ABSTRACT
Diabetes mellitus is a world-wide disease associated with many complications among which is cardiovascular autonomic nervous system dysfunction and divers group of other systemic involvements mainly retinopathy, nephropathy, dermopathy by micro- and macrovascular unique angiopathies and there is no organ in the body that is immune against this metabolic and vascular disorder. The aim of this study is to assess the incidence and pattern of cardiovascular autonomic dysfunction in type 2 diabetic patients and its possible association to patient's age, sex, duration of disease and its 5 relation to diabetic nephropathy and retinopathy. This is a cross sectional study of 50 type 2 diabetic patients and 50 healthy controls between age of j 40 and 55 years. After full history, complete clinical examination, laboratory analysis did which included complete blood count, random blood sugar, general urine examination, and 24 hour urine collection for protein to assess nephropathy. Both direct and indirect fundoscopy conducted by ophthalmologist after papillary dilatation to check for retinopathy. Cardiac autonomic dysfunctions were checked and categorized as normal, parasympathetic, sympathetic, and mixed pattern using 5 standard technique described by Ewing et al. Thirty one [62%] diabetic patients have cardiac autonomic dysfunction compared with none [0%] of controls [p=value was 0.000000001] was highly significant and the most common autonomic dysfunction pattern was the mixed pattern 32 [64%] patients. The patients showed a significantly higher resting rate [89.7 +/- 7.7 in female and 88 +/- 7.4 in male] compared to the controls [75.2 +/- 7.2 in female and 74.1 +/- 5.4 in male]. Diabetic nephropathy 23 patients [46%] or retinopathy 21 patients [42%] had a significantly higher prevalence of diabetic autonomic neuropathy than diabetic patients without these complications. The patients with sympathetic and parasymathatic autonomic neuropathy has significantly longer duration of diabetes mellitus [9.8 +/- 1.8, and 8.42 +/- 2.19 years respectively] compared to patient with no autonomic dysfunction [4.9 +/- 1.3 and 3.9 +/- 0.6 years respectively]. The incidence of autonomic dysfunction in diabetic patients using non-invasive tests is high [62%] and the most common pattern was the mixed pattern [32%]. Also there was significant association 1 between autonomic dysftmction, duration of the disease and autonomic nervous system symptoms