A call for cardiologists and diabetologists to embrace neurological investigation for diabetic neuropathy in cardiovascular risk stratification

Dragan Tesic; Dragica Andric; Milena Mitrovic; Bojan Vukovic; Mirjana Tomic

doi:10.1530/endoabs.70.AEP1028

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Endocrine Abstracts (2020) 70 AEP1028 | DOI: 10.1530/endoabs.70.AEP1028

ECE2020 Audio ePoster Presentations Hot topics (including COVID-19) (110 abstracts)

A call for cardiologists and diabetologists to embrace neurological investigation for diabetic neuropathy in cardiovascular risk stratification

Dragan Tesic ¹ , Dragica Andric ² , Milena Mitrovic ³ , Bojan Vukovic ⁴ & Mirjana Tomic ⁵

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Author affiliations

¹Institut for Internal Diseases, Clinic of Endocrinology, Diabetes and Metabolic Disorders, Novi Sad, Serbia; ²Institut for Cardiovascular Diseases, Clinic of Cardiology, Sremska Kamenica, Serbia; ³Institut for Internal Diseases, Clinic of Endocrionology, Diabetes and Metabolic Disorders, Novi Sad, Serbia; ⁴Institut for Internal Diseases, Clinic of Endocrinology, Novi Sad, Serbia; ⁵Institut for Internal Diseases, Clinic of Hematology, Novi Sad, Serbia

Background: In the 2019 ESC Guidelines on diabetes, pre-diabetes and cardiovascular diseases, only retinopathy appears as a target organ damage as a parameter for stratification patients into very high-risk group. The aim of study was to check the strength of association between DN and isolated DR groups with cardiovascular complications.

Methods: Chronic kidney disease (CKD) was defined by eGFR ≤ 59 ml/min/1.73 m² and proteinuria (PrU) was determined (mg/24 h). Neuropathy was diagnosed by neuropathy disability score and sudomotor function using Neuropad. Presence of coronary artery disease (CAD) and cervico-cerebral ischaemic aterial disease (CCAD) was documented. Lower-extremity artery disease (LEAD) was diagnosed with ankle-brachial index (ABI) and continuous wave Doppler.

Results: Of 262 people, 49.6% were male and 71% had T2DM; 130 had DN [90 (69.2%) with retinopathy], 75 had DR without neuropathy, 57 had no evidence of retinopathy, CKD and DN (controls). All (n = 48) CKD patients were with DR and/or DN: 15 (31.3%) with DR, 10 (20.8%) with DN, 23 (47.9%) with both DN and DR. Patients with DN compared with controls after multivariable logistic regression analysis (MVLR) significant remained model: age (OR 1.16 [95% CI : 1.07–1.25]; P < 0.01), duration of diabetes (1.12 [1.05–1.19]; P < 0.01), PrU (1.003 [1.00–1.005]; P = 0.06), NeuroPad time 1.11 [1.00–1.22]; P = 0.04). Compared with controls, those with DR were more frequently women (62.7% vs 42.1%; P = 0.01) and older (54.8 ± 14.6 vs 45 ± 12.8 years; P < 0.01), had high blood pressure (49.3% vs 26.3%; P < 0.01), T2DM (69.3% vs 43.9%; P < 0.01), had longer duration of diabetes (17.1 ± 7.7 vs 10.2 ± 7.4 y.; P < 0.01).After MVLR only duration of diabetes (OR 1.12 [1.05–1.19]; P < 0.01) persisted. DN group was significantly more associated with macrovascular complications (CCAD, CAD, LEAD) [n = 56 (43.1%)] vs DR group n = 16 (21.3%) and control group n = 9 (15.5%); P < 0.01. CAD (n = 43) in univariate analysis showed association with DN (OR 2.4 [1.2–4.8]; P = 0.01), and in MVLR anaylsis with LEAD (OR 3.4 [1.6–7.1]; P ≤ 0.01).

Conclusion: In the algorithm for cardiovascular risk stratificationwe would recommend examination of diabetic neuropathy and LEAD as the first line approach. As earlier these complications would be detected the indication for more comprehensive management of diabetic patients would be established.