med. 1991;71:495-502.
Marchant B, Umachandran V, Stevenson R, Kopelman PG, Timmis AD. Silent myocardial ischemia: role of subclinical neuropathy in patients with and without diabetes. J Amer Coll Cardiol. 1993;22(5):1433-7.
Faerman I, Faccio E, Milei J, Nunez R, Jadzinsky M, Fox D, et al. Autonomic neuropathy and painless myocardial infarction in diabetic patients: histologic evidence of their relationship. Diab. 1977;26(12):1147-58.
Ambepityia G, Kopelman PG, Ingram D, Swash M, Mills PG, Timmis AD. Exertional myocardial ischemia in diabetes: A quantitative analysis of anginal perceptual threshold and the influnce of autonomic function. J Ame Coll Cardiol. 1990;15(1):72-7.
Burgos LG, Ebert TJ, Asiddao C, Turner LA, Pattison CZ, Wang-Cheng R, et al. Increased intraoperative cardiovascular morbidity in diabetics with autonomic neuropathy. Anesthesiol. 1989;70(4):591-7.
Bradley RF, Scronfeld A. Diminished pain in diabetic patients with myocardial infarction-silent and asymptomatic. Eighteen year follow up:the Frammingham Study. Am J Cardiol. 1973;32:1-7.
Soler NG, Bennett MA, Pentecost BL, Fitzgerald MG, Malins JM. Myocardial infarction in diabetics. QJM: Inter J Medic. 1975;44(1):125-32.
Zarich S, Waxman S, Freeman RT, Mittleman M, Hegarty P, Nesto RW. Effect of autonomic nervous system dysfunction on the circadian pattern of myocardial ischemia in diabetes mellitus. J Ame Coll Cardiol. 1994;24(4):956-62.
Muller JE, Tofler GH, Stone PH. Circadian variation and triggers of onset of acute cardiovascular disease. Circulation. 1989;79:733-43.
Bernardi L, Ricordi L, Lazzari P, Solda P, Calciati A, Ferrari MR, et al. Impaired circadian modulation of sympathovagal activity in diabetes. A possible explanation for altered temporal onset of cardiovascular disease. Circ. 1992;86(5):1443-52.
Di Carli MF, Tobes MC, Mangner T, Levine AB, Muzik O, Chakroborty P, Levine TB. Effects of cardiac sympathetic innervation on coronary blood flow. N Eng J Medic. 1997;336(17):1208-16.
Di Carli MF, Bianco-Batlles D, Landa ME, Kazmers A, Groehn H, Muzik O, et al. Effects of autonomic neuropathy on coronary blood flow in patients with diabetes mellitus. Circulation. 1999;100(8):813-9.
Curb JD, Rodriguez BL, Burchfiel CM, Abbott RD, Chiu D, Yano K. Sudden death, impaired glucose tolerance, and diabetes in Japanese American men. Circulation. 1995;91(10):2591-5.
Kahn JK, Sisson JC, Vinik AI. QT interval prolongation and sudden cardiac death in diabetic autonomic neuropathy. J Clin Endocrinol Metab. 1987;64:751-4.
Ziegler D, Dannehl K, Mühlen H, Spüler M, Gries FA. Prevalence of cardiovascular autonomic dysfunction assessed by spectral analysis and standard tests of heart-rate variation in newly diagnosed IDDM patients. Di Care. 1992;15(7):908-11.
Ewing DJ, Neilson JM, Shapiro CM, Stewart JA, Reid W. Twenty-four-hour heart rate variability: effects of posture, sleep, and time of day in healthy controls and comparison with bedside tests of autonomic function in diabetic patients. Heart. 1991;65(5):239-44.
Ewing DJ, Campbell IW, Clark BF. Assessment of cardiovascular effects in diabetic autonomic neuropathy and prognostic implications. Ann Intern Med. 1980;92;308-11
Mehta S, Mathur D, Chaturvedi M, Verma K. Incidence of cardiac autonomic neuropathy and its correlation with retinopathy, microalbuminuria and glycated haemoglobin in non-insulin dependent diabetes mellitus. JIMA. 2002;100(3):1-2.
