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Risk stratification and screening for coronary artery disease in asymptomatic patients with diabetes mellitus: Position paper of the French Society of Cardiology and the French-speaking Society of Diabetology. Arch Cardiovasc Dis 2020; 114:150-172. [PMID: 33309203 DOI: 10.1016/j.acvd.2020.07.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Revised: 07/07/2020] [Accepted: 07/09/2020] [Indexed: 01/09/2023]
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202
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Leptin mediate central obesity on the severity of cardiovascular autonomic neuropathy in well-controlled type 2 diabetes and prediabetes. J Transl Med 2020; 18:396. [PMID: 33076921 PMCID: PMC7574496 DOI: 10.1186/s12967-020-02559-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Accepted: 10/03/2020] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Evidences support the view that central obesity is an independently cardiovascular risk. It is thought that leptin contributes to autonomic dysfunction and cardiovascular risks in type 1 and type 2 diabetes mellitus (T1DM and T2DM). This raises the possibility that leptin might mediate the relationship between central obesity and the severity of cardiovascular autonomic neuropathy (CAN) in patients with well-controlled T2DM and prediabetes. METHODS The complete cardiovascular reflex tests and biomarkers were assessed for each patient. The severity of CAN was assessed using composite autonomic scoring scale (CASS). A single-level three-variable mediation model was used to investigate the possible relationships among central obesity [as indicated by waist circumference (WC)], leptin level, and severity of CAN (as indicated by CASS value). RESULTS A total of 107 patients were included in this study: 90 with diabetes and 17 with prediabetes. The results demonstrate that increased WC is associated with increased severity of CAN (r = 0.242, P = 0.017). We further discovered that leptin level is positively correlated with WC (r = 0.504, P < 0.0001) and the CASS value (r = 0.36, P < 0.0001). Further mediation analysis shows that leptin level serves as mediators between higher WC and higher CASS. CONCLUSIONS Our results highlighted the relationship among leptin, central obesity, and severity of CAN. As the leptin level serves as mediator between central obesity and severity of CAN, a longitudinal study is needed to confirm that control of WC can decrease leptin levels and can be effective in reducing CAN progression.
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203
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Agochukwu-Mmonu N, Pop-Busui R, Wessells H, Sarma AV. Autonomic neuropathy and urologic complications in diabetes. Auton Neurosci 2020; 229:102736. [PMID: 33197694 DOI: 10.1016/j.autneu.2020.102736] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Revised: 05/21/2020] [Accepted: 10/05/2020] [Indexed: 12/31/2022]
Abstract
Diabetic autonomic neuropathy affects the entire autonomic nervous system and can lead to dysfunction of the cardiovascular, gastrointestinal, and genitourinary organ systems. Genitourinary dysfunction associated with diabetic autonomic neuropathy includes diabetic bladder dysfunction, sexual dysfunction, and recurrent urinary tract infections. Urological complications in diabetes mellitus are very common; in fact, genitourinary complications are more common than diabetic neuropathy or nephropathy. While several studies have reported on genitourinary dysfunction in individuals with diabetes, UroEDIC, an ancillary study to the Diabetes Control and Complications Trial (DCCT) and its observational follow up, the Epidemiology of Diabetes Interventions and Complications study (EDIC), comprehensively characterized the association between urologic complications and cardiovascular autonomic neuropathy. UroEDIC demonstrated significant associations between autonomic neuropathy and urologic complications in type 1 diabetes, specifically erectile dysfunction, female sexual dysfunction, and lower urinary tract symptoms. In this narrative review, we review the current literature on urological complications in diabetes.
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Affiliation(s)
| | - Rodica Pop-Busui
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI, United States of America
| | - Hunter Wessells
- Department of Urology, University of Washington School of Medicine, Seattle, WA, United States of America
| | - Aruna V Sarma
- Department of Urology, University of Michigan, Ann Arbor, MI, United States of America
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204
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Qu Y, Liu J, Guo ZN, Zhang PD, Yan XL, Zhang P, Qi S, Yang Y. The Impact of Remote Ischaemic Conditioning on Beat-to-Beat Heart Rate Variability Circadian Rhythm in Healthy Adults. Heart Lung Circ 2020; 30:531-539. [PMID: 33032892 DOI: 10.1016/j.hlc.2020.08.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Revised: 07/28/2020] [Accepted: 08/31/2020] [Indexed: 11/24/2022]
Abstract
BACKGROUND Remote ischaemic conditioning (RIC) is an intervention that may exert a protective effect over multiple tissues or organs by regulating neuronal signal transduction. Heart rate variability (HRV) can assess the state of the autonomic nervous system. However, whether RIC can also regulate HRV in humans remains unknown. METHOD This was a self-controlled interventional study in which serial beat-to-beat monitoring was performed at the same seven time points (7, 9, and 11 AM; 2, 5, and 8 PM; and 8 AM on the next day) with or without RIC in 50 healthy adults. The seven time points on the RIC day were defined as baseline, 1 hour, 3 hours, 6 hours, 9 hours, 12 hours, and 24 hours after RIC. The RIC protocol consisted of 4×5-minute inflation/deflation in one arm and one thigh cuff at 200 mmHg pressure from 7:20 to 8 AM. This study is registered on ClinicalTrials.gov (NCT02965547). RESULTS We included 50 healthy adult volunteers (aged 34.54±12.01 years, 22 men [44%], all Asian). The variables analysed in frequency-domain measures performed as power of low-frequency in normalised units (0.04-0.15 Hz), high-frequency in normalised units (0.15-0.40 Hz), and ratio of low frequency to high frequency. The time-domain parameters standard deviation (SD) of all normal to normal (NN) intervals (SDNN), mean of the 5-minute SD of the NN intervals, SD of the consecutive 5-minute averages of NN intervals, and the root mean square of successive differences of NN intervals, and time-domain parameters calculated from Poincaré plots, SD of the short diagonal axis in Poincaré plot (SD1), SD of the long diagonal axis in Poincaré plot (SD2), and SD1/SD2 were also obtained. The SDNN and SD2 significantly increased 1 hour after RIC (p=0.029 and p=0.045, respectively). Additionally, the SD2 increased a second time 12 hours after RIC (p=0.041), which represented inhibited sympathetic activity. CONCLUSIONS Heart rate variability increase and sympathetic inhibition induced by RIC appeared both on the early and delayed protective window of RIC, which may indicate some of the underlying mechanisms by which RIC may offer protection.
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Affiliation(s)
- Yang Qu
- Stroke Center, Department of Neurology, the First Hospital of Jilin University, Chang Chun, Jilin, China
| | - Jia Liu
- Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China
| | - Zhen-Ni Guo
- Clinical Trial and Research Center for Stroke, Department of Neurology, the First Hospital of Jilin University, Chang Chun, Jilin, China
| | - Pan-Deng Zhang
- Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China
| | - Xiu-Li Yan
- Stroke Center, Department of Neurology, the First Hospital of Jilin University, Chang Chun, Jilin, China
| | - Peng Zhang
- Clinical Trial and Research Center for Stroke, Department of Neurology, the First Hospital of Jilin University, Chang Chun, Jilin, China
| | - Shuang Qi
- Stroke Center, Department of Neurology, the First Hospital of Jilin University, Chang Chun, Jilin, China
| | - Yi Yang
- Stroke Center, Department of Neurology, the First Hospital of Jilin University, Chang Chun, Jilin, China; Clinical Trial and Research Center for Stroke, Department of Neurology, the First Hospital of Jilin University, Chang Chun, Jilin, China.
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205
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Malik V, Mishima R, D Elliott A, H Lau D, Sanders P. The "Road" to Atrial Fibrillation: The Role of the Cardiac Autonomic Nervous System. J Atr Fibrillation 2020; 13:2400. [PMID: 33024501 DOI: 10.4022/jafib.2400] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Revised: 02/16/2020] [Accepted: 03/18/2020] [Indexed: 01/04/2023]
Abstract
At the population level, there is a parallel escalation in the healthcare burden of both, atrial fibrillation (AF) as well its risk factors. Compounding this relationship, AF is associated with escalating burden at an individual level, due its self-perpetuating and progressive nature. The mechanisms by which these risk factors interact to produce atrial remodelling and subsequent AF are unclear. This intersection is critical to the development of strategies to combat this disease at both the individual and population-level. It is well known that AF can manifest from disturbances in autonomic activity. At the population level, there is growing data to suggest a role of the autonomic nervous system in the future incidence of AF. Here, we provide an overview of the association of cardiac autonomic dysfunction with the incidence of AF, review the role of the autonomic nervous system (ANS) as an intermediary between risk factors and the development of AF and finally, we discuss the bidirectional relationship between AF and cardiac autonomic nervous system dysfunction; to determine whether this is implicated in the progression of AF.
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Affiliation(s)
- Varun Malik
- Centre for Heart Rhythm Disorders, University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia
| | - Ricardo Mishima
- Centre for Heart Rhythm Disorders, University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia
| | - Adrian D Elliott
- Centre for Heart Rhythm Disorders, University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia
| | - Dennis H Lau
- Centre for Heart Rhythm Disorders, University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia
| | - Prashanthan Sanders
- Centre for Heart Rhythm Disorders, University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia
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206
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Shah AS, Jaiswal M, Dabelea D, Divers J, Isom S, Liese AD, Lawrence JM, Kim G, Urbina EM. Cardiovascular risk and heart rate variability in young adults with type 2 diabetes and arterial stiffness: The SEARCH for Diabetes in Youth Study. J Diabetes Complications 2020; 34:107676. [PMID: 32713707 PMCID: PMC7502460 DOI: 10.1016/j.jdiacomp.2020.107676] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2020] [Revised: 07/06/2020] [Accepted: 07/09/2020] [Indexed: 02/07/2023]
Abstract
AIMS To evaluate cardiovascular risk factors and heart rate variability (HRV) in young adults with type 2 diabetes and arterial stiffness and to explore the relationship between HRV and arterial stiffness. METHODS We studied 185 young adults with youth-onset T2D enrolled in the SEARCH for Diabetes in Youth Study. Cardiovascular risk factors and HRV were compared between individuals with and without type 2 diabetes and arterial stiffness (defined as a pulse wave velocity greater than the 90th percentile of healthy controls, >6.767 m/s). Semiparametric regression evaluated the independent relationship between HRV and PWV. RESULTS Participants with T2D and arterial stiffness were more likely to be older, non-Hispanic Black, have higher systolic and diastolic blood pressure, greater adiposity and obesity-related dyslipidemia (higher triglycerides and lower HDLC). Participants with T2D and arterial stiffness also had lower overall HRV (lower SDNN) with parasympathetic loss (lower RMSSD and PNN50), p < 0.05. Lower HRV tended to be but was not significantly associated with arterial stiffness after adjustment for age, race/ethnicity, sex and cardiovascular risk factors (beta coefficient = -1.11, p = 0.08). CONCLUSIONS Youth with T2D and arterial stiffness have a worse cardiovascular risk profile, specifically risk factors related to the metabolic syndrome and lower HRV.
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Affiliation(s)
- Amy Sanghavi Shah
- Cincinnati Children's Hospital Medical Center and the University of Cincinnati, United States of America.
| | - Mamta Jaiswal
- Department of Neurology, University of Michigan, Ann Arbor, MI, United States of America
| | - Dana Dabelea
- Department of Epidemiology, Colorado School of Public Health, University of Colorado Denver, Aurora, CO, United States of America
| | - Jasmin Divers
- Division of Health Services Research, NYU Long Island School of Medicine, Mineola, NY, United States of America
| | - Scott Isom
- Department of Biostatistics and Data Science, Wake Forest School of Medicine, Winston-Salem, NC, United States of America
| | - Angela D Liese
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC, United States of America
| | - Jean M Lawrence
- Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, CA, United States of America
| | - Grace Kim
- Seattle Children's Hospital, Seattle, WA, United States of America
| | - Elaine M Urbina
- Cincinnati Children's Hospital Medical Center and the University of Cincinnati, United States of America
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207
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Eads JR, Reidy-Lagunes D, Soares HP, Chan JA, Anthony LB, Halfdanarson TR, Naraev BG, Wolin EM, Halperin DM, Li D, Pommier RF, Zacks JS, Morse MA, Metz DC. Differential Diagnosis of Diarrhea in Patients With Neuroendocrine Tumors. Pancreas 2020; 49:1123-1130. [PMID: 32991344 DOI: 10.1097/mpa.0000000000001658] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Patients with neuroendocrine tumors (NETs) and carcinoid syndrome experience diarrhea that can have a debilitating effect on quality of life. Diarrhea also may develop in response to other hormonal syndromes associated with NETs, surgical complications, medical comorbidities, medications, or food sensitivities. Limited guidance on the practical approach to the differential diagnosis of diarrhea in these patients can lead to delays in appropriate treatment. This clinical review and commentary underscore the complexity in identifying the etiology of diarrhea in patients with NETs. Based on our collective experience and expertise, we offer a practical algorithm to guide medical oncologists and other care providers to expedite effective management of diarrhea and related symptoms in patients with NETs.
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Affiliation(s)
- Jennifer R Eads
- From the Department of Medicine, Division of Hematology and Oncology, Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA
| | - Diane Reidy-Lagunes
- Department of Medicine, Division of Solid Tumor, Gastrointestinal Malignancies, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Heloisa P Soares
- Division of Medical Oncology, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT
| | - Jennifer A Chan
- Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA
| | - Lowell B Anthony
- Division of Medical Oncology, University of Kentucky Medical Center, Markey Cancer Center, Lexington, KY
| | | | - Boris G Naraev
- Division of Cancer Medicine, Banner MD Anderson Cancer Center, The University of Texas MD Anderson Cancer Center, Gilbert, AZ
| | - Edward M Wolin
- Department of Medicine, Division of Hematology/Oncology, Icahn School of Medicine, Center for Carcinoid and Neuroendocrine Tumors, Tisch Cancer Institute, Mount Sinai School of Medicine, New York, NY
| | - Daniel M Halperin
- Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Daneng Li
- Department of Medical Oncology and Therapeutics Research, City of Hope Comprehensive Cancer Center and Beckman Research Institute, Duarte, CA
| | - Rodney F Pommier
- Division of Surgical Oncology, Oregon Health & Science University, Portland, OR
| | - Jerome S Zacks
- Department of Medicine (Cardiology), The Mount Sinai School of Medicine, The Carcinoid Heart Center, New York, NY
| | - Michael A Morse
- Department of Medical Oncology, Duke University Medical Center, Durham, NC
| | - David C Metz
- Division of Gastroenterology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
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208
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Hansen CS, Lundby-Christiansen L, Tarnow L, Gluud C, Hedetoft C, Thorsteinsson B, Hemmingsen B, Wiinberg N, Sneppen SB, Lund SS, Krarup T, Madsbad S, Almdal T, Carstensen B, Jørgensen ME. Metformin may adversely affect orthostatic blood pressure recovery in patients with type 2 diabetes: substudy from the placebo-controlled Copenhagen Insulin and Metformin Therapy (CIMT) trial. Cardiovasc Diabetol 2020; 19:150. [PMID: 32979921 PMCID: PMC7520024 DOI: 10.1186/s12933-020-01131-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Accepted: 09/18/2020] [Indexed: 02/08/2023] Open
Abstract
Background Metformin has been shown to have both neuroprotective and neurodegenerative effects. The aim of this study was to investigate the effect of metformin in combination with insulin on cardiovascular autonomic neuropathy (CAN) and distal peripheral neuropathy (DPN) in individuals with type 2 diabetes (T2DM). Methods The study is a sub-study of the CIMT trial, a randomized placebo-controlled trial with a 2 × 3 factorial design, where 412 patients with T2DM were randomized to 18 months of metformin or placebo in addition to open-labelled insulin. Outcomes were measures of CAN: Changes in heart rate response to deep breathing (beat-to-beat), orthostatic blood pressure (OBP) and heart rate and vibration detection threshold (VDT) as a marker DPN. Serum levels of vitamin B12 and methyl malonic acid (MMA) were analysed. Results After 18 months early drop in OBP (30 s after standing) was increased in the metformin group compared to placebo: systolic blood pressure drop increased by 3.4 mmHg (95% CI 0.6; 6.2, p = 0.02) and diastolic blood pressure drop increased by 1.3 mmHg (95% CI 0.3; 2.6, p = 0.045) compared to placebo. Beat-to-beat variation decreased in the metformin group by 1.1 beats per minute (95% CI − 2.4; 0.2, p = 0.10). Metformin treatment did not affect VDT group difference − 0.33 V (95% CI − 1.99; 1.33, p = 0.39) or other outcomes. Changes in B12, MMA and HbA1c did not confound the associations. Conclusions Eighteen months of metformin treatment in combination with insulin compared with insulin alone increased early drop in OBP indicating an adverse effect of metformin on CAN independent of vitamin B12, MMA HbA1c. Trial registration The protocol was approved by the Regional Committee on Biomedical Research Ethics (H–D-2007-112), the Danish Medicines Agency and registered with ClinicalTrials.gov (NCT00657943).
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Affiliation(s)
| | - Louise Lundby-Christiansen
- Steno Diabetes Center Copenhagen, A/S, Niels Steensens Vej 2-4, 2820, Gentofte, Denmark.,Dept of Paediatrics, Nordsjaellands Hospital, Copenhagen University, Copenhagen, Denmark
| | - Lise Tarnow
- Department of Clinical Research, Nordsjaellands Hospital, Hillerød, Denmark.,Health, Aarhus University, Aarhus, Denmark
| | - Christian Gluud
- Copenhagen Trial Unit, Centre for Clinical Intervention Research, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | | | - Birger Thorsteinsson
- Department of Cardiology, Nephrology and Endocrinology, Nordsjællands University Hospital - Hillerød, Hillerød, Denmark
| | - Bianca Hemmingsen
- Department of Cardiology, Nephrology and Endocrinology, Nordsjællands University Hospital - Hillerød, Hillerød, Denmark
| | - Niels Wiinberg
- Department of Clinical Physiology, Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Simone B Sneppen
- Department of Medicine, Gentofte, Copenhagen University Hospital, Hellerup, Denmark
| | - Søren S Lund
- Steno Diabetes Center Copenhagen, A/S, Niels Steensens Vej 2-4, 2820, Gentofte, Denmark
| | - Thure Krarup
- Department of Endocrinology, Bispebjerg, Copenhagen University Hospital, Copenhagen, Denmark
| | - Sten Madsbad
- Department of Endocrinology, Hvidovre Hospital, University of Copenhagen, Hvidovre, Denmark
| | - Thomas Almdal
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.,Dept. of Endocrinology PE, Copenhagen University Hospital, Rigshospitalet, Denmark
| | - Bendix Carstensen
- Steno Diabetes Center Copenhagen, A/S, Niels Steensens Vej 2-4, 2820, Gentofte, Denmark
| | - Marit E Jørgensen
- Steno Diabetes Center Copenhagen, A/S, Niels Steensens Vej 2-4, 2820, Gentofte, Denmark.,National Institute of Public Health, Southern Denmark University, Odense, Denmark
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209
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Chen J, Cai J, Wei M, Zhang X, Zhong M, Liu M, Yu Y, Chen Q. Effects of Guizhi decoction for diabetic cardiac autonomic neuropathy: A protocol for a systematic review and meta-analysis. Medicine (Baltimore) 2020; 99:e22317. [PMID: 32991439 PMCID: PMC7523786 DOI: 10.1097/md.0000000000022317] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Accepted: 08/20/2020] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Diabetic cardiac autonomic neuropathy (DCAN) is one of the serious complications of diabetes. The pathogenesis of DCAN has not been fully elucidated. There is currently no effective treatment for such chronic disease. Traditional Chinese medicine has a long clinical history for the prevention and treatment of diabetes and chronic complications, and it also shows certain advantages in the treatment of DCAN. Many clinical studies have confirmed that Chinese medicine Guizhi decoction can reduce the clinical symptoms and improve neuronal function of patients with DCAN. So we intend to conduct a systematic review further clarified the effectiveness and safety of Guizhi decoction for DCAN. METHODS We will search each database from the built-in until July 2020. The English literature mainly searches Cochrane Library, PubMed, EMBASE, and Web of Science, while the Chinese literature comes from CNKI, CBM, VIP, and Wangfang database. Simultaneously we will retrieval clinical registration tests and grey literatures. In this study, only the clinical randomized controlled trials (RCTs) were selected to evaluate the efficacy and safety of Guizhi decoction in the treatment of DCAN. The 2 researchers independently conducted literature selection, data extraction, and quality assessment. Statistical heterogeneity among studies will be evaluated using the Cochran Q test (x) and the I statistical value. We will utilize the Review Manage software V5.3.0 (The Nordic Cochrane Center, The Cochrane Collaboration, 2014, Copenhagen, Denmark) to statistically analyze all data. ETHICS AND DISSEMINATION This study is a protocol for a systematic review of Guizhi decoction as a treatment of DCAN patients. RESULTS This study will provide high-quality synthesis of effectiveness and safety of Guizhi decoction for DCAN. CONCLUSION This systematic review aims to provide new options for Guizhi decoction treatment of DCAN in terms of its efficacy and safety. REGISTRATION NUMBER INPLASY202080018.
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Affiliation(s)
- Junmin Chen
- Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu
| | - Jiawei Cai
- Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu
| | - Mengya Wei
- Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu
| | - Xiaoran Zhang
- Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu
| | - Min Zhong
- Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu
| | - Min Liu
- Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu
| | - Yang Yu
- College of acupuncture and massage, Chengdu University of Traditional Chinese Medicine , No 37 Shi-er-qiao Road, Chengdu, Sichuan Province, PR China
| | - Qiu Chen
- Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu
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210
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Su Z, Cao Q, Zhang H, Sun W, Zhang H, Sheng Y, Yang R, Kong X. Early changes in ambulatory electrocardiography after transcatheter closure in patients with atrial septal defect and factors affecting heart rate variability. BMC Cardiovasc Disord 2020; 20:411. [PMID: 32917130 PMCID: PMC7488228 DOI: 10.1186/s12872-020-01699-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2020] [Accepted: 09/03/2020] [Indexed: 11/10/2022] Open
Abstract
Background Factors affecting heart rate variability (HRV) in patients with atrial septal defect (ASD) have not been clarified. This study sought to identify those factors and establish a preliminary risk model. Methods A total of 154 patients with ASD who underwent transcatheter closure and met the study requirements were analyzed in this study. Moreover, 26 patients with patent foramen ovale (PFO) were enrolled in our study as a control group. All patients underwent echocardiography and ambulatory electrocardiography before and one day after the procedure. Results The standard deviation of all normal-to-normal (NN) intervals (SDNN) and the standard deviation of the averages of the NN intervals in all 5 min segments of the entire recording (SDANN) were significantly higher and the heart rate was lower after closure than before closure in patients with ASD (SDNN: 6.08, 95% CI 3.00 to 9.15, p < 0.001; SDANN: 7.57, 95% CI 4.50 to 10.64, p < 0.001; heart rate: -1.17, 95% CI − 2.86 to − 0.48, p = 0.006). Multiple regression analyses indicated that age, sex, defect diameter, heart rate and diabetes were significantly associated with HRV indices (SDNN: R2 = 0.415; P < 0.001). SDNN and SDANN had obvious correlations with right ventricular systolic pressure (SDNN: R = − 0.370, p < 0.001; SDANN: R = − 0.360, p < 0.001). Conclusions Factors affecting HRV in patients with ASD include age, sex, heart rate, defect size and diabetes. Furthermore, right ventricular systolic pressure plays an important role in the change in HRV.
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Affiliation(s)
- Zhenyang Su
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, No. 300, Guangzhou Road, Nanjing, 210029, China
| | - Qing Cao
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, No. 300, Guangzhou Road, Nanjing, 210029, China
| | - Hao Zhang
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, No. 300, Guangzhou Road, Nanjing, 210029, China.
| | - Wei Sun
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, No. 300, Guangzhou Road, Nanjing, 210029, China
| | - Haifeng Zhang
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, No. 300, Guangzhou Road, Nanjing, 210029, China
| | - Yanhui Sheng
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, No. 300, Guangzhou Road, Nanjing, 210029, China
| | - Rong Yang
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, No. 300, Guangzhou Road, Nanjing, 210029, China
| | - Xiangqing Kong
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, No. 300, Guangzhou Road, Nanjing, 210029, China
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211
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Suryavanshi SV, Kulkarni YA. Attenuation of Cardiac Autonomic Neuropathy by Escin in Diabetic Rats. Pharmacology 2020; 106:211-217. [PMID: 32877906 DOI: 10.1159/000509730] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Accepted: 06/19/2020] [Indexed: 11/19/2022]
Abstract
Cardiac autonomic neuropathy (CAN) is a least diagnosed complication of diabetes. Inflammation and oxidative stress play a crucial role in the pathophysiology of cardiomyopathy and neuropathy. Escin has anti-inflammatory activity and antioxidant activity. Hence, the present study was designed to evaluate the effect of escin in the management of CAN. Diabetes was induced in Sprague Dawley rats with streptozotocin (STZ). Diabetic animals were randomized in different groups after 6 weeks. Animals in the diabetic control group received no treatment, while animals in other groups received escin at dose 5, 10, and 20 mg/kg for 4 weeks. One group was kept as normal control. Various parameters like basic hemodynamic parameters, heart rate variability (HRV), oxidative stress parameters, and matrix metalloproteinase 9 (MMP-9) were assessed at the end of study. Escin significantly normalized hemodynamic parameters and HRV as compared to diabetic animals. Escin significantly reduced the malondialdehyde level and significantly increased reduced glutathione, catalase and superoxide dismutase levels in diabetic animals. Escin treatment significantly reduced plasma MMP-9 level in diabetic rats. The improvement in the studied parameters was found mainly with administration of higher doses of escin (10 and 20 mg/kg). The escin treatment mitigates CAN in diabetic rats. The results of study indicate that escin can be useful option for management of CAN.
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Affiliation(s)
- Sachin V Suryavanshi
- Shobhaben Pratapbhai Patel School of Pharmacy & Technology Management, SVKM's NMIMS, Mumbai, India
| | - Yogesh A Kulkarni
- Shobhaben Pratapbhai Patel School of Pharmacy & Technology Management, SVKM's NMIMS, Mumbai, India,
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Azmi S, Alam U, Burgess J, Malik RA. State-of-the-art pharmacotherapy for diabetic neuropathy. Expert Opin Pharmacother 2020; 22:55-68. [PMID: 32866410 DOI: 10.1080/14656566.2020.1812578] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
INTRODUCTION The global epidemic of diabetes has led to an epidemic of diabetes complications. Diabetic neuropathy is the most common microvascular complication, of which diabetic peripheral neuropathy (DPN) and autonomic neuropathy (AN) are the most prevalent, affecting ~50% of patients. DPN results in pain with a poor quality of life and a loss of sensation with an increased risk of foot ulceration. Autonomic neuropathy can cause significant morbidity in a minority and is associated with increased mortality. The cornerstone of treatment to prevent or limit the progression of DPN/AN is multifactorial risk factor modification including treatment of glycemia, lipids and blood pressure. Whilst, there are no FDA-approved disease-modifying therapies, there are a number of therapies to relieve symptoms in DPN and AN. AREAS COVERED The authors discuss current approved therapies for painful diabetic neuropathy and autonomic neuropathy. They also address the potential role of improving risk factors to limit the development and progression of diabetic neuropathy and new pathogenetic and pain-relieving treatments. EXPERT OPINION The FDA-approved Pregabalin and Duloxetine over 25 years ago and Tapentadol, 6 years ago for painful diabetic neuropathy. There are currently no FDA-approved disease-modifying treatments for diabetic neuropathy which has been attributed to inappropriate models of the disease with limited translational capacity and major limitations of trial designs and endpoints in clinical trials.
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Affiliation(s)
- Shazli Azmi
- Institute of Cardiovascular Science, University of Manchester and Manchester NHS Foundation Trust , Manchester, UK
| | - Uazman Alam
- Division of Diabetes, Endocrinology and Gastroenterology, Institute of Human Development, University of Manchester , Manchester, UK.,Department of Cardiovascular & Metabolic Medicine, Institute of Life Course and Medical Sciences, University of Liverpool , Liverpool, UK.,Department of Diabetes and Endocrinology, Liverpool University Hospital NHS Foundation Trust , Liverpool, UK
| | - Jamie Burgess
- Department of Cardiovascular & Metabolic Medicine, Institute of Life Course and Medical Sciences, University of Liverpool , Liverpool, UK
| | - Rayaz A Malik
- Department of Medicine, Weill Cornell Medicine-Qatar , Doha, Qatar
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213
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Sohinki D, Javed I, Scherlag B, Thomas W, Po S, Dasari T. Left Atrial Size May Predict Blood Pressure Improvement After Ganglionated Plexi Ablation in Addition to Pulmonary Vein Isolation. J Atr Fibrillation 2020; 13:2326. [PMID: 34950295 DOI: 10.4022/jafib.2326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Revised: 04/17/2020] [Accepted: 06/22/2020] [Indexed: 11/10/2022]
Abstract
Background Hypertension (HTN) and atrial fibrillation (AF) commonly co-exist. An improvement in control of HTN in a subset of patients undergoing AF ablation was previously demonstrated by our group. In the present study, we aimed to assess whether left atrial (LA) size based on transthoracic echocardiography may predict the patients who demonstratebetter HTN improvement after ganglionated plexus ablation (GPA) in addition to pulmonary vein isolation (PVI). Methods This was a retrospective chart review of patients with AF and HTN who underwent GPA+PVI. Patients were divided into 2 groupsbased on LA size: Patients with normal LA size and patients with LA enlargement. Systolic blood pressure (SBP) levelswere compared at baseline, and 3, 6, and 12 months post-ablation. The primary endpoints of the study weremean systolic blood pressure change compared between groups from baseline to 12-months, as well as the absolute difference in systolic blood pressure at 12 months follow-up.Medical therapy for HTN was also assessed before the procedure, and at 12 months post-procedure. Results 53 patients (37 with LA enlargement, 16 with normal LA size) met inclusion criteria. At 12 months follow-up, SBP was 136.46 ± 22.38 mmHg in patients with LA enlargementand 118.25 ± 9.81 mmHg in patients with normal LA size (estimated difference of 19.04 ± 6.98 mmHg, p = 0.01). Patients with normal LA size were on significantly fewer anti-hypertensive agents at 12 months (2.33 ± 1.49 vs. 1.44 ± 1.21, p < 0.05). Conclusions In patients undergoing PVI+GP ablation, normal LA size may predict HTN improvement at 12 months post-procedure. Normal LA size may identify hypertensive AF patients for whom autonomic modulation could be an effective therapy.
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Affiliation(s)
- Daniel Sohinki
- Department of Cardiology, Medical College of Georgia at Augusta University, Augusta, GA
| | | | - Benjamin Scherlag
- Department of Cardiology.,Heart Rhythm Institute, University of Oklahoma Health Sciences Center, Oklahoma City, OK
| | | | - Sunny Po
- Department of Cardiology.,Heart Rhythm Institute, University of Oklahoma Health Sciences Center, Oklahoma City, OK
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Valensi P, Henry P, Boccara F, Cosson E, Prevost G, Emmerich J, Ernande L, Marcadet D, Mousseaux E, Rouzet F, Sultan A, Ferrières J, Vergès B, Van Belle E. Risk stratification and screening for coronary artery disease in asymptomatic patients with diabetes mellitus: Position paper of the French Society of Cardiology and the French-speaking Society of Diabetology. DIABETES & METABOLISM 2020; 47:101185. [PMID: 32846201 DOI: 10.1016/j.diabet.2020.08.002] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Key Words] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Revised: 07/07/2020] [Accepted: 07/09/2020] [Indexed: 01/09/2023]
Affiliation(s)
- Paul Valensi
- Unit of Endocrinology Diabetology Nutrition, AP-HP, Jean Verdier hospital, CINFO, CRNH-IdF, Paris 13 University, Sorbonne Paris Cité, Bondy, France
| | - Patrick Henry
- Department of Cardiology, Inserm U942, Lariboisiere Hospital, Assistance Publique - Hôpitaux de Paris, University of Paris, Paris, France.
| | - Franck Boccara
- AP-HP, Hôpitaux de l'Est Parisien, Hôpital Saint-Antoine, Department of Cardiology, Sorbonne Université-Inserm UMR S_938, Centre de Recherche Saint-Antoine, Paris, France
| | - Emmanuel Cosson
- AP-HP, Avicenne Hospital, Paris 13 University, Sorbonne Paris Cité, Department of Endocrinology-Diabetology-Nutrition, CRNH-IdF, CINFO, Bobigny, France; Paris 13 University, Sorbonne Paris Cité, UMR U557 Inserm/U11125 INRAE/CNAM/Université Paris13, Unité de Recherche Epidémiologique Nutritionnelle, Bobigny, France
| | - Gaetan Prevost
- Department of Endocrinology, Diabetes and Metabolic Diseases, Normandie Univ, UNIROUEN, Rouen University Hospital, Centre d'Investigation Clinique (CIC-CRB)-Inserm 1404, Rouen University Hospital, 76000 Rouen, France
| | - Joseph Emmerich
- Service de Médecine Vasculaire, Groupe Hospitalier Paris Saint-Joseph, Université de Paris, Inserm UMR1153-CRESS, 75674 Paris cedex 14, France
| | - Laura Ernande
- Service des explorations fonctionnelles, Hôpital Henri Mondor, AP-HP et Inserm U955, Université Paris-Est Créteil, France
| | - Dany Marcadet
- Centre Coeur et Santé Bernoulli - Cardiologie du sport et Réadaptation Cardiaque, 3, rue Bernoulli, 75008 Paris, France
| | - Elie Mousseaux
- Radiology Department, Hôpital Européen Georges Pompidou & Inserm U 970; Assistance Publique - Hôpitaux de Paris, University of Paris, French Society of Cardiovascular Imaging (SFICV), Paris, France
| | - François Rouzet
- Nuclear Medicine Department, Bichat Hospital, AP-HP Paris - Université de Paris, Laboratory for Vascular Translational Science, Inserm, UMR 1148, 75018 Paris, France
| | - Ariane Sultan
- Physiologie et Médecine Expérimentale du Coeur et des Muscles (PHYMEDEX), U1046 Inserm, UMR9214 CNRS, Université de Montpellier, 34295 Montpellier; Département Endocrinologie, Nutrition, Diabète, Equipe Nutrition, Diabète, CHRU Montpellier, 34090 Montpellier, France
| | - Jean Ferrières
- Department of Cardiology and UMR Inserm 1027, Toulouse Rangueil University Hospital, Toulouse University School of Medicine, Toulouse, France
| | - Bruno Vergès
- Service Endocrinologie-Diabétologie, CHU Dijon - Inserm LNC-UMR 1231, Dijon, France
| | - Eric Van Belle
- Department of Interventional Cardiology for Coronary, Valves and Structural Heart Diseases, Institut Coeur Poumon, Centre Hospitalier Universitaire de Lille, Lille, France; Inserm, U1011, Institut Pasteur de Lille, EGID, Lille, France; Department of Medicine, Université de Lille, Lille, France
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Macartney MJ, Notley SR, Herry CL, Seely AJE, Sigal RJ, Kenny GP. Cardiac autonomic modulation in type 1 diabetes during exercise-heat stress. Acta Diabetol 2020; 57:959-963. [PMID: 32144491 DOI: 10.1007/s00592-020-01505-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2019] [Accepted: 02/14/2020] [Indexed: 12/30/2022]
Abstract
AIMS Cardiac autonomic modulation, as assessed by heart rate variability (HRV), is independently attenuated by both type 1 diabetes (T1D) and exercise-heat stress, although their combined effects remain unclear. We therefore assessed HRV during exercise-heat stress in young individuals (18-37 years) with (n = 14) and without type 1 diabetes (n = 14). METHODS Participants completed 30-min seated rest and three, 30-min bouts of semi-recumbent cycling at light, moderate, and vigorous metabolic heat productions (200, 250, 300 W/m2, respectively), each followed by 30-min recovery. Body core temperature (Tcore) and electrocardiogram were recorded throughout and analyzed during the final 5-min of rest and each exercise period. RESULTS Relative to baseline, Tcore was increased in both groups, albeit to a greater extent in type 1 diabetes during vigorous exercise (T1D, 1.1 ± 0.3 °C; control, 0.8 ± 0.3 °C; P < 0.05). Overall HRV (as reflected by entropy) was attenuated throughout exercise relative to baseline in both groups, with the magnitude of the reduction greater in type 1 diabetes during vigorous exercise (T1D, - 108%; control, - 70%; P < 0.05). CONCLUSIONS Given the negative correlations between decreased HRV and cardiac risk, our novel observations indicate that vigorous exercise in hot environments may pose a health concern for individuals with type 1 diabetes.
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Affiliation(s)
- Michael J Macartney
- School of Health Sciences, College of Health and Medicine, University of Tasmania, Hobart, Australia
| | - Sean R Notley
- Human and Environmental Physiology Research Unit, School of Human Kinetics, University of Ottawa, 125 University, Room 367, Montpetit Hall, Ottawa, ON, K1N 6N5, Canada
| | - Christophe L Herry
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
| | - Andrew J E Seely
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
- Thoracic Surgery and Critical Care Medicine, The Ottawa Hospital, Ottawa, Canada
- Department of Medicine, University of Ottawa, Ottawa, Canada
| | - Ronald J Sigal
- Human and Environmental Physiology Research Unit, School of Human Kinetics, University of Ottawa, 125 University, Room 367, Montpetit Hall, Ottawa, ON, K1N 6N5, Canada
- Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Canada
- Departments of Medicine, Cardiac Sciences and Community Health Sciences, Cumming School of Medicine, Faculties of Medicine and Kinesiology, University of Calgary, Calgary, Canada
| | - Glen P Kenny
- Human and Environmental Physiology Research Unit, School of Human Kinetics, University of Ottawa, 125 University, Room 367, Montpetit Hall, Ottawa, ON, K1N 6N5, Canada.
- Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Canada.
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216
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Nguyen L, Wilson LA, Miriel L, Pasricha PJ, Kuo B, Hasler WL, McCallum RW, Sarosiek I, Koch KL, Snape WJ, Farrugia G, Grover M, Clarke J, Parkman HP, Tonascia J, Hamilton F, Abell TL. Autonomic function in gastroparesis and chronic unexplained nausea and vomiting: Relationship with etiology, gastric emptying, and symptom severity. Neurogastroenterol Motil 2020; 32:e13810. [PMID: 32061038 PMCID: PMC7377964 DOI: 10.1111/nmo.13810] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Revised: 12/05/2019] [Accepted: 12/09/2019] [Indexed: 12/14/2022]
Abstract
BACKGROUND Autonomic dysfunction can be present in patients with idiopathic and diabetic gastroparesis. The role of autonomic dysfunction relating to gastric emptying and upper gastrointestinal symptoms in patients with gastroparesis and chronic unexplained nausea and vomiting (CUNV) remains unclear. The aim of our study is to evaluate autonomic function in patients with gastroparesis and CUNV with respect to etiology, gastric emptying and symptom severity. METHODS We studied 242 patients with chronic gastroparetic symptoms recruited at eight centers. All patients had a gastric emptying scintigraphy within 6 months of the study. Symptom severity was assessed using the gastroparesis cardinal symptom index. Autonomic function testing was performed at baseline enrollment using the ANX 3.0 autonomic monitoring system which measures heart rate variability and respiratory activity measurements. KEY RESULTS Low sympathetic response to challenge (Valsalva or standing) was the most common abnormality seen impacting 89% diabetic and 74% idiopathic patients. Diabetics compared to idiopathics, exhibited greater global hypofunction with sympathetic (OR = 4.7, 95% CI 2.2-10.3; P < .001) and parasympathetic (OR = 7.2, 95% CI 3.4-15.0; P < .001) dysfunction. Patients with delayed gastric emptying were more likely to have paradoxic parasympathetic excessive during sympathetic challenge [(Valsalva or standing) 40% vs. 26%, P = .05]. Patients with more severe symptoms exhibited greater parasympathetic dysfunction compared to those with mild-moderate symptoms: resting sympathovagal balance [LFa/RFa 1.8 (1.0-3.1) vs. 1.2 (0.6-2.3), P = .006)] and standing parasympathetic activity [0.4 (0.1-0.8) vs. 0.6 (0.2-1.7); P = .03]. CONCLUSIONS Autonomic dysfunction was common in patients with gastroparesis and CUNV. Parasympathetic dysfunction was associated with delayed gastric emptying and more severe upper gastrointestinal symptoms. Conversely, sympathetic hypofunction was associated with milder symptoms. INFERENCES Gastroparesis and CUNV may be a manifestation of GI autonomic dysfunction or imbalance, such that sympathetic dysfunction occurs early on in the manifestation of chronic upper GI symptoms, while parasympathetic dysfunction results in more severe symptoms and delayed gastric emptying.
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Affiliation(s)
| | | | | | | | - Braden Kuo
- Harvard University, Boston, Massachusetts
- Massachusetts General Hospital, Boston, Massachusetts
| | | | | | | | | | | | | | | | | | | | | | - Frank Hamilton
- National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, Maryland
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Understanding Diabetic Neuropathy: Focus on Oxidative Stress. OXIDATIVE MEDICINE AND CELLULAR LONGEVITY 2020; 2020:9524635. [PMID: 32832011 PMCID: PMC7422494 DOI: 10.1155/2020/9524635] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/14/2020] [Accepted: 07/22/2020] [Indexed: 02/06/2023]
Abstract
Diabetic neuropathy is one of the clinical syndromes characterized by pain and substantial morbidity primarily due to a lesion of the somatosensory nervous system. The burden of diabetic neuropathy is related not only to the complexity of diabetes but also to the poor outcomes and difficult treatment options. There is no specific treatment for diabetic neuropathy other than glycemic control and diligent foot care. Although various metabolic pathways are impaired in diabetic neuropathy, enhanced cellular oxidative stress is proposed as a common initiator. A mechanism-based treatment of diabetic neuropathy is challenging; a better understanding of the pathophysiology of diabetic neuropathy will help to develop strategies for the new and correct diagnostic procedures and personalized interventions. Thus, we review the current knowledge of the pathophysiology in diabetic neuropathy. We focus on discussing how the defects in metabolic and vascular pathways converge to enhance oxidative stress and how they produce the onset and progression of nerve injury present in diabetic neuropathy. We discuss if the mechanisms underlying neuropathy are similarly operated in type I and type II diabetes and the progression of antioxidants in treating diabetic neuropathy.
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218
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Plasma sphingosine 1-phosphate concentrations and cardiovascular autonomic neuropathy in individuals with type 2 diabetes. Sci Rep 2020; 10:12768. [PMID: 32728147 PMCID: PMC7391653 DOI: 10.1038/s41598-020-69566-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Accepted: 07/15/2020] [Indexed: 12/14/2022] Open
Abstract
The aim of this study was to test the hypothesis that plasma sphingosine 1-phosphate (S1P) levels are associated with the risk of cardiovascular autonomic neuropathy (CAN) in type 2 diabetes patients. This cross-sectional study included 287 individuals with type 2 diabetes. CAN was evaluated using cardiovascular reflex tests. Logistic regression analyses were conducted to assess the relationship between plasma S1P levels and CAN. Plasma S1P concentrations were significantly lower in individuals with CAN than in those without CAN. There was a significant interaction between plasma S1P levels and sex with respect to CAN (p for interaction = 0.003). When stratified by sex, the association between plasma S1P levels and CAN exhibited a sex difference; in multivariable analysis, plasma S1P levels were significantly associated with CAN in women (odds ratio per standard deviation increase in the log-transformed value, 0.40; 95% confidence interval, 0.23–0.70, p = 0.001). However, there was no significant association between plasma S1P and CAN in men. Plasma S1P concentrations were inversely associated with CAN only in women with type 2 diabetes.
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219
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Noor B, Akhavan S, Leuchter M, Yang EH, Ajijola OA. Quantitative assessment of cardiovascular autonomic impairment in cancer survivors: a single center case series. CARDIO-ONCOLOGY (LONDON, ENGLAND) 2020; 6:11. [PMID: 32742722 PMCID: PMC7388471 DOI: 10.1186/s40959-020-00065-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Accepted: 07/13/2020] [Indexed: 12/20/2022]
Abstract
BACKGROUND Cardiovascular autonomic dysfunction in cancer survivors is poorly understood. OBJECTIVES To better characterize the clinical characteristics and types of autonomic dysfunction in this population. METHODS A retrospective analysis of cancer survivors within an academic cardio-oncology program referred for suspected autonomic dysfunction was performed. Autonomic reflex testing of adrenergic, cardiovagal, and sudomotor function was done. Autonomic impairment was graded on severity based on the Composite Autonomic Severity Score system. Patients with pre-existing autonomic dysfunction prior to their cancer diagnosis were excluded. RESULTS Of approximately 282 total patients in the UCLA Cardio-Oncology program, 24 were referred for suspected autonomic dysfunction and met the inclusion criteria. 22 had autonomic impairment on autonomic reflex testing. Eight patients were female, and the mean age at time of autonomic testing was 51.3 years. The average duration from cancer diagnosis to autonomic testing was 10.3 years. The reasons for referral included dizziness, tachycardia, palpitations, and syncope. The majority of patients (75%) had hematologic disorders. The most common chemotherapies administered were vinca alkaloids (54.2%), alkylating agents (66.7%), and anthracyclines (54.2%). Most patients received radiation to the thorax (66.7%) and neck (53.3%). Eleven patients had mild autonomic impairment, 7 had moderate, and 4 had severe autonomic impairment. Dysfunction was commonly present in the sympathetic and parasympathetic branches, but most pronounced in the sympathetic system. The majority of patients were diagnosed with orthostatic hypotension (50%), inappropriate sinus tachycardia (20.8%), and postural orthostatic tachycardia syndrome (12.5%) and had subjective improvement with treatment. CONCLUSION Cardiovascular autonomic dysfunction occurs in cancer survivors, and commonly affects both the sympathetic and parasympathetic systems. Symptom recognition in patients should prompt autonomic testing and treatment where appropriate.
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Affiliation(s)
- Benjamin Noor
- Division of Internal Medicine, Department of Medicine, University of California at Los Angeles, Los Angeles, CA USA
| | - Shannel Akhavan
- UCLA Cardio-Oncology Program and Division of Cardiology, Department of Medicine, University of California at Los Angeles, Los Angeles, CA USA
| | - Michael Leuchter
- UCLA Cardiac Arrhythmia and Neurocardiology Research Center, David Geffen School of Medicine at UCLA, University of California at Los Angeles, 100 Medical Plaza, Suite 660, Westwood Blvd, Los Angeles, CA 90095-1679 USA
| | - Eric H. Yang
- UCLA Cardio-Oncology Program and Division of Cardiology, Department of Medicine, University of California at Los Angeles, Los Angeles, CA USA
| | - Olujimi A. Ajijola
- UCLA Cardio-Oncology Program and Division of Cardiology, Department of Medicine, University of California at Los Angeles, Los Angeles, CA USA
- UCLA Cardiac Arrhythmia and Neurocardiology Research Center, David Geffen School of Medicine at UCLA, University of California at Los Angeles, 100 Medical Plaza, Suite 660, Westwood Blvd, Los Angeles, CA 90095-1679 USA
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220
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An orthopaedist’s review of diabetic foot wounds and osteomyelitis. CURRENT ORTHOPAEDIC PRACTICE 2020. [DOI: 10.1097/bco.0000000000000908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Lai YR, Huang CC, Chang HW, Chiu WC, Tsai NW, Cheng BC, Chen JF, Lu CH. Severity of Cardiovascular Autonomic Neuropathy Is a Predictor Associated With Major Adverse Cardiovascular Events in Adults With Type 2 Diabetes Mellitus: A 6-Year Follow-up Study. Can J Diabetes 2020; 45:155-161. [PMID: 33046397 DOI: 10.1016/j.jcjd.2020.06.017] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Revised: 06/12/2020] [Accepted: 06/28/2020] [Indexed: 12/21/2022]
Abstract
OBJECTIVES Cardiovascular autonomic function impairment has been reported in patients with type 2 diabetes mellitus and is associated with cardiovascular events. In this study, we test the hypothesis that the severity of cardiovascular autonomic neuropathy is a predictor associated with subsequent 3-point major adverse cardiovascular events (3-P MACE; combined endpoint of cardiovascular death, nonfatal myocardial infarction and nonfatal stroke). METHODS In this prospective study, we enrolled 168 patients with type 2 diabetes mellitus over a 6-year follow-up period. We constructed the Composite Autonomic Scoring Scale as a measure of the severity of cardiovascular autonomic neuropathy and examined baseline clinical and laboratory data of 168 patients with diabetes. Cardiovascular autonomic testing included heart rate response to deep breathing, Valsalva ratio and baroreflex sensitivity. Therapeutic outcome was defined as 3-P MACE. RESULTS The overall incidence of new 3-P MACE was 23.2% and overall fatality rate was 9.5% during the 6-year follow-up period. Only underlying coronary heart disease and Composite Autonomic Scoring Scale were independently associated with subsequent 3-P MACE in the Cox proportional hazards model. Any increase of 1 point in Composite Autonomic Scoring Scale would increase the risk of new 3-P MACE by 9.7%. Area under the curve on receiver-operating characteristic curve analysis was 0.72 in predicting subsequent 3-point MACE in combined heart rate response to deep breathing and Valsalva ratio. CONCLUSIONS Besides underlying coronary heart disease, the severity of cardiovascular autonomic neuropathy is strongly associated with subsequent 3-P MACE. Combined heart rate response to deep breathing and Valsalva ratio testing can increase sensitivity and specificity in predicting subsequent 3-point MACE, and it can serve as a time-effective cardiovascular autonomic screening service in the outpatient clinic sitting.
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Affiliation(s)
- Yun-Ru Lai
- Department of Biological Science, National Sun Yat-Sen University, Kaohsiung, Taiwan; Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Chih-Cheng Huang
- Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Hsueh-Wen Chang
- Department of Biological Science, National Sun Yat-Sen University, Kaohsiung, Taiwan
| | - Wen-Chan Chiu
- Department of Neurology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Nai-Wen Tsai
- Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Ben-Chung Cheng
- Department of Biological Science, National Sun Yat-Sen University, Kaohsiung, Taiwan; Department of Neurology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Jung-Fu Chen
- Department of Neurology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Cheng-Hsien Lu
- Department of Biological Science, National Sun Yat-Sen University, Kaohsiung, Taiwan; Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan; Center for Shockwave Medicine and Tissue Engineering, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan; Department of Neurology, Xiamen Chang Gung Memorial Hospital, Xiamen, Fujian, China.
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Low BH, Lin YD, Huang BW, Chia T, Bau JG, Huang HY. Impaired Microvascular Response to Muscle Stretching in Chronic Smokers With Type 2 Diabetes. Front Bioeng Biotechnol 2020; 8:602. [PMID: 32596231 PMCID: PMC7300253 DOI: 10.3389/fbioe.2020.00602] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Accepted: 05/18/2020] [Indexed: 11/25/2022] Open
Abstract
Objective Cigarette smoking promotes endothelial dysfunction and is a prominent catalyst for vascular disease. This study employed laser doppler flowmetry (LDF) and spectral analysis to investigate the skin microvascular response to relatively mild stimulus of stretching in diabetic smokers. Methods The study population consisted of thirty type 2 diabetic male patients (15 smokers vs. 15 non-smokers) and 15 normal non-smoking subjects. The cutaneous blood flow of the calf at both lower limbs was measured by LDF at a supine position throughout and after muscle stretching by passive dorsiflexion of the ankle. Results Following the stretch, post-stretch reactive hyperemia (PSRH) responses were found in all subjects. However, the diabetic non-smokers had relatively higher reactive blood flow than that of the diabetic smokers. The PSRH sustained for a longer time in both diabetic non-smokers and non-diabetic non-smokers in the time domain analysis. By spectral analysis, an observed discrepancy between that of diabetic smokers and diabetic non-smokers was statistically significant. Specifically, the frequency intervals corresponded to a nitric oxide dependent endothelial activity. In addition, an excessive response induced by stretching in frequency intervals of neurogenic activity, when compared with the non-smoking control, was found on diabetic non-smokers. Conclusion All subjects expressed the PSRH effect in cutaneous microcirculation after a 10-s stretch stimulus; however, this effect was observed at a significantly lower intensity in chronic smokers with diabetes. The spectral analysis of the skin blood flow signals provides a pathological index for the assessment of the endothelial dysfunction induced by cigarette smoking. Furthermore, the discrepancy of neurovascular function between that of diabetic non-smokers and normal subjects could also be distinguished via the variations of the spectrum related to neurogenic activity.
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Affiliation(s)
- Boon-Hua Low
- Division of Endocrinology and Metabolism, Kuang Tien General Hospital, Taichung, Taiwan
| | - Yue-Der Lin
- Department of Automatic Control Engineering, Feng Chia University, Taichung, Taiwan
| | - Bo-Wen Huang
- Bioinformatics and Biomedical Engineering, Feng Chia University, Taichung, Taiwan
| | - Taipau Chia
- Department of Safety, Health and Environmental Engineering, Hungkuang University, Taichung, Taiwan
| | - Jian-Guo Bau
- Department of Biomedical Engineering, Hungkuang University, Taichung, Taiwan
| | - Hao-Yu Huang
- Department of Biomolecular Chemistry, UW School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, United States
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Singh R, Rao HK, Singh TG. Neuropathic pain in diabetes mellitus: Challenges and future trends. ACTA ACUST UNITED AC 2020. [DOI: 10.1016/j.obmed.2020.100215] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Reis de Matos M, Santos-Bezerra DP, Dias Cavalcante CDG, Xavier de Carvalho J, Leite J, Neves JAJ, Admoni SN, Passarelli M, Parisi MC, Correa-Giannella ML. Distal Symmetric and Cardiovascular Autonomic Neuropathies in Brazilian Individuals with Type 2 Diabetes Followed in a Primary Health Care Unit: A Cross-Sectional Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17093232. [PMID: 32384735 PMCID: PMC7246466 DOI: 10.3390/ijerph17093232] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Revised: 04/23/2020] [Accepted: 04/30/2020] [Indexed: 01/27/2023]
Abstract
The paucity of epidemiological data regarding diabetes complications in Brazil motivated us to evaluate the prevalence rates of distal symmetric polyneuropathy (DSP) and of cardiovascular autonomic neuropathy (CAN) in individuals with type 2 diabetes (T2D) followed in a primary care unit. A total of 551 individuals (59.3% women, 65 years old; diabetes duration of 10 years; HbA1c of 7.2%, medians) were included in this cross-sectional study. DSP was diagnosed by sum of the Neuropathy Symptoms Score (NSS) and Modified Neuropathy Disability Score (NDS) and by the Semmes-Weinstein monofilament. CAN was diagnosed by cardiovascular autonomic reflex tests combined with spectral analysis of heart rate variability. The prevalence rates of DSP were 6.3% and 14.3%, as evaluated by the sum of NSS and NDS and by the Semmes-Weinstein monofilament, respectively. Those with DSP diagnosed by monofilament presented longer diabetes duration, worse glycemic control and a higher stature. The prevalence rates of incipient and definitive CAN were 12.5% and 10%, respectively. Individuals with definitive CAN presented a higher frequency of hypercholesterolemia and of arterial hypertension. The higher prevalence rate of DSP with the use of the monofilament suggests that it may be a more appropriate tool to diagnose DSP in the primary care setting in Brazil.
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Affiliation(s)
- Mozania Reis de Matos
- Programa de Pos-Graduaçao em Medicina, Universidade Nove de Julho (UNINOVE), Rua Vergueiro 235, 2° subsolo, Pos-graduação, Sao Paulo 01504-001, Brazil; (M.R.d.M.); (J.L.); (J.A.J.N.); (M.P.)
- Unidade Basica de Saude Dra. Ilza Weltman Hutzler. Rua Coronel Walfrido de Carvalho, Sao Paulo 02472-180, Brazil; (C.d.G.D.C.); (J.X.d.C.)
| | - Daniele Pereira Santos-Bezerra
- Laboratorio de Carboidratos e Radioimunoensaio (LIM-18), Hospital das Clinicas HCFMUSP, Faculdade de Medicina da Universidade de Sao Paulo. Avenida Dr. Arnaldo, 455, Sala 3321, Sao Paulo 01246-903, Brazil; (D.P.S.-B.); (S.N.A.)
| | | | - Jacira Xavier de Carvalho
- Unidade Basica de Saude Dra. Ilza Weltman Hutzler. Rua Coronel Walfrido de Carvalho, Sao Paulo 02472-180, Brazil; (C.d.G.D.C.); (J.X.d.C.)
| | - Juliana Leite
- Programa de Pos-Graduaçao em Medicina, Universidade Nove de Julho (UNINOVE), Rua Vergueiro 235, 2° subsolo, Pos-graduação, Sao Paulo 01504-001, Brazil; (M.R.d.M.); (J.L.); (J.A.J.N.); (M.P.)
| | - Jose Antonio Januario Neves
- Programa de Pos-Graduaçao em Medicina, Universidade Nove de Julho (UNINOVE), Rua Vergueiro 235, 2° subsolo, Pos-graduação, Sao Paulo 01504-001, Brazil; (M.R.d.M.); (J.L.); (J.A.J.N.); (M.P.)
| | - Sharon Nina Admoni
- Laboratorio de Carboidratos e Radioimunoensaio (LIM-18), Hospital das Clinicas HCFMUSP, Faculdade de Medicina da Universidade de Sao Paulo. Avenida Dr. Arnaldo, 455, Sala 3321, Sao Paulo 01246-903, Brazil; (D.P.S.-B.); (S.N.A.)
| | - Marisa Passarelli
- Programa de Pos-Graduaçao em Medicina, Universidade Nove de Julho (UNINOVE), Rua Vergueiro 235, 2° subsolo, Pos-graduação, Sao Paulo 01504-001, Brazil; (M.R.d.M.); (J.L.); (J.A.J.N.); (M.P.)
- Laboratorio de Lipides (LIM-10), Hospital das Clinicas HCFMUSP, Faculdade de Medicina da Universidade de Sao Paulo, Avenida Dr. Arnaldo, 455, Sala 3305, Sao Paulo 01246-903, Brazil
| | - Maria Candida Parisi
- Divisao de Endocrinologia, Departamento de Clinica Medica, Faculdade de Medicina da Universidade Estadual de Campinas (UNICAMP), Rua Tessalia Vieira de Camargo, 126 – Cidade Universitaria, Campinas 13083-887, Brazil;
| | - Maria Lucia Correa-Giannella
- Programa de Pos-Graduaçao em Medicina, Universidade Nove de Julho (UNINOVE), Rua Vergueiro 235, 2° subsolo, Pos-graduação, Sao Paulo 01504-001, Brazil; (M.R.d.M.); (J.L.); (J.A.J.N.); (M.P.)
- Laboratorio de Carboidratos e Radioimunoensaio (LIM-18), Hospital das Clinicas HCFMUSP, Faculdade de Medicina da Universidade de Sao Paulo. Avenida Dr. Arnaldo, 455, Sala 3321, Sao Paulo 01246-903, Brazil; (D.P.S.-B.); (S.N.A.)
- Correspondence:
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225
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Jiao X, Lu D, Pei X, Qi D, Huang S, Song Z, Gu J, Li Z. Type 1 diabetes mellitus impairs diurnal oscillations in murine extraorbital lacrimal glands. Ocul Surf 2020; 18:438-452. [PMID: 32360784 DOI: 10.1016/j.jtos.2020.04.013] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Revised: 04/20/2020] [Accepted: 04/23/2020] [Indexed: 01/09/2023]
Abstract
PURPOSE People with diabetes are at high risk of lacrimal gland dysfunction, but the underlying mechanism is not well understood. In this study, we determined how type 1 diabetes mellitus (T1DM) influences circadian homeostasis of the murine extraorbital lacrimal glands (ELGs). METHODS A T1DM animal model was established by systemic streptozotocin injection in C57BL/6J mice. After 5 weeks, ELGs were collected at 3-h intervals over a 24-h circadian cycle. Total extracted RNA was subjected to high-throughput RNA sequencing, and rhythmic transcriptional data were evaluated using the Jonckheere-Terpstra-Kendall algorithm, Kyoto Encyclopedia of Genes and Genomes pathway analysis, Phase Set Enrichment Analysis, and time series cluster analysis to determine the phase, rhythmicity, and unique signature of the transcripts over temporally coordinated expression. Additionally, mass, cell size, histology, and tear secretion of the ELGs were evaluated. RESULTS T1DM globally altered the composition of the ELG transcriptome. Specifically, T1DM significantly reprogrammed the circadian transcriptomic profiles of normal ELGs and reorganized core clock machinery. Unique temporal and clustering enrichment pathways were also rewired by T1DM. Finally, normal daily rhythms of mass, cell size, and tear secretion of mouse ELGs were significantly impaired by streptozotocin-induced diabetes. CONCLUSIONS T1DM significantly reprograms the diurnal oscillations of the lacrimal glands and impairs their structure and tear secretion. This information may reveal potential targets for improving lacrimal gland dysfunction in patients with diabetes.
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Affiliation(s)
- Xinwei Jiao
- Henan Eye Institute, Henan Eye Hospital and Henan Key Laboratory of Ophthalmology and Visual Science, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, People's Hospital of Henan University, Zhengzhou, China
| | - Dingli Lu
- Henan Eye Institute, Henan Eye Hospital and Henan Key Laboratory of Ophthalmology and Visual Science, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, People's Hospital of Henan University, Zhengzhou, China
| | - Xiaoting Pei
- Henan Eye Institute, Henan Eye Hospital and Henan Key Laboratory of Ophthalmology and Visual Science, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, People's Hospital of Henan University, Zhengzhou, China
| | - Di Qi
- Henan Eye Institute, Henan Eye Hospital and Henan Key Laboratory of Ophthalmology and Visual Science, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, People's Hospital of Henan University, Zhengzhou, China
| | - Shenzhen Huang
- Henan Eye Institute, Henan Eye Hospital and Henan Key Laboratory of Ophthalmology and Visual Science, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, People's Hospital of Henan University, Zhengzhou, China
| | - Zongming Song
- Henan Eye Institute, Henan Eye Hospital and Henan Key Laboratory of Ophthalmology and Visual Science, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, People's Hospital of Henan University, Zhengzhou, China
| | - Jianqin Gu
- Henan Eye Institute, Henan Eye Hospital and Henan Key Laboratory of Ophthalmology and Visual Science, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, People's Hospital of Henan University, Zhengzhou, China
| | - Zhijie Li
- Henan Eye Institute, Henan Eye Hospital and Henan Key Laboratory of Ophthalmology and Visual Science, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, People's Hospital of Henan University, Zhengzhou, China.
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226
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Coopmans C, Zhou TL, Henry RMA, Heijman J, Schaper NC, Koster A, Schram MT, van der Kallen CJH, Wesselius A, den Engelsman RJA, Crijns HJGM, Stehouwer CDA. Both Prediabetes and Type 2 Diabetes Are Associated With Lower Heart Rate Variability: The Maastricht Study. Diabetes Care 2020; 43:1126-1133. [PMID: 32161051 DOI: 10.2337/dc19-2367] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Accepted: 02/22/2020] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Low heart rate variability (HRV), a marker for cardiac autonomic dysfunction, is a known feature of type 2 diabetes, but it remains incompletely understood whether this also applies to prediabetes or across the whole glycemic spectrum. Therefore, we investigated the association among prediabetes, type 2 diabetes, and measures of glycemia and HRV. RESEARCH DESIGN AND METHODS In the population-based Maastricht Study (n = 2,107; mean ± SD age 59 ± 8 years; 52% men; normal glucose metabolism [n = 1,226], prediabetes [n = 331], and type 2 diabetes [n = 550, oversampled]), we determined 24-h electrocardiogram-derived HRV in time and frequency domains (individual z-scores, based upon seven and six variables, respectively). We used linear regression with adjustments for age, sex, and major cardiovascular risk factors. RESULTS After adjustments, both time and frequency domain HRV were lower in prediabetes and type 2 diabetes as compared with normal glucose metabolism (standardized β [95% CI] for time domain: -0.15 [-0.27; -0.03] and -0.34 [-0.46; -0.22], respectively, P for trend <0.001; for frequency domain: -0.14 [-0.26; -0.02] and -0.31 [-0.43; -0.19], respectively, P for trend <0.001). In addition, 1-SD higher glycated hemoglobin, fasting plasma glucose, and 2-h postload glucose were associated with lower HRV in both domains (time domain: -0.16 [-0.21; -0.12], -0.16 [-0.21; -0.12], and -0.15 [-0.20; -0.10], respectively; frequency domain: -0.14 [-0.19; -0.10], -0.14 [-0.18; -0.09], and -0.13 [-0.18; -0.08], respectively). CONCLUSIONS Both prediabetes and type 2 diabetes were independently associated with lower HRV. This is further substantiated by independent continuous associations between measures of hyperglycemia and lower HRV. These data strongly suggest that cardiac autonomic dysfunction is already present in prediabetes.
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Affiliation(s)
- Charlotte Coopmans
- CARIM School for Cardiovascular Diseases, Maastricht University, Maastricht, the Netherlands.,Department of Internal Medicine, Maastricht University Medical Center+, Maastricht, the Netherlands
| | - Tan Lai Zhou
- CARIM School for Cardiovascular Diseases, Maastricht University, Maastricht, the Netherlands.,Department of Internal Medicine, Maastricht University Medical Center+, Maastricht, the Netherlands
| | - Ronald M A Henry
- CARIM School for Cardiovascular Diseases, Maastricht University, Maastricht, the Netherlands.,Department of Internal Medicine, Maastricht University Medical Center+, Maastricht, the Netherlands.,Heart+Vascular Center, Maastricht University Medical Center+, Maastricht, the Netherlands
| | - Jordi Heijman
- CARIM School for Cardiovascular Diseases, Maastricht University, Maastricht, the Netherlands.,Department of Cardiology, Maastricht University Medical Center+, Maastricht, the Netherlands
| | - Nicolaas C Schaper
- CARIM School for Cardiovascular Diseases, Maastricht University, Maastricht, the Netherlands.,Department of Internal Medicine, Maastricht University Medical Center+, Maastricht, the Netherlands.,Care and Public Health Research Institute School for Public Health and Primary Care, Maastricht University, Maastricht, the Netherlands
| | - Annemarie Koster
- Care and Public Health Research Institute School for Public Health and Primary Care, Maastricht University, Maastricht, the Netherlands.,Department of Social Medicine, Maastricht University, Maastricht, the Netherlands
| | - Miranda T Schram
- CARIM School for Cardiovascular Diseases, Maastricht University, Maastricht, the Netherlands.,Department of Internal Medicine, Maastricht University Medical Center+, Maastricht, the Netherlands.,Heart+Vascular Center, Maastricht University Medical Center+, Maastricht, the Netherlands
| | - Carla J H van der Kallen
- CARIM School for Cardiovascular Diseases, Maastricht University, Maastricht, the Netherlands.,Department of Internal Medicine, Maastricht University Medical Center+, Maastricht, the Netherlands
| | - Anke Wesselius
- Department of Complex Genetics, Maastricht University, Maastricht, the Netherlands
| | | | - Harry J G M Crijns
- CARIM School for Cardiovascular Diseases, Maastricht University, Maastricht, the Netherlands.,Department of Cardiology, Maastricht University Medical Center+, Maastricht, the Netherlands
| | - Coen D A Stehouwer
- CARIM School for Cardiovascular Diseases, Maastricht University, Maastricht, the Netherlands .,Department of Internal Medicine, Maastricht University Medical Center+, Maastricht, the Netherlands
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227
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Kane P, Larsen P, Wiltshire E. Early identification of cardiac autonomic neuropathy using complexity analysis in children with type 1 diabetes. J Paediatr Child Health 2020; 56:786-790. [PMID: 31883287 DOI: 10.1111/jpc.14745] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Revised: 12/02/2019] [Accepted: 12/08/2019] [Indexed: 11/30/2022]
Abstract
AIM In children and adolescents, there are significant limitations to detecting cardiac autonomic neuropathy (CAN), an important contributor to morbidity and mortality in adults with type 1 diabetes (T1D). The analysis of heart rate variability (HRV) is one method available to detect CAN. Some evidence shows traditional linear HRV measures detect abnormalities in youth with T1D. In this study, we aimed to assess whether non-linear complexity analysis of HRV would assist identification of CAN in youth with T1D and to assess contributory factors. METHODS We studied 19 youth with T1D and 17 healthy controls. Each had an electrocardiogram recorded continuously for 10 min, at a sampling frequency of 1000 Hz. Using Labview software and an algorithm for complexity analysis, along with standard time-domain and spectral analysis, recordings of the electrocardiogram were analysed to detect differences in HRV between groups. RESULTS Youth with T1D had significantly higher sample entropy than controls (P = 0.015) suggesting increased complexity in HRV, but similar detrended fluctuation analysis (P = 0.68). Youth with T1D also had increased % high frequency power (P = 0.017) and reduced mid-frequency power (P = 0.019) on spectral analysis. There were no differences in heart rate or blood pressure responses to standing, or time-domain analysis of HRV. Within the T1D group, sample entropy correlated strongly with triglycerides (r = 0.76, P = 0.001) and detrended fluctuation analysis correlated strongly with serum potassium (r = -0.86, P < 0.001). CONCLUSIONS Complexity analysis of HRV, particularly using sample entropy, may aid detection of CAN in youth with T1D.
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Affiliation(s)
- Penny Kane
- Department of Paediatrics and Child Health, Capital and Coast District Health Board, Wellington, New Zealand
| | - Peter Larsen
- Department of Surgery and Anaesthesia, University of Otago Wellington, Wellington, New Zealand
| | - Esko Wiltshire
- Department of Paediatrics and Child Health, Capital and Coast District Health Board, Wellington, New Zealand.,Department of Paediatrics and Child Health, University of Otago Wellington, Wellington, New Zealand
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228
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Naemi R, Chockalingam N, Lutale JK, Abbas ZG. Predicting the risk of future diabetic foot ulcer occurrence: a prospective cohort study of patients with diabetes in Tanzania. BMJ Open Diabetes Res Care 2020; 8:8/1/e001122. [PMID: 32371531 PMCID: PMC7228475 DOI: 10.1136/bmjdrc-2019-001122] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Revised: 02/28/2020] [Accepted: 03/24/2020] [Indexed: 01/01/2023] Open
Abstract
OBJECTIVES The aim of this study was to identify the parameters that predict the risk of future foot ulcer occurrence in patients with diabetes. RESEARCH DESIGN AND METHODS 1810 (male (M)/female (F): 1012/798) patients, with no foot ulcer at baseline, participated in this study. Data from a set of 28 parameters were collected at baseline. During follow-up, 123 (M/F: 68/55) patients ulcerated. Survival analyses together with logistic regression were used to identify the parameters that could predict the risk of future diabetic foot ulcer occurrence. RESULTS A number of parameters (HR (95% CI)) including neuropathy (2.525 (1.680 to 3.795)); history of ulceration (2.796 (1.029 to 7.598)); smoking history (1.686 (1.097 to 2.592)); presence of callus (1.474 (0.999 to 2.174)); nail ingrowth (5.653 (2.078 to 15.379)); foot swelling (3.345 (1.799 to 6.218)); dry skin (1.926 (1.273 to 2.914)); limited ankle (1.662 (1.365 to 2.022)) and metatarsophalangeal (MTP) joint (2.745 (1.853 to 4.067)) ranges of motion; and decreased (3.141 (2.102 to 4.693)), highly decreased (5.263 (1.266 to 21.878)), and absent (9.671 (5.179 to 18.059)) sensation to touch; age (1.026 (1.010 to 1.042)); vibration perception threshold (1.079 (1.060 to 1.099)); duration of diabetes (1.000 (1.000 to 1.000)); and plantar pressure at the first metatarsal head (1.003 (1.001 to 1.005)), temperature sensation (1.019 (1.004 to 1.035)) and temperature tolerance (1.523 (1.337 to 1.734)) thresholds to hot stimuli and blood sugar level (1.027 (1.006 to 1.048)) were all significantly associated with increased risk of ulceration. However, plantar pressure underneath the fifth toe (0.990 (0.983 to 0.998)) and temperature sensation (0.755 (0.688 to 0.829)) and temperature tolerance (0.668 (0.592 to 0.0754)) thresholds to cold stimuli showed to significantly decrease the risk of future ulcer occurrence. Multivariate survival model indicated that nail ingrowth (4.42 (1.38 to 14.07)); vibration perception threshold (1.07 (1.04 to 1.09)); dry skin status (4.48 (1.80 to 11.14)); and temperature tolerance threshold to warm stimuli (1.001 (1.000 to 1.002)) were significant predictors of foot ulceration risk in the final model. The mean time to ulceration was significantly (p<0.05) shorter for patients with: dry skin (χ2=11.015), nail ingrowth (χ2=14.688), neuropathy (χ2=21.284), or foot swelling (χ2=16.428). CONCLUSION Nail ingrowth and dry skin were found to be strong indicators of vulnerability of patients to diabetic foot ulceration. Results highlight that assessments of neuropathy in relation to both small and larger fiber impairment need to be considered for predicting the risk of diabetic foot ulceration.
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Affiliation(s)
- Roozbeh Naemi
- School of Life Sciences and Education, Staffordshire University, Stoke-on-Trent, UK
| | | | - Janet K Lutale
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Zulfiqarali G Abbas
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
- Abbas Medical Centre, Dar es Salaam, Tanzania
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229
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Südy R, Schranc Á, Fodor GH, Tolnai J, Babik B, Peták F. Lung volume dependence of respiratory function in rodent models of diabetes mellitus. Respir Res 2020; 21:82. [PMID: 32272932 PMCID: PMC7146915 DOI: 10.1186/s12931-020-01334-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2019] [Accepted: 03/09/2020] [Indexed: 12/16/2022] Open
Abstract
Background Diabetes mellitus causes the deterioration of smooth muscle cells and interstitial matrix proteins, including collagen. Collagen and smooth muscle cells are abundant in the lungs, but the effect of diabetes on airway function and viscoelastic respiratory tissue mechanics has not been characterized. This study investigated the impact of diabetes on respiratory function, bronchial responsiveness, and gas exchange parameters. Methods Rats were allocated randomly to three groups: a model of type 1 diabetes that received a high dose of streptozotocin (DM1, n = 13); a model of type 2 diabetes that received a low dose of streptozotocin with a high-fat diet (DM2, n = 14); and a control group with no treatment (C, n = 14). Forced oscillations were applied to assess airway resistance (Raw), respiratory tissue damping (G), and elastance (H). The arterial partial pressure of oxygen to the inspired oxygen fraction (PaO2/FiO2) and intrapulmonary shunt fraction (Qs/Qt) were determined from blood gas samples at positive end-expiratory pressures (PEEPs) of 0, 3, and 6 cmH2O. Lung responsiveness to methacholine was also assessed. Collagen fibers in lung tissue were quantified by histology. Results The rats in groups DM1 and DM2 exhibited elevated Raw, G, H, and Qs/Qt, compromised PaO2/FiO2, and diminished airway responsiveness. The severity of adverse tissue mechanical change correlated with excessive lung collagen expression. Increased PEEP normalized the respiratory mechanics, but the gas exchange abnormalities remained. Conclusions These findings indicate that diabetes reduces airway and lung tissue viscoelasticity, resulting in alveolar collapsibility that can be compensated by increasing PEEP. Diabetes also induces persistent alveolo-capillary dysfunction and abnormal adaptation ability of the airways to exogenous constrictor stimuli.
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Affiliation(s)
- Roberta Südy
- Department of Medical Physics and Informatics, University of Szeged, 9 Koranyi fasor, Szeged, H-6720, Hungary.,Department of Anaesthesiology and Intensive Therapy, University of Szeged, 6 Semmelweis Street, Szeged, H 6725, Hungary
| | - Álmos Schranc
- Department of Medical Physics and Informatics, University of Szeged, 9 Koranyi fasor, Szeged, H-6720, Hungary.,Department of Anaesthesiology and Intensive Therapy, University of Szeged, 6 Semmelweis Street, Szeged, H 6725, Hungary
| | - Gergely H Fodor
- Department of Medical Physics and Informatics, University of Szeged, 9 Koranyi fasor, Szeged, H-6720, Hungary
| | - József Tolnai
- Department of Medical Physics and Informatics, University of Szeged, 9 Koranyi fasor, Szeged, H-6720, Hungary
| | - Barna Babik
- Department of Anaesthesiology and Intensive Therapy, University of Szeged, 6 Semmelweis Street, Szeged, H 6725, Hungary
| | - Ferenc Peták
- Department of Medical Physics and Informatics, University of Szeged, 9 Koranyi fasor, Szeged, H-6720, Hungary.
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230
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Tesema DG, Gobena T, Ayalew A. Pulmonary Function Tests and Their Associated Factors Among Type 2 Diabetic Patients at Jimma Medical Center, in 2019; Comparative Cross-Sectional Study. Int J Gen Med 2020; 13:111-119. [PMID: 32308467 PMCID: PMC7152549 DOI: 10.2147/ijgm.s249683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Accepted: 03/18/2020] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND The presence of widespread lung microvascular circulation and abundant connective tissue with a large reserve raises the possibility that the lung may be a target organ of the pathologic processes induced by type 2 diabetes. Pulmonary function tests (PFTs) are noninvasive medical tests that show how well the lungs are working. OBJECTIVE The aim was to compare pulmonary function tests (PFTs) and their associated factors among type 2 diabetic patients and non-diabetics at Jimma Medical Center (JMC). METHODS A comparative cross-sectional study was conducted at JMC, Jimma, Southwest Ethiopia among 298 study participants from April 1 to May 30, 2019. A face-to-face interview with semi-structured questionnaire was conducted. Forced vital capacity (FVC), forced expiratory volume in one second (FEV1), ratio of FEV1/FVC, peak expiratory flow (PEF), and forced expiratory flow (FEF25-75) were recorded by using a digital Spirometer. Independent samples t-test, simple and multiple linear regression analysis were used. RESULTS The present study indicated that means of the PFTs among type 2 diabetics were significantly reduced when compared to their matched non-diabetics (FVC (%) (m=73.7±13.8 vs m=93.8±12.3), FEV1 (%) (m=76.4±13.4 vs m=93.3±12.4), FEV1/FVC (%) (m=78.99±11.4 vs m=96.6±9.33), PEF (L/s) (m=3.91±0.28 vs m=5.03±0.35), and FEF25-75 (L/s) (m=2.89±0.75 vs m=3.39±0.82)). This study also indicated that body mass index (BMI) (β=-1.93, P<0.001) and fasting blood sugar (FBS) (β=-0.22, P<0.001) were negative predictors of FVC%. BMI (β=-1.93, P<0.001) and FBS (β=-0.29, P<0.001) were negative predictors of FEV1%. BMI (β=-1.403, P<0.001) was a negative predictor of mean FEV1/FVC. BMI (β=-1.39 P<0.001) and FBS (β=-0.15, P<0.001) were negative predictors of mean PEF (L/s). BMI (β=-0.075, P<0.001) and FBS (β=-0.075, P<0.001) were negative predictors of FEF25-75 (L/s). CONCLUSION The present study showed that there were significantly reduced mean scores of FVC, FEV1, FEV1/FVC, PEF, and FEF25-75 among type 2 diabetic patients as compared to non-diabetic participants. The FBS and BMI were independent risk factors of the PFTs among the diabetics, unlike among non-diabetic participants.
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Affiliation(s)
- Dereje Gemeda Tesema
- Mettu University, Faculty of Medical Sciences, Department of Biomedical Sciences, Mettu, Ethiopia
| | - Teshome Gobena
- Jimma University, Institute of Health, Faculty of Medical Sciences, Department of Biomedical Sciences, Jimma, Ethiopia
| | - Almaz Ayalew
- Jimma University, Institute of Health, Faculty of Medical Sciences, Department of Biomedical Sciences, Jimma, Ethiopia
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231
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Sasaki H, Kawamura N, Dyck PJ, Dyck PJB, Kihara M, Low PA. Spectrum of diabetic neuropathies. Diabetol Int 2020; 11:87-96. [PMID: 32206478 PMCID: PMC7082443 DOI: 10.1007/s13340-019-00424-7] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Accepted: 12/29/2019] [Indexed: 02/06/2023]
Abstract
The diabetic state results in neuropathy. The main causative mechanism is hyperglycemia, although microvascular involvement, hypertriglyceridemia, as well as genetic and immune mechanisms may be contributory. There is a growing spectrum of types of diabetic neuropathies that differ based on the type of fibers involved (e.g. myelinated, unmyelinated, autonomic, somatic), distribution of nerves involved, and mechanisms of neuropathy. The most common type is distal sensory neuropathy (DSN), which affects the distal ends of large myelinated fibers, more often sensory than motor, and is often asymptomatic. The next-most common is distal small fiber neuropathy (DSFN), which largely affects the unmyelinated fibers and carries the phenotype of burning feet syndrome. Diabetic autonomic neuropathy (DAN) occurs when widespread involvement of autonomic unmyelinated fibers occurs, and patients can be incapacitated with orthostatic hypotension as well as neurogenic bladder and bowel involvement. Radiculoplexus diabetic neuropathy causes proximal weakness and pain, usually in the lower extremity, and has a combination of immune, inflammatory, and vascular mechanisms. The nerve roots and plexus are involved. These patients present with proximal weakness of a subacute onset, often with severe pain and some autonomic failure. Finally, rapid and sustained reduction of blood glucose can result in treatment-induced diabetic neuropathy (TIND), which largely affects the sensory and autonomic fibers. This occurs if HbA1c is rapidly reduced within 3 months, and the likelihood is proportional to the original A1c and the size of the reduction.
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Affiliation(s)
| | | | - Peter J. Dyck
- Department of Neurology, Mayo Clinic, 200 First Street SW, Rochester, MN 55905 USA
| | - P. James B. Dyck
- Department of Neurology, Mayo Clinic, 200 First Street SW, Rochester, MN 55905 USA
| | | | - Phillip A. Low
- Department of Neurology, Mayo Clinic, 200 First Street SW, Rochester, MN 55905 USA
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232
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Javed S, Hayat T, Menon L, Alam U, Malik RA. Diabetic peripheral neuropathy in people with type 2 diabetes: too little too late. Diabet Med 2020; 37:573-579. [PMID: 31797434 DOI: 10.1111/dme.14194] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/30/2019] [Indexed: 12/12/2022]
Abstract
Diabetic peripheral neuropathy in people with type 2 diabetes is poorly managed because of its insidious onset, delayed diagnosis and more complex aetiology resulting from the contribution of not only hyperglycaemia, but also ageing, hyperlipidaemia, hypertension and obesity. Because there is no US Food and Drug Adminstration-approved disease-modifying therapy for diabetic peripheral neuropathy, the key to ameliorating it in type 2 diabetes has to be through earlier diagnosis and timely multi-factorial risk factor reduction. The management of painful diabetic peripheral neuropathy also requires a detailed appraisal of the choice of therapy, taking into account efficacy, patient wishes, comorbidities, side effect profile and potential for abuse.
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Affiliation(s)
- S Javed
- Division of Cardiovascular Sciences, School of Medical Sciences, University of Manchester, Manchester, UK
| | - T Hayat
- Primary Health Care Corporation, Doha, Qatar
| | - L Menon
- Department of Medicine, Weill-Cornell Medicine-Qatar, Doha, Qatar
| | - U Alam
- Institute of Ageing and Chronic Disease, University of Liverpool, Liverpool, UK
| | - R A Malik
- Division of Cardiovascular Sciences, School of Medical Sciences, University of Manchester, Manchester, UK
- Department of Medicine, Weill-Cornell Medicine-Qatar, Doha, Qatar
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233
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DEMİRTAŞ ŞAHİN T. Resveratrolün streptozotosin ile diyabet oluşturulan sıçanlarda vas deferens kontraktilitesi üzerindeki antioksidan etkileri. CUKUROVA MEDICAL JOURNAL 2020. [DOI: 10.17826/cumj.656102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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234
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Chang JF, Wu CC, Hsieh CY, Li YY, Wang TM, Liou JC. A Joint Evaluation of Impaired Cardiac Sympathetic Responses and Malnutrition-Inflammation Cachexia for Mortality Risks in Hemodialysis Patients. Front Med (Lausanne) 2020; 7:99. [PMID: 32292788 PMCID: PMC7135880 DOI: 10.3389/fmed.2020.00099] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Accepted: 03/05/2020] [Indexed: 01/24/2023] Open
Abstract
Background: Cardiac sympathetic response (CSR) and malnutrition-inflammation syndrome (MIS) score are validated assessment tools for patients' health condition. We aim to evaluate the joint effect of CSR and MIS on all-cause and cardiovascular (CV) mortality in patients with hemodialysis (HD). Methods: Changes in normalized low frequency (ΔnLF) during HD were utilized for quantification of CSR. Unadjusted and adjusted hazard ratios (aHRs) of mortality risks were analyzed in different groups of ΔnLF and MIS score. Results: In multivariate analysis, higher ΔnLF was related to all-cause, CV and sudden cardiac deaths [aHR: 0.78 (95% confidence interval (CI): 0.72–0.85), 0.78 (95% CI: 0.70–0.87), and 0.74 (95% CI: 0.63–0.87), respectively]. Higher MIS score was associated with incremental risks of all-cause, CV and sudden cardiac deaths [aHR: 1.36 (95% CI: 1.13–1.63), 1.33 (95% CI: 1.06 – 1.38), and 1.50 (95% CI: 1.07–2.11), respectively]. Patients with combined lower ΔnLF (≤6.8 nu) and higher MIS score were at the greatest risk of all-cause and CV mortality [aHR: 5.64 (95% CI: 1.14–18.09) and 5.86 (95% CI: 1.64–13.65), respectively]. Conclusion: Our data indicate a joint evaluation of CSR and MIS score to identify patients at high risk of death is more comprehensive and convincing. Considering the extremely high prevalence of cardiac autonomic neuropathy and malnutrition-inflammation cachexia in HD population, a non-invasive monitoring system composed of CSR analyzer and MIS score calculator should be developed in the artificial intelligence-based prediction of clinical events.
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Affiliation(s)
- Jia-Feng Chang
- Division of Nephrology, Department of Internal Medicine, Taipei Medical University-Shuang Ho Hospital, New Taipei City, Taiwan.,Graduate Institute of Aerospace and Undersea Medicine, Academy of Medicine, National Defense Medical Center, Taipei, Taiwan.,Division of Nephrology, Department of Internal Medicine, En Chu Kong Hospital, New Taipei City, Taiwan.,Department of Nursing, Yuanpei University of Medical Technology, Hsinchu, Taiwan.,Renal Care Joint Foundation, New Taipei City, Taiwan.,Department of Pathology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Chang-Chin Wu
- Department of Biomedical Engineering, Yuanpei University of Medical Technology, Hsinchu, Taiwan.,Department of Orthopedics, En Chu Kong Hospital, New Taipei City, Taiwan
| | - Chih-Yu Hsieh
- Department of Pathology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Yen-Yao Li
- Department of Orthopedic Surgery, Chang Gung Memorial Hospital, Chiayi City, Taiwan.,College of Medicine, Chang Gung University, Taoyuan City, Taiwan
| | - Ting-Ming Wang
- Department of Orthopaedic Surgery, National Taiwan University Hospital, Taipei, Taiwan
| | - Jian-Chiun Liou
- School of Biomedical Engineering, Taipei Medical University, Taipei, Taiwan
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235
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Attenuation of Cortically Evoked Motor-Neuron Potential in Streptozotocin-Induced Diabetic Rats: A Study about the Effect of Diabetes upon Cortical-Initiated Movement. BIOMED RESEARCH INTERNATIONAL 2020; 2020:1942534. [PMID: 32185194 PMCID: PMC7061124 DOI: 10.1155/2020/1942534] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/16/2019] [Revised: 02/03/2020] [Accepted: 02/05/2020] [Indexed: 12/25/2022]
Abstract
Aims/Hypothesis. The complications affecting the peripheral nervous system, associated with diabetes mellitus, have been the focus of considerable research. Comparably less research has focused upon the effect of diabetes upon the central nervous system. In this study, we investigate the effect of diabetes upon motor-neuron potentials evoked in the motor cortex of streptozotocin diabetic rats. Methods In this study, we investigated the cortical-evoked motor-neuron potentials in streptozotocin-induced diabetic rats. Cortical potentials were evoked using direct current stimulation to the motor cortex, and the resulting evoked potentials were recorded in the sciatic nerve. As voluntary movement consists of repeated activation of muscles, repeated stimulation trials were used to determine the effect of diabetes upon the animals' ability to recuperate between stimulations. Results Our findings showed that diabetes severely decreased the amplitude of cortical-evoked potentials and compromised the recuperation of motor neurons between activation. Conclusion/Interpretation. The reduced amplitude and weakened recuperation of diabetic motor neurons potentially may contribute to impaired transmission in motor pathways and thereby motor dysfunction.
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Prevalence and Correlates of Cardiovascular Autonomic Neuropathy Among Patients with Diabetes in Uganda: A Hospital-Based Cross-sectional Study. Glob Heart 2020; 15:21. [PMID: 32489794 PMCID: PMC7218768 DOI: 10.5334/gh.765] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Background: Cardiovascular autonomic neuropathy (CAN) is a common complication in individuals with diabetes mellitus (DM) but often overlooked in clinical practice. The burden and correlates of CAN have not been extensively studied in low-income countries, particularly in sub-Saharan Africa. Objectives: To determine the prevalence and correlates of CAN among adults in ambulatory diabetes care in southwestern Uganda. Method: We conducted a cross-sectional study among adults with diabetes from November 2018 to April 2019. CAN was assessed using the five autonomic function tests: deep breathing, Valsalva maneuver, postural index on standing, change in blood pressure during standing and diastolic blood pressure response to isometric exercise. We estimated the prevalence of CAN and fit regression models to identify its demographic and clinical correlates. Results: We enrolled 299 individuals. The mean age was 50.1 years (SD ± 9.8), mean HbA1c was 9.7 (SD ± 2.6) and 69.6% were female. CAN was detected in 156/299 (52.2%) of the participants on the basis of one or more abnormal cardiovascular autonomic reflex tests. Out of 299 participants, 88 (29.4%) were classified as early CAN while 61/299 (20.4%) and 7/299 (2.3%) were classified as definite and severe (advanced) CAN respectively. In multivariable regression models, age over 50 years (aOR 3.48, 95%CI 1.35 –8.99, p = 0.010), duration of diabetes over 10 years (aOR 4.09, 95%CI 1.78 –9.38, p = 0.001), and presence of diabetic retinopathy (aOR 2.25, 95%CI 1.16 –4.34, p = 0.016) were correlated with CAN. Conclusions: Our findings reveal a high prevalence of CAN among individuals in routine outpatient care for diabetes mellitus in Uganda. Older age, longer duration of diabetes and coexistence of retinopathy are associated with CAN. Future work should explore the clinical significance and long term outcomes associated with CAN in this region.
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237
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Ju J, Tomaszewski EL, Orchard TJ, Evans RW, Feingold E, Costacou T. The haptoglobin 2-2 genotype is associated with cardiac autonomic neuropathy in type 1 diabetes: the RETRO HDLc study. Acta Diabetol 2020; 57:271-278. [PMID: 31529337 PMCID: PMC7054154 DOI: 10.1007/s00592-019-01422-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Accepted: 09/06/2019] [Indexed: 10/26/2022]
Abstract
AIM The haptoglobin (Hp) 2-2 genotype has been shown to increase the risk of coronary artery disease, kidney dysfunction and mortality from cardiovascular and renal causes in type 1 diabetes (T1D). Similar associations, however, have not been observed in those without diabetes. As cardiac autonomic neuropathy (CAN) is a cardiovascular disease risk factor, we assessed the presence of an association between the Hp 2-2 genotype and CAN. METHODS The study included 216 individuals with childhood-onset T1D and 200 individuals with normal glucose tolerance (NGT) of similar age and gender distribution to their counterparts with T1D. CAN was assessed using an electrocardiogram as an abnormal, age-specific, heart rate response to deep breathing. Multivariable logistic regression models were used to assess the association between the Hp 2-2 genotype and CAN. RESULTS Compared with NGT, participants with T1D had a similar proportion of Hp 2-2 carriers (41.5% vs. 32.0%, p = 0.05) but a greater CAN prevalence (28.2% vs. 5.0%, p < 0.0001). In multivariable logistic regression models, those carrying the Hp 2-2 genotype had significantly higher odds of CAN compared with Hp 1-1 or Hp 2-1 carriers (OR = 2.27, p = 0.01). The presence of T1D (OR = 4.20, p = 0.0003), hypertension (OR = 2.08, p = 0.03), eGFR (OR = 0.98, p = 0.01) and WBC count (OR = 1.21, p = 0.02) were also associated with CAN. There was no T1D by Hp interaction (p = 0.92), although in stratified analyses, the Hp-CAN association was significant only in T1D. CONCLUSIONS The Hp 2-2 genotype was independently associated with greater odds of CAN in T1D though no definitive conclusions could be made in NGT.
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Affiliation(s)
- Jinghui Ju
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, 130 De Soto St, Pittsburgh, PA, 15261, USA
| | - Erin L Tomaszewski
- Diabetes and Lipid Research Clinic, Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, 3512 Fifth Avenue, Pittsburgh, PA, 15213, USA
| | - Trevor J Orchard
- Diabetes and Lipid Research Clinic, Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, 3512 Fifth Avenue, Pittsburgh, PA, 15213, USA
| | - Rhobert W Evans
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, 130 De Soto St, Pittsburgh, PA, 15261, USA
| | - Eleanor Feingold
- Department of Human Genetics, Graduate School of Public Health, University of Pittsburgh, 130 De Soto St, Pittsburgh, PA, 15261, USA
| | - Tina Costacou
- Diabetes and Lipid Research Clinic, Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, 3512 Fifth Avenue, Pittsburgh, PA, 15213, USA.
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238
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Tan JS, Lin CC, Chen GS. Vasomodulation of peripheral blood flow by focused ultrasound potentiates improvement of diabetic neuropathy. BMJ Open Diabetes Res Care 2020; 8:8/1/e001004. [PMID: 32188594 PMCID: PMC7078690 DOI: 10.1136/bmjdrc-2019-001004] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Revised: 01/31/2020] [Accepted: 02/22/2020] [Indexed: 01/25/2023] Open
Abstract
OBJECTIVE Effective treatment methods for diabetic peripheral neuropathy are still lacking. Here, a focused ultrasound (FUS) technique was developed to improve blood flow in diabetic peripheral vessels and potentially treat diabetic peripheral neuropathy. RESEARCH DESIGN AND METHODS Male adult Sprague-Dawley rats at 4 weeks poststreptozotocin injections were adopted as models for diabetic neuropathic rats. For single FUS treatment, blood perfusion in the skin of the pad of the middle toe was measured before, during, and after the medial and lateral plantar arteries were treated by FUS. For multiple FUS treatments, blood perfusion measurements, von Frey and hot plate testing and nerve conduction velocity measurements were performed before ultrasonic treatment on the first day of each week, and the microvascular and neural fiber densities in the pad of the toe were measured on the first day of the last week. RESULTS The blood perfusion rate significantly increased for 7-10 min in the control and neuropathic rats after a single ultrasound exposure. Multiple ultrasound treatments compared with no treatments significantly increased blood perfusion at the second week and further enhanced perfusion at the third week in the neuropathic rats. Additionally, the paw withdrawal force and latency significantly increased from 34.33±4.55 g and 3.96±0.25 s at the first week to 39.10±5.02 g and 4.77±0.71 s at the second week and to 41.13±2.57 g and 5.24±0.86 s at the third week, respectively. The low nerve conduction velocity in the diabetic rats also improved after the ultrasound treatments. Additionally, ultrasound treatments halted the decrease in microvessel and neural fiber densities in the skin of the diabetic toes. Histologic analysis indicated no damage to the treated arteries or neighboring tissue. CONCLUSIONS FUS treatment can increase upstream arterial blood flow in diabetic feet, ameliorate the decrease in downstream microvessel perfusion and halt neuropathic progression.
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Affiliation(s)
- Joo-Shin Tan
- Department of Biomedical Engineering and Nanomedicine, National Health Research Institutes, Zhunan, Taiwan
| | - Chou-Ching Lin
- Department of Neurology, National Cheng Kung University Hospital, Tainan, Taiwan
| | - Gin-Shin Chen
- Department of Biomedical Engineering and Nanomedicine, National Health Research Institutes, Zhunan, Taiwan
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239
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Selbuz S, Buluş AD. Gastrointestinal symptoms in pediatric patients with type 1 diabetes mellitus. J Pediatr Endocrinol Metab 2020; 33:185-190. [PMID: 31846427 DOI: 10.1515/jpem-2019-0350] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Accepted: 10/03/2019] [Indexed: 12/12/2022]
Abstract
Background Various gastrointestinal (GI) symptoms are associated with diabetes. Common GI complaints associated with the manifestation of the disease include abdominal pain, diarrhea, nausea, bloating and vomiting. There have been very few studies examining GI problems of pediatric patients with type 1 diabetes mellitus (T1DM). The aims of this study were to find out the prevalence of GI symptoms in pediatric patients with T1DM and to determine the correlation among such symptoms, duration of diabetes and glycemic control. Methods One hundred and thirty-seven (median age 13.2 years, female 45.3%) patients with T1DM were examined. Demographic features, GI symptoms, signs and physical examination findings of the patients were recorded by pediatric gastroenterology specialists for the differential diagnosis and exclusion of other etiologies. Complete blood count, blood glucose, lipid profile, electrolytes, amylase, lipase, celiac antibodies and glycated hemoglobin (HbA1c) levels were evaluated and stool examination was performed. Endoscopy was performed on the patients who had refractory GI complaints. Gastric emptying (GE) time was evaluated using GE scintigraphy. Results Overall, 74 (54%) patients had ≥1 GI complaints. Patients often reported gastroesophageal reflux (32.8%) and abdominal pain (18%). The most significant findings in terms of GI symptoms were determined when patients were classified according to the glycemic control status. Reflux and dyspeptic symptoms were significantly more common in poorly or very poorly controlled diabetic patients (p=0.003 and p=0.004, respectively). Conclusions Diabetes can affect the entire GI tract, and GI symptoms are common in pediatric patients. We recommend that T1DM patients be evaluated for GI symptoms.
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Affiliation(s)
- Suna Selbuz
- Keçiören Research and Training Hospital, Pediatric Endocrinology, Ankara, Turkey
| | - Ayşe Derya Buluş
- Keçiören Research and Training Hospital, Pediatric Endocrinology, Ankara, Turkey
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240
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Clinical Impact of Atypical Chest Pain and Diabetes Mellitus in Patients with Acute Myocardial Infarction from Prospective KAMIR-NIH Registry. J Clin Med 2020; 9:jcm9020505. [PMID: 32059609 PMCID: PMC7074023 DOI: 10.3390/jcm9020505] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Revised: 02/04/2020] [Accepted: 02/10/2020] [Indexed: 11/27/2022] Open
Abstract
Atypical chest pain and diabetic autonomic neuropathy attract less clinical attention, leading to underdiagnosis and delayed treatment. To evaluate the long-term clinical impact of atypical chest pain and diabetes mellitus (DM), we categorized 11,159 patients with acute myocardial infarction (AMI) from the Korea AMI-National Institutes of Health between November 2011 and December 2015 into four groups (atypical DM, atypical non-DM, typical DM, and typical non-DM). The primary endpoint was defined as patient-oriented composite endpoint (POCE) at 2 years including all-cause death, any myocardial infarction (MI), and any revascularization. Patients with atypical chest pain showed higher 2-year mortality than those with typical chest pain in both DM (29.5% vs. 11.4%, p < 0.0001) and non-DM (20.4% vs. 6.3%, p < 0.0001) groups. The atypical DM group had the highest risks of POCE (hazard ratio (HR) 1.76, 95% confidence interval (CI) 1.48–2.10), all-cause death (HR 2.23, 95% CI 1.80–2.76) and any MI (HR 2.34, 95% CI 1.51–3.64) in the adjusted model. In conclusion, atypical chest pain was significantly associated with mortality in patients with AMI. Among four groups, the atypical DM group showed the worst clinical outcomes at 2 years. Application of rapid rule in/out AMI protocols would be beneficial to improve clinical outcomes.
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241
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Abstract
Cardiac autonomic neuropathy (CAN) is an underdiagnosed cardiovascular complication associated with diabetes. NPs are in a pivotal position to screen patients for CAN. As the incidence of diabetes increases in an aging population, NPs can help prevent complications associated with diabetes and CAN.
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242
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Goldberger JJ, Arora R, Buckley U, Shivkumar K. Autonomic Nervous System Dysfunction: JACC Focus Seminar. J Am Coll Cardiol 2020; 73:1189-1206. [PMID: 30871703 DOI: 10.1016/j.jacc.2018.12.064] [Citation(s) in RCA: 130] [Impact Index Per Article: 32.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Revised: 12/21/2018] [Accepted: 12/30/2018] [Indexed: 12/20/2022]
Abstract
Autonomic nervous system control of the heart is a dynamic process in both health and disease. A multilevel neural network is responsible for control of chronotropy, lusitropy, dromotropy, and inotropy. Intrinsic autonomic dysfunction arises from diseases that directly affect the autonomic nerves, such as diabetes mellitus and the syndromes of primary autonomic failure. Extrinsic autonomic dysfunction reflects the changes in autonomic function that are secondarily induced by cardiac or other disease. An array of tests interrogate various aspects of cardiac autonomic control in either resting conditions or with physiological perturbations from resting conditions. The prognostic significance of these assessments have been well established. Clinical usefulness has not been established, and the precise mechanistic link to mortality is less well established. Further efforts are required to develop optimal approaches to delineate cardiac autonomic dysfunction and its adverse effects to develop tools that can be used to guide clinical decision-making.
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Affiliation(s)
- Jeffrey J Goldberger
- Cardiovascular Division, Department of Medicine, University of Miami Miller School of Medicine, Miami, Florida.
| | - Rishi Arora
- Feinberg Cardiovascular Research Institute, Division of Cardiology, Department of Medicine, Northwestern University-Feinberg School of Medicine, Chicago, Illinois
| | - Una Buckley
- Cardiac Arrhythmia Center and Neurocardiology Research Center of Excellence, University of California-Los Angeles Los Angeles, California
| | - Kalyanam Shivkumar
- Cardiac Arrhythmia Center and Neurocardiology Research Center of Excellence, University of California-Los Angeles Los Angeles, California
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243
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Roy S, Goswami DP, Sengupta A. Geometry of the Poincaré plot can segregate the two arms of autonomic nervous system - A hypothesis. Med Hypotheses 2020; 138:109574. [PMID: 32014816 DOI: 10.1016/j.mehy.2020.109574] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Revised: 01/01/2020] [Accepted: 01/16/2020] [Indexed: 10/25/2022]
Abstract
Autonomic Nervous System (ANS) operates to achieve the optimum physiological functioning and maintains homeostasis in a tonic and continuous manner. Evaluation of ANS profile is crucial in assessing autonomic dysfunction. Conventional ANS evaluation procedures fail to capture minute dynamic alterations of ANS activities. The ANS output pattern is appropriately reflected in the fine alteration of the resting heart rate (HR). HR is a non-stationary variable, results from the dynamic interplay between the multiple physiologic mechanisms. The control of cardiac rate or the chronotropic regulation of heart is considered as a coupled network of oscillators, each representing a specific facet of the cardiovascular reflex. The slower vasomotor oscillation via sympathetic system is combined with rapid respiratory oscillation by parasympathetic system to modulate the intrinsic oscillation pattern of the SA Node. Heart Rate Variability (HRV) is used to understand the autonomic influence on cardiovascular system in health and disease. Fourier decomposition of HRV offers us mainly two different frequency components. High frequency (HF) variation indicates parasympathetic variability due to respiration and Low frequency (LF) mainly implicates tonic sympathetic influence, due to slower vasomotor modulation of heart rate. However, different studies show conflicting results and direct recording of sympathetic nerve activity also failed to correlate with LF power in either healthy subjects or in patients with increased cardiac sympathetic drive. A scatter-plot where each R-R interval is plotted against the preceding R-R interval forms a distributed elliptic point cloud in two dimensional plane. The phase space realization of this plot with dimension two and delay one is referred to as Poincaré plot analysis, an emerging quantitative-visual technique where the shape of the plot is categorized into different functional classes. The plot provides summary as well as detailed beat-to-beat information of the heart. This plot can be extended to three dimensions and with multi-lag, offering more insight and information. A mathematical expression was developed by an interventional study by Toichi et al., using pharmacological blockers during different physiological variables that calculated the lengths of transverse and longitudinal axes of the Poincaré plot to derive two quantitative expressions of sympathetic and vagal influence on HRV: 'cardiac sympathetic index' (CSI)) and 'cardiac vagal index' (CVI). In the present study, we emulate Poincaré plot patterns seen in normal range of sympatho-vagal balances and also in Diabetes Mellitus (DM), known to cause autonomic dysfunction. The emerging pattern of R-R interval time series would provide valuable insight into the altered temporal dynamics and also extract crucial features embedded within. DM is a major public health crisis globally and particularly in Indian population. We hypothesize that, CSI and CVI will effectively segregate the two arms of ANS and can be utilized as an effective evaluation tool to explore the disease status in patients of Diabetes Mellitus. We also propose that, the dynamics of fluctuations in physiological rhythms that exhibit long-term correlation and memory, can also be explored and expressed quantitatively by incorporating various degrees of 'lag' in these recurrence plots.
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Affiliation(s)
- Soma Roy
- Dept. of Physiology, Rampurhat Govt. Medical College & Hospital Birbhum, 731224 WB, India
| | - Damodar Prasad Goswami
- Dept. of Mathematics, Netaji Subhash Engineering College, Panchpota, Garia, Kolkata 700152, West Bengal, India
| | - Arnab Sengupta
- Dept. of Physiology, Calcutta Medical College, 88, College Street, Calcutta 700073, India.
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Perry S, Khovanova N, Khovanov I. Physical fitness contributes to cardio-respiratory synchronization. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2020; 2019:4957-4960. [PMID: 31946972 DOI: 10.1109/embc.2019.8857193] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Cardio-respiratory synchronization is a phenomenon of particular interest- especially at a 1:1 ratio- and may give greater insight into the underlying mechanisms of cardio-respiratory communication. Synchronization of this ratio is hypothesised to occur when breathing rate exceeds heart rate, which is the premise of this research. A novel experimental design focused on guiding elevated respiration to induce the entrainment of heart rate, and produce an equivalent rise in value. Application of instantaneous phase for identification and analysis of synchronization allowed for a reliable method of measuring the interaction between these stochastic processes. We have identified 1:1 phase synchronization in all volunteers measured. Longer synchronization episodes were observed reliably in athletic individuals, corroborating previous research for spontaneous breathing. This observation suggests that cardio-respiratory synchronization at all respiration rates is associated with a common underlying communication mechanism. Furthermore, it presents cardio-respiratory synchronization as a potential future measurement of fitness and autonomic health.
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Argente-Pla M, Pérez-Lázaro A, Martinez-Millana A, Del Olmo-García MI, Espí-Reig J, Beneyto-Castello I, López-Andújar R, Merino-Torres JF. Simultaneous Pancreas Kidney Transplantation Improves Cardiovascular Autonomic Neuropathy with Improved Valsalva Ratio as the Most Precocious Test. J Diabetes Res 2020; 2020:7574628. [PMID: 32337297 PMCID: PMC7168717 DOI: 10.1155/2020/7574628] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Revised: 02/18/2020] [Accepted: 03/09/2020] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Simultaneous pancreas-kidney (SPK) transplantation is a proven option of treatment for patients with type 1 diabetes mellitus (T1DM) and related end-stage renal disease. There is discrepancy between the results of different studies about the impact of prolonged normalization of glucose metabolism achieved by SPK on the course of diabetic complications including severe forms of diabetic neuropathy. The objective of the study was to evaluate the prevalence of cardiovascular autonomic neuropathy (CAN) in patients undergoing SPK transplantation and its evolution 10 years after transplantation. METHODS Prospective study of 81 patients transplanted in a single center from year 2002 to 2015. Autonomic function was assessed using cardiovascular autonomic reflex tests (CARTs). CARTs were made before SPK transplantation and during the follow-up. Evolution of tests after SPK transplantation was evaluated by contrasting hypotheses (paired tests). Multiple testing was adjusted with the Benjamini-Hochberg procedure with a false discovery rate of 10%. RESULTS 48 males and 33 females, mean age 37.4 ± 5.7 years, mean BMI 24.0 ± 3.4 kg/m2, and mean duration of diabetes 25.5 ± 6.5 years, received SPK transplantation. Ten years after SPK transplantation, 56 patients re tained the pancreatic graft (42 of them with normofunctioning pancreas and 14 with low doses of insulin therapy). These 42 patients were selected for the autonomic study. Before transplant procedure, all CART results were abnormal. After SPK transplantation, paired test analysis showed an improvement of systolic blood pressure (SBP) response to orthostasis at the 5th year after SPK (p = 0.03), as well as improvement of the Valsalva ratio at the 3rd (p < 0.001) and 5th (p = 0.001) year after SPK. After correcting for the false discovery rate, all the variables of autonomic study reached significance at different time points. CONCLUSIONS Prevalence of CAN in patients who are candidates for SPK transplantation is high and is generally advanced. SPK transplantation improves CAN with improved Valsalva ratio as the most precocious test.
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Affiliation(s)
- María Argente-Pla
- Endocrinology and Nutrition Department, Hospital Universitario i Politécnico La Fe, Valencia, Spain
- Mixed Research Unit of Endocrinology, Nutrition and Dietetics, La Fe Health Research Institute, Valencia, Spain
| | - Antonia Pérez-Lázaro
- Endocrinology and Nutrition Department, Hospital Universitario i Politécnico La Fe, Valencia, Spain
- Mixed Research Unit of Endocrinology, Nutrition and Dietetics, La Fe Health Research Institute, Valencia, Spain
| | | | - María Isabel Del Olmo-García
- Endocrinology and Nutrition Department, Hospital Universitario i Politécnico La Fe, Valencia, Spain
- Mixed Research Unit of Endocrinology, Nutrition and Dietetics, La Fe Health Research Institute, Valencia, Spain
| | - Jordi Espí-Reig
- Nephrology Department, Hospital Universitario i Politécnico La Fe, Valencia, Spain
| | | | - Rafael López-Andújar
- Hepato-pancreato-biliary (HPB) Surgery and Transplant Unit, Hospital Universitario i Politécnico La Fe, Valencia, Spain
| | - Juan Francisco Merino-Torres
- Endocrinology and Nutrition Department, Hospital Universitario i Politécnico La Fe, Valencia, Spain
- Mixed Research Unit of Endocrinology, Nutrition and Dietetics, La Fe Health Research Institute, Valencia, Spain
- Medicine Department, Universitat de Valencia, Spain
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Hassanabad MF, Fatehi M. Androgen Therapy in Male Patients Suffering from Type 2 Diabetes: A Review of Benefits and Risks. Curr Diabetes Rev 2020; 16:189-199. [PMID: 30073928 DOI: 10.2174/1573399814666180731125724] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2018] [Revised: 07/23/2018] [Accepted: 07/29/2018] [Indexed: 12/18/2022]
Abstract
BACKGROUND The current estimated numbers of patients with Type 2 Diabetes (T2D) is believed to be close to 10% of the whole populations of many geographical regions, causing serious concerns over the resulting elevated morbidity and mortality as well as the impact on health care systems around the world. In addition to negatively affecting the quality of life, diabetes is associated with cardiovascular and cerebrovascular complications, indicating that appropriate drug therapy should not only deal with metabolic dysfunction but also protect the vascular system, kidney function and skeletal muscle mass from the effects of the epigenetic changes induced by hyperglycaemia. OBJECTIVE To provide an insight into the management of hypogonadism associated with T2D, this review focuses on clinical observations related to androgen therapy in qualified diabetic patients, and discusses the lines of evidence for its benefits and risks. The potential interactions of testosterone with medicines used by patients with T2D will also be discussed. CONCLUSION From recent clinical findings, it became evident that a considerable percentage of patients suffering from T2D manifested low serum testosterone and experienced diminished sexual activity, as well as reduced skeletal muscle mass and lower bone density. Although there are some controversies, Testosterone Replacement Therapy (TRT) for this particular population of patients appears to be beneficial overall only if it is implemented carefully and monitored regularly.
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Affiliation(s)
- Mortaza F Hassanabad
- Alberta Institute of Diabetes and Department of Pharmacology, Faculty of Sciences, University of Alberta, Edmonton, Canada
| | - Mohammad Fatehi
- Alberta Institute of Diabetes and Department of Pharmacology, Faculty of Medicine, University of Alberta, Edmonton, Canada
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Singh P, Bansal S, Kuhad A, Kumar A, Chopra K. Naringenin ameliorates diabetic neuropathic pain by modulation of oxidative-nitrosative stress, cytokines and MMP-9 levels. Food Funct 2020; 11:4548-4560. [DOI: 10.1039/c9fo00881k] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Diabetes mellitus is a serious debilitating epidemic affecting all social strata, imposing huge health, social and economic burdens.
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Affiliation(s)
- Pratishtha Singh
- University Institute of Pharmaceutical Sciences
- Panjab University
- Chandigarh-160014
- India
| | - Seema Bansal
- University Institute of Pharmaceutical Sciences
- Panjab University
- Chandigarh-160014
- India
| | - Anurag Kuhad
- University Institute of Pharmaceutical Sciences
- Panjab University
- Chandigarh-160014
- India
| | - Anil Kumar
- University Institute of Pharmaceutical Sciences
- Panjab University
- Chandigarh-160014
- India
| | - Kanwaljit Chopra
- University Institute of Pharmaceutical Sciences
- Panjab University
- Chandigarh-160014
- India
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Silva LDSD, de Queiroz NNM, de Melo FTC, Abrahão Neto JF, Janaú LC, de Souza Neto NJK, de Lemos MN, de Oliveira MCNI, de Alcântara AL, de Moraes LV, da Silva WM, de Souza ÍJA, Said NM, de Lemos GN, Felício KM, dos Santos MC, Motta ARB, dos Reis MDSO, Lobato IJC, de Figueiredo PBB, de Souza ACCB, Piani PPF, Felício JS. Improvement in Cardiovascular Autonomic Neuropathy After High-Dose Vitamin D Supplementation in Patients With Type 1 Diabetes. Front Endocrinol (Lausanne) 2020; 11:605681. [PMID: 33329405 PMCID: PMC7711089 DOI: 10.3389/fendo.2020.605681] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2020] [Accepted: 10/21/2020] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Cardiovascular autonomic neuropathy (CAN) is associated with diabetes mellitus, increasing morbidity and mortality. Some cross-sectional studies associated CAN with low 25-hydroxyvitamin D levels. The aim of our study was to evaluate the effect of high-dose vitamin D (VD) supplementation on CAN in Type 1 Diabetes Mellitus (T1DM) patients. METHODS We performed a prospective study with 23 patients diagnosed with T1DM and CAN. Subjects with VD levels <30 ng/ml received 10,000 IU/day; the ones with VD levels between 30-60 ng/ml were given 4,000 IU/day for 12 weeks. RESULTS There was an improvement in CAN parameters related to resting heart rate variability, such as time domain parameters [Maximum RR interval (0.77 ± 0.11 vs 0.94 ± 0.51 s, p <0.05), Mean length of regular RR intervals (0.71 ± 0.10 vs 0.76 ± 0.09 s, p <0.05) and Standard deviation of all NN intervals (0.02 ± 0.01 vs 0.03 ± 0.02 s; p <0.01)] and frequency domain parameters [Low Frequency (1.9 ± 0.5 vs 2.5 ± 0.9 s, p < 0.001), Total Power (2.5 ± 0.4 vs 2.8 ± 0.6 s, p <0.05)]. In addition, there was a correlation between absolute VD level variation and posttreatment High Frequency (%), as well as among percent variation in VD level and end-of-study Low Frequency/High Frequency ratio (r=0.6, p<0.01; r= -0.5, p<0.05, respectively). CONCLUSION Our pilot study is the first to suggest a strong association between high-dose vitamin D supplementation and improved cardiovascular autonomic neuropathy in T1DM patients. It occurred without any variation in HbA1C, blood pressure levels, lipids, and insulin dose. CLINICAL TRIAL REGISTRATION http://www.isrctn.com/ISRCTN32601947, identifier ISRCTN32601947.
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Affiliation(s)
| | | | | | - João Felício Abrahão Neto
- Endocrinology Division, University Hospital João de Barros Barreto, Federal University of Pará, Belém, Brazil
| | | | | | - Manuela Nascimento de Lemos
- Endocrinology Division, University Hospital João de Barros Barreto, Federal University of Pará, Belém, Brazil
| | | | - Angélica Leite de Alcântara
- Endocrinology Division, University Hospital João de Barros Barreto, Federal University of Pará, Belém, Brazil
| | - Lorena Vilhena de Moraes
- Endocrinology Division, University Hospital João de Barros Barreto, Federal University of Pará, Belém, Brazil
| | - Wanderson Maia da Silva
- Endocrinology Division, University Hospital João de Barros Barreto, Federal University of Pará, Belém, Brazil
| | - Ícaro José Araújo de Souza
- Endocrinology Division, University Hospital João de Barros Barreto, Federal University of Pará, Belém, Brazil
| | - Nivin Mazen Said
- Endocrinology Division, University Hospital João de Barros Barreto, Federal University of Pará, Belém, Brazil
| | | | - Karem Miléo Felício
- Endocrinology Division, University Hospital João de Barros Barreto, Federal University of Pará, Belém, Brazil
| | - Márcia Costa dos Santos
- Endocrinology Division, University Hospital João de Barros Barreto, Federal University of Pará, Belém, Brazil
| | - Ana Regina Bastos Motta
- Endocrinology Division, University Hospital João de Barros Barreto, Federal University of Pará, Belém, Brazil
| | | | - Isabel Jane Campos Lobato
- Endocrinology Division, University Hospital João de Barros Barreto, Federal University of Pará, Belém, Brazil
| | | | | | - Pedro Paulo Freire Piani
- Endocrinology Division, University Hospital João de Barros Barreto, Federal University of Pará, Belém, Brazil
| | - João Soares Felício
- Endocrinology Division, University Hospital João de Barros Barreto, Federal University of Pará, Belém, Brazil
- *Correspondence: João Soares Felício,
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Cankurtaran V, Ozates S, Ozler S. Association of pupil responses with severity of erectile dysfunction in diabetes mellitus. Indian J Ophthalmol 2019; 67:1314-1319. [PMID: 31332117 PMCID: PMC6677051 DOI: 10.4103/ijo.ijo_220_19] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Purpose: To investigate the relation between erectile dysfunction (ED) severity and pupillary functions in patients with diabetes mellitus (DM). Methods: This prospective and observational study included 90 patients with type 2 DM and ED. Patients divided into three subgroups according to severity of ED: (i) Mild ED, (ii) Moderate ED and (iii) Severe ED groups. Thirty age-matched healthy subjects formed the control group. Main outcome measures were pupil diameter and average speed of pupil dilation. Static and dynamic pupillometry analysis was performed using the Sirius Topographer (CSO, Firenze, Italy). Results: Mean pupil diameter during static and dynamic pupillometry analysis were significantly greater in the control group than in the all study groups (P < 0.05). Mean pupil diameter in static pupillometry analysis was significantly different in each study group and pupil was more miotic in the Severe ED group than in the both Moderate and Mild ED groups (P < 0.05 for each). Dynamic pupillometry analysis revealed that mean pupil diameter and mean average dilation speed were significantly different in each study group throughout measurement period and the highest speed was observed in the Mild ED group and the lowest speed was observed in the severe ED group (P < 0.005 for each). Conclusion: Our study results suggest that abnormal pupil functions due to diabetic autonomic neuropathy may indicate the associated ED in patients with DM.
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Affiliation(s)
- Veysel Cankurtaran
- Department of Ophthalmology, Medical School of Mustafa Kemal University, Hatay, Turkey
| | - Serdar Ozates
- Department of Ophthalmology, Kars Harakani State Hospital, Kars, Turkey
| | - Serkan Ozler
- Department of Urology, Medical School of Mustafa Kemal University, Hatay, Turkey
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