ABSTRACT
Background: Diabetes mellitus refers to group of metabolic disorders characterized by hyperglycemia due to an absolute or relative deficit in insulin production or action. Diabetes mellitus produces pathological changes in most organs of the body including heart, blood vessels, kidneys, nerves and eyes. Cardiovascular autonomic neuropathy (CAN) is a severely debilitating yet underdiagnosed complication of diabetes. Diabetes-associated cardiovascular autonomic neuropathy damages autonomic nerve fibers that innervate the heart and blood vessels causing abnormalities in heart rate and vascular dynamics.Methods: Total 80 cases of diabetes mellitus were selected. Cardiac autonomic neuropathy in them was diagnosed by a series of tests recommended by Ewing et al, which include - Valsalva ratio, Deep Breath Test, Heart rate response to standing, Postural Hypotension, SHGT Increase in diastolic BP on sustained hand grip. They were divided into 2 groups A and B depending on presence or absence of cardiac autonomic neuropathy. ECG was done to calculate QTc and QTd.Results: In group A mean QTc was 0.344 sec and in group B in patients with mild CAN mean QTc was 0.432, moderate CAN mean QTc was 0.444, and in patients of severe CAN mean QTc was 0.481. p value was 0.001 that it is highly significant. Means more was degree of CAN more was prolongation of QT and similarly more the degree of CAN more was QTd.Conclusions: Diagnosis of cardiac autonomic neuropathy by battery of cardiac autonomic function tests is a comlex procedure. The prolongation of QTc interval and more specifically QTd interval on ECG is a marker in diagnosis of cardiac autonomic neuropathy which can be easily evaluated.
ABSTRACT
Background: Liver plays a central role in glucose homeostasis. Chronic liver disease is associated with an increased incidence of insulin resistance (IR) and Diabetes Mellitus. Diabetes that develops as a complication of cirrhosis of liver is known as 慔epatogenous diabetes (HD)�. This study was conducted to study the prevalence of insulin resistance in liver cirrhosis.Methods: One Hundered (100) non-diabetic patients of liver cirrhosis considering the inclusion and exclusion criteria and visiting both indoor and outpatient department of medicine, SGRDIMSAR were included in the study. All cirrhotic patients irrespective of etiology were subjected to fasting plasma glucose level and fasting plasma insulin levels and insulin resistance was calculated by HOMA-IR method. Study was statistically analyzed.Results: 79 out of 100 patients were found to have insulin resistance and increase in prevalence with grades of child pugh score were noted.Conclusions: Keeping in view the results of the study, we conclude that FPG and HbA1c are not sufficient in detecting glucose metabolism disorders in cirrhosis. As insulin resistance can be used as an important prognostic marker in patients with cirrhosis of liver, serum insulin levels can be recommended as routine investigation in these patients. Diabetes mellitus increases the risk of HCC in cirrhosis patients. So, by early detection of diabetes mellitus by calculating insulin resistance with HOMA-IR method we can prevent progression of disease to development into HCC.