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Hajdú N, Rácz R, Tordai DZ, Békeffy M, Vági OE, Istenes I, Körei AE, Kempler P, Putz Z. Genetic Variants Influence the Development of Diabetic Neuropathy. Int J Mol Sci 2024; 25:6429. [PMID: 38928135 PMCID: PMC11203776 DOI: 10.3390/ijms25126429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2024] [Revised: 05/22/2024] [Accepted: 06/06/2024] [Indexed: 06/28/2024] Open
Abstract
The exact mechanism by which diabetic neuropathy develops is still not fully known, despite our advances in medical knowledge. Progressing neuropathy may occur with a persistently favorable metabolic status in some patients with diabetes mellitus, while, in others, though seldom, a persistently unfavorable metabolic status is not associated with significant neuropathy. This might be significantly due to genetic differences. While recent years have brought compelling progress in the understanding of the pathogenetic background-in particular, accelerated progress is being made in understanding molecular biological mechanisms-some aspects are still not fully understood. A comparatively small amount of information is accessible on this matter; therefore, by summarizing the available data, in this review, we aim to provide a clearer picture of the current state of knowledge, identify gaps in the previous studies, and possibly suggest directions for future studies. This could help in developing more personalized approaches to the prevention and treatment of diabetic neuropathy, while also taking into account individual genetic profiles.
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Körei AE, Putz Z, Vági OE, Tordai DZ, Menyhárt A, Istenes I, Horváth VJ, Kempler P. The handgrip test - A historical test for diabetic autonomic neuropathy or a marker of something else? J Diabetes Complications 2024; 38:108668. [PMID: 38241880 DOI: 10.1016/j.jdiacomp.2023.108668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Revised: 12/10/2023] [Accepted: 12/17/2023] [Indexed: 01/21/2024]
Abstract
Cardiovascular autonomic neuropathy (CAN) is a frequent complication of diabetes mellitus and is associated with increased morbidity and mortality in patients with diabetes. Hence, early and correct diagnosis of CAN is crucial. Standard cardiovascular reflex rests (CARTs) have been the gold standard of CAN assessment. Originally, CARTs consisted of five reflex tests, but measuring diastolic blood pressure response to sustained handgrip exercise has no longer been suggested as an established clinical test. Increasing body of evidence suggests that isometric handgrip test should no longer be used for the evaluation of sympathetic dysfunction during cardiovascular autonomic neuropathy assessment in diabetic patients. The associations of isometric handgrip test results with parameters of hypertension and markers of hypertension-related target-organ damage in diabetic and non-diabetic individuals point toward its potential role as a screening tool to identify patients with high cardiovascular risk. The current review summarizes historical view of standard cardiovascular reflex tests and latest data on isometric handgrip test.
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Affiliation(s)
- Anna Erzsébet Körei
- Department of Internal Medicine and Oncology, Semmelweis University, Budapest, Hungary.
| | - Zsuzsanna Putz
- Department of Internal Medicine and Oncology, Semmelweis University, Budapest, Hungary
| | - Orsolya Erzsébet Vági
- Department of Internal Medicine and Oncology, Semmelweis University, Budapest, Hungary
| | - Dóra Zsuzsanna Tordai
- Department of Internal Medicine and Oncology, Semmelweis University, Budapest, Hungary
| | - Adrienn Menyhárt
- Department of Internal Medicine and Oncology, Semmelweis University, Budapest, Hungary
| | - Ildikó Istenes
- Department of Internal Medicine and Oncology, Semmelweis University, Budapest, Hungary
| | - Viktor József Horváth
- Department of Internal Medicine and Oncology, Semmelweis University, Budapest, Hungary
| | - Péter Kempler
- Department of Internal Medicine and Oncology, Semmelweis University, Budapest, Hungary
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Lee N, Kim K, Kim H. Severe bradycardia and hypotension induced by autonomic neuropathy in a diabetic patient during general anesthesia - A case report. Saudi J Anaesth 2023; 17:80-82. [PMID: 37032674 PMCID: PMC10077768 DOI: 10.4103/sja.sja_502_22] [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: 07/08/2022] [Revised: 07/09/2022] [Accepted: 07/09/2022] [Indexed: 12/24/2022] Open
Abstract
Cardiovascular autonomic neuropathy (CAN) is characterized by dysregulation of sympathetic and parasympathetic nervous systems that causes cardiovascular and respiratory disorders. The number of diabetic patients undergoing surgery is increasing in line with the prevalence of DM. Anesthesiologists should pay attention to diabetic patients with CAN because it is related to serious cardiovascular morbidity and mortality. We report an 80-year-old male who underwent cervical laminoplasty. He had severe bradycardia and hypotension from induction to the suspension of surgery. His blood pressure dropped to 70/40 mmHg and his heart rate to 20 bpm. Ephedrine, phenylephedrine, and atropine administration had minimal effect, but after epinephrine administrations, his heart rate and blood pressure increased to 70 bpm and 170/90 mmHg. The operation was discontinued because of the patient's unstable, fluctuating vital signs. The results of autonomic nervous system function examination indicated postganglionic cholinergic sympathetic dysfunction, sympathetic adrenergic dysfunction, and parasympathetic cholinergic dysfunction.
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Affiliation(s)
- Nawon Lee
- Department of Anesthesiology and Pain Medicine, College of Medicine, Yeungnam University, Daegu, Republic of Korea
| | - Kanghui Kim
- Department of Anesthesiology and Pain Medicine, College of Medicine, Yeungnam University, Daegu, Republic of Korea
| | - Hyuckgoo Kim
- Department of Anesthesiology and Pain Medicine, College of Medicine, Yeungnam University, Daegu, Republic of Korea
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Putz Z, Tordai D, Hajdú N, Vági OE, Kempler M, Békeffy M, Körei AE, Istenes I, Horváth V, Stoian AP, Rizzo M, Papanas N, Kempler P. Vitamin D in the Prevention and Treatment of Diabetic Neuropathy. Clin Ther 2022; 44:813-823. [DOI: 10.1016/j.clinthera.2022.03.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Revised: 03/22/2022] [Accepted: 03/23/2022] [Indexed: 12/17/2022]
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Bönhof GJ, Herder C, Ziegler D. Diagnostic Tools, Biomarkers, and Treatments in Diabetic polyneuropathy and Cardiovascular Autonomic Neuropathy. Curr Diabetes Rev 2022; 18:e120421192781. [PMID: 33845748 DOI: 10.2174/1573399817666210412123740] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Revised: 02/24/2021] [Accepted: 03/02/2021] [Indexed: 11/22/2022]
Abstract
The various manifestations of diabetic neuropathy, including distal symmetric sensorimotor polyneuropathy (DSPN) and cardiovascular autonomic neuropathy (CAN), are among the most prevalent chronic complications of diabetes. Major clinical complications of diabetic neuropathies, such as neuropathic pain, chronic foot ulcers, and orthostatic hypotension, are associated with considerable morbidity, increased mortality, and diminished quality of life. Despite the substantial individual and socioeconomic burden, the strategies to diagnose and treat diabetic neuropathies remain insufficient. This review provides an overview of the current clinical aspects and recent advances in exploring local and systemic biomarkers of both DSPN and CAN assessed in human studies (such as biomarkers of inflammation and oxidative stress) for better understanding of the underlying pathophysiology and for improving early detection. Current therapeutic options for DSPN are (I) causal treatment, including lifestyle modification, optimal glycemic control, and multifactorial risk intervention, (II) pharmacotherapy derived from pathogenetic concepts, and (III) analgesic treatment against neuropathic pain. Recent advances in each category are discussed, including non-pharmacological approaches, such as electrical stimulation. Finally, the current therapeutic options for cardiovascular autonomic complications are provided. These insights should contribute to a broader understanding of the various manifestations of diabetic neuropathies from both the research and clinical perspectives.
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Affiliation(s)
- Gidon J Bönhof
- Institute for Clinical Diabetology, German Diabetes Center, Leibniz Center for Diabetes Research at Heinrich Heine University Düsseldorf, Düsseldorf, Germany
- Department of Endocrinology, Medical Faculty and University Hospital, Heinrich Heine University, Düsseldorf, Germany
| | - Christian Herder
- Institute for Clinical Diabetology, German Diabetes Center, Leibniz Center for Diabetes Research at Heinrich Heine University Düsseldorf, Düsseldorf, Germany
- Department of Endocrinology, Medical Faculty and University Hospital, Heinrich Heine University, Düsseldorf, Germany
- German Center for Diabetes Research, Partner Düsseldorf, München-Neuherberg, Germany
| | - Dan Ziegler
- Institute for Clinical Diabetology, German Diabetes Center, Leibniz Center for Diabetes Research at Heinrich Heine University Düsseldorf, Düsseldorf, Germany
- Department of Endocrinology, Medical Faculty and University Hospital, Heinrich Heine University, Düsseldorf, Germany
- German Center for Diabetes Research, Partner Düsseldorf, München-Neuherberg, Germany
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Diabetic Foot Ulcers and Cardiac Autonomic Neuropathy. Clin Ther 2021; 44:323-330. [PMID: 34974945 DOI: 10.1016/j.clinthera.2021.12.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2021] [Revised: 11/21/2021] [Accepted: 12/08/2021] [Indexed: 01/19/2023]
Abstract
PURPOSE Diabetic foot ulcers (DFUs) and cardiac autonomic neuropathy (CAN) are severe complications of diabetes mellitus (DM). Both DFU and CAN are associated with increased risk of major cardiovascular events and mortality. Because of the clinical impact of both these conditions, it is important to establish what effect the presence of CAN has on DFU outcomes. METHODS This is a narrative review of original research articles identified through an electronic search of PubMed, Scopus, and Google scholar databases until June 2021 exploring CAN in individuals with DFUs. We explored prevalence, patient outcomes (DFU healing and amputation), and mortality. FINDINGS Evidence suggests that the prevalence of CAN is high, ranging from 43% to 66% among those with DFUs. The presence of CAN may also increase the odds of developing DFUs. A single-center, prospective, observational study has suggested that the presence of CAN significantly reduces DFU healing time. The impact on amputation is indeterminate, with conflicting reports from studies reporting either no or increased risk. On the basis of limited evidence, CAN may be associated with increased mortality in individuals with DFUs. IMPLICATIONS The interplay between CAN and DFUs is poorly understood from current literature. Given the high prevalence of CAN in individuals with DFUs and the potential for suboptimal outcomes, further high-quality studies are required to determine future management approaches when both conditions coexist and to establish whether early CAN screening in individuals with diabetes at high risk of foot ulceration may ultimately improve their outlook.
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Choi MS, Jun JE, Park SW, Yoo JH, Ahn J, Kim G, Jin SM, Hur KY, Lee MK, Kim JH. Association of Urinary N-Acetyl-β-D-Glucosaminidase with Cardiovascular Autonomic Neuropathy in Type 1 Diabetes Mellitus without Nephropathy. Diabetes Metab J 2021; 45:349-357. [PMID: 33517614 PMCID: PMC8164949 DOI: 10.4093/dmj.2019.0211] [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: 11/07/2019] [Accepted: 02/26/2020] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Cardiovascular autonomic neuropathy (CAN) is a common microvascular complication of diabetes and related to albuminuria in diabetic nephropathy (DN). Urinary N-acetyl-β-D-glucosaminidase (uNAG) is a renal tubular injury marker which has been reported as an early marker of DN even in patients with normoalbuminuria. This study evaluated whether uNAG is associated with the presence and severity of CAN in patients with type 1 diabetes mellitus (T1DM) without nephropathy. METHODS This cross-sectional study comprised 247 subjects with T1DM without chronic kidney disease and albuminuria who had results for both uNAG and autonomic function tests within 3 months. The presence of CAN was assessed by age-dependent reference values for four autonomic function tests. Total CAN score was assessed as the sum of the partial points of five cardiovascular reflex tests and was used to estimate the severity of CAN. The correlations between uNAG and heart rate variability (HRV) parameters were analyzed. RESULTS The association between log-uNAG and presence of CAN was significant in a multivariate logistic regression model (adjusted odds ratio, 2.39; 95% confidence interval [CI], 1.08 to 5.28; P=0.031). Total CAN score was positively associated with loguNAG (β=0.261, P=0.026) in the multivariate linear regression model. Log-uNAG was inversely correlated with frequency-domain and time-domain indices of HRV. CONCLUSION This study verified the association of uNAG with presence and severity of CAN and changes in HRV in T1DM patients without nephropathy. The potential role of uNAG should be further assessed for high-risk patients for CAN in T1DM patients without nephropathy.
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Affiliation(s)
- Min Sun Choi
- Division of Endocrinology and Metabolism, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Ji Eun Jun
- Division of Endocrinology and Metabolism, Department of Medicine, Kyung Hee University Hospital at Gangdong, Kyung Hee University School of Medicine, Seoul, Korea
| | - Sung Woon Park
- Division of Endocrinology and Metabolism, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jee Hee Yoo
- Division of Endocrinology and Metabolism, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
- Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Jiyeon Ahn
- Division of Endocrinology and Metabolism, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Myongji Hospital, Hanyang University College of Medicine, Goyang, Korea
| | - Gyuri Kim
- Division of Endocrinology and Metabolism, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Sang-Man Jin
- Division of Endocrinology and Metabolism, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Kyu Yeon Hur
- Division of Endocrinology and Metabolism, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Moon-Kyu Lee
- Division of Endocrinology and Metabolism, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jae Hyeon Kim
- Division of Endocrinology and Metabolism, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
- Department of Clinical Research Design & Evaluation, Samsung Advanced Institute for Health Sciences & Technology, Sungkyunkwan University, Seoul, Korea
- Corresponding author: Jae Hyeon Kim https://orcid.org/0000-0001-5001-963X Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul 06351, Korea E-mail:
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Differences and Similarities in Neuropathy in Type 1 and 2 Diabetes: A Systematic Review. J Pers Med 2021; 11:jpm11030230. [PMID: 33810048 PMCID: PMC8004786 DOI: 10.3390/jpm11030230] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Revised: 03/10/2021] [Accepted: 03/18/2021] [Indexed: 12/11/2022] Open
Abstract
Background: Diabetic neuropathy is defined as the dysfunction of the peripheral nervous system in diabetic patients. It is considered a microvascular complication of diabetes mellitus. Its presence is associated with increased morbidity and mortality. Although several studies have found alterations at somatic motor, sensory levels and at the level of autonomic nervous system in diabetic patients, there is not a systematic approach regarding the differences in neuropathy between the major variants of diabetes, e.g., type 1 and 2 diabetes at both neurological and molecular level. Data sources: we systematically (Medline, Scopus, and Cochrane databases) evaluated the literature related to the difference of neuropathy in type 1 and 2 diabetes, differences in molecular biomarkers. Study characteristics: seventeen articles were selected based on pre-defined eligibility criteria. Conclusions: both superficial sensitivity (primarily thermal sensitivity to cold) and deep sensitivity (such as vibratory sensitivity), have been reported mainly in type 2 diabetes. Cardiac autonomic neuropathy is one of the diabetic complications with the greatest impact at a clinical level but is nevertheless one of the most underdiagnosed. While for type 1 diabetes patients most neuropathy alterations have been reported for the Valsalva maneuver and for the lying-to-standing test, for type 2 diabetes patients, alterations have been reported for deep-breathing test and the Valsalva test. In addition, there is a greater sympathetic than parasympathetic impairment, as indicated by the screening tests for autonomic cardiac neuropathy. Regarding subclinical inflammation markers, patients with type 2 diabetes showed higher blood levels of inflammatory markers such as high-sensitivity C-reactive protein, proinflammatory cytokines IL-6, IL-18, soluble cell adhesion molecules and E-selectin and ICAM-1, than in type 1 diabetes patients. By contrast, the blood levels of adiponectin, an adipocyte-derived protein with multiple paracrine and endocrine activities (anti-inflammatory, insulin-sensitizing and proangiogenic effects) are higher in type 1 than in type 2 diabetic patients. This review provides new insights into the clinical differences in type 1 and 2 diabetes and provide future directions in this research field.
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Lin X, Chen C, Liu Y, Peng Y, Chen Z, Huang H, Xu L. Peripheral Nerve Conduction And Sympathetic Skin Response Are Reliable Methods to Detect Diabetic Cardiac Autonomic Neuropathy. Front Endocrinol (Lausanne) 2021; 12:709114. [PMID: 34621241 PMCID: PMC8490774 DOI: 10.3389/fendo.2021.709114] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Accepted: 08/31/2021] [Indexed: 11/23/2022] Open
Abstract
AIM This study aimed to investigate the role of nerve conduction studies (NCS) and sympathetic skin response (SSR) in evaluating diabetic cardiac autonomic neuropathy (DCAN). METHODS DCAN was diagnosed using the Ewing test combined with heart rate variability analysis. NCS and SSR were assessed by electrophysiological methods. The association between NCS/SSR and DCAN was assessed via multivariate regression and receiver-operating characteristic analyses. RESULTS The amplitude and conduction velocity of the motor/sensory nerve were found to be significantly lower in the DCAN+ group (all P < 0.05). A lower amplitude of peroneal nerve motor fiber was found to be associated with increased odds for DCAN (OR 2.77, P < 0.05). The SSR amplitude was lower while the SSR latency was longer in the DCAN+ group than in the DCAN- group. The receiver-operating characteristic analysis revealed that the optimal cutoff points of upper/lower limb amplitude of SSR to indicate DCAN were 1.40 mV (sensitivity, 61.9%; specificity, 66.3%, P < 0.001) and 0.85 mV (sensitivity, 66.7%; specificity, 68.5%, P < 0.001), respectively. The optimal cutoff points of upper/lower limb latency to indicate DCAN were 1.40 s (sensitivity, 61.9%; specificity, 62%, P < 0.05) and 1.81 s (sensitivity, 69.0%; specificity, 52.2%, P < 0.05), respectively. CONCLUSIONS NCS and SSR are reliable methods to detect DCAN. Abnormality in the peroneal nerve (motor nerve) is crucial in predicting DCAN. SSR may help predict DCAN.
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Affiliation(s)
- Xiaopu Lin
- Department of Huiqiao Building, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Chuna Chen
- Department of Endocrinology, Shenzhen Hospital, Southern Medical University, Shenzhen, China
- The Third School of Clinical Medicine, Southern Medical University, Guangzhou, China
| | - Yingshan Liu
- Department of Endocrinology, Shenzhen Hospital, Southern Medical University, Shenzhen, China
- The Third School of Clinical Medicine, Southern Medical University, Guangzhou, China
| | - Yu Peng
- Department of Neurology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Zhenguo Chen
- Department of Endocrinology, Shenzhen Hospital, Southern Medical University, Shenzhen, China
- The Third School of Clinical Medicine, Southern Medical University, Guangzhou, China
| | - Haishan Huang
- Department of Endocrinology, Shenzhen Hospital, Southern Medical University, Shenzhen, China
- The Third School of Clinical Medicine, Southern Medical University, Guangzhou, China
| | - Lingling Xu
- Department of Endocrinology, Shenzhen Hospital, Southern Medical University, Shenzhen, China
- The Third School of Clinical Medicine, Southern Medical University, Guangzhou, China
- *Correspondence: Lingling Xu,
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Kempler M, Hajdú N, Putz Z, Istenes I, Vági O, Békeffy M, Schnabel K, Kempler P, Körei AE. Diabetic Cardiovascular Autonomic Neuropathy, the Handgrip Test and Ambulatory Blood Pressure Monitoring Parameters: Are There Any Diagnostic Implications? J Clin Med 2020; 9:jcm9103322. [PMID: 33081140 PMCID: PMC7602698 DOI: 10.3390/jcm9103322] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2020] [Revised: 10/07/2020] [Accepted: 10/14/2020] [Indexed: 12/19/2022] Open
Abstract
Cardiovascular autonomic neuropathy (CAN) is a common complication of diabetes mellitus. Cardiovascular reflex tests (CARTs) are the gold standard in the diagnosis of CAN, but the handgrip test is no longer recommended to be performed. Previously, the inverse association between the presence of hypertension and handgrip test abnormality was demonstrated and hypertension as major cause for excessive diastolic blood pressure rise during handgrip testing in diabetic individuals proposed. The aim of the present study is to describe more precisely the association between handgrip test and hypertension by performing ambulatory blood pressure monitoring (ABPM) among diabetic patients. A more comprehensive evaluation of the relationship between cardiovascular autonomic function, hypertension and the handgrip test was targeted using heart rate variability (HRV) analysis. Our study involved 163 patients with diabetes. Cardiovascular autonomic neuropathy was assessed by the CARTs and sustained handgrip test was performed. All patients underwent ABPM and HRV analysis well. CAN was diagnosed in 69 patients. Significant associations were found between the diastolic blood pressure increase in response to handgrip exercise and the 24-h (rho = 0.245, p = 0.003), daytime (rho = 0.230, p = 0.005) and night-time (rho = 0.230, p = 0.006) mean systolic and 24-h diastolic (rho = 0.176, p = 0.034) blood pressure values, systolic blood pressure load (rho = 0.252, p = 0.003) and systolic (rho = 0.236, p = 0.005) and diastolic (rho = 0.165, p = 0.047) hyperbaric impacts. Higher values of ambulatory blood pressure monitoring parameters are associated with greater increases in diastolic blood pressure during isometric handgrip exercise. Diastolic blood pressure elevations during the handgrip test are also correlated, in order to diminished heart rate variability parameters attributable to parasympathetic dysfunction highlighting the pivotal role of sympathetic overactivity in evolving handgrip test results. Our study provides further evidence on the inverse association between handgrip test abnormality and hypertension in diabetic patients.
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Affiliation(s)
- Miklós Kempler
- Department of Internal Medicine and Haematology, Semmelweis University, Szentkirályi street 46, 1088 Budapest, Hungary
- Correspondence: ; Tel.: +36-203165030
| | - Noémi Hajdú
- Department of Internal Medicine and Oncology, Semmelweis University, Korányi Sándor street 2/a, 1083 Budapest, Hungary; (N.H.); (Z.P.); (I.I.); (O.V.); (M.B.); (K.S.); (P.K.); (A.E.K.)
| | - Zsuzsanna Putz
- Department of Internal Medicine and Oncology, Semmelweis University, Korányi Sándor street 2/a, 1083 Budapest, Hungary; (N.H.); (Z.P.); (I.I.); (O.V.); (M.B.); (K.S.); (P.K.); (A.E.K.)
| | - Ildikó Istenes
- Department of Internal Medicine and Oncology, Semmelweis University, Korányi Sándor street 2/a, 1083 Budapest, Hungary; (N.H.); (Z.P.); (I.I.); (O.V.); (M.B.); (K.S.); (P.K.); (A.E.K.)
| | - Orsolya Vági
- Department of Internal Medicine and Oncology, Semmelweis University, Korányi Sándor street 2/a, 1083 Budapest, Hungary; (N.H.); (Z.P.); (I.I.); (O.V.); (M.B.); (K.S.); (P.K.); (A.E.K.)
| | - Magdolna Békeffy
- Department of Internal Medicine and Oncology, Semmelweis University, Korányi Sándor street 2/a, 1083 Budapest, Hungary; (N.H.); (Z.P.); (I.I.); (O.V.); (M.B.); (K.S.); (P.K.); (A.E.K.)
| | - Karolina Schnabel
- Department of Internal Medicine and Oncology, Semmelweis University, Korányi Sándor street 2/a, 1083 Budapest, Hungary; (N.H.); (Z.P.); (I.I.); (O.V.); (M.B.); (K.S.); (P.K.); (A.E.K.)
| | - Péter Kempler
- Department of Internal Medicine and Oncology, Semmelweis University, Korányi Sándor street 2/a, 1083 Budapest, Hungary; (N.H.); (Z.P.); (I.I.); (O.V.); (M.B.); (K.S.); (P.K.); (A.E.K.)
| | - Anna E. Körei
- Department of Internal Medicine and Oncology, Semmelweis University, Korányi Sándor street 2/a, 1083 Budapest, Hungary; (N.H.); (Z.P.); (I.I.); (O.V.); (M.B.); (K.S.); (P.K.); (A.E.K.)
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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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Paes T, Rolim LC, Filho CS, de Sa JR, Dib SA. Awareness of hypoglycemia and spectral analysis of heart rate variability in type 1 diabetes. J Diabetes Complications 2020; 34:107617. [PMID: 32546420 DOI: 10.1016/j.jdiacomp.2020.107617] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Revised: 04/17/2020] [Accepted: 05/03/2020] [Indexed: 01/26/2023]
Abstract
AIMS To investigate the relationship of unawareness of hypoglycemia with spectral analysis of heart rate variability (HRV) and clinical variables in type 1 diabetes (T1D) individuals. METHODS Participants with type 1 diabetes mellitus (type 1 diabetes) were prospectively assessed for hypoglycemia awareness using the Pedersen-Bjergaard method and were classified as normal hypoglycemia awareness, impaired hypoglycemia awareness and hypoglycemia unawareness. Indices of HRV in frequency domain were evaluated and Ewing tests were used for the diagnosis of cardiovascular autonomic neuropathy (CAN). RESULTS Ninety-eight participants with T1D (mean age 26 years, average diabetes duration 13 years, and mean HbA1c 8.4%) were included in this study. The prevalence of hypoglycemia unawareness was 28%. No significant difference was observed on the prevalence of CAN among groups of different hypoglycemia awareness (p = 0.740). On regression analyses, abnormal results of HRV in frequency domain were not associated with unawareness of hypoglycemia. On univariable regression analysis, age, diabetes duration and estimated creatinine clearance were associated with unawareness of hypoglycemia. CONCLUSION CAN as assessed by Ewing tests and spectral analysis of HRV is not associated with unawareness of hypoglycemia. There is association of age, diabetes duration and renal deficit with unawareness of hypoglycemia.
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Affiliation(s)
- Ticiana Paes
- Division of Endocrinology and Metabolism, Escola Paulista de Medicina of Federal University of São Paulo, São Paulo, Brazil
| | - L Clemente Rolim
- Division of Endocrinology and Metabolism, Escola Paulista de Medicina of Federal University of São Paulo, São Paulo, Brazil
| | - Celso Sallum Filho
- Division of Endocrinology and Metabolism, Escola Paulista de Medicina of Federal University of São Paulo, São Paulo, Brazil
| | - João Roberto de Sa
- Division of Endocrinology and Metabolism, Escola Paulista de Medicina of Federal University of São Paulo, São Paulo, Brazil
| | - Sérgio A Dib
- Division of Endocrinology and Metabolism, Escola Paulista de Medicina of Federal University of São Paulo, São Paulo, Brazil.
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Gastoł J, Kapusta P, Polus A, Pitera E, Biela M, Wołkow P, Pawliński Ł, Kieć-Wilk B. Epigenetic mechanism in search for the pathomechanism of diabetic neuropathy development in diabetes mellitus type 1 (T1DM). Endocrine 2020; 68:235-240. [PMID: 31902112 DOI: 10.1007/s12020-019-02172-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Accepted: 12/23/2019] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The aim of this study was to check the hypothesis concerning the crucial role of DNA methylation (one of the epigenetic mechanisms) within selected genes related to the destruction and regeneration of neural cells and its input in the pathogenesis of diabetic neuropathy, using a model of the DNA in peripheral blood cells. METHODS A cross-sectional, case-control study was conducted, consisting of 24 adult Type 1 Diabetes Melitus (T1DM) patients with autonomic neuropathy (CAN), 25 T1DM patients without neuropathy and 25 matched, healthy adults acting as a control (Ctrl). The Ewing's tests, using the ProSciCard apparatus (Mewicon CATEEM-Tec GmbH), was employed to assess the severity of the patients' symptoms of autonomic neuropathy. For DNA methylation analysis, DNA material of each sample DNA after bisulfite conversion was used for the hybridization of BeadChips (Infinium Methylation EPIC Kit, Illumina), and imaged on the Illumina HiScan. The changes in the expression of selected genes were examined using real-time PCR. Probes were labeled using fluorescein amidite, FAM (Thermo Fisher Scientific). Amplification was performed using the continuous fluorescence detection 7900 HT Fast Real-Time PCR system (Thermo Fisher Scientific). The expression ratio of the target mRNA was normalized to the level of 18s RNA and compared with the control. Statistical analysis was performed using Statistica version 13.1. The statistically significant results were recognized, with a value of p < 0.05. RESULTS Clinical analysis of the investigated groups revealed a significantly higher percentage of personal insulin pump users in the group without neuropathy. The glucose metabolic control, based on the HbA1c level analysis, was also significantly better in T1DM patients without CAN. The Bumphunter method for DNA methylation analysis showed statistically significant regions related to the genes involved in nerve regeneration ninjurin 2 (NINJ2) and functionality (BR serine/threonine kinase 2 BRSK2, claudin 4 CLDN4). When compared with T1DM patients without neuropathy, T1DM patients with neuropathy showed significantly increased methylation in the first NINJ2 axon, and a lower level of DNA methylation in the region of the first intron of BRSK2, as well as the CLDN4 5'UTR regions. The qRT-PCR results confirmed the decreased expression of NINJ2 and CLDN4 genes in patients with T1DM with CAN. CONCLUSIONS The different DNA methylation profiles, correlating with the expression of genes related to nervous tissue development and regeneration in patients with T1DM with autonomic neuropathy provide evidence for the role of epigenetic mechanisms promoting the development of CAN, a chronic complication of T1DM.
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Affiliation(s)
| | - Przemysław Kapusta
- Center for Medical Genomics- Omicron, Jagiellonian University Medical College, Kraków, Poland
| | - Anna Polus
- Department of Clinical Biochemistry, Jagiellonian University Medical College, Kraków, Poland
| | - Ewelina Pitera
- Center for Medical Genomics- Omicron, Jagiellonian University Medical College, Kraków, Poland
| | - Maria Biela
- Department of Clinical Biochemistry, Jagiellonian University Medical College, Kraków, Poland
| | - Paweł Wołkow
- Center for Medical Genomics- Omicron, Jagiellonian University Medical College, Kraków, Poland
| | | | - Beata Kieć-Wilk
- University Hospital in Krakow, Kraków, Poland.
- Department of Metabolic Diseases, Jagiellonian University Medical College, Kraków, Poland.
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Fabiyi-Edebor TD. Vitamin C ameliorated cardiac autonomic neuropathy in type 2 diabetic rats. World J Diabetes 2020; 11:52-65. [PMID: 32180894 PMCID: PMC7061237 DOI: 10.4239/wjd.v11.i3.52] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Revised: 12/07/2019] [Accepted: 01/13/2020] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Vitamin C (VC) is a common antioxidant with cell protection potentials. However, its possible protective effect on cardiac autonomic nerves from diabetic induced insults is yet to be explored.
AIM To investigate the effects of VC on diabetic cardiac autonomic neuropathy.
METHODS Thirty male Wistar rats were equally grouped into control, diabetic and diabetic + VC. Type 2 diabetes was induced with fructose diet and alloxan. VC (1 g/kg) was administered for 4 wk via oral canula. Blood pressure and heart rate were measured non-invasively using tail flick blood pressure monitor. Spectral analysis of heart rate variability (HRV) was used to assess cardiac autonomic neuropathy. Blood was collected from the ocular sinus for biochemical analysis. Urethane (1 g/kg-ip) was used for anaesthesia prior to HRV and cervical dislocation to harvest hearts. Intracardiac autonomic nerve was assessed using tyrosine hydroxylase immunohistochemistry on fixed heart sections.
RESULTS Results were analysed using ANOVA at α0.05. Unlike VC and control groups, diabetic rats showed significantly (P < 0.0001) reduced HRV, increased heart-rate and blood pressure, initial increase in cardiac tyrosine hydroxylase activities at week-2 and sparse activity at week-4 of diabetes. Furthermore, apolipoprotein B, Oxidative stress and inflammatory markers were significantly (P < 0.01) reduced in VC treated rats.
CONCLUSION VC possesses cardio-autonomic nerve protective potential and ameliorates the symptoms of cardiac autonomic neuropathy in type 2 diabetes. The possible mechanisms via which VC exert these effects may be via downregulation of oxidative stress, inflammation and apolipoprotein B.
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Riguetto CM, Takano CR, Admoni SN, Parisi MCR, Giannella MLC, Pavin EJ, Moura Neto A. Identification and performance of multiple clinical and laboratorial risk factors for diagnosis of cardiac autonomic neuropathy in type 1 diabetes patients. J Diabetes Metab Disord 2019; 18:565-573. [PMID: 31890683 DOI: 10.1007/s40200-019-00467-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2019] [Accepted: 11/05/2019] [Indexed: 01/05/2023]
Abstract
Purpose The incidence of cardiac autonomic neuropathy (CAN) in patients with type 1 diabetes (T1D) is frequently underestimated. Individuals with T1D and CAN have an increased mortality risk, mainly from cardiovascular causes. The objectives of the present study were to assess the clinical and laboratory characteristics associated with CAN in patients with T1D and verify the ability of multiple clinical factors to help identify patients with this condition. Methods 102 patients with T1D were evaluated for CAN using standardized cardiovascular reflex testing. Clinical characteristics were used to compute a numerical score for CAN diagnosis and a ROC curve elaborated for assessment of the best cutoff to predict CAN. This score was then applied to the second sample of 120 patients. The sensitivity, specificity, and positive and negative predictive values were calculated. Results Prevalence of CAN was around 35% in the first sample of patients and just below 20% in the second sample. Hypertension, total cholesterol, triglycerides, postprandial sweating, diastolic blood pressure, abnormal right and left 10 g monofilament, retinopathy, and nephropathy were considered independent predictors of CAN. The CAN-score cut-off was 16.88. This yielded a sensitivity of 50%, specificity 73.8%, positive predictive value 22.9%, and negative predictive value 90.5%. Conclusion The use of a subset of clinical and laboratory characteristics can be more accessible than the cardiac reflex tests and more accurate than a single isolated characteristic.
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Affiliation(s)
- Cinthia Minatel Riguetto
- 1Endocrinology Division, Internal Medicine Department, Faculty of Medical Sciences, University of Campinas, Rua Tessália Vieira de Camargo, 126 Campinas, São Paulo, 13084-971 Brazil
| | - Caroline Rigoleto Takano
- 1Endocrinology Division, Internal Medicine Department, Faculty of Medical Sciences, University of Campinas, Rua Tessália Vieira de Camargo, 126 Campinas, São Paulo, 13084-971 Brazil
| | - Sharon Nina Admoni
- 2Serviço de Endocrinologia e Metabologia do Hospital da Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, São Paulo Brazil
| | - Maria Candida Ribeiro Parisi
- 1Endocrinology Division, Internal Medicine Department, Faculty of Medical Sciences, University of Campinas, Rua Tessália Vieira de Camargo, 126 Campinas, São Paulo, 13084-971 Brazil
| | - Maria Lucia Correa Giannella
- 2Serviço de Endocrinologia e Metabologia do Hospital da Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, São Paulo Brazil
| | - Elizabeth João Pavin
- 1Endocrinology Division, Internal Medicine Department, Faculty of Medical Sciences, University of Campinas, Rua Tessália Vieira de Camargo, 126 Campinas, São Paulo, 13084-971 Brazil
| | - Arnaldo Moura Neto
- 1Endocrinology Division, Internal Medicine Department, Faculty of Medical Sciences, University of Campinas, Rua Tessália Vieira de Camargo, 126 Campinas, São Paulo, 13084-971 Brazil
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Dmytriiev D, Lysak Y, Glazov Y, Geranin S, Zaletska O. Mini-invasive methods of treatment of diabetic foot pain. PAIN MEDICINE 2019. [DOI: 10.31636/pmjua.v4i3.1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Neuropathic pain occurs with diabetic polyneuropathy more often than with all polyneuropathies of another etiology. Because the cause of pain can rarely be cured, treatment is usually symptomatic. Neuropathic pain is usually poorly controlled by analgesics. Management of neuropathic pain is started with conservative pharmacotherapy before invasive pain management is applied. Although there are many drugs that can be used in patients with diabetic pain syndrome, pain syndrome can not be surely stoped with monotherapy. In addition, the patient may not tolerate the full therapeutic dose of the drug.
All this dictates the need for combination therapy. It is believed that regional anesthesia as an independent type of analgesia or a component of combined anesthesia is the method of choice for the elderly and senile patients. The main reasons for this choice, when comparing regional anesthesia with narcosis, are less stressful response of the organism, absence of depression of the central nervous system, stable reliable analgesia with complete blockade of nociceptive reflexes with the provision of adequate muscle relaxation, prevention of neurovegetative reactions, which ultimately helps to reduce the incidence of postoperative complications and mortality. Clinicians have accumulated considerable experience demonstrating the need for regional analgesia in the management of diabetic foot pain.
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França da Silva AK, Destro Christofaro DG, Manata Vanzella L, Marques Vanderlei F, Lopez Laurino MJ, Marques Vanderlei LC. Relationship of the Aggregation of Cardiovascular Risk Factors in the Parasympathetic Modulation of Young People with Type 1 Diabetes. MEDICINA (KAUNAS, LITHUANIA) 2019; 55:E534. [PMID: 31454959 PMCID: PMC6780872 DOI: 10.3390/medicina55090534] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Revised: 08/20/2019] [Accepted: 08/21/2019] [Indexed: 11/20/2022]
Abstract
Background and objectives: In healthy individuals, autonomic alterations are associated with the aggregation of cardiovascular risk factors. However, in individuals with type 1 diabetes, who are known to present autonomic alterations, mainly characterized by a reduction in parasympathetic modulation, these associations have not yet been investigated. We assess whether the aggregation of cardiovascular risk factors influences parasympathetic indices of heart rate variability in young people with type 1 diabetes. Materials and methods: This cross-sectional study included 39 individuals with type 1 diabetes (22.54 ± 4.31), evaluated in relation to the risk factors: blood pressure, fat percentage, and resting heart rate. For heart rate variability analysis, heart rate was recorded beat-to-beat using a cardio frequency meter (PolarS810i) for 30 min with the volunteers in dorsal decubitus. The parasympathetic heart rate variability indices were calculated: rMSSD, pNN50, high frequency (HF) n.u (normalized units), SD1, 2LV, and 2ULV. Data collection was carried out in 2014 and analyzed in 2017. Results: Individuals with two aggregate risk factors present a reduction in the values of the indices that reflect parasympathetic autonomic modulation compared to individuals without the risk factors analyzed, regardless of sex and age. Conclusion: In young people with type 1 diabetes, the aggregation of cardiovascular risk factors is associated with parasympathetic autonomic impairment.
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Affiliation(s)
- Anne Kastelianne França da Silva
- Department of Physical Therapy, Faculty of Science and Technology, São Paulo State University (UNESP), Roberto Simonsen Street, 305, Presidente Prudente, São Paulo 19060-900, Brazil.
| | - Diego Giulliano Destro Christofaro
- Department of Physical Education, Faculty of Science and Technology, São Paulo State University (UNESP), Roberto Simonsen Street, 305, Presidente Prudente, São Paulo 19060-900, Brazil
| | - Laís Manata Vanzella
- Department of Physical Therapy, Faculty of Science and Technology, São Paulo State University (UNESP), Roberto Simonsen Street, 305, Presidente Prudente, São Paulo 19060-900, Brazil
| | - Franciele Marques Vanderlei
- Department of Physical Therapy, Faculty of Science and Technology, São Paulo State University (UNESP), Roberto Simonsen Street, 305, Presidente Prudente, São Paulo 19060-900, Brazil
| | - Maria Júlia Lopez Laurino
- Department of Physical Therapy, Faculty of Science and Technology, São Paulo State University (UNESP), Roberto Simonsen Street, 305, Presidente Prudente, São Paulo 19060-900, Brazil
| | - Luiz Carlos Marques Vanderlei
- Department of Physical Therapy, Faculty of Science and Technology, São Paulo State University (UNESP), Roberto Simonsen Street, 305, Presidente Prudente, São Paulo 19060-900, Brazil
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Ponirakis G, Petropoulos IN, Alam U, Ferdousi M, Asghar O, Marshall A, Azmi S, Jeziorska M, Mahfoud ZR, Boulton AJM, Efron N, Nukada H, Malik RA. Hypertension Contributes to Neuropathy in Patients With Type 1 Diabetes. Am J Hypertens 2019; 32:796-803. [PMID: 31013342 PMCID: PMC6636691 DOI: 10.1093/ajh/hpz058] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2019] [Revised: 04/10/2019] [Accepted: 04/15/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Diabetic peripheral neuropathy (DPN) can lead to foot ulceration and amputation. There are currently no disease-modifying therapies for DPN. The aim of this study was to determine if hypertension contributes to DPN in patients with type 1 diabetes mellitus (T1DM). METHODS Subjects with T1DM (n = 70) and controls (n = 78) underwent a comprehensive assessment of DPN. RESULTS Hypertension was present in 40 of 70 T1DM subjects and 20 of 78 controls. Hypertension was associated with abnormal nerve conduction parameters (P = 0.03 to <0.001), increased vibration perception threshold (P = 0.01) and reduced corneal nerve fiber density and length (P = 0.02) in subjects with T1DM. However, after adjusting for confounding factors only tibial compound motor action potential and nerve conduction velocity were associated with hypertension (P = 0.03) and systolic blood pressure (P < 0.01 to <0.0001). Hypertension had no effect on neuropathy in subjects without diabetes. CONCLUSIONS This study shows that hypertension is associated with impaired nerve conduction in T1DM. It supports previous small trials showing that angiotensin-converting enzyme inhibitors improve nerve conduction and advocates the need for larger clinical trials with blood pressure lowering agents in DPN.
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Affiliation(s)
- Georgios Ponirakis
- Weill Cornell Medicine–Qatar, Qatar Foundation, Education City, Doha, Qatar
| | | | - Uazman Alam
- Institute of Cardiovascular Science, University of Manchester, Manchester, UK
- Eye and Vision Sciences, Institute of Ageing and Chronic Disease, University of Liverpool, UK
| | - Maryam Ferdousi
- Institute of Cardiovascular Science, University of Manchester, Manchester, UK
| | - Omar Asghar
- Institute of Cardiovascular Science, University of Manchester, Manchester, UK
| | - Andrew Marshall
- Institute of Cardiovascular Science, University of Manchester, Manchester, UK
| | - Shazli Azmi
- Institute of Cardiovascular Science, University of Manchester, Manchester, UK
| | - Maria Jeziorska
- Institute of Cardiovascular Science, University of Manchester, Manchester, UK
| | - Ziyad R Mahfoud
- Weill Cornell Medicine–Qatar, Qatar Foundation, Education City, Doha, Qatar
| | - Andrew J M Boulton
- Centre for Endocrinology and Diabetes, Institute of Human Development, Faculty of Medical and Human Sciences, University of Manchester and NIHR/Wellcome Trust Clinical Research Facility, Manchester, UK
| | - Nathan Efron
- Institute of Health and Biomedical Innovation, Queensland University of Technology, Queensland, Australia
| | - Hitoshi Nukada
- Nukada Institute for Medical and Biological Research, Chiba, Japan
| | - Rayaz A Malik
- Weill Cornell Medicine–Qatar, Qatar Foundation, Education City, Doha, Qatar
- Institute of Cardiovascular Science, University of Manchester, Manchester, UK
- Faculty of Science and Engineering, Manchester Metropolitan University, Manchester, UK
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Haq T, Ahmed T, Latif ZA, Sayeed MA, Ashrafuzzaman SM. Cardiac autonomic neuropathy in patients with type 2 diabetes mellitus having peripheral neuropathy: A cross-sectional study. Diabetes Metab Syndr 2019; 13:1523-1528. [PMID: 31336516 DOI: 10.1016/j.dsx.2019.03.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Accepted: 03/05/2019] [Indexed: 01/28/2023]
Abstract
AIMS The aim was to see the frequency of CAN in type 2 diabetes mellitus patients with peripheral neuropathy, and its association with peripheral nerve conduction abnormalities. METHODS A cross-sectional study at BIRDEM was conducted in 62 patients with type 2 diabetes mellitus having electrophysiologically diagnosed peripheral neuropathy. CAN was detected by four clinical tests - heart rate response to deep breathing and valsalva maneuver, blood pressure response to standing and sustained handgrip. RESULT The study showed that all patients had CAN - 14.52% had early, 26.67% had definitive and 59.68% had severe CAN. Patients with severe CAN had significantly reduced nerve conduction velocity and amplitude of peripheral nerves (sural 4.36 ± 12.77 vs 9.65 ± 17.77 m/s, p = 0.009; 2.23 ± 1.89 vs 3.01 ± 2.76 mV, p = 0.001; peroneal 7 ± 4.23 vs 8.53 ± 5.99 mV, p = 0.047; tibial 0.008 ± 0.03 vs 0.026 ± 0.05 mV, p = 0.009) and higher serum triglyceride levels (221.17 ± 120.61 vs 197.76 ± 68.43 mg/dl, p = 0.033). CONCLUSION Diabetic patients with peripheral neuropathy have CAN, the severity of which increases with worsening neuropathy.
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Affiliation(s)
- Tahniyah Haq
- Department of Endocrinology, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh.
| | - Tofail Ahmed
- Department of Endocrinology, Bangladesh Institute of Research, Rehabilitation of Diabetes, Endocrine and Metabolic Disorders (BIRDEM), Dhaka, Bangladesh
| | - Zafar A Latif
- Department of Endocrinology, BIRDEM, Dhaka, Bangladesh
| | - Mohammad A Sayeed
- Department of Community Medicine, Ibrahim Medical College, Dhaka, Bangladesh
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The prevalence of cardiovascular autonomic neuropathy and its influence on post induction hemodynamic variables in patients with and without diabetes; A prospective cohort study. PLoS One 2018; 13:e0207384. [PMID: 30475825 PMCID: PMC6261040 DOI: 10.1371/journal.pone.0207384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2018] [Accepted: 10/30/2018] [Indexed: 11/30/2022] Open
Abstract
Background Cardiovascular autonomic neuropathy (CAN) is a known complication of diabetes, but is also diagnosed in patients without diabetes. CAN may be related to perioperative hemodynamic instability. Our objective was to investigate if patients with diabetes would have a higher prevalence of CAN compared to patients without diabetes undergoing surgery. We further studied its relation to changes in post-induction hemodynamic variables. Methods We prospectively included 82 adult patients, 55 with DM, 27 without DM, scheduled for major abdominal or cardiac surgery. Patients performed four autonomic function tests on the day before surgery. Primary outcomes were the prevalence of CAN and the relation between CAN and severe post-induction hypotension, defined as mean arterial pressure (MAP) < 50 mmHg or ≥ 50% decrease from baseline. Secondary outcomes were the relation between CAN, intraoperative hypotension, MAP < 65 mmHg for more than 13 minutes, and the use of vasopressor therapy. Results The prevalence of CAN in patients with or without DM was 71% versus 63%, (p = 0.437). CAN was not associated with severe post induction hypotension (CAN+ vs. CAN–: 21% vs. 19.2%, p = 0.819) nor with intraoperative hypotension (16% vs. 15%, p = 0.937). Patients with definite CAN received more norepinephrine in the perioperative period compared to patients with mild CAN or no CAN (0.07 mcg kg-1 min-1 (0.05–0.08) vs. 0.03 (0.01–0.07) vs. 0.02 (0.01–0.06) respectively, p = 0.001). Conclusions The majority of patients studied had mild to moderate CAN, regardless of the presence of DM. Assessing CAN before surgery did not identify patients at risk for post induction and intraoperative hypotension in our cohort. Trial registration Dutch Trial Registry (www.trialregister.nl) NTR4976.
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Pemp B, Palkovits S, Howorka K, Pumprla J, Sacu S, Garhöfer G, Bayerle-Eder M, Schmetterer L, Schmidt-Erfurth U. Correlation of retinal neurodegeneration with measures of peripheral autonomic neuropathy in type 1 diabetes. Acta Ophthalmol 2018; 96:e804-e810. [PMID: 29504257 PMCID: PMC6282971 DOI: 10.1111/aos.13733] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2017] [Accepted: 01/21/2018] [Indexed: 12/21/2022]
Abstract
Purpose To evaluate the relationship of neuroretinal layer thickness with sensitive measures of cardiovascular autonomic neuropathy in diabetic patients with non‐proliferative diabetic retinopathy (NPDR). Methods Twenty‐seven eyes of 27 patients with type 1 diabetes presenting with mild‐to‐moderate NPDR were compared to 27 healthy control (HC) eyes matched for age and gender. The total macular volume (TMV) and the volumes of individual neurosensory layers in the macula were analysed from spectral domain optical coherence tomography using automated layer segmentation. Cardiovascular autonomic regulation was assessed by short‐term power spectrum analysis of heart rate variability (HRV) before, during and after an orthostatic challenge. Results The patients had an age of 46 ± 12 years and diabetes since 28 ± 9 years. Diastolic and mean arterial pressure was lower in the patients compared to HCs. TMV (r = 0.58, p = 0.002), inner plexiform layer volume (IPLV; r = 0.39, p = 0.047) and inner nuclear layer volume (INLV; r = 0.60, p = 0.001) were associated with reduced recovery of low‐frequency (LF) spectral power of HRV after orthostatic load in diabetic patients but not in HCs. The response of LF spectral power during the orthostatic manoeuvre was blunted in patients compared to HCs (p = 0.02). Diabetes duration was negatively associated with TMV and INLV, whereas IPLV was significantly reduced in eyes with moderate NPDR compared to HCs. Conclusion The results indicate a correlation between inner retinal tissue loss and diminished autonomic regulation in type 1 diabetic patients with mild‐to‐moderate NPDR. The observed changes can be interpreted as congruent early signs of retinal and systemic neuropathy in diabetes.
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Affiliation(s)
- Berthold Pemp
- Department of Ophthalmology; Medical University of Vienna; Vienna Austria
| | - Stefan Palkovits
- Department of Clinical Pharmacology; Medical University of Vienna; Vienna Austria
| | - Kinga Howorka
- Center for Biomedical Engineering and Physics; Medical University of Vienna; Vienna Austria
| | - Jiri Pumprla
- Center for Biomedical Engineering and Physics; Medical University of Vienna; Vienna Austria
| | - Stefan Sacu
- Department of Ophthalmology; Medical University of Vienna; Vienna Austria
| | - Gerhard Garhöfer
- Department of Clinical Pharmacology; Medical University of Vienna; Vienna Austria
| | | | - Leopold Schmetterer
- Department of Clinical Pharmacology; Medical University of Vienna; Vienna Austria
- Center for Biomedical Engineering and Physics; Medical University of Vienna; Vienna Austria
- Lee Kong Chian School of Medicine; Nanyang Technological University and Singapore Eye Research Institute; Singapore Singapore
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Moningi S, Nikhar S, Ramachandran G. Autonomic disturbances in diabetes: Assessment and anaesthetic implications. Indian J Anaesth 2018; 62:575-583. [PMID: 30166651 PMCID: PMC6100274 DOI: 10.4103/ija.ija_224_18] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Diabetes mellitus is the most common medical condition and with increased awareness of heath and related issues, several patients are getting diagnosed with diabetes. The poor control of sugar and long-standing status of disease affects the autonomic system of body. The autonomic nervous system innervates cardiovascular, gastrointestinal, and genitourinary system, thus affecting important functions of the body. The cardiovascular system involvement can manifest as mild arrhythmias to sudden death. Our search for this review included PubMed, Google Search and End Note X6 version and the key words used for the search were autonomic neuropathy, diabetes, anesthesia, tests and implications. This review aims to highlight the dysfunction of autonomic system due to diabetes and its clinical presentations. The various modalities to diagnose the involvement of different systems are mentioned. An estimated 25% of diabetic patients will require surgery. It has been already established that mortality rates in diabetic patients are higher than in nondiabetic patients. Hence, complete workup is needed prior to any surgery. Diabetic autonomic neuropathy and its implications may sometimes be disastrous and further increase the incidence of in hospital morbidity and mortality. Overall, complete knowledge of diabetes and its varied effects with anaesthetic implications and careful perioperative management is the key guiding factor for a successful outcome.
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Affiliation(s)
- Srilata Moningi
- Department of Anaesthesia and Intensive Care, Nizam's Institute of Medical Sciences, Hyderabad, Telangana, India
| | - Sapna Nikhar
- Department of Anaesthesia and Intensive Care, Nizam's Institute of Medical Sciences, Hyderabad, Telangana, India
| | - Gopinath Ramachandran
- Department of Anaesthesia and Intensive Care, Nizam's Institute of Medical Sciences, Hyderabad, Telangana, India
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Hjortkjær HØ, Jensen T, Hilsted J, Corinth H, Mogensen UM, Køber L, Fuchs A, Nordestgaard BG, Kofoed KF. Possible early detection of coronary artery calcium progression in type 1 diabetes: A case-control study of normoalbuminuric type 1 diabetes patients and matched controls. Diabetes Res Clin Pract 2018; 141:18-25. [PMID: 29679631 DOI: 10.1016/j.diabres.2018.04.027] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2017] [Revised: 04/05/2018] [Accepted: 04/12/2018] [Indexed: 01/06/2023]
Abstract
AIMS Coronary artery calcium (CAC) is associated with cardiovascular (CV) disease and progression of CAC is an independent predictor of mortality. Type 1 diabetes is associated with increased CV risk, especially in persons with cardiovascular autonomic neuropathy (CAN). This study aimed to examine whether short-term progression of CAC is increased in persons with type 1 diabetes compared to matched controls and if CAN increases risk of CAC progression. METHODS Fifty-three normoalbuminuric persons with long-term type 1 diabetes (20 with CAN) were matched in a 1:2 ratio with 106 controls without diabetes according to age, sex and baseline CAC. All were examined twice with cardiac computed tomography scans. Progression of CAC was defined as a value ≥2.5 between the square root-transformed values of follow-up and baseline CAC volume scores. RESULTS The participants were examined median (interquartile range) of 25 (23-27) months (type 1 diabetes) and 29 (25-33) months (controls) apart. In multivariable logistic regression, participants with type 1 diabetes had an odds ratio of 3.3 (95% CI 1.3-8.2, p = 0.01) for CAC progression. CAN did not increase progression of CAC (p = 0.64). CONCLUSIONS Progression of CAC was increased in well-treated, normoalbuminuric persons with type 1 diabetes compared to matched controls without diabetes, suggesting that type 1 diabetes is a risk factor for short-term progression. This finding could explain some of the increased morbidity and mortality observed in persons with type 1 diabetes, but it does not specifically explain the increased CV risk in persons with CAN.
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Affiliation(s)
- Henrik Ø Hjortkjær
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Denmark; Department of Endocrinology, Rigshospitalet, Copenhagen University Hospital, Denmark.
| | - Tonny Jensen
- Department of Endocrinology, Rigshospitalet, Copenhagen University Hospital, Denmark
| | - Jannik Hilsted
- Department of Endocrinology, Rigshospitalet, Copenhagen University Hospital, Denmark
| | - Helle Corinth
- Department of Endocrinology, Rigshospitalet, Copenhagen University Hospital, Denmark
| | - Ulrik M Mogensen
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Denmark
| | - Lars Køber
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Denmark; Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Andreas Fuchs
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Denmark
| | - Børge G Nordestgaard
- Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark; Department of Clinical Biochemistry, Herlev and Gentofte Hospital, Copenhagen University Hospital Herlev, Denmark
| | - Klaus F Kofoed
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Denmark; Department of Radiology, Rigshospitalet, Copenhagen University Hospital, Denmark
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Lin K, Wei L, Huang Z, Zeng Q. Combination of Ewing test, heart rate variability, and heart rate turbulence analysis for early diagnosis of diabetic cardiac autonomic neuropathy. Medicine (Baltimore) 2017; 96:e8296. [PMID: 29137013 PMCID: PMC5690706 DOI: 10.1097/md.0000000000008296] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2017] [Revised: 08/30/2017] [Accepted: 09/15/2017] [Indexed: 02/05/2023] Open
Abstract
The aim of this study was to compare and analyze Ewing test, heart rate variability (HRV), and heart rate turbulence (HRT) in the diagnosis of cardiac autonomic neuropathy (CAN) in diabetic patients.Ninety diabetic patients (age 18-78) and 20 nondiabetic control subjects were studied. Standard Ewing test and 24-hour Holter was performed in all participants to evaluate CAN. Patients with Ewing score ≥2 were classified as CAN+.The rate of CAN+ in diabetic patients [44.4% (40/90)] was higher than that in the controls [5% (1/20)] (P < .05). Using the HRV analysis and HRT analysis, rates of CAN+ in diabetic patients were 56.67% (51/90) and 52.22% (47/90), respectively. SD of all normal-to-normal (NN) intervals (SDNN), SD of the average NN intervals calculated over 5-minute periods of the entire recording (SDANN), low frequency power (LF), and turbulence slope (TS) were significantly correlated negatively with Ewing scores. TS (r = -0.68, P < .05) and SDNN (r = -0.58, P < .05) had the strongest correlation with Ewing scores among relevant factors. Combining TS with SDNN as diagnostic criteria for CAN, the diagnostic sensitivity can be increased to 98%.Parameters used for evaluating parasympathetic functions in Ewing test, HR variability, and HR turbulence were found to significantly decrease in CAN+ group. The combination of SDNN and TS showed greater diagnostic value than Ewing test, HRV analysis, or HRT analysis alone.
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Affiliation(s)
| | - Liling Wei
- Department of Neurology, The First Affiliated Hospital of Shantou University Medical College
| | - Zhihua Huang
- Shantou University Medical College, Shantou, China
| | - Qiong Zeng
- Department of Neurology, The First Affiliated Hospital of Shantou University Medical College
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Cardiovascular Autonomic Neuropathy Is an Independent Risk Factor for Left Ventricular Diastolic Dysfunction in Patients with Type 2 Diabetes. BIOMED RESEARCH INTERNATIONAL 2017. [PMID: 28638827 PMCID: PMC5468548 DOI: 10.1155/2017/3270617] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Aim This study aimed to evaluate the association between cardiovascular autonomic neuropathy (CAN) and left ventricular diastolic dysfunction (LVDD) in type 2 diabetes patients. Methods 315 type 2 diabetes patients from inpatients of Drum Tower Hospital were included and classified into no CAN (NCAN), possible CAN (PCAN), and definite CAN (DCAN) based on cardiovascular autonomic reflex tests. The left ventricular diastolic function was assessed by tissue Doppler imaging echocardiography. Results The distribution of NCAN, PCAN, and DCAN was 11.4%, 51.1%, and 37.5%, respectively. The proportion of LVDD increased among the groups of NCAN, PCAN, and DCAN (39.4%, 45.3%, and 68.0%, P = 0.001). Patients with DCAN had higher filling pressure (E/e′ ratio) (10.9 ± 2.7 versus 9.4 ± 2.8, P = 0.013) and impaired diastolic performance (e′) (6.8 ± 1.7 versus 8.6 ± 2.4, P = 0.004) compared with NCAN. CAN was found to be an independent risk factor for LVDD from the multivariate regression analysis (OR = 1.628, P = 0.009, 95% CI 1.131–2.344). Conclusions Our results indicated that CAN was an independent risk marker for the presence of LVDD in patients with diabetes. Early diagnosis and treatment of CAN are advocated for preventing LVDD in type 2 diabetes.
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Fricke L, Petroff D, Desch S, Lurz P, Reinhardt S, Sonnabend M, Classen J, Baum P. Does dysfunction of the autonomic nervous system affect success of renal denervation in reducing blood pressure? SAGE Open Med 2017; 5:2050312117702031. [PMID: 28507735 PMCID: PMC5415324 DOI: 10.1177/2050312117702031] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2016] [Accepted: 03/06/2017] [Indexed: 11/18/2022] Open
Abstract
Objectives: Renal denervation is an interventional approach aiming to reduce high blood pressure. Its efficacy is subject of controversial debate. We analyzed autonomic function in patients undergoing renal denervation to identify responders. Methods: A total of 21 patients with treatment-resistant hypertension scheduled for renal denervation were included. Heart rate variability, pupillary function and sympathetic skin response were examined prior to intervention. Before and 1 or 3 months after intervention, 24-h ambulatory blood pressure readings were taken. Results: Patients were stratified according to sympathetic nervous system function. Sympathetic activity was reduced in 12 participants (group 1) and normal or enhanced in nine patients (group 2). The mean of daytime systolic blood pressure decreased in groups 1 and 2 from 168 to 157 mmHg (95% confidence interval for difference, 1–21 mmHg, p = 0.035) and from 166 to 145 mmHg (8–34 mmHg, p = 0.005), respectively. In a linear model, blood pressure reduction was 11.3 mmHg (0.3–22 mmHg) greater in group 2 than in group 1 (p = 0.045). Conclusion: Patients with preexisting reduced activity of the sympathetic nervous system benefited less from renal denervation.
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Affiliation(s)
- Lisa Fricke
- Department of Neurology, University Hospital Leipzig, Leipzig, Germany
| | - David Petroff
- Clinical Trial Centre, Leipzig University, Leipzig, Germany
| | - Steffen Desch
- Medical Clinic II-Department of Cardiology, Angiology and Intensive Care Medicine, University Lübeck Heart Centre, University of Lübeck, Lübeck, Germany
| | - Philipp Lurz
- Department of Internal Medicine/Cardiology, Heart Centre, Leipzig University, Leipzig, Germany
| | - Sebastian Reinhardt
- Department of Cardiology and Angiology, University Hospital Leipzig, Leipzig, Germany
| | - Melanie Sonnabend
- Department of Internal Medicine/Cardiology, Heart Centre, Leipzig University, Leipzig, Germany
| | - Joseph Classen
- Department of Neurology, University Hospital Leipzig, Leipzig, Germany
| | - Petra Baum
- Department of Neurology, University Hospital Leipzig, Leipzig, Germany
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Dimova R, Tankova T, Chakarova N, Grozeva G, Dakovska L. Cardio-metabolic profile of subjects with early stages of glucose intolerance and cardiovascular autonomic dysfunction. Diabetes Res Clin Pract 2017; 126:115-121. [PMID: 28242436 DOI: 10.1016/j.diabres.2017.02.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2016] [Accepted: 02/02/2017] [Indexed: 01/25/2023]
Abstract
AIMS The present study evaluates the cardio-metabolic profile of subjects with early stages of glucose intolerance and presence of cardiovascular autonomic dysfunction (CAD). MATERIALS AND METHODS 478 subjects, of mean age 49.3±13.7years and mean BMI 31.0±6.2kg/m2, divided according to glucose tolerance: 130 with normal glucose tolerance, 227 with prediabetes, and 121 with newly-diagnosed type 2 diabetes, were enrolled. Glucose tolerance was studied during OGTT applying 2006 WHO criteria. Anthropometric indices, blood pressure, HbA1c, serum lipids, hsCRP, and albumin-to-creatinine ratio (ACR) were measured. Body fat distribution was estimated by a bioimpedance method (InBody720, BioSpace). Tissue AGEs accumulation was assessed by skin autofluorescence (AGE-Reader-DiagnOptics™). CAD was assessed by ANX-3.0 method. RESULTS CAD was found in 24.1% of subjects with any disorder of glucose tolerance in comparison to 12.3% in NGT, OR 2.0 (95% CI: 1.2-3.2), p=0.005. Sympathetic and parasympathetic tone declined with the progression of glucose intolerance. Age, waist circumference, visceral fat area, fasting and 120-min plasma glucose, HbA1c, AGEs, ACR and QTc interval were higher in subjects with CAD, p<0.05. In a logistic regression analysis the panel of age >53years (76% sensitivity, 61% specificity), HbA1c >6.0% (66% sensitivity, 60% specificity), QTc interval >423ms (65% sensitivity, 61% specificity) and presence of arterial hypertension (83% sensitivity, 55% specificity) was related to the presence of CAD - AUC 0.778 (95% CI: 0.73-0.83), p<0.001. CONCLUSION Our results demonstrate a high prevalence of CAD in early stages of glucose dysmetabolism. Age, HbA1c, QTc interval and presence of arterial hypertension are related to the presence of CAD in this population.
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Affiliation(s)
- Rumyana Dimova
- Department of Diabetology, Clinical Center of Endocrinology, Medical University Sofia, 2, Zdrave Str., Sofia 1431, Bulgaria.
| | - Tsvetalina Tankova
- Department of Diabetology, Clinical Center of Endocrinology, Medical University Sofia, 2, Zdrave Str., Sofia 1431, Bulgaria
| | - Nevena Chakarova
- Department of Diabetology, Clinical Center of Endocrinology, Medical University Sofia, 2, Zdrave Str., Sofia 1431, Bulgaria
| | - Greta Grozeva
- Department of Diabetology, Clinical Center of Endocrinology, Medical University Sofia, 2, Zdrave Str., Sofia 1431, Bulgaria
| | - Lilia Dakovska
- Department of Diabetology, Clinical Center of Endocrinology, Medical University Sofia, 2, Zdrave Str., Sofia 1431, Bulgaria
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Silva TP, Rolim LC, Sallum Filho C, Zimmermann LM, Malerbi F, Dib SA. Association between severity of hypoglycemia and loss of heart rate variability in patients with type 1 diabetes mellitus. Diabetes Metab Res Rev 2017; 33. [PMID: 27239809 DOI: 10.1002/dmrr.2830] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2015] [Revised: 04/27/2016] [Accepted: 05/24/2016] [Indexed: 01/18/2023]
Abstract
BACKGROUND The occurrence of hypoglycemia has been associated with the presence of cardiovascular autonomic neuropathy. Cardiovascular autonomic reflex tests are the gold standard diagnostic method for cardiovascular autonomic neuropathy. Nevertheless, impaired heart rate variability indices on spectral analysis have been reported before cardiovascular autonomic reflex test abnormalities arise. The objective of the present study was to analyse the association between the severity of hypoglycemia and indices of heart rate variability on spectral analysis. METHODS Consecutive type 1 diabetes patients were prospectively enrolled. Heart rate variability indices were assessed by spectral analysis. One abnormal test result was used to define impaired spectral analysis. The severity of hypoglycemia was evaluated by a hypoglycemia score and patients were classified into absent/minor or moderate/severe hypoglycemia groups. RESULTS Patients with moderate/severe hypoglycemia were older, had longer duration of diabetes and had higher rates of diabetic complications. After adjusting for baseline clinical characteristics, impaired spectral analysis (OR: 3.85; 95% IC 1.23 - 12.02; p = 0.020), nephropathy (OR: 4.15, 95% IC 1.27 - 13.54; p = 0.018) and macrovascular complications (OR: 12.18, 95% IC 1.14 - 129.84; p = 0.038) remained independent predictors of moderate/severe hypoglycemia. Patients with moderate/severe hypoglycemia had lower heart rate variability in the high frequency band of spectral analysis, reflecting a decreased parasympathetic tonus on the heart. These patients also had higher low frequency/high frequency ratios, ultimately denoting the occurrence of cardiovascular autonomic imbalance. CONCLUSIONS Impaired heart rate variability on spectral analysis, nephropathy and macrovascular complication were shown to independently predict moderate/severe hypoglycemia. Patients with moderate/severe hypoglycemia showed loss of the cardio protective effect of vagal activity according to spectral analysis. Copyright © 2016 John Wiley & Sons, Ltd.
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Affiliation(s)
- Ticiana Paes Silva
- Division of Endocrinology and Metabolism, Federal University of São Paulo, São Paulo, Brazil
| | - Luiz Clemente Rolim
- Division of Endocrinology and Metabolism, Federal University of São Paulo, São Paulo, Brazil
| | - Celso Sallum Filho
- Division of Endocrinology and Metabolism, Federal University of São Paulo, São Paulo, Brazil
| | - Livia M Zimmermann
- Division of Endocrinology and Metabolism, Federal University of São Paulo, São Paulo, Brazil
| | - Fernando Malerbi
- Division of Endocrinology and Metabolism, Federal University of São Paulo, São Paulo, Brazil
| | - Sergio Atala Dib
- Division of Endocrinology and Metabolism, Federal University of São Paulo, São Paulo, Brazil
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Razanskaite-Virbickiene D, Danyte E, Mockeviciene G, Dobrovolskiene R, Verkauskiene R, Zalinkevicius R. Can coefficient of variation of time-domain analysis be valuable for detecting cardiovascular autonomic neuropathy in young patients with type 1 diabetes: a case control study. BMC Cardiovasc Disord 2017; 17:34. [PMID: 28103812 PMCID: PMC5244586 DOI: 10.1186/s12872-016-0467-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2016] [Accepted: 12/29/2016] [Indexed: 02/07/2023] Open
Abstract
Background Cardiovascular autonomic neuropathy (CAN) increases morbidity and mortality in diabetes through association with a high risk of cardiac arrhythmias and sudden death, possibly related to silent myocardial ischemia. During the sub-clinical stage, CAN can be detected through reduction in heart rate variability (HRV). The aim of our study was to estimate if the time and frequency-domain analysis can be valuable for detecting CAN in young patients with type 1 diabetes mellitus (T1DM). Methods For this case control study of evaluation of cardiovascular autonomic function the 15–25 years age group of patients with duration of T1DM more than 9 years (n = 208, 89 males and 119 females) were selected. 67 patients with confirmed CAN were assigned to the “case group” and 141 patients without CAN served as a control group, the duration of T1DM was similar (15.07 ± 4.89 years vs.13.66 ± 4.02 years; p = 0.06) in both groups. Cardiovascular autonomic reflex tests and time and frequency domains analysis of HRV were performed for all subjects. Results Time domain measures were significantly lower in CAN group compared with control (p < 0.05). R-R max / R-R min ratio and coefficient of variation (CV) were the lowest during deep breathing among T1DM patients with CAN. Receivers operating characteristic (ROC) curves were constructed to compare the accuracies of the parameters of time-domain analysis for diagnosing CAN. We estimated a more reliable cut-off value of parameters of time-domain. The CV values in supine position <1.65, reflected sensitivity 94.3%, specificity 91.5%. The CV values during deep breathing <1.45 reflected sensitivity 97.3%, specificity 96.2%. The CV values in standing position <1.50 reflected sensitivity 96.2%, specificity 93.0%. The most valuable CV was during deep breathing (AUC 0.899). The results of frequency-domain (spectral analysis) analysis showed significant decrease in LF power and LFPA, HF Power and HFPA, total power among subjects with CAN than compared with subjects without CAN (p < 0.05). Conclusions Time and frequency domain analysis of HRV permits a more accurate evaluation of cardiovascular autonomic function, providing more information about sympathetic and parasympathetic activity. The coefficient of variation (time-domain analysis) especially during deep breathing could be valuable for detecting CAN.
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Affiliation(s)
| | - Evalda Danyte
- Institute of Endocrinology, Medical Academy, Lithuanian University of Health Sciences, LT-44307, Kaunas, Lithuania
| | - Giedre Mockeviciene
- Department of Endocrinology Medical Academy, Lithuanian University of Health Sciences, LT-44307, Kaunas, Lithuania
| | - Rimante Dobrovolskiene
- Department of Endocrinology Medical Academy, Lithuanian University of Health Sciences, LT-44307, Kaunas, Lithuania
| | - Rasa Verkauskiene
- Institute of Endocrinology, Medical Academy, Lithuanian University of Health Sciences, LT-44307, Kaunas, Lithuania
| | - Rimantas Zalinkevicius
- Institute of Endocrinology, Medical Academy, Lithuanian University of Health Sciences, LT-44307, Kaunas, Lithuania
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30
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Fisher VL, Tahrani AA. Cardiac autonomic neuropathy in patients with diabetes mellitus: current perspectives. Diabetes Metab Syndr Obes 2017; 10:419-434. [PMID: 29062239 PMCID: PMC5638575 DOI: 10.2147/dmso.s129797] [Citation(s) in RCA: 68] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Cardiac autonomic neuropathy (CAN) is a common and often-underdiagnosed complication of diabetes mellitus (DM). CAN is associated with increased mortality, cardiovascular disease, chronic kidney disease, and morbidity in patients with DM, but despite these significant consequences CAN often remains undiagnosed for a prolonged period. This is commonly due to the disease being asymptomatic until the later stages, as well as a lack of easily available screening strategies. In this article, we review the latest developments in the epidemiology, pathogenesis, diagnosis, consequences, and treatments of CAN in patients with DM.
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Affiliation(s)
| | - Abd A Tahrani
- Institute of Metabolism and Systems Research, University of Birmingham
- Department of Diabetes and Endocrinology, Birmingham Heartlands Hospital
- Centre for Endocrinology, Diabetes and Metabolism, Birmingham Health Partners, Birmingham, UK
- Correspondence: Abd A Tahrani, Institute of Metabolism and Systems Research, Medical School, University of Birmingham, Birmingham B15 2TT, UK, Email
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Bissinger A. Cardiac Autonomic Neuropathy: Why Should Cardiologists Care about That? J Diabetes Res 2017; 2017:5374176. [PMID: 29214181 PMCID: PMC5682059 DOI: 10.1155/2017/5374176] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2017] [Revised: 05/06/2017] [Accepted: 05/21/2017] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Cardiac autonomic neuropathy (CAN) is a frequent but underdiagnosed complication of diabetes mellitus. It has a strong influence on various cardiac disorders including myocardial ischemia and infarction, hypertension, orthostatic hypotonia, heart failure, and arrhythmias. CAN can lead to severe morbidity and mortality and increase the risk of sudden cardiac death. METHODS This review article summarizes the latest evidence regarding the epidemiology, pathogenesis, influence on the cardiovascular system, and diagnostic methods for CAN. The methodology of this review involved analyzing available data from recent papers relevant to the topic of diabetic autonomic neuropathy and cardiac disorders. CONCLUSIONS The early diagnosis of CAN can improve the prognosis and reduce adverse cardiac events. Methods based on heart rate variability enable the diagnosis of CAN even at a preclinical stage. These methods are simple and widely available for use in everyday clinical practice. According to the recently published Toronto Consensus Panel on Diabetic Neuropathy, all diabetic patients should be screened for CAN. Because diabetes mellitus often coexists with heart diseases and the most common methods used for diagnosis of CAN are based on ECG, not only diabetologists but also cardiologists should be responsible for diagnosis of CAN.
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Affiliation(s)
- Andrzej Bissinger
- Department of Interventional Cardiology and Arrhythmias, Medical University of Lodz, Lodz, Poland
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Stern K, Cho YH, Benitez-Aguirre P, Jenkins AJ, McGill M, Mitchell P, Keech AC, Donaghue KC. QT interval, corrected for heart rate, is associated with HbA1c concentration and autonomic function in diabetes. Diabet Med 2016; 33:1415-21. [PMID: 26823095 DOI: 10.1111/dme.13085] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2015] [Revised: 12/28/2015] [Accepted: 01/25/2016] [Indexed: 11/29/2022]
Abstract
AIMS To examine QT intervals corrected for heart rate (QTc) in adolescents with Type 1 diabetes compared with control subjects, and to determine associations with metabolic control and autonomic function. METHODS Resting electrocardiogram recordings of 142 adolescents with Type 1 diabetes [mean (sd) age 15.3 (2.0) years, diabetes duration 9.0 (3.5) years, HbA1c 71 (17) mmol/mol or 8.7 (1.6)%] and 125 control subjects [mean (sd) age 15.7 (2.5) years] were used to calculate QTc duration and derive mean heart rate and heart rate variability (HRV) values. Linear and logistic regression models were used to examine the associations between QTc, metabolic control and autonomic function (HRV and pupillary function). RESULTS QTc duration was not significantly different between subjects with Type 1 diabetes and control subjects (mean duration 392 vs 391 ms; P = 0.65). In the Type 1 diabetes group, QTc was positively associated with HbA1c [β = 4 (95% CI 2, 6); P < 0.001] and inversely associated with severe hypoglycaemic events [β = -10 (95% CI -20,-2); P = 0.01], less insulin/kg [β = -12 (95% CI -22, -2); P = 0.024] and less HRV. In the Type 1 diabetes group, QTc in the highest quintile (≥409 ms) vs quintiles 1-4 had more pupillary abnormalities (83 vs 56%; P = 0.03), lower pupillary maximum constriction velocity (4.8 vs 5.3 mm/s; P = 0.04), higher heart rate (78 vs 72 beats per min; P = 0.02) and lower HRV (standard deviation of mean NN intervals 4.0 vs 4.3 ms, P = 0.004 and root-mean-square difference of successive NN intervals 3.7 vs 4.1 ms; P = 0.004). CONCLUSIONS Although there are concerns about hypoglycaemia in general in people with Type 1 diabetes, chronic hyperglycaemia, rather than intermittent hypoglycaemia, appears to be more deleterious to autonomic cardiac function, even in adolescence. Longer QTc was associated with higher HbA1c concentration, lower risk of hypoglycaemia and autonomic dysfunction. Longitudinal studies are warranted.
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Affiliation(s)
- K Stern
- Sydney Medical School, University of Sydney, Sydney, Australia
| | - Y H Cho
- Children's Hospital at Westmead, Institute of Endocrinology and Diabetes, Sydney, Australia
- Discipline of Paediatrics and Child Health, University of Sydney, Sydney, Australia
| | - P Benitez-Aguirre
- Children's Hospital at Westmead, Institute of Endocrinology and Diabetes, Sydney, Australia
- Discipline of Paediatrics and Child Health, University of Sydney, Sydney, Australia
| | - A J Jenkins
- National Health and Medical Research Council, Clinical Trials Centre, Sydney, Australia
| | - M McGill
- Department of Endocrinology, Royal Prince Alfred Hospital, Sydney, Australia
| | - P Mitchell
- Centre for Vision Research, Westmead Millennium Institute, Sydney, Australia
- Department of Ophthalmology, University of Sydney, Sydney, Australia
| | - A C Keech
- National Health and Medical Research Council, Clinical Trials Centre, Sydney, Australia
- Department of Cardiology, Royal Prince Alfred Hospital, Sydney, Australia
| | - K C Donaghue
- Children's Hospital at Westmead, Institute of Endocrinology and Diabetes, Sydney, Australia.
- Discipline of Paediatrics and Child Health, University of Sydney, Sydney, Australia.
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Abstract
Cardiac autonomic neuropathy (CAN) represents a serious complication as it carries an approximately five-fold risk of mortality in patients with diabetes just as in those with chronic liver diseases. The high mortality rate may be related to silent myocardial infarction, cardiac arrhythmias, cardiovascular and cardiorespiratory instability and to other causes not yet explained. Resting tachycardia due to parasympathetic damage may represent one of the earliest signs. Typical findings referring to autonomic dysfunction may include exercise intolerance, orthostatic hypotension and cardiac dysfunction to rest or exercise. Severe autonomic neuropathy may be responsible for spontaneous respiratory arrest and unexplained sudden death. A relationship between the presence and/or severity of CAN and corrected QT interval prolongation is well documented. Better understanding of the prognostic importance of autonomic neuropathy followed the use of simple non-invasive cardiovascular reflex tests. These most commonly include heart rate variation in response to deep breathing, standing, the Valsalva maneouvre and blood pressure response to standing and sustained handgrip. Near normoglycaemia is now generally accepted as the primary approach to the prevention of diabetic neuropathy, but is not achievable in most patients. Our experience of the use of the antioxidant alpha-lipoic acid in the treatment of cardiac autonomic neuropathy is described.
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Affiliation(s)
- Peter Kempler
- Department of Medicine, Semmelweis University, 1083 Budapest, Korányi S.u. 2/a, Hungary,
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34
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Yu TY, Lee DH. Dizziness and Syncope Related with Diabetic Autonomic Neuropathy. INTERNATIONAL JOURNAL OF ARRHYTHMIA 2016. [DOI: 10.18501/arrhythmia.2016.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Vidigal GADP, Tavares BS, Garner DM, Porto AA, Carlos de Abreu L, Ferreira C, Valenti VE. Slow breathing influences cardiac autonomic responses to postural maneuver: Slow breathing and HRV. Complement Ther Clin Pract 2016; 23:14-20. [PMID: 27157952 DOI: 10.1016/j.ctcp.2015.11.005] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2015] [Accepted: 11/26/2015] [Indexed: 11/29/2022]
Abstract
Chronic slow breathing has been reported to improve Heart Rate Variability (HRV) in patients with cardiovascular disorders. However, it is not clear regarding its acute effects on HRV responses on autonomic analysis. We evaluated the acute effects of slow breathing on cardiac autonomic responses to postural change manoeuvre (PCM). The study was conducted on 21 healthy male students aged between 18 and 35 years old. In the control protocol, the volunteer remained at rest seated for 15 min under spontaneous breathing and quickly stood up within 3 s and remained standing for 15 min. In the slow breathing protocol, the volunteer remained at rest seated for 10 min under spontaneous breath, then performed slow breathing for 5 min and rapidly stood up within 3 s and remained standing for 15 min. Slow breathing intensified cardiac autonomic responses to postural maneuver.
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Affiliation(s)
- Giovanna Ana de Paula Vidigal
- Centro de Estudos do Sistema Nervoso Autônomo (CESNA), Departamento de Fisioterapia e Terapia Ocupacional, Faculdade de Filosofia e Ciências, UNESP, Marília, SP, Brazil
| | - Bruna S Tavares
- Centro de Estudos do Sistema Nervoso Autônomo (CESNA), Departamento de Fisioterapia e Terapia Ocupacional, Faculdade de Filosofia e Ciências, UNESP, Marília, SP, Brazil
| | - David M Garner
- Cardiorespiratory Research Group, Department of Biological and Medical Sciences, Faculty of Health and Life Sciences, Oxford Brookes University, Gipsy Lane, Oxford OX3 0BP, United Kingdom
| | - Andrey A Porto
- Disciplina de Cardiologia, Departamento de Medicina, UNIFESP, São Paulo, SP, Brazil
| | - Luiz Carlos de Abreu
- Department of Environmental Health, Harvard Medical School of Public Health, Boston, MA, United States
| | - Celso Ferreira
- Disciplina de Cardiologia, Departamento de Medicina, UNIFESP, São Paulo, SP, Brazil
| | - Vitor E Valenti
- Centro de Estudos do Sistema Nervoso Autônomo (CESNA), Programa de Pós-Graduação em Fisioterapia, Faculdade de Ciências e Tecnologia, UNESP, Presidente Prudente, SP, Brazil.
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Mendivil CO, Kattah W, Orduz A, Tique C, Cárdenas JL, Patiño JE. Neuropad for the detection of cardiovascular autonomic neuropathy in patients with type 2 diabetes. J Diabetes Complications 2016; 30:93-8. [PMID: 26525688 DOI: 10.1016/j.jdiacomp.2015.10.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2015] [Revised: 09/24/2015] [Accepted: 10/08/2015] [Indexed: 12/16/2022]
Abstract
BACKGROUND Cardiovascular autonomic neuropathy (CAN) is a prevalent and neglected chronic complication of diabetes, with a large impact on morbidity and mortality. Part of the reason why it is not detected and treated opportunely is because of the complexity of the tests required for its diagnosis. We evaluated the Neuropad®, a test based on sudomotor function, as a screening tool for CAN in adult patients with type 2 diabetes in Bogotá, Colombia. METHODS This was a cross-sectional evaluation of Neuropad® for the detection of CAN. Patients were 20-75years of age and did not suffer from any other type of neuropathy. CAN was diagnosed using the Ewing battery of tests for R-R variability during deep breathing, Valsalva and lying-to-standing maneuvers. Additionally, distal symmetric polyneuropathy (DSP) was diagnosed using a sign-based scale (Michigan Neuropathy Disability Score - NDS) and a symptom-based score (Total Symptom Score - TSS). The primary outcome was the sensitivity and specificity of the Neuropad® for the diagnosis of CAN, and secondary outcomes were the sensitivity and specificity of Neuropad® for DSP. RESULTS We studied 154 patients (74 men and 80 women). Prevalence of CAN was extremely high (68.0% of study participants), but also DSP was prevalent, particularly according to the signs-based definition (45%). The sensitivity of the Neuropad® for any degree of CAN was 70.1%, being slightly higher for the deep breathing and Valsalva tests than for lying-to-standing. The specificity of the Neuropad® for any type of CAN was only 37.0%, as expected for a screening exam. The negative predictive value was higher for the deep breathing and Valsalva tests (69.4 and 81.6%, respectively). Neuropad showed also a good sensitivity and negative predictive value for DSP. The sensitivity and specificity of Neuropad were better among men, and among patients with diabetes duration above the group median. CONCLUSIONS The Neuropad is a simple and inexpensive device that demonstrated an adequate performance as a screening tool for cardiovascular autonomic neuropathy in Latin American patients with DM2.
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Affiliation(s)
- Carlos O Mendivil
- Endocrinology Section, Department of Internal Medicine, Fundación Santafé de Bogotá, Bogotá, Colombia; School of Medicine, Universidad de los Andes, Bogotá, Colombia.
| | - William Kattah
- Endocrinology Section, Department of Internal Medicine, Fundación Santafé de Bogotá, Bogotá, Colombia; School of Medicine, Universidad de los Andes, Bogotá, Colombia.
| | - Arturo Orduz
- Endocrinology Section, Department of Internal Medicine, Fundación Santafé de Bogotá, Bogotá, Colombia.
| | - Claudia Tique
- Endocrinology Section, Department of Internal Medicine, Fundación Santafé de Bogotá, Bogotá, Colombia.
| | - José L Cárdenas
- School of Medicine, Universidad de los Andes, Bogotá, Colombia.
| | - Jorge E Patiño
- School of Medicine, Universidad de los Andes, Bogotá, Colombia.
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Grisé KN, Olver TD, McDonald MW, Dey A, Jiang M, Lacefield JC, Shoemaker JK, Noble EG, Melling CWJ. High Intensity Aerobic Exercise Training Improves Deficits of Cardiovascular Autonomic Function in a Rat Model of Type 1 Diabetes Mellitus with Moderate Hyperglycemia. J Diabetes Res 2016; 2016:8164518. [PMID: 26885531 PMCID: PMC4739461 DOI: 10.1155/2016/8164518] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2015] [Revised: 12/11/2015] [Accepted: 12/15/2015] [Indexed: 02/07/2023] Open
Abstract
Indices of cardiovascular autonomic neuropathy (CAN) in experimental models of Type 1 diabetes mellitus (T1DM) are often contrary to clinical data. Here, we investigated whether a relatable insulin-treated model of T1DM would induce deficits in cardiovascular (CV) autonomic function more reflective of clinical results and if exercise training could prevent those deficits. Sixty-four rats were divided into four groups: sedentary control (C), sedentary T1DM (D), control exercise (CX), or T1DM exercise (DX). Diabetes was induced via multiple low-dose injections of streptozotocin and blood glucose was maintained at moderate hyperglycemia (9-17 mM) through insulin supplementation. Exercise training consisted of daily treadmill running for 10 weeks. Compared to C, D had blunted baroreflex sensitivity, increased vascular sympathetic tone, increased serum neuropeptide Y (NPY), and decreased intrinsic heart rate. In contrast, DX differed from D in all measures of CAN (except NPY), including heart rate variability. These findings demonstrate that this T1DM model elicits deficits and exercise-mediated improvements to CV autonomic function which are reflective of clinical T1DM.
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Affiliation(s)
- Kenneth N. Grisé
- Exercise Biochemistry Laboratory, School of Kinesiology, Faculty of Health Sciences, Western University, London, ON, Canada N6A 3K7
| | - T. Dylan Olver
- Neurovascular Research Laboratory, School of Kinesiology, Faculty of Health Sciences, Western University, London, ON, Canada N6A 3K7
| | - Matthew W. McDonald
- Exercise Biochemistry Laboratory, School of Kinesiology, Faculty of Health Sciences, Western University, London, ON, Canada N6A 3K7
| | - Adwitia Dey
- Exercise Biochemistry Laboratory, School of Kinesiology, Faculty of Health Sciences, Western University, London, ON, Canada N6A 3K7
| | - Mao Jiang
- Exercise Biochemistry Laboratory, School of Kinesiology, Faculty of Health Sciences, Western University, London, ON, Canada N6A 3K7
| | - James C. Lacefield
- Department of Electrical and Computer Engineering, Department of Medical Biophysics and Robarts Research Institute, Western University, London, ON, Canada N6A 3K7
| | - J. Kevin Shoemaker
- Neurovascular Research Laboratory, School of Kinesiology, Faculty of Health Sciences, Western University, London, ON, Canada N6A 3K7
- Department of Physiology and Pharmacology, Western University, London, ON, Canada N6A 3K7
- Lawson Health Research Institute, London, ON, Canada N6C 2R5
| | - Earl G. Noble
- Exercise Biochemistry Laboratory, School of Kinesiology, Faculty of Health Sciences, Western University, London, ON, Canada N6A 3K7
- Lawson Health Research Institute, London, ON, Canada N6C 2R5
| | - C. W. James Melling
- Exercise Biochemistry Laboratory, School of Kinesiology, Faculty of Health Sciences, Western University, London, ON, Canada N6A 3K7
- *C. W. James Melling:
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Gaspar L, Kruzliak P, Komornikova A, Celecova Z, Krahulec B, Balaz D, Sabaka P, Caprnda M, Kucera M, Rodrigo L, Uehara Y, Dukat A. Orthostatic hypotension in diabetic patients-10-year follow-up study. J Diabetes Complications 2016; 30:67-71. [PMID: 26412028 DOI: 10.1016/j.jdiacomp.2015.08.020] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2015] [Revised: 08/26/2015] [Accepted: 08/27/2015] [Indexed: 12/28/2022]
Abstract
INTRODUCTION Cardiovascular autonomic neuropathy in diabetics is a common but often underestimated and underdiagnosed complication of diabetes mellitus. One of the most clinical apparent forms of cardiovascular autonomic neuropathy is orthostatic hypotension. OBJECTIVES To retrospectively assess the association of the orthostatic hypotension (OH) with macrovascular and microvascular complications of diabetes mellitus and to determine its effect on mortality. DESIGN AND METHODS We retrospectively analyzed 187 patients with diabetes mellitus (60 patients with diabetes type 1 and 127 patients with diabetes type 2). Patients were divided into groups according to presence or absence of OH and type of diabetes. Association of OH with macrovascular and microvascular complications was evaluated and the effect of OH on 10-year all-cause mortality was also assessed. RESULTS OH was present in 31.7% of patients with diabetes type 1 (DM1) and in 32.3% of patients with diabetes type 2 (DM2). OH was positively associated with the prevalence of myocardial infarction in DM1 (OR=10.67) and with prevalence of stroke in DM2 (OR=3.33). There was also a strong association of OH and the prevalence of peripheral artery disease in both DM1 (OR=14.18) and DM2 (OR=3.26). Patients with both types of diabetes and OH had significantly higher prevalence of nephropathy (DM1 OR=8.68, DM2 OR=3.24), retinopathy (DM1 OR=8.09, DM2 OR=4.08) and peripheral neuropathy (DM1 OR=17.14, DM2 OR=7.51) Overall 10year mortality rate was higher in diabetic patients with OH. CONCLUSIONS Presence of OH in diabetics is associated with higher prevalence of macrovascular and microvascular complications of diabetes mellitus and also with higher 10-year mortality.
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Affiliation(s)
- Ludovit Gaspar
- 2(nd) Department of Internal Medicine, Comenius University and University Hospital, Bratislava, Slovak Republic.
| | - Peter Kruzliak
- 2(nd) Department of Internal Medicine, St. Anne's University Hospital and Masaryk University, Brno, Czech Republic.
| | - Andrea Komornikova
- 2(nd) Department of Internal Medicine, Comenius University and University Hospital, Bratislava, Slovak Republic
| | - Zuzana Celecova
- 2(nd) Department of Internal Medicine, Comenius University and University Hospital, Bratislava, Slovak Republic
| | - Boris Krahulec
- 2(nd) Department of Internal Medicine, Comenius University and University Hospital, Bratislava, Slovak Republic
| | - David Balaz
- 2(nd) Department of Internal Medicine, Comenius University and University Hospital, Bratislava, Slovak Republic
| | - Peter Sabaka
- 2(nd) Department of Internal Medicine, Comenius University and University Hospital, Bratislava, Slovak Republic
| | - Martin Caprnda
- 2(nd) Department of Internal Medicine, Comenius University and University Hospital, Bratislava, Slovak Republic
| | - Marek Kucera
- 2(nd) Department of Internal Medicine, Comenius University and University Hospital, Bratislava, Slovak Republic
| | - Luis Rodrigo
- Department of Gastroenterology, Central University Hospital of Asturias (HUCA), Oviedo, Spain
| | - Yoshio Uehara
- Division of Clinical Nutrition, Faculty of Home Economics, Kyoritsu Women's University, Tokyo, Japan
| | - Andrej Dukat
- 2(nd) Department of Internal Medicine, Comenius University and University Hospital, Bratislava, Slovak Republic
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Fialová E, Kittnar O. The development of selected cardiovascular parameters in patients with type 2 diabetes mellitus during a spa treatment. Physiol Res 2015; 64:S661-7. [PMID: 26674292 DOI: 10.33549/physiolres.933228] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Diabetes mellitus is not just a simple metabolic disorder, however, it is considered to be a cardiovascular disease of a metabolic origin. This is apparent especially when speaking about type 2 diabetes (DM II). The objective of our study was to determine whether a comprehensive spa treatment (procedures and drinking cure) may affect the level of the sympathetic tone of patients suffering from DM II. As an indicator of the sympathetic tone, selected electrocardiographic parameters derived from the heart rate variability and microwave alternans were chosen. There were 96 patients enrolled in our study: 38 patients with poorly controlled DM II and two control groups: 9 patients with compensated DM II and 49 patients, average age without diabetes or other disorders of the glucose metabolism. All received an identical spa treatment and continued their medical therapy. The electrophysiological examination of patients was performed before and after a three-week spa treatment using the KARDiVAR system. Parameters derived from the analysis of heart rate variability (HRV), microvolt T-wave alternans, and microvolt R-wave alternans were analyzed in order to evaluate the tones of the autonomic nervous system (ANS). The control group showed a slight increase of parameter the index of activity of regulatory systems (IRSA) (4.4+/-1.3 vs. 3.8+/-1.4; p=0.006) after the spa treatment, while increased heart rate (80.9+/-11.0 vs. 74.6+/-9.6; p=0.028), reduced index of centralization (IC) (1.3+/-0.6 vs. 2.9+/-1.4; p=0.027) and reduced index of myocardium (IM) (9.9+/-7.4 vs. 18.0+/-6.3; p=0.041) were found in patients with a compensated DM II. Patients with a poorly compensated DM II showed a decreased IM (10.9+/-8.6 vs. 16.9+/-5.2; p=0.001) and also a reduced IRSA (4.1+/-3.5 vs. 6.3+/-1.9; p=0.001). The results proved favorable changes in ANS cardiovascular control of patients with DM II after a spa treatment, especially in terms of reducing the sympathoadrenal system activity (decreased IRSA), improving electrical stability of the myocardium and increasing centrally controlled heart rate variability without overloading the cardiovascular system (drop of IM).
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Affiliation(s)
- E Fialová
- Institute of Physiology, First Faculty of Medicine, Charles University in Prague, Prague, Czech Republic.
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Jung CH, Jung SH, Kim BY, Kim CH, Kang SK, Mok JO. Association of serum omentin levels with cardiac autonomic neuropathy in patients with type 2 diabetes mellitus: a hospital-based study. Cardiovasc Diabetol 2015; 14:140. [PMID: 26466574 PMCID: PMC4606473 DOI: 10.1186/s12933-015-0303-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2015] [Accepted: 10/02/2015] [Indexed: 01/29/2023] Open
Abstract
Background Whereas a few studies have reported associations of serum omentin levels with subclinical atherosclerosis in patients with diabetes, little information is available with respect to the associations of serum omentin levels and diabetic microvascular complications. The aim of this study was to investigate the relationships of serum omentin levels and vascular complications including cardiac autonomic neuropathy (CAN) in patients with type 2 diabetes mellitus (T2DM). Methods We recruited 97 patients who evaluated complications of diabetes. CAN was assessed by five standard cardiovascular reflex tests according to Ewing’s protocol. Diabetic nephropathy (DN), retinopathy (DR), and peripheral neuropathy (DPN) were evaluated. Serum omentin levels were assessed by ELISA. Atherosclerotic burden was evaluated by measuring the brachial-ankle pulse wave velocity (baPWV) and ankle brachial index (ABI). Results The prevalence of CAN increased borderline significantly across the omentin tertiles (p = 0.05) and CAN point increased significantly and progressively across the omentin tertiles (p = 0.013). The prevalence of other microvascular complications (DPN, DN, and DR) did not differ among omentin tertiles. The mean levels of baPWV also increased significantly and progressively across the omentin tertiles (p = 0.002). Serum omentin levels were significantly positively correlated with CAN point (p = 0.004) and borderline significantly correlated with baPWV (p = 0.05) after multivariate adjustment. Regarding linear regression analysis for CAN point, univariate regression analysis demonstrated that CAN point associated with omentin, diastolic blood pressure (DBP) and hsCRP. Multiple regression analysis revealed that omentin levels, together DBP and baPWV correlated with CAN point. This present study suggests that serum omentin levels may be independently associate with CAN in patients with T2DM.
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Affiliation(s)
- Chan-Hee Jung
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Soonchunhyang University College of Medicine, #170 Jomaru-ro, Wonmi-gu, Bucheon-si, Gyeonggi-do, 420-767, Republic of Korea.
| | - Sang-Hee Jung
- Department of Obstetrics and Gynecology, Cha University School of Medicine, Bundang, Korea.
| | - Bo-Yeon Kim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Soonchunhyang University College of Medicine, #170 Jomaru-ro, Wonmi-gu, Bucheon-si, Gyeonggi-do, 420-767, Republic of Korea.
| | - Chul-Hee Kim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Soonchunhyang University College of Medicine, #170 Jomaru-ro, Wonmi-gu, Bucheon-si, Gyeonggi-do, 420-767, Republic of Korea.
| | - Sung-Koo Kang
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Soonchunhyang University College of Medicine, #170 Jomaru-ro, Wonmi-gu, Bucheon-si, Gyeonggi-do, 420-767, Republic of Korea.
| | - Ji-Oh Mok
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Soonchunhyang University College of Medicine, #170 Jomaru-ro, Wonmi-gu, Bucheon-si, Gyeonggi-do, 420-767, Republic of Korea.
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Bassi D, Arakelian VM, Mendes RG, Caruso FCR, Bonjorno Júnior JC, Zangrando KTL, Oliveira CRD, Haus J, Arena R, Borghi-Silva A. Poor glycemic control impacts linear and non-linear dynamics of heart rate in DM type 2. REV BRAS MED ESPORTE 2015. [DOI: 10.1590/1517-869220152104150003] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
INTRODUCTION: It is well known that type 2 diabetes mellitus (T2DM) produces cardiovascular autonomic neuropathy (CAN), which may affect the cardiac autonomic modulation. However, it is unclear whether the lack of glycemic control in T2DM without CAN could impact negatively on cardiac autonomic modulation. Objective: To evaluate the relationship between glycemic control and cardiac autonomic modulation in individuals with T2DM without CAN. Descriptive, prospective and cross sectional study.METHODS: Forty-nine patients with T2DM (51±7 years) were divided into two groups according to glycosylated hemoglobin (HbA1c): G1≤7% and G2>7.0%. Resting heart rate (HR) and RR interval (RRi) were obtained and calculated by linear (Mean iRR; Mean HR; rMSSD; STD RR; LF; HF; LF/HF, TINN and RR Tri,) and non-linear (SD1; SD2; DFα1; DFα2, Shannon entropy; ApEn; SampEn and CD) methods of heart rate variability (HRV). Insulin, HOMA-IR, fasting glucose and HbA1c were obtained by blood tests.RESULTS: G2 (HbA1c≤7%) showed lower values for the mean of iRR; STD RR; RR Tri, TINN, SD2, CD and higher mean HR when compared with G1 (HbA1c > 7%). Additionally, HbA1c correlated negatively with mean RRi (r=0.28, p=0.044); STD RR (r=0.33, p=0.017); RR Tri (r=-0.35, p=0.013), SD2 (r=-0.39, p=0.004) and positively with mean HR (r=0.28, p=0.045). Finally, fasting glucose correlated negatively with STD RR (r=-0.36, p=0.010); RR Tri (r=-0.36, p=0.010); TINN (r=-0.33, p=0.019) and SD2 (r=-0.42, p=0.002).CONCLUSION: We concluded that poor glycemic control is related to cardiac autonomic modulation indices in individuals with T2DM even if they do not present cardiovascular autonomic neuropathy.
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Affiliation(s)
| | | | | | | | | | | | | | - Jacob Haus
- University of Illinois, United States; University of Illinois, United States
| | - Ross Arena
- University of Illinois, United States; University of Illinois, United States
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Körei AE, Istenes I, Papanas N, Kempler P. Small-Fiber Neuropathy: A Diabetic Microvascular Complication of Special Clinical, Diagnostic, and Prognostic Importance. Angiology 2015; 67:49-57. [PMID: 25957257 DOI: 10.1177/0003319715583595] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Damage of small nerve fibers may lead to a large variety of clinical symptoms. Small-fiber neuropathy underlies the symptoms of painful diabetic neuropathy, which may decrease quality of life. It also contributes to the poor prognosis of diabetic neuropathy because it plays a key role in the pathogenesis of foot ulceration and autonomic neuropathy. Impairment of small nerve fibers is considered the earliest alteration in the course of diabetic neuropathy. Therefore, assessment of functional and morphological abnormalities of small nerve fibers may enable timely diagnosis. The definition, symptoms, and clinical significance of small-fiber neuropathy are considered in the present review. An apparently more complex interaction between small-fiber impairment and microcirculation is extensively discussed. Diagnostic modalities include morphometric and functional methods. Corneal confocal microscopy and punch skin biopsy are considered gold standards, but noninvasive functional tests are also diagnostically useful. However, in routine clinical practice, small-fiber neuropathy is diagnosed by its typical clinical presentation. Finally, prompt treatment should be initiated following diagnosis.
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Affiliation(s)
- A E Körei
- First Department of Medicine, Semmelweis University, Budapest, Hungary
| | - I Istenes
- First Department of Medicine, Semmelweis University, Budapest, Hungary
| | - N Papanas
- Second Department of Internal Medicine, Outpatient Clinic of the Diabetic Foot, Democritus University of Thrace, University Hospital of Alexandroupolis, Alexandroupolis, Greece
| | - P Kempler
- First Department of Medicine, Semmelweis University, Budapest, Hungary
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Balcıoğlu AS, Müderrisoğlu H. Diabetes and cardiac autonomic neuropathy: Clinical manifestations, cardiovascular consequences, diagnosis and treatment. World J Diabetes 2015; 6:80-91. [PMID: 25685280 PMCID: PMC4317320 DOI: 10.4239/wjd.v6.i1.80] [Citation(s) in RCA: 108] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2014] [Revised: 09/24/2014] [Accepted: 12/01/2014] [Indexed: 02/05/2023] Open
Abstract
Cardiac autonomic neuropathy (CAN) is a frequent chronic complication of diabetes mellitus with potentially life-threatening outcomes. CAN is caused by the impairment of the autonomic nerve fibers regulating heart rate, cardiac output, myocardial contractility, cardiac electrophysiology and blood vessel constriction and dilatation. It causes a wide range of cardiac disorders, including resting tachycardia, arrhythmias, intraoperative cardiovascular instability, asymptomatic myocardial ischemia and infarction and increased rate of mortality after myocardial infarction. Etiological factors associated with autonomic neuropathy include insufficient glycemic control, a longer period since the onset of diabetes, increased age, female sex and greater body mass index. The most commonly used methods for the diagnosis of CAN are based upon the assessment of heart rate variability (the physiological variation in the time interval between heartbeats), as it is one of the first findings in both clinically asymptomatic and symptomatic patients. Clinical symptoms associated with CAN generally occur late in the disease process and include early fatigue and exhaustion during exercise, orthostatic hypotension, dizziness, presyncope and syncope. Treatment is based on early diagnosis, life style changes, optimization of glycemic control and management of cardiovascular risk factors. Medical therapies, including aldose reductase inhibitors, angiotensin-converting enzyme inhibitors, prostoglandin analogs and alpha-lipoic acid, have been found to be effective in randomized controlled trials. The following article includes the epidemiology, clinical findings and cardiovascular consequences, diagnosis, and approaches to prevention and treatment of CAN.
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Abstract
In spite of new therapy options the life expectancy of patients with diabetes mellitus is clearly reduced compared to the average population. In addition to coronary heart disease and diabetic cardiomyopathy, cardiac autonomic neuropathy (CAN) is also a factor in patients with diabetes mellitus. The CAN is an impairment of cardiovascular control. A reduced variability of heart rate up to the point of a fixed heart rate are symptoms of CAN. In addition symptomatic hypotension, a reduced left ventricular ejection fraction, cardiac arrhythmia and sudden cardiac death are also signs of CAN. Prevalence rates of CAN increase with age and are approximately 38 % in patients 40-70 years old with diabetes mellitus type 1 and 44 % in patients with diabetes mellitus type 2. The disease is usually documented using miscellaneous cardiovascular autonomic tests so that therapy can be started as soon as possible.
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Archer T, Garcia D. Exercise and Dietary Restriction for Promotion of Neurohealth Benefits. Health (London) 2015. [DOI: 10.4236/health.2015.71016] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Bissinger A, Ruxer J, Ahmed RB, Lubinski A. Heart rate turbulence in patients with poorly controlled diabetes mellitus type 2. Arch Med Sci 2014; 10:1073-7. [PMID: 25624841 PMCID: PMC4296065 DOI: 10.5114/aoms.2014.47819] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2012] [Revised: 11/02/2012] [Accepted: 01/26/2013] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Cardiac autonomic neuropathy (CAN) causes substantial morbidity and increased mortality in patients with diabetes mellitus (DM). Besides heart rate variability (HRV), heart rate turbulence (HRT) is an important method of assessment of cardiac autonomic regulation. The aim of the study was to assess the correlation between HRT and diabetic control. MATERIAL AND METHODS Fifty-nine patients met the inclusion criteria - 38 males and 21 females, age 64.4 ±7.6. The patients included had inadequately controlled DM type 2 defined as glycated haemoglobin (HbA1c) > 9% (mean 11.8 ±2.7%). In all patients, intensive insulin treatment had been applied for 6 months. After 6 months, HbA1c was measured. ECG Holter monitoring was performed before and after insulin treatment to evaluate the time domain HRV and HRT parameters (turbulence onset (TO) and turbulence slope (TS)). RESULTS After 6 months of intensive insulin treatment, HbA1c concentrations ranged from 6.3% (45 mmol/mol) to 11.2% (99 mmol/mol) - mean 8.5 ±3.8% (69 ±18 mmol/mol). Significant improvement of TO, TS and SDNN was observed. The TO and TS significantly correlated with HbA1c (r = 0.35, p = 0.006 and r = -0.31, p = 0.02 respectively). Among analyzed HRV time domain parameters such as SDNN, rMSSD and pNN50, only SDNN correlated with HbA1c (r = -0.41, p = 0.001). It was further concluded that intensive insulin therapy led to better glycemic control, resulting in improvement of HRT. CONCLUSIONS Heart rate turbulence may be useful in monitoring changes of the autonomic nervous system functions in patients with DM, similarly to HRV parameters.
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Affiliation(s)
- Andrzej Bissinger
- Department of Invasive Cardiology and Cardiodiabetology, Medical University of Lodz, Lodz, Poland
| | - Jan Ruxer
- Department of Invasive Cardiology and Cardiodiabetology, Medical University of Lodz, Lodz, Poland
| | - Rehana B Ahmed
- Department of Invasive Cardiology and Cardiodiabetology, Medical University of Lodz, Lodz, Poland
| | - Andrzej Lubinski
- Department of Invasive Cardiology and Cardiodiabetology, Medical University of Lodz, Lodz, Poland
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A body shape index and heart rate variability in healthy indians with low body mass index. J Nutr Metab 2014; 2014:865313. [PMID: 25371818 PMCID: PMC4202247 DOI: 10.1155/2014/865313] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2014] [Accepted: 09/12/2014] [Indexed: 02/07/2023] Open
Abstract
Background. One third of Indian population is said to be suffering from chronic energy deficiency (CED), with increased risk of developing chronic diseases. A new anthropometric measure called A Body Shape Index (ABSI) is said to be a better index in predicting risks for premature mortality. ABSI is also in part said to be a surrogate of visceral fat. Objective. The present study aimed to explore the association between indices of HRV (heart rate variability), BMI, WC, and ABSI in healthy Indian males with low BMI (BMI < 18.5 kg/m2) and to compare with normal BMI group (BMI 18.5 to 24.9 kg/m2). Methodology. ABSI and BMI were derived from anthropometric parameters, namely, height, weight, and waist circumference in 178 males aged 18 to 78 years. Subjects were categorized into two groups based on their BMI. Results and Conclusions. Power spectral analysis of HRV demonstrated a significant negative correlation between Log HF (high frequency) and ABSI in both low BMI [−24.2 (9.4), P < 0.05] and normal BMI group [−23.41 (10.1), P < 0.05] even after controlling for age. Thus even with slight increase in BMI among low BMI individuals, there could be a greater risk of cardiovascular morbidity and mortality.
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Putz Z, Martos T, Németh N, Körei AE, Vági OE, Kempler MS, Kempler P. Is there an association between diabetic neuropathy and low vitamin D levels? Curr Diab Rep 2014; 14:537. [PMID: 25142719 DOI: 10.1007/s11892-014-0537-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
In the past few years, the effects of vitamin D that go beyond its relationship with bone metabolism have come into the focus of scientific attention. Research concerning diabetes and its complications has become a public health priority. An increasing number of reports link vitamin D deficiency to diabetes; however, so far, there has only been limited and contradictory data available on the correlation between diabetic peripheral neuropathy and vitamin D. Studies of people with type 2 diabetes confirmed the relationship between vitamin D deficiency and neuropathy incidence as well as the severity of the symptoms caused by neuropathy. The latest studies are also suggesting a relationship between the incidence of plantar ulcers and vitamin D deficiency.
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Affiliation(s)
- Zsuzsanna Putz
- 1st Department of Internal Medicine, Faculty of Medicine, Semmelweis University, Budapest, Korányi S. u. 2/a, 1089, Hungary,
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Barbosa JC, Guida HL, Fontes AM, Antonio AM, de Abreu LC, Barnabé V, Marcomini RS, Vanderlei LCM, da Silva ML, Valenti VE. Cardiac autonomic responses induced by mental tasks and the influence of musical auditory stimulation. Complement Ther Clin Pract 2014; 20:135-40. [DOI: 10.1016/j.ctcp.2014.04.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2013] [Revised: 04/14/2014] [Accepted: 04/15/2014] [Indexed: 10/25/2022]
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de Souza AC, Cisternas JR, de Abreu LC, Roque AL, Monteiro CB, Adami F, Vanderlei LCM, Sousa FH, Ferreira LL, Valenti VE. Fractal correlation property of heart rate variability in response to the postural change maneuver in healthy women. Int Arch Med 2014; 7:25. [PMID: 24910714 PMCID: PMC4030044 DOI: 10.1186/1755-7682-7-25] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2013] [Accepted: 05/06/2014] [Indexed: 11/10/2022] Open
Abstract
Background We evaluated the effects of the PCM on the fractal analysis of the HRV in healthy women Method We evaluated healthy women between 18 and 30 years old. HRV was analyzed in the time (SDNN, RMSSD, NN50 and pNN50) and frequency (LF, HF and LF/HF ratio) domains as well as short and long-term fractal exponents (alpha-1 and alpha-2) of the detrended fluctuation analysis (DFA). HRV was recorded at rest for ten minutes at seated rest and then the women quickly stood up from a seated position in up to three seconds and remained standing for 15 minutes. HRV was recorded at the following time: rest, 0–5 min, 5–10 min and 10–15 min during standing. Results We observed decrease (p < 0.05) in the time-domain indices of HRV between seated and 10–15 minutes after the volunteer stood up. The LF (ms2) and HF (ms2) indices were also reduced (p < 0.05) at 10–15 minutes after the volunteer stood up compared to seated while the LF (nu) was increased at 5–10 min and 10–15 min (p < 0.05). The short-term alpha-1 exponent was increased (p < 0.05) at all moments investigated compared to seated. Increase in the properties of short-term fractal correlations of heart rate dynamics accompanied by a decrease in the parasympathetic modulation and global HRV was observed in response to the postural change maneuver. Conclusion We suggest that fractal analysis of HRV is more sensitive than frequency and time-domain analysis of HRV during the postural change maneuver.
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Affiliation(s)
- Ana Ca de Souza
- Departamento de Morfologia e Fisiologia, Faculdade de Medicina do ABC, Av. Príncipe de Gales, 821, Santo André, SP 09060-650, Brazil
| | - José R Cisternas
- Departamento de Morfologia e Fisiologia, Faculdade de Medicina do ABC, Av. Príncipe de Gales, 821, Santo André, SP 09060-650, Brazil
| | - Luiz Carlos de Abreu
- Departamento de Morfologia e Fisiologia, Faculdade de Medicina do ABC, Av. Príncipe de Gales, 821, Santo André, SP 09060-650, Brazil
| | - Adriano L Roque
- Departamento de Fisioterapia, Faculdade de Filosofia e Ciências, Universidade Estadual Paulista, Marília,UNESP, Av. Higyno Muzzi Filho, 737, Marília, SP 17.525-900, Brazil
| | - Carlos Bm Monteiro
- Departamento de Morfologia e Fisiologia, Faculdade de Medicina do ABC, Av. Príncipe de Gales, 821, Santo André, SP 09060-650, Brazil
| | - Fernando Adami
- Departamento de Morfologia e Fisiologia, Faculdade de Medicina do ABC, Av. Príncipe de Gales, 821, Santo André, SP 09060-650, Brazil
| | - Luiz Carlos M Vanderlei
- Programa de Pós-Graduação em Fisioterapia, Faculdade de Ciências e Tecnologia, Universidade Estadual Paulista, UNESP, R. Roberto Simonsen, 305, Presidente Prudente, SP 19060-900, Brazil
| | - Fernando H Sousa
- Universidade Estadual Paulista, UNESP, Av. Eng. Luiz Edmundo Carrijo Coube, 14-01, Bauru, SP 17033-360, Brazil
| | - Lucas L Ferreira
- Programa de Pós-Graduação em Fisioterapia, Faculdade de Ciências e Tecnologia, Universidade Estadual Paulista, UNESP, R. Roberto Simonsen, 305, Presidente Prudente, SP 19060-900, Brazil
| | - Vitor E Valenti
- Departamento de Morfologia e Fisiologia, Faculdade de Medicina do ABC, Av. Príncipe de Gales, 821, Santo André, SP 09060-650, Brazil ; Programa de Pós-Graduação em Fisioterapia, Faculdade de Ciências e Tecnologia, Universidade Estadual Paulista, UNESP, R. Roberto Simonsen, 305, Presidente Prudente, SP 19060-900, Brazil
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