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Kofod DH, Almdal TP, Sørensen VR, Feldt‐Rasmussen B, Hornum M. Micro‐ and macrovascular complications and risk factors for foot ulceration and amputation in individuals receiving dialysis with and without diabetes. Endocrinol Diabetes Metab 2022; 5:e00305. [PMID: 34658171 PMCID: PMC8754241 DOI: 10.1002/edm2.305] [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: 07/05/2021] [Revised: 09/28/2021] [Accepted: 10/04/2021] [Indexed: 11/21/2022] Open
Abstract
Introduction This study examined the prevalence of microvascular and macrovascular complications in people receiving dialysis with and without diabetes and investigated independent risk factors for foot ulcers and lower‐extremity amputations. Methods We performed a cross‐sectional study of 119 individuals with diabetes and 219 individuals without diabetes receiving chronic dialysis during June 2019 at the Department of Nephrology, Rigshospitalet, University of Copenhagen, Denmark. Effects of diabetes and other risk factors were assessed by log‐binomial regression. Prevalence data were compared with a historical control group of 38 individuals with diabetes receiving dialysis examined in 2004 in the same department. Results We found that persons with diabetes had a twofold higher risk ratio of current (unadjusted risk ratio 2.2 [95% CI 1.1, 4.7]) and previous foot ulcer (2.5 [1.7, 3.7]) and a fourfold higher risk ratio of lower‐extremity amputation (4.2 [2.1, 8.6]) in comparison with persons without diabetes (all p < .05). Furthermore, persons with diabetes had a 70% increased risk ratio of myocardial infarction (1.7 [1.0–2.8], p = .041). In multivariable‐adjusted analysis, current foot ulcer was independently associated with previous foot ulcer (adjusted risk ratio 4.0 [95% CI 1.8, 8.9]), while lower‐extremity amputation was independently associated with diabetes (3.8 [1.8, 8.2]) and male sex (4.1 [1.5, 11.3]) (all p < .01). Conclusions Individuals with diabetes receiving dialysis had a higher prevalence of foot ulcer, lower‐extremity amputation and myocardial infarction compared to individuals without diabetes. Previous foot ulcer was the most important risk factor for current foot ulcer, while diabetes and male sex were important risk factors for lower‐extremity amputation.
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Affiliation(s)
- Dea Haagensen Kofod
- Department of Nephrology RigshospitaletUniversity of Copenhagen Copenhagen Denmark
| | - Thomas Peter Almdal
- Department of Endocrinology RigshospitaletUniversity of Copenhagen Copenhagen Denmark
- Department of Clinical Medicine Faculty of Health and Medical Sciences University of Copenhagen Copenhagen Denmark
| | | | - Bo Feldt‐Rasmussen
- Department of Nephrology RigshospitaletUniversity of Copenhagen Copenhagen Denmark
- Department of Clinical Medicine Faculty of Health and Medical Sciences University of Copenhagen Copenhagen Denmark
| | - Mads Hornum
- Department of Nephrology RigshospitaletUniversity of Copenhagen Copenhagen Denmark
- Department of Clinical Medicine Faculty of Health and Medical Sciences University of Copenhagen Copenhagen Denmark
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Motataianu A, Barcutean L, Bajko Z, Stoian A, Maier S, Voidazan S, Balasa R. Autonomic and Somatic Nerve Functions in Type 2 Diabetes Mellitus Patients: Electrophysiological Aspects. Diagnostics (Basel) 2021; 11:diagnostics11112005. [PMID: 34829352 PMCID: PMC8621884 DOI: 10.3390/diagnostics11112005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Revised: 10/25/2021] [Accepted: 10/25/2021] [Indexed: 11/30/2022] Open
Abstract
Objectives: To investigate the relationship between neurophysiological sensory and motor nerve function parameters, assessed by nerve conduction studies (NCS) with parasympathetic autonomic function and by heart rate variability (HRV) tests in patients with type 2 diabetes mellitus (T2DM). Material and Methods: A total of 161 T2DM patients underwent NCS. Cardiac autonomic response was assessed by HRV tests to deep breathing (HRV DB), to Valsalva manoeuvre, and during postural change from lying to standing. Results: The amplitude of motor response in the median nerve, tibial nerve, and peroneal nerve was associated with reduced HRV DB (p = 0.0001). The amplitude of motor response in the median nerve, tibial nerve, and peroneal nerve was associated with reduced HRV Valsalva (p = 0.0001). The correlation between the amplitude of response in all sensory nerves (sural, median, and ulnar) and HRV DB was statistically significant (p = 0.0001). Conclusion: The results indicate that there is a correlation in T2DM patients between the damage of small myelinated and unmyelinated nerve fibres from cardiac autonomic nerves, assessed by HRV tests and damage of large motor and sensory fibres, assessed by NCS. Based on the above results, a combination of NCS and HRV tests should be considered in the neurophysiological approach to diabetic neuropathy.
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Affiliation(s)
- Anca Motataianu
- Neurology 1 Clinic, Emergency Clinical County Hospital Mureș, Gh. Marinescu Str., No. 50, 540136 Târgu Mureș, Romania; (A.M.); (Z.B.); (A.S.); (S.M.); (R.B.)
- Department of Neurology, University of Medicine, Pharmacy, Science and Technology “George Emil Palade” of Târgu Mureș, Gh. Marinescu Str., No. 38, 540139 Târgu Mureș, Romania
| | - Laura Barcutean
- Neurology 1 Clinic, Emergency Clinical County Hospital Mureș, Gh. Marinescu Str., No. 50, 540136 Târgu Mureș, Romania; (A.M.); (Z.B.); (A.S.); (S.M.); (R.B.)
- Department of Neurology, University of Medicine, Pharmacy, Science and Technology “George Emil Palade” of Târgu Mureș, Gh. Marinescu Str., No. 38, 540139 Târgu Mureș, Romania
- Correspondence: ; Tel.: +40-7453-73947
| | - Zoltan Bajko
- Neurology 1 Clinic, Emergency Clinical County Hospital Mureș, Gh. Marinescu Str., No. 50, 540136 Târgu Mureș, Romania; (A.M.); (Z.B.); (A.S.); (S.M.); (R.B.)
- Department of Neurology, University of Medicine, Pharmacy, Science and Technology “George Emil Palade” of Târgu Mureș, Gh. Marinescu Str., No. 38, 540139 Târgu Mureș, Romania
| | - Adina Stoian
- Neurology 1 Clinic, Emergency Clinical County Hospital Mureș, Gh. Marinescu Str., No. 50, 540136 Târgu Mureș, Romania; (A.M.); (Z.B.); (A.S.); (S.M.); (R.B.)
- Department of Pathophysiology, University of Medicine, Pharmacy, Science and Technology “George Emil Palade” of Târgu Mureș, Gh. Marinescu Str., No. 38, 540139 Târgu Mureș, Romania
| | - Smaranda Maier
- Neurology 1 Clinic, Emergency Clinical County Hospital Mureș, Gh. Marinescu Str., No. 50, 540136 Târgu Mureș, Romania; (A.M.); (Z.B.); (A.S.); (S.M.); (R.B.)
- Department of Neurology, University of Medicine, Pharmacy, Science and Technology “George Emil Palade” of Târgu Mureș, Gh. Marinescu Str., No. 38, 540139 Târgu Mureș, Romania
| | - Septimiu Voidazan
- Department of Epidemiology, University of Medicine, Pharmacy, Science and Technology “George Emil Palade” of Târgu Mureș, Gh. Marinescu Str., No. 38, 540139 Târgu Mureș, Romania;
| | - Rodica Balasa
- Neurology 1 Clinic, Emergency Clinical County Hospital Mureș, Gh. Marinescu Str., No. 50, 540136 Târgu Mureș, Romania; (A.M.); (Z.B.); (A.S.); (S.M.); (R.B.)
- Department of Neurology, University of Medicine, Pharmacy, Science and Technology “George Emil Palade” of Târgu Mureș, Gh. Marinescu Str., No. 38, 540139 Târgu Mureș, Romania
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Reynolds EL, Akinci G, Banerjee M, Looker HC, Patterson A, Nelson RG, Feldman EL, Callaghan BC. The determinants of complication trajectories in American Indians with type 2 diabetes. JCI Insight 2021; 6:146849. [PMID: 34027894 PMCID: PMC8262294 DOI: 10.1172/jci.insight.146849] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Accepted: 04/14/2021] [Indexed: 12/16/2022] Open
Abstract
BACKGROUNDWe aimed to determine whether metabolic syndrome (MetS) affects longitudinal trajectories of diabetic complications, including neuropathy, cardiovascular autonomic neuropathy (CAN), and kidney disease in American Indians with type 2 diabetes.METHODSWe performed a prospective study where participants underwent annual metabolic phenotyping and outcome measurements. The updated National Cholesterol Education Program criteria were used to define MetS and its individual components, using BMI instead of waist circumference. Neuropathy was defined using the Michigan Neuropathy Screening Instrument index, CAN with the expiration/inspiration ratio, and kidney disease with glomerular filtration rate. Mixed-effects models were used to evaluate associations between MetS and these outcomes.RESULTSWe enrolled 141 participants: 73.1% female, a mean (±SD) age of 49.8 (12.3), and a diabetes duration of 19.6 years (9.7 years) who were followed for a mean of 3.1 years (1.7 years). MetS components were stable during follow-up except for declining obesity and cholesterol. Neuropathy (point estimate [PE]: 0.30, 95% CI: 0.24, 0.35) and kidney disease (PE: -14.2, 95% CI: -16.8, -11.4) worsened over time, but CAN did not (PE: -0.002, 95% CI: -0.006, 0.002). We found a significant interaction between the number of MetS components and time for neuropathy (PE: 0.05, 95% CI: 0.01-0.10) but not CAN (PE: -0.003, 95% CI: -0.007, 0.001) or kidney disease (PE: -0.69, 95% CI: -3.16, 1.76). Systolic blood pressure (SBP, unit = 10 mmHg) was associated with each complication: neuropathy (PE: 0.23, 95% CI: 0.07, 0.39), CAN (PE: -0.02, 95% CI: -0.03, -0.02), and kidney disease (PE: -10.2, 95% CI: -15.4, -5.1).CONCLUSIONIn participants with longstanding diabetes, neuropathy and kidney disease worsened during follow-up, despite stable to improving MetS components, suggesting that early metabolic intervention is necessary to prevent complications in such patients. Additionally, the number of MetS components was associated with an increased rate of neuropathy progression, and SBP was associated with each complication.FUNDINGThe following are funding sources: NIH T32NS0007222, NIH R24DK082841, NIH R21NS102924, NIH R01DK115687, the Intramural Program of the NIDDK, the NeuroNetwork for Emerging Therapies, the Robert and Katherine Jacobs Environmental Health Initiative, the Robert E. Nederlander Sr. Program for Alzheimer's Research, and the Sinai Medical Staff Foundation.TRIAL REGISTRATIONClinicalTrials.gov, NCT00340678.
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Affiliation(s)
- Evan L. Reynolds
- Department of Neurology, University of Michigan, Ann Arbor, Michigan, USA
| | - Gulcin Akinci
- Department of Neurology, University of Michigan, Ann Arbor, Michigan, USA
- Division of Pediatric Neurology, Dr. Behcet Uz Children’s Hospital, Izmir, Turkey
| | - Mousumi Banerjee
- Department of Biostatistics, University of Michigan, Ann Arbor, Michigan, USA
| | - Helen C. Looker
- Chronic Kidney Disease Section, National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), Phoenix, Arizona, USA
| | - Adam Patterson
- Department of Neurology, University of Michigan, Ann Arbor, Michigan, USA
| | - Robert G. Nelson
- Chronic Kidney Disease Section, National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), Phoenix, Arizona, USA
| | - Eva L. Feldman
- Department of Neurology, University of Michigan, Ann Arbor, Michigan, USA
| | - Brian C. Callaghan
- Department of Neurology, University of Michigan, Ann Arbor, Michigan, USA
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Dhumad MM, Hamdan FB, Khudhair MS, Al-Matubsi HY. Correlation of staging and risk factors with cardiovascular autonomic neuropathy in patients with type II diabetes mellitus. Sci Rep 2021; 11:3576. [PMID: 33574349 PMCID: PMC7878737 DOI: 10.1038/s41598-021-80962-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2020] [Accepted: 12/29/2020] [Indexed: 12/26/2022] Open
Abstract
The impairment of cardiovascular autonomic control among the underdiagnosed complication of diabetes mellitus (DM) with a high prevalence rate of up to 60% in type 2 DM (T2DM). Cardiac autonomic neuropathy (CAN) is an independent risk factor for cardiovascular mortality, arrhythmia, silent ischemia, any major cardiovascular event, and heart failure. We aimed to evaluate cardiovascular autonomic activity by different physiological maneuvers, study risk factors for diabetic CAN including age, gender, duration of diabetes, body mass index (BMI), and glycemic control, and correlate CAN stage with risk factors. One hundred and forty-two T2DM patients consisted of 62 males and 80 females and 100 volunteers as a control sample. Cardiac autonomic functions were assessed by Ewing's tests. Glycated hemoglobin (HbA1c), body weight, height, body mass index (BMI), and waist-hip ratio (WHR) were also measured. Cardiovascular autonomic functions and Ewing scores were significantly different in people with diabetes when compared with control healthy subjects. Ewings test values and Ewing scores were significantly different between diabetics with and without CAN and within patients with different CAN staging. People with diabetes with CAN have a significantly longer duration of disease when compared to those without CAN. A strong association has been found between CAN severity and patient age, duration of disease, HbA1c severity, and the WHR (P < 0.001) but not with BMI. The duration of disease and HbA1c level appear to be associated with the development of CAN (P = 0.001 and P = 0.008, respectively). The poorer glycemic control and the longer the duration of the disease, the higher the prevalence of CAN in T2DM. Age, duration of disease, WHR, and HbA1c are well correlated with the severity of CAN. Parasympathetic impairment is more sensitive to the detection of autonomic dysfunctions than do sympathetic impairment.
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Affiliation(s)
- Muhanad M Dhumad
- Section of Pharmacy, Baghdad College of Medical Sciences, Baghdad, Iraq
| | - Farqad B Hamdan
- Department of Physiology, College of Medicine, Al-Nahrain University, Baghdad, Iraq
| | - Mahmood S Khudhair
- Endocrinology Section, Department of Medicine, College of Medicine, Al-Nahrain University, Baghdad, Iraq
| | - Hisham Y Al-Matubsi
- Department of Pharmacology and Medical Sciences, University of Petra, Amman, Jordan.
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Lee KA, Kim YJ, Park TS, Lee JH, Jin HY. The association between cardiac autonomic neuropathy and heart function in type 2 diabetic patients. Somatosens Mot Res 2020; 37:149-156. [PMID: 32323604 DOI: 10.1080/08990220.2020.1756245] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Aim: Cardiac autonomic neuropathy (CAN) is a common and important chronic complication in diabetic patients. Heart failure resulting from cardiomyopathy is also a lethal complication in diabetic patients. However, data showing the exact association between CAN and heart failure in diabetic patients are relatively scarce. Therefore, our study aimed to determine the association between the parameters assessing CAN and heart function in diabetic patients.Method: The medical records of type 2 diabetic patients who underwent an autonomic function test with heart rate variability (HRV) and echocardiography were reviewed from January 2018 to December 2018. A total of 100 type 2 diabetic patients were included, and the association between the parameters assessing CAN and heart function was analysed.Results: Among the 100 analysed patients, 65 were diagnosed with CAN and 26 showed diastolic dysfunction. Moreover, 19 (73.1%) diabetic patients with diastolic dysfunction were complicated with CAN. The occurrence of diastolic dysfunction was higher in diabetic patients with CAN than in diabetic patients without CAN (29.2% vs 20.0%, p < 0.05), and the occurrence of CAN was higher in diabetic patients with diastolic dysfunction than in patients without diastolic dysfunction (73.1% vs 62.2%, p < 0.05). However, there were no significant associations between HRV parameters and heart function.Conclusion: We demonstrated that diastolic dysfunction is more common in diabetic patients complicated with CAN than in diabetic patients without CAN, although several diabetic patients without diastolic dysfunction are also diagnosed with CAN. Moreover, further studies about the long-term serial monitoring of heart function according to the progression of CAN are required to confirm the exact association between CAN and heart function.
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Affiliation(s)
- Kyung Ae Lee
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Research Institute of Clinical Medicine of Jeonbuk National University, Biomedical Research Institute of Jeonbuk National University Hospital, Jeonbuk National University Medical School, Jeonju, South Korea
| | - Yu Ji Kim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Research Institute of Clinical Medicine of Jeonbuk National University, Biomedical Research Institute of Jeonbuk National University Hospital, Jeonbuk National University Medical School, Jeonju, South Korea
| | - Tae Sun Park
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Research Institute of Clinical Medicine of Jeonbuk National University, Biomedical Research Institute of Jeonbuk National University Hospital, Jeonbuk National University Medical School, Jeonju, South Korea
| | - Ju Hyung Lee
- Department of Preventive Medicine, Research Institute of Clinical Medicine of Jeonbuk National University, Biomedical Research Institute of Jeonbuk National University Hospital, Jeonbuk National University Medical School, Jeonju, South Korea
| | - Heung Yong Jin
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Research Institute of Clinical Medicine of Jeonbuk National University, Biomedical Research Institute of Jeonbuk National University Hospital, Jeonbuk National University Medical School, Jeonju, South Korea
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Pafili K, Trypsianis G, Papazoglou D, Maltezos E, Papanas N. Cardiovascular Autonomic Neuropathy and Distal Symmetric Sensorimotor Polyneuropathy: These Two Diabetic Microvascular Complications do not Invariably Co-Exist. Curr Vasc Pharmacol 2019; 18:50-56. [PMID: 30156161 DOI: 10.2174/1570161116666180829120101] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2018] [Revised: 08/02/2018] [Accepted: 08/07/2018] [Indexed: 11/22/2022]
Abstract
Background:
Cardiovascular autonomic neuropathy (CAN) and distal symmetrical sensorimotor
polyneuropathy (DSPN) are serious microvascular complications of diabetes mellitus (DM).
Their simultaneous development remains disputable. The aim of the present study was to examine the
correlation between CAN and the presence/severity of DSPN in DM.
Methods:
Subjects with type 1 (group A: n=51; mean age 40.4 years) and type 2 DM (group B: n=153;
mean age 64.6 years) were studied. Evaluation of DSPN was based on neuropathy disability score. Assessment
of CAN was based on the battery of 4 standardized cardiovascular autonomic function tests.
Results:
In group A, patients with moderate/severe DSPN exhibited a 12-fold higher likelihood of CAN
in univariate analysis (p=0.035). However, significance was lost after adjustment for gender, age, DM
duration, and haemoglobin A1c. In group A, likelihood for CAN did not correlate with the presence of
mild DSPN in univariate and multivariate analysis. In group B, likelihood of CAN was similar in patients
with mild and in those with moderate/severe DSPN compared with patients without DSPN in
univariate and multivariate analysis. In between group comparison CAN was similarly distributed in the
2 groups (p for interaction=0.367), in patients with no, mild and moderate/severe DSPN.
Conclusion:
CAN does not always co-exist with degrees of DSPN, ranging from mild to moderate/
severe and is similarly distributed in T1DM and T2DM patients with mild and moderate/severe
DSPN and in patients without DSPN.
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Affiliation(s)
- Kalliopi Pafili
- Diabetes Centre, Second Department of Internal Medicine, Democritus University of Thrace, University Hospital of Alexandroupolis, Alexandroupolis, Greece
| | - Grigoris Trypsianis
- Department of Medical Statistics, Medical Faculty, Democritus University of Thrace, Alexandroupolis, Alexandroupolis, Greece
| | - Dimitrios Papazoglou
- Diabetes Centre, Second Department of Internal Medicine, Democritus University of Thrace, University Hospital of Alexandroupolis, Alexandroupolis, Greece
| | - Efstratios Maltezos
- Diabetes Centre, Second Department of Internal Medicine, Democritus University of Thrace, University Hospital of Alexandroupolis, Alexandroupolis, Greece
| | - Nikolaos Papanas
- Diabetes Centre, Second Department of Internal Medicine, Democritus University of Thrace, University Hospital of Alexandroupolis, Alexandroupolis, Greece
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Bhati P, Moiz JA, Naqvi IH, Hussain ME. Diagnostic performance of resting and post-exercise heart rate variability for detecting cardiac autonomic neuropathy in type 2 diabetes mellitus. Auton Neurosci 2019; 219:53-65. [DOI: 10.1016/j.autneu.2019.04.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Revised: 04/19/2019] [Accepted: 04/23/2019] [Indexed: 01/15/2023]
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Bhuyan AK, Baro A, Sarma D, Choudhury B. A Study of Cardiac Autonomic Neuropathy in Patients with Type 2 Diabetes Mellitus: A Northeast India Experience. Indian J Endocrinol Metab 2019; 23:246-250. [PMID: 31161112 PMCID: PMC6540895 DOI: 10.4103/ijem.ijem_336_18] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
AIM To investigate the prevalence and the risk factors for cardiac autonomic neuropathy (CAN) in type 2 diabetes mellitus (DM) patients. STUDY DESIGN Cross-sectional cohort study. PLACE AND DURATION OF STUDY This study was conducted in the Department of Endocrinology, Gauhati Medical College and Hospital, Assam, India between December 2016 to March 2018. METHODOLOGY We included 100 patients (60 males and 40 females; age range: 36-72 years) with type 2 DM. Their clinical, biochemical, and metabolic parameters were analyzed and assessment of CAN were done based on the Ewing's criteria. RESULTS Out of 100 patients, 60 were males and 40 were females. The mean age of the patients was 53.3 ± 10.37 years (36-72 years) and the mean duration of diabetes was 9.03 ± 6.4 years (6 months-25 years). Patients were divided into two groups: "without CAN" (CAN-) and "with CAN" (CAN+). The prevalence of CAN was 70%, with early CAN in 25%, definite CAN in 24%, and severe CAN in 21% cases The patients with CAN were older (P = 0.0005), had longer diabetes duration (11.56 vs. 3.13; P = 0.0001), higher creatinine (P < 0.0001), and lower estimated glomerular filtration rate (eGFR) (P = 0.0001) compared to patients without CAN. Retinopathy, peripheral neuropathy, and nephropathy were common in CAN + patients. On multiple logistic regression analysis, duration of diabetes [odds ratio (OR); 6.7, P < 0.0001), older age (OR; 1.07, P < 0.016), and lower eGFR (OR; 0.97, P < 0.03) were risk factors for CAN. CONCLUSION CAN is a common microvascular complication in type 2 DM with duration of diabetes, age, and severity of nephropathy being its significant determinants.
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Affiliation(s)
- Ashok K. Bhuyan
- Department of Endocrinology, Gauhati Medical College and Hospital, Guwahati, Assam, India
| | - Abhamoni Baro
- Department of Endocrinology, Gauhati Medical College and Hospital, Guwahati, Assam, India
| | - Dipti Sarma
- Department of Endocrinology, Gauhati Medical College and Hospital, Guwahati, Assam, India
| | - Bipul Choudhury
- Department of Endocrinology, Gauhati Medical College and Hospital, Guwahati, Assam, India
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Jun JE, Lee SE, Lee YB, Ahn JY, Kim G, Jin SM, Hur KY, Lee MK, Kim JH. Glycated albumin and its variability as an indicator of cardiovascular autonomic neuropathy development in type 2 diabetic patients. Cardiovasc Diabetol 2017; 16:127. [PMID: 29017498 PMCID: PMC5635541 DOI: 10.1186/s12933-017-0619-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2017] [Accepted: 10/06/2017] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND We investigated whether glycated albumin (GA) and its variability are associated with cardiovascular autonomic neuropathy (CAN) and further compared their associations with glycated hemoglobin (HbA1c). METHODS This retrospective longitudinal study included 498 type 2 diabetic patients without CAN. CAN was defined as at least two abnormal results in parasympathetic tests or presence of orthostatic hypotension. The mean, standard deviation (SD), and coefficient of variance (CV) were calculated from consecutively measured GA (median 7 times) and HbA1c levels (median 8 times) over 2 years. Logistic regression analysis was used to compare the associations between CAN and GA- or HbA1c-related parameters. Receiver operating characteristic (ROC) curve analysis was used to compare the predictive power for CAN between GA- and HbA1c-related parameters. RESULTS A total of 53 subjects (10.6%) developed CAN over 2 years. The mean, SD, and CV of GA or HbA1c were significantly higher in subjects with CAN. Higher mean GA and GA variability were associated with the risk of developing CAN, independent of conventional risk factors and HbA1c. In ROC curve analysis, the SD and CV of GA showed higher predictive value for CAN compared to the SD and CV of HbA1c, whereas the predictive value of mean GA did not differ from that of mean HbA1c. The mean, SD, and CV of GA showed additive predictive power to detect CAN development along with mean HbA1c. CONCLUSIONS Higher serum GA and its variability are significantly associated with the risk of developing CAN. Serum GA might be a useful indicator for diabetic complications and can enhance HbA1c's modest clinical prediction for CAN.
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Affiliation(s)
- Ji Eun Jun
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Republic of Korea
| | - Seung-Eun Lee
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Republic of Korea
| | - You-Bin Lee
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Republic of Korea
| | - Ji Yeon Ahn
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Republic of Korea
| | - Gyuri Kim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Republic of Korea
| | - Sang-Man Jin
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Republic of Korea
| | - Kyu Yeon Hur
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Republic of Korea
| | - Moon-Kyu Lee
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Republic of Korea
| | - Jae Hyeon Kim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Republic of Korea. .,Department of Clinical Research Design & Evaluation, SAIHST, Sungkyunkwan University, 81 Irwon-ro, Gangnam-gu, Seoul, Republic of Korea.
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Lange-Maia BS, Newman AB, Jakicic JM, Cauley JA, Boudreau RM, Schwartz AV, Simonsick EM, Satterfield S, Vinik AI, Zivkovic S, Harris TB, Strotmeyer ES. Relationship between sensorimotor peripheral nerve function and indicators of cardiovascular autonomic function in older adults from the Health, Aging and Body Composition Study. Exp Gerontol 2017; 96:38-45. [PMID: 28442382 DOI: 10.1016/j.exger.2017.04.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2016] [Revised: 04/06/2017] [Accepted: 04/18/2017] [Indexed: 01/17/2023]
Abstract
BACKGROUND Age-related peripheral nervous system (PNS) impairments are highly prevalent in older adults. Although sensorimotor and cardiovascular autonomic function have been shown to be related in persons with diabetes, the nature of the relationship in general community-dwelling older adult populations is unknown. METHODS Health, Aging and Body Composition participants (n=2399, age=76.5±2.9years, 52% women, 38% black) underwent peripheral nerve testing at the 2000/01 clinic visit. Nerve conduction amplitude and velocity were measured at the peroneal motor nerve. Sensory nerve function was assessed with vibration detection threshold and monofilament (1.4-g/10-g) testing at the big toe. Symptoms of lower-extremity peripheral neuropathy were collected by self-report. Cardiovascular autonomic function indicators included postural hypotension, resting heart rate (HR), as well as HR response to and recovery from submaximal exercise testing (400m walk). Multivariable modeling adjusted for demographic/lifestyle factors, medication use and comorbid conditions. RESULTS In fully adjusted models, poor motor nerve conduction velocity (<40m/s) was associated with greater odds of postural hypotension, (OR=1.6, 95% CI: 1.0-2.5), while poor motor amplitude (<1mV) was associated with 2.3beats/min (p=0.003) higher resting HR. No associations were observed between sensory nerve function or symptoms of peripheral neuropathy and indicators of cardiovascular autonomic function. CONCLUSIONS Motor nerve function and indicators of cardiovascular autonomic function remained significantly related even after considering many potentially shared risk factors. Future studies should investigate common underlying processes for developing multiple PNS impairments in older adults.
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Affiliation(s)
- Brittney S Lange-Maia
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, 130 N. Bellefield Ave., 5th Floor, Pittsburgh, PA 15213, United States
| | - Anne B Newman
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, 130 N. Desoto Street., A528 Crabtree Hall, Pittsburgh, PA 15261, United States
| | - John M Jakicic
- Department of Health and Physical Activity, School of Education, University of Pittsburgh, Oak Hill Commons, 32 Oak Hill Court, Pittsburgh, PA 15261, United States
| | - Jane A Cauley
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, 130 N. Desoto Street, A510 Crabtree Hall, Pittsburgh, PA 15261, United States
| | - Robert M Boudreau
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, 130 N. Bellefield Ave., 5th Floor, Pittsburgh, PA 15213, United States
| | - Ann V Schwartz
- Department of Epidemiology and Biostatistics, University of California San Francisco, 550 16th Street, San Francisco, CA 94158, United States
| | - Eleanor M Simonsick
- Translational Gerontology Branch, National Institute on Aging, National Institutes of Health, 251 Bayview Boulevard, Suite 100, Baltimore, MD 21224, United States
| | - Suzanne Satterfield
- Department of Preventive Medicine, University of Tennessee Health Science Center, 649 Doctor's Office Building, 66 N. Pauline St., Memphis, TN 38163, United States
| | - Aaron I Vinik
- Department of Neurobiology, Eastern Virginia Medical School, 855 W. Brambleton Avenue, Norfolk, VA 23510, United States
| | - Sasa Zivkovic
- Department of Neurology, University of Pittsburgh, 3471 Fifth Ave. Suite 810, Pittsburgh, PA 15213, United States
| | - Tamara B Harris
- Intramural Research Program, Laboratory of Epidemiology, and Population Sciences, National Institute on Aging, National Institutes of Health, Laboratory of Epidemiology, Demography, and Biometry, Gateway Building, 3C309, 7201 Wisconsin Avenue, Bethesda, MD 20892, United States
| | - Elsa S Strotmeyer
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, 130 N. Bellefield Ave., 5th Floor, Pittsburgh, PA 15213, United States.
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11
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Christou GA, Kiortsis DN. The effects of body weight status on orthostatic intolerance and predisposition to noncardiac syncope. Obes Rev 2017; 18:370-379. [PMID: 28112481 DOI: 10.1111/obr.12501] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2016] [Revised: 11/07/2016] [Accepted: 11/24/2016] [Indexed: 12/16/2022]
Abstract
Orthostatic intolerance (OI) is frequently the mechanism underlying the occurrence of noncardiac syncope (NCS) and is associated with substantial risk for injury. Body weight status appears to be a modifier of orthostatic responses and possibly influences the propensity to NCS. The majority of cross-sectional studies have found that the lower the body mass index (BMI) the greater the predisposition to OI is, accompanied with both down-regulation of sympathetic nervous system activity and up-regulation of parasympathetic nervous system activity. These changes appear to occur across the whole spectrum of BMI values from underweight to obesity, while they may be associated more strongly with central body fat than total body fat. Weight loss following bariatric surgery has been consistently found to increase OI, attributed first to the effects of weight loss per se, second to the specific type of surgical procedure and third to the potential postoperative autonomic neuropathy due to vitamin deficiency. The increased OI following bariatric surgery renders this intervention not easily tolerable for the affected individuals, mandating increased fluid and salt intake, pharmacological measures or surgical adjustments to attenuate OI. All future studies investigating orthostatic responses and NCS should implement a matching of the population arms for BMI and ideally for body fat.
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Affiliation(s)
- G A Christou
- Laboratory of Physiology, Medical School, University of Ioannina, Ioannina, Greece
| | - D N Kiortsis
- Laboratory of Physiology, Medical School, University of Ioannina, Ioannina, Greece
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12
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Rothberg LJ, Lees T, Clifton-Bligh R, Lal S. Association Between Heart Rate Variability Measures and Blood Glucose Levels: Implications for Noninvasive Glucose Monitoring for Diabetes. Diabetes Technol Ther 2016; 18:366-76. [PMID: 27258123 DOI: 10.1089/dia.2016.0010] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
BACKGROUND Diabetes mellitus (DM) is a global metabolic epidemic associated with numerous adverse complications. Invasive finger prick tests or invasive monitors are currently the most common means of monitoring and controlling blood glucose levels (BGLs). Heart rate variability (HRV) is a noninvasive measure of the autonomic nervous system, and its dynamic physiological nature may provide an alternative means of blood glucose monitoring. However, the relationship between BGL and HRV parameters remains relatively unknown. MATERIALS AND METHODS Thirty-two participants with diabetes (39.97 ± 17.21 years of age) and 31 without diabetes (27.87 ± 10.55 years of age) participated in the current study. Fasting preceded a 10-min three-lead electrocardiogram (ECG), which was followed by a finger prick blood glucose assessment. Following this, a regular meal was consumed, and 30 min after ingestion, a second postprandial 10-min ECG was obtained, and blood glucose assessment was conducted. RESULTS Low-frequency (LF) power, high-frequency (HF) power, and total power (TP) of HRV were negatively associated with BGL in participants with DM. Additionally, the ratio of LF to HF was positively correlated with BGL. Duration of DM was also associated with multiple HRV parameters, with negative associations to both LF and HF parameters as well as TP. CONCLUSIONS This study demonstrates links between specific HRV variables and BGL. In the future the dynamic nature of HRV could provide a unique and real-time method for monitoring BGL, for continuous noninvasive prediction and/or management of DM.
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Affiliation(s)
- Leon J Rothberg
- 1 Neuroscience Research Unit, School of Life Sciences, University of Technology Sydney , Broadway, New South Wales, Australia
| | - Ty Lees
- 1 Neuroscience Research Unit, School of Life Sciences, University of Technology Sydney , Broadway, New South Wales, Australia
| | - Roderick Clifton-Bligh
- 2 Medicine, Northern Clinical School, Kolling Institute of Medical Research , Sydney, New South Wales, Australia
| | - Sara Lal
- 1 Neuroscience Research Unit, School of Life Sciences, University of Technology Sydney , Broadway, New South Wales, Australia
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13
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Abstract
Cardiac autonomic neuropathy (CAN) is the least recognized and understood complication of peripheral neuropathy. However, because of its potential adverse effects including sudden death, CAN is one of the most important forms of autonomic neuropathies. CAN presents with different clinical manifestations including postural hypotension, exercise intolerance, fluctuation of blood pressure and heart rate, arrhythmia, and increased risk of myocardial infarction. In this article, the prevalence, clinical presentations, and management of cardiac involvement in certain peripheral neuropathies, including diabetic neuropathy, Guillain-Barré syndrome, chronic inflammatory polyneuropathy, human immunodeficiency virus-associated neuropathy, hereditary neuropathies, and amyloid neuropathy are examined in detail.
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Affiliation(s)
- Ahmet Z Burakgazi
- *Department of Medicine, MDA/ALS Clinic at Carilion Clinic, Roanoke, VA; Virginia Tech Carilion School of Medicine and Research Institute; and †Department of Medicine, Carilion Clinic Heart Rhythm Services; Virginia Tech Carilion School of Medicine and Research Institute
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14
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Waqar F, Gerson MC. Cardiac sympathetic imaging in the diagnosis of cardiac autonomic neuropathy in pre-diabetes. J Nucl Cardiol 2015; 22:1269-72. [PMID: 25736176 DOI: 10.1007/s12350-015-0082-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2015] [Accepted: 01/23/2015] [Indexed: 01/02/2023]
Affiliation(s)
- Fahad Waqar
- Division of General Internal Medicine, Department of Internal Medicine, University of Cincinnati College of Medicine, P.O. Box 670535, Cincinnati, OH, 45267-0535, USA.
| | - Myron C Gerson
- Division of Cardiovascular Health and Disease, Department of Internal Medicine, University of Cincinnati College of Medicine, P.O. Box 670542, Cincinnati, OH, 45267-0542, USA.
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15
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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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16
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Witzel II, Jelinek HF, Khalaf K, Lee S, Khandoker AH, Alsafar H. Identifying Common Genetic Risk Factors of Diabetic Neuropathies. Front Endocrinol (Lausanne) 2015; 6:88. [PMID: 26074879 PMCID: PMC4447004 DOI: 10.3389/fendo.2015.00088] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2015] [Accepted: 05/13/2015] [Indexed: 12/13/2022] Open
Abstract
Type 2 diabetes mellitus (T2DM) is a global public health problem of epidemic proportions, with 60-70% of affected individuals suffering from associated neurovascular complications that act on multiple organ systems. The most common and clinically significant neuropathies of T2DM include uremic neuropathy, peripheral neuropathy, and cardiac autonomic neuropathy. These conditions seriously impact an individual's quality of life and significantly increase the risk of morbidity and mortality. Although advances in gene sequencing technologies have identified several genetic variants that may regulate the development and progression of T2DM, little is known about whether or not the variants are involved in disease progression and how these genetic variants are associated with diabetic neuropathy specifically. Significant missing heritability data and complex disease etiologies remain to be explained. This article is the first to provide a review of the genetic risk variants implicated in the diabetic neuropathies and to highlight potential commonalities. We thereby aim to contribute to the creation of a genetic-metabolic model that will help to elucidate the cause of diabetic neuropathies, evaluate a patient's risk profile, and ultimately facilitate preventative and targeted treatment for the individual.
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Affiliation(s)
- Ini-Isabée Witzel
- Biomedical Engineering Department, Khalifa University of Science, Technology and Research, Abu Dhabi, United Arab Emirates
| | - Herbert F. Jelinek
- Australian School of Advanced Medicine, Macquarie University, Sydney, NSW, Australia
- Centre for Research in Complex Systems, School of Community Health, Charles Sturt University, Albury, NSW, Australia
| | - Kinda Khalaf
- Biomedical Engineering Department, Khalifa University of Science, Technology and Research, Abu Dhabi, United Arab Emirates
| | - Sungmun Lee
- Biomedical Engineering Department, Khalifa University of Science, Technology and Research, Abu Dhabi, United Arab Emirates
| | - Ahsan H. Khandoker
- Biomedical Engineering Department, Khalifa University of Science, Technology and Research, Abu Dhabi, United Arab Emirates
- Electrical and Electronic Engineering Department, The University of Melbourne, Parkville, VIC, Australia
| | - Habiba Alsafar
- Biomedical Engineering Department, Khalifa University of Science, Technology and Research, Abu Dhabi, United Arab Emirates
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