Endocrine Abstracts

Background: Diabetic autonomic neuropathy (DAN) is among the least recognized and understood complication of diabetes despite its significant negative impact on survival and quality of life in people with diabetes. Diabetic neuropathies including cardiac autonomic neuropathy (CAN), are a common chronic complication of type 1 and Type 2 diabetes and confer a high morbidity and mortality to diabetic pateints. The reported prevalence of CAN varies greatly depending on the criteria used to identify CAN and the population studied. CAN is ultimately the result of complex interactions among degree of glycemic control, disease duration and vascular risk factors. CAN encompasses damage to the autonomic nerve fibers that innervate the heart and blood vessels, resulting in abnormalities in heart rate control and vascular dynamics and is associated with a high risk of cardiac arrhythmias, sudden death, (possibly related to silent myocardial ischemia) and large costs to the welfare system. Clinical symptoms of autonomic neuropathy generally do not occur until long after the onset of diabetes. Subclinical autonomic dysfunction, however, can occur within a year of diagnosis in type 2 diabetic patients and within 2 years in type 1 diabetic patients.

Objective: Possibility of the use of non-invasive cardiovascular tests for early detection of subclinical autonomic neuropathy in type 2 diabetic patients.

Study design: This study included 40 type 2 diabetic male patients (from 30 to 70 years old) with new onset or longstanding diabetes.

Results

20 (50%) diabetic patients had one abnormal test and 10 (25%) diabetic patients had two abnormal reflex cardiovascular tests. Cardiovascular tests were affected by age, higher body mass index, glucose control and diabetes duration.

Conclusion: Reflex cardiovascular tests can be used for the early screening of cardiovascular autonomic neuropathy before more sophisticated and specific tests.

Keywords: DAN and reflex cardiovascular tests