A correlation study of arterial stiffness, cardiac autonomic neuropathy and lipid profile in type 2 diabetes mellitus patients

Objectives: Micro and macrovasculopathy are common complications of undertreated or undiagnosed type 2 diabetes mellitus (T2DM) patients. One of the underlying factors of macrovasculopathy is arterial stiffness, which may lead to cardiovascular and cerebrovascular diseases. Understandably, diabetic micro and macrovasculopathy affect vital functions, which may affect the well-being of the individual. However, few studies have attempted to determine arterial stiffness, cardiac autonomic neuropathy (CAN) and lipid profile separately in South Asian population and examined its associations with T2DM. Moreover, there is a need to understand the mechanistic links among cardiovascular risk factors. This forms the basis of the present study. Materials and Methods: T2DM patients of 53–62 years and age- and gender-matched healthy control subjects were recruited in the cross-sectional and observational study (n = 30 each, eight women). Anthropometric measurements, physiological parameters such as resting heart rate, peripheral blood pressure (PBP), central blood pressure (CBP), augmentation index% (AIx%), brachial-ankle pulse wave velocity and lead II ECG for analysis of heart rate variability parameters were recorded after obtaining the consent of the study participants. The lipid profile and fasting blood glucose were also analysed. Results: Peripheral systolic blood pressure was significantly higher (P = 0.05) in T2DM patients. Dyslipidaemia was evident in T2DM patients. Atherogenic index of plasma (AIP) was also significantly higher in T2DM patients. Correlation analysis revealed a positive association between AIx% with PBP and CBP as well as between AIP index and central systolic blood pressure, serum triglyceride (TG), low-density lipoprotein cholesterol (LDL-C) and very low-density lipoprotein cholesterol (VLDL-C) levels. AIP index was found to be negatively associated with HF (nu). Serum TG, high-density lipoprotein cholesterol (HDL-C) levels and AIP index have emerged as significant independent predictors of T2DM vasculopathy by multiple regression analysis. Conclusion: In the present study, atherogenic dyslipidaemia was observed in T2DM patients in combination with increased serum levels of TG, VLDL-C and decreased serum levels of HDL-C. Moreover, AIP index, a predictor cardiovascular risk, was found to be significantly higher in T2DM patients. Dyslipidaemia was found to be associated with dysregulation of autonomic nervous system in those patients. A positive association between noninvasive, surrogate markers of arterial stiffness with PBP and CBP indicates that enhanced arterial stiffness may elevate systemic arterial pressure. Therefore, early screening of T2DM patients for the estimation of serum lipid profile, arterial stiffness and cardiac autonomic neuropathy may be performed to unravel diabetic vasculopathy.

Factors affecting cardiac autonomic neuropathy in diabetic patients with complications and construction of Nomogram prediction model / 中国医师进修杂志

Objective:To investigate the risk factors for concomitant cardiac autonomic neuropathy in diabetic patients and to develop a Nomogram prediction model.Methods:One hundred and fifty-eight diabetic patients admitted to in Southern Hospital Zengcheng Branch from March 2019 to March 2021 were selected. Patients with normal heart rate variability were the diabetic group, and patients with abnormal heart rate variability were the group with diabetes mellitus complicated by cardiac autonomic neuropathy. Logistic regression analysis was used to analyze the risk factors of cardiac autonomic neuropathy. Nomogram models were developed and model performance was evaluated. Decision curve analysis (DCA) was used to assess the net clinical benefit of the Nomogram model.Results:Comparison of general data showed that fasting blood glucose, tumour necrosis factor-α (TNF-α), glomerular filtration rate (eGER), uric acid, C-reactive protein (CRP), interleukin-6 (IL-6), free fatty acids (FFA), standard deviation of sinus heart beat RR interval (SDNN), and duration of diabetes compared to the diabetic group had statistically significant ( P<0.05); the results of the subject work characteristics (ROC) curve analysis showed that the best cut-off values for fasting glucose, TNF-α, eGFR, uric acid, CRP, IL-6, FFA, SDNN and duration of diabetes were >7.53 mmol/L, >98.45 ng/L, ≤94.79 ml/(min·1.73 m 2), > 87.3 μmol/L, >6.22 μmol/L, >37.84 ng/L, >839.19 μmol/L, ≤ 95.88 ms, >9 years; multi-factorial Logistic regression analysis showed that fasting glucose (>7.53 mmol/L), TNF-α (>98.45 ng/L), CRP (>6.22 μmol/L), IL-6 (>37.84 ng/L), FFA (>839.19 μmol/L), SDNN (≤95.88 ms), and duration of diabetes (>9 years) were risk factors for the development of cardiac autonomic neuropathy in diabetic patients; internal validation showed that the Nomogram model predicted a C-index of 0.706 (95% CI 0.668 - 0.751) for the risk of cardiac autonomic neuropathy. The DCA results showed that the Nomogram model predicted a risk threshold of >0.25 for the development of cardiac autonomic neuropathy and that the Nomogram model provided a net clinical benefit. Conclusions:There are many risk factors for cardiac autonomic neuropathy, and the nomogram model based on risk factors in this study has good predictive power and may provide a reference for clinical screening of high-risk patients and further improvement of treatment planning.

Lianmei Qiwu Decoction relieves diabetic cardiac autonomic neuropathy by regulating AMPK/TrkA/TRPM7 signaling pathway / 中国中药杂志

This study investigated the effect of Lianmei Qiwu Decoction(LMQWD) on the improvement of cardiac autonomic nerve remodeling in the diabetic rat model induced by the high-fat diet and explored the underlying mechanism of LMQWD through the AMP-activated protein kinase(AMPK)/tropomyosin receptor kinase A(TrkA)/transient receptor potential melastatin 7(TRPM7) signaling pathway. The diabetic rats were randomly divided into a model group, an LMQWD group, an AMPK agonist group, an unloaded TRPM7 adenovirus group(TRPM7-N), an overexpressed TRPM7 adenovirus group(TRPM7), an LMQWD + unloaded TRPM7 adenovirus group(LMQWD+TRPM7-N), an LMQWD + overexpressed TRPM7 adenovirus group(LMQWD+TRPM7), and a TRPM7 channel inhibitor group(TRPM7 inhibitor). After four weeks of treatment, programmed electrical stimulation(PES) was employed to detect the arrhythmia susceptibility of rats. The myocardial cell structure and myocardial tissue fibrosis of myocardial and ganglion samples in diabetic rats were observed by hematoxylin-eosin(HE) staining and Masson staining. The immunohistochemistry, immunofluorescence, real-time quantitative polymerase chain reaction(RT-PCR), and Western blot were adopted to detect the distribution and expression of TRPM7, tyrosine hydroxylase(TH), choline acetyltransferase(ChAT), growth associated protein-43(GAP-43), nerve growth factor(NGF), p-AMPK/AMPK, and other genes and related neural markers. The results showed that LMQWD could significantly reduce the arrhythmia susceptibility and the degree of fibrosis in myocardial tissues, decrease the levels of TH, ChAT, and GAP-43 in the myocardium and ganglion, increase NGF, inhibit the expression of TRPM7, and up-regulate p-AMPK/AMPK and p-TrkA/TrkA levels. This study indicated that LMQWD could attenuate cardiac autonomic nerve remodeling in the diabetic state, and its mechanism was associated with the activation of AMPK, further phosphorylation of TrkA, and inhibition of TRPM7 expression.

Corneal confocal microscopy identifies structural small fibre abnormalities in an adolescent with type 1 diabetes and impaired awareness of hypoglycaemia / Journal of the ASEAN Federation of Endocrine Societies

@#Impaired awareness of hypoglycaemia (IAH) is present in around 25-40% of individuals with type 1 diabetes mellitus (T1DM). Herein, we present a case of an adolescent with T1DM and IAH who had worse corneal nerve parameters compared to a T1DM adolescent without IAH. Small fibre abnormalities detected by corneal confocal microscopy in an objective easy-to-perform non-invasive test might be a surrogate indicator of underlying autonomic dysfunction in T1DM and IAH.

Congenital corneal anesthesia: A case series

Congenital corneal anesthesia (CCA) is an extremely rare condition where the cornea is affected in isolation or as a part of congenital syndrome, or can be associated with systemic anomalies. This case series of 12 eyes provides an overview of various clinical presentations and their final treatment outcomes. The average age of presentation was 3.2 years with a female preponderance (75%). Fifty percent of the patients had bilateral involvement and 50% had corneal ulcers at presentation. Two eyes required therapeutic keratoplasty for corneal perforation. All patients had isolated CCA except for one who had an associated hereditary and sensory autonomic neuropathy.

Taste dysfunction in type 2 diabetes mellitus patients with autonomic neuropathy and its relation with HbA1C level and disease duration

Background:Type 2 diabetes mellitus (T2DM) is a multifactorial, complex disease associated with chronic hyperglycemia, resulting from the interplay of genetic, environmental, and epigenetic factors. T2DM can causes various disabling complications. Diabetic autonomicneuropathy (DAN) is one of the common complications in diabetes. The taste threshold affected by various factors such as age, ethnic backgrounds, drugs, local and systemic diseases, consumption of alcohol, smoking, and tobacco chewing.Method: The presentstudy is undertaken with the objectives to compare the taste dysfunction of four primary sensations in Type 2 DM with autonomic neuropathy and its relation with glycemic control. The 60 patients of T2DM with autonomic neuropathy and 60 healthy controls were taken for the study. Autonomic neuropathy was assessed clinically. Chemical taste test using four solutions of basic tastes (sweet, sour, salty, bitter) were done.Results: Taste dysfunction for sweet was significant in T2DM with uncontrolled hyperglycemia. The taste dysfunction in T2DM patients was not related to gender, disease duration, and type of treatment taken. The study found a significant correlation between taste dysfunction, HbA1C level and blood sugar fasting level in T2DM patients. Conclusions: The taste dysfunction was mainly for sweet. Sour and bitter did not show any difference in case groups compared to controls

Role of skin punch biopsy in diagnosis of small fiber neuropathy-A review for the neuropathologist

Over the last three decades, skin punch biopsy has become the gold standard for diagnosis of small fiber neuropathies, including autonomic neuropathies commonly seen in diabetics, patients with HIV, and children with hereditary sensory autonomic neuropathies and toxin-induced neuropathy. Clinical, biochemical, electrophysiological tests are inconclusive, making it difficult to diagnose and initiate treatment. A skin punch biopsy is easy to perform in the outpatient clinic, is highly sensitive, and provides an objective diagnosis. Importantly, it helps avoid performing invasive nerve biopsy in patients with small fiber neuropathy, thereby preventing complications such as non-healing of the biopsy site, which is common in these patients. Secondly, the greatest advantage of skin punch biopsies is that they can be repeated any number of times, unlike a nerve biopsy, and are useful to evaluate disease progression and therapeutic response. More recently, its use has been expanded to the diagnosis of large fiber neuropathies, inherited demyelinating neuropathies, etc., obviating the need for a nerve biopsy. The European Federation of Neurological Societies has published guidelines for evaluation to ensure uniformity with regard to the site of biopsy, processing, and quantification. The evaluation of the skin biopsy involves morphometric assessment of the intraepidermal nerve fiber density using PGP 9.5 immunostained sections by bright-field microscopy. This review focuses on the practical aspects of skin punch biopsy and its utility for the practicing pathologist.

Manifestaciones clínicas y complicaciones de la Neuropatía Autonómica y Sensorial Hereditaria Tipo II / Clinical manifestations and complications of Hereditary Sensory and Autonomic Neuropathy Type II / Manifestações clínicas e complicações da Neuropatia Autonômica e Sensorial Hereditária Tipo II

Resumen La percepción del dolor es una respuesta adaptativa ante la presencia de eventos dañinos y potencialmente fatales. La Insensibilidad Congénita al Dolor, Neuropatía Autonómica y Sensorial Hereditaria Tipo II, o Síndrome de Morvan de causa desconocida, es una afección en la que se produce una pérdida de la discriminación de las señales dolorosas, así como de la respuesta emocional-afectiva. Debido a esto, la persona afectada no evade los estímulos dolorosos y, en consecuencia, puede infligirse daño a sí mismo. Incluso, durante el tratamiento de dichas lesiones pueden producir complicaciones graves como se describe en el desarrollo del presente caso clínico. Este síndrome es muy raro, de ahí la importancia de dar a conocer las complicaciones que pueden ocurrir con el fin de que la comunidad médica detecte a tiempo a este tipo de pacientes. Este reporte de caso muestra el seguimiento durante diez años de un paciente femenino con diagnóstico de Neuropatía Autonómica y Sensorial Hereditaria Tipo II. La paciente tuvo ingresos repetidos en los servicios de salud por procesos infecciosos en la cavidad bucal que involucró a múltiples órganos dentales, evolucionando a osteomielitis, por lo que tuvo que recurrirse a la mandibulectomía, incluso después de que se sometió a varios tratamientos farmacológicos. A pesar de los esfuerzos por mantener a la paciente con la mejor calidad de vida posible, este caso muestra que un diagnóstico tardío conduce a un pronóstico y condición de vida desfavorables.

Abstract The perception of pain is an adaptive response to the presence of harmful and potentially fatal events. Congenital insensitivity to pain, Hereditary Sensory and Autonomic Neuropathy Type II or Morvan syndrome of unknown cause, is a condition in which there is a loss of discrimination of the painful signals, as well as the emotional-affective response. Due to this, the person, that suffering this disorder, does not evade the painful stimuli and, consequently, can inflict damage to himself or herself. Even during the treatment of such lesions can produce serious complications as described in the development of the present clinical case. This syndrome is very rare, hence the importance of publicizing the complications that may occur in order for the medical community to detect this type of patients as soon as possible. This case report shows the follow-up of a female patient with Hereditary Sensory and Autonomic Neuropathy Type II for ten years. The patient has had several admissions to the hospital, due to infectious processes in the oral cavity that involved multiple dental organs, evolving to osteomyelitis, and for this reason, the mandibulectomy must performed in the patient; even after she underwent several pharmacological treatments. Despite the efforts to maintain the patient with the best possible quality of life, this case shows that a late diagnosis lead to an unfavorable prognosis and life condition for patients suffering from this genetic anomaly.

Resumo A percepção da dor é uma resposta adaptativa à presença de eventos potencialmente fatais e prejudiciais. A insensibilidade congênita à dor, neuropatia autonômica e sensorial hereditária tipo II, ou síndrome de Morvan de causa desconhecida, é uma condição na qual há perda de discriminação de sinais dolorosos e resposta emocional-emocional. Por esse motivo, a pessoa afetada não evita estímulos dolorosos e, consequentemente, danos podem ser infligidos a si mesma. Mesmo durante o tratamento das referidas lesões, elas podem produzir complicações graves, como descrito no desenvolvimento do presente caso clínico. Essa síndrome é muito rara, daí a importância de divulgar as complicações que podem ocorrer para que a comunidade médica detecte esse tipo de paciente a tempo. Este relato de caso mostra o seguimento de dez anos de uma paciente com diagnóstico de Neuropatia hereditária autonômica e sensorial tipo II. A paciente repetiu internações nos serviços de saúde por processos infecciosos na cavidade bucal que envolviam múltiplos órgãos dentários, evoluindo para osteomielite e, portanto, precisou recorrer à mandibulectomia, mesmo após vários tratamentos farmacológicos. Apesar dos esforços para manter o paciente com a melhor qualidade de vida possível, este caso mostra que um diagnóstico tardio leva a um prognóstico e condição de vida desfavoráveis.

Detailed ECG analysis in type 2 diabetes mellitus: a predictor of multitude of complications

Background: Type 2 diabetes mellitus is a systemic disease with life-threatening complications and morbidity. The 12 lead ECG, an easily available investigation, when studied in detail can give a lot of information and predict various microvascular and macrovascular complications apart from coronary artery disease.Methods: A random cross sectional study involving 100 patients of type 2 diabetes mellitus, in the age group of 18-80 years were included in study after applying various inclusion and exclusion criteria. They were subjected to ECG, 2D echocardiography and laboratory tests. Data were collected and analysed.Results: Arrythmia was not detected in any patient. A resting tachycardia (HR >100) in 30 patients correlated with Prolonged QTc (>440 miliseconds) (p=0.04). QRS amplitude was reduced in 26 patients. Prolonged QTc also correlated with presence of diabetic complications, retinopathy of NPDR type and nephropathy (p=0.004). Hence about 30% of the study group did show signs of early diabetic cardiac autonomic neuropathy and cardiomyopathy.Conclusions: The statistically significant utility of electrocardiogram in predicting various complications of diabetes apart from coronary artery disease.

The evaluation of QTc prolongation and QT dispersion in type 2 diabetes mellitus as an indicator of cardiac autonomic neuropathy

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.

Neuropatia autonômica cardiovascular em pacientes com diabetes mellitus: perspectivas atuais / Cardiovascular autonomic neuropathy in patients with diabetes mellitus: current outlook

A neuropatia autonômica cardíaca (NAC) é uma complicação comum do diabetes mellitus (DM) e frequentemente, subdiagnosticada. A NAC está associada ao aumento da mortalidade, cardiovascular e renal, doença renal crônica e maior morbidade em pacientes com DM. Apesar dessas consequências, muitas vezes, a NAC permanece sem diagnóstico por um período prolongado. Isso geralmente porque a doença é assintomática até a fase avançada, bem como pela falta de informações e de estratégias de triagem. Clinicamente NAC se manifesta por distúrbios funcionais ou condições clínicas que envolvem desajuste das atividades reflexas cardiovasculares, tais como taquicardia em repouso, intolerância ao exercício, hipotensão ortostática, instabilidade cardiovascular intraoperatória, disfunção elétrica do coração traduzida por arritmias e isquemia miocárdica silenciosa. Essas alterações comprometem a qualidade de vida e a sobrevida dos pacientes. A NAC, segundo sua evolução, pode ser subdividida em subclínica (fase em que predominam alterações funcionais reversíveis) e clínica (quando as alterações neuronais estruturais estão plenamente estabelecidas). A avaliação da integridade do sistema nervoso autonômico é realizada por meio de exploração da atividade parassimpática, analisando o comportamento da frequência cardíaca (FC) em resposta à respiração profunda, ortostatismo ou manobra de Valsalva. A atividade simpática é explorada por meio de aferição da pressão arterial em resposta a mudança de postura (ortostatismo) e esforço isométrico. A análise da variabilidade da frequência cardíaca (VFC), no domínio do tempo, no domínio da frequência e por métodos gráficos complementam essa avaliação. Neste artigo de revisão, analisamos recentes informações sobre a epidemiologia, manifestações clínicas, diagnóstico, e tratamentos da NAC

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. Clinically, CAN is manifested by functional disorders or clinical conditions that involve maladjustment of cardiovascular reflex activities, such as tachycardia at rest, exercise intolerance, orthostatic hypotension, intraoperative cardiovascular instability, electrical dysfunction of the heart translated by arrhythmias and silent myocardial ischemia. These changes compromise patients' quality of life and survival. CAN, according to its evolution, can be subdivided into subclinical (phase in which reversible functional changes predominate) and clinical (when structural neuronal changes are fully established). The assessment of the integrity of the autonomic nervous system is performed by exploring parasympathetic activity, analyzing the heart rate in response to deep breathing, orthostatism or Valsalva maneuver. Sympathetic activity is explored by measuring blood pressure in response to a change in posture (orthostatism) and isometric effort. The analysis of heart rate variability (HRV), in the time domain, in the frequency domain and by graphic methods, complement this assessment. In this article, we review the latest developments in the epidemiology, pathogenesis, diagnosis, consequences, and treatments of CAN in patients with DM.

Association of pupil responses with severity of erectile dysfunction in diabetes mellitus

Purpose: To investigate the relation between erectile dysfunction (ED) severity and pupillary functions in patients with diabetes mellitus (DM). Methods: This prospective and observational study included 90 patients with type 2 DM and ED. Patients divided into three subgroups according to severity of ED: (i) Mild ED, (ii) Moderate ED and (iii) Severe ED groups. Thirty age-matched healthy subjects formed the control group. Main outcome measures were pupil diameter and average speed of pupil dilation. Static and dynamic pupillometry analysis was performed using the Sirius Topographer (CSO, Firenze, Italy). Results: Mean pupil diameter during static and dynamic pupillometry analysis were significantly greater in the control group than in the all study groups (P < 0.05). Mean pupil diameter in static pupillometry analysis was significantly different in each study group and pupil was more miotic in the Severe ED group than in the both Moderate and Mild ED groups (P < 0.05 for each). Dynamic pupillometry analysis revealed that mean pupil diameter and mean average dilation speed were significantly different in each study group throughout measurement period and the highest speed was observed in the Mild ED group and the lowest speed was observed in the severe ED group (P < 0.005 for each). Conclusion: Our study results suggest that abnormal pupil functions due to diabetic autonomic neuropathy may indicate the associated ED in patients with DM.

Gall bladder ejection fraction as a marker of autonomic neuropathy in type 2 diabetes mellitus

Background: Diabetic neuropathy is one of the commonest complications of diabetes mellitus and associated with considerable morbidity and mortality. The influence of diabetes on gall bladder function was not demonstrated in many studies. In this study, the association of fasting gall bladder volume and gall bladder ejection fraction with degree of cardiac autonomic neuropathy was assessed and correlated with duration of diabetes and severity of diabetes..Methods: The study was conducted in Government Sivagangai Medical College Hospital, Sivagangai, Madurai during a period of January 2018 to September 2018 as a Prospective observational study conducted among 100 patients in study group and 50 healthy subjects in control group. The aim of the study was to find out the incidence of autonomic neuropathy in study group by simple bed side tests, to determine the fasting gall bladder ejection fraction in diabetics, comparison of gall bladder volume in both study and control group, correlation of gall bladder ejection fraction with autonomic neuropathy.Results: The incidence of CAN is found to be high with longer duration of the disease and the degree is also correlated with duration of the disease. The correlation coefficient of this association is 0.792 which indicates high correlation. The correlation of severity of DM   with incidence and degree of CAN was 0.81 which indicates high correlation and also the study showed an increase in the FGBV and a decrease in the GBEF with increase in the severity of cardiac autonomic neuropathy.Conclusions: In patients with type 2 diabetes mellitus, the gall bladder ejection fraction is  significantly  related  to  the  duration  of diabetes mellitus and degree of hyperglycemia in addition to cardiac autonomic neuropathy(CAN). Similarly,  fasting  gall  bladder  volume (FGBV)  is  significantly increased  in  type 2  diabetes  mellitus  patients  with  cardiac autonomic neuropathy.

A study of cardiological autonomic neuropathy in Type 2 Diabetes Mellitus with reference to QT interval for its diagnosis

Background: Presence of cardiac autonomic neuropathy (CAN) is responsible for silent myocardial infarction and sudden death in diabetics. Hence recognizing cardiac dysautonomia early, which is asymptomatic will help to delay or arrest its progression.Methods: A cross-sectional study to evaluate the Prevalence of Cardiovascular Autonomic Neuropathy in Type 2 diabetes and correlate it with duration of Diabetes and to investigate the relationship between cardiac autonomic dysfunction and corrected QT interval.Results: In the study population, the prevalence of definite CAN was 8%, 24% and 58% in group A, B and C respectively. The prevalence of definite CAN increases with increase in duration of diabetes. P value <0.001 significant.Conclusions: A significant correlation is present between Cardiovascular autonomic dysfunction and QTc prolongation. QTc interval in the ECG can be used to diagnose Cardiovascular autonomic neuropathy with a reasonable sensitivity and specificity.

Neuropatía precoz: Importancia de la evaluación neurofisiológica en el sindrome metabólico con o sin disregulación glucémica / Early neuropathy. Importance of neurophysiological assessment in cases of metabolic syndrome with or without hyperglycemia

La neuropatía periférica y autonómica es una de las complicaciones más comunes en pacientes con diabetes. La lesión nerviosa comienza tempranamente, en aquellos con diabetes mellitus de tipo II puede comenzar antes de la disregulación glucémica, en la etapa del síndrome metabólico. En un primer momento puede ser asintomática, por lo que es fundamental la realización de técnicas electrofisiológicas para su detección temprana, para implementar medidas terapéuticas que impidan su progresión. Se presentan nueve casos, tres con síndrome metabólico y alteración del metabolismo de la glucosa, uno con síndrome metabólico sin hiperglucemia y cinco con alteración del metabolismo de la glucemia sin otros criterios diagnósticos de síndrome metabólico. Todos estaban asintomáticos y el examen neurológico fue normal. Se realizaron técnicas de detección de neuropatía periférica temprana (razón sural/radial, ondas F, reflejo H, respuestas simpáticas de la piel, período silente cutáneo y variabilidad del intervalo RR). Ocho pacientes tuvieron neuropatía autonómica cardíaca incipiente y uno neuropatía autonómica establecida. Ocho presentaron neuropatía somática incipiente (siete con alteración de la razón sural/radial, y uno con alteración de las ondas F). Un paciente tuvo alteración sublínica de las fibras finas (alteración de las respuestas simpáticas de la piel y del período silente cutáneo). Es importante la detección de la neuropatía temprana antes de su manifestación clínica ya que existen tratamientos para detenerla e incluso revertirla.

Características de la neuropatía autonómica cardiovascular en pacientes con Diabetes Mellitus tipo 2 / Cardiovascular autonomic neuropathy characteristics in patients with type 2 Diabetes Mellitus

La neuropatía autonómica cardiovascular en el paciente diabético (NACD) se define como una complicación crónica de la diabetes de tipo microangiopática, que se expresa en disautonomía del sistema cardiovascular. Se realizó un estudio descriptivo transversal cuyo objetivo fue la caracterización epidemiológica y clínica de los pacientes diabéticos tipo 2 con NACD que acudieron a la Unidad de Diabetes del CCR-ASCARDIO de la ciudad de Barquisimeto, estado Lara durante el mes de diciembre del año 2014. La muestra estuvo conformada por 68 individuos diabéticos tipo 2, con una prevalencia de NACD según la prueba de RV del 63,2%, por ortostatismo de 45,6% y por taquicardia sinusal inapropiada de 8,8%. Hubo un predominio del género femenino y un mayor porcentaje de pacientes con NACD no tenían control metabólico de la diabetes y tenían más de 5 años con la enfermedad. En conclusión, se sugiere el diagnóstico precoz de la DM así como la identificación temprana de síntomas que sugieran el desarrollo de disautonomía por deterioro neuropático del sistema cardiovascular en estos pacientes(AU)

Cardiovascular autonomic neuropathy in diabetic patients (CAN) is defined as a chronic complication of diabetes (DM) of the microangiopathic type, which is expressed as dysautonomia of the cardiovascular system. We performed an observational descriptive cross-sectional study to characterize clinically and epidemiologically type 2 diabetic patients with CAN that were attended in December 2014 at the Unidad de Diabetes of CCR-ASCARDIO in Barquisimeto, Lara state. The sample consisted of 68 type 2 diabetic patients with a prevalence of CAN according to the RINES VALCARDI (RV) test of 63.2%, by orthostatism of 45.6% and by the presence of inappropriate sinus tachycardia of 8.8%. In patients with CAN, there was female predominance and a greater percentage of patients had more than five years with diabetes and no metabolic control their disease. In conclusion, it is important to make an early diagnosis of diabetes and clearly identify symptoms that suggest dysautonomia in these patients(AU)

Alteration of cardiovascular autonomic activity in type 2 diabetes mellitus

Background: Diabetes mellitus (DM) is a clinical syndrome characterized by hyperglycaemia due to absolute or relative insulin deficiency. Cardiovascular autonomic neuropathy (CAN) invokes potentially life-threatening outcomes especially in poorly controlled diabetic patients. This study was to evaluate the prevalence of CAN in diabetic patients and its relationship with QTc interval.Methods: This observational study of two year duration was included total 123 patients of more than 30 (thirty) years and up to 60 (sixty) years of age who were presented with diabetic mellitus (DM) those were evaluated for CAN using four distinct clinical tests-Resting heart rate (RHR), test for orthostatic hypotension (OH), hand gripping test (HGT) and QTc interval on ECG. Data were analyzed with statistical package for social sciences (SPSS), version 23.Results: The mean age of all 103 studied patients was 48.94±8.69 years; Mostly patients belong to 50-60 years of age and the majority was males (69.0%). Out of 103 72.8% patients were reported with CAN (51 males and 24 females) and without CAN were 27.2.0% (20 males and 8 females), 36% of patients of Definite Parasympathetic neuropathy, 25% Normal and 20% of Sympathetic neuropathic patients. HbA1c level increases the danger of CAN also. QTc interval is a reliable indicator for the presence of CAN.Conclusions: Duration of diabetes is directly proportional to the prevalence of CAN. Various cardiac autonomic function tests detect CAN.

Prevalence of cardiac autonomic neuropathy in type 2 diabetes mellitus and its correlation with other microvascular complications in South Indian population

Background: In individuals with type 2 diabetes mellitus (T2DM) the presence of Cardiac autonomic neuropathy (CAN) increases the risk of severe hypoglycaemia, cardiac arrhythmias, silent myocardial ischemia and stroke. It is also associated with increased perioperative morbidity and mortality, even with minor surgeries in these patients. The present study was conducted to assess the prevalence of CAN in T2DM patients and to investigate any possible association between CAN and micro vascular complications.Methods: 102 T2DM patients between the age of 30 years and 70 years, who attended outpatient department of Institute of Diabetology, Rajiv Gandhi Government General Hospital and Madras Medical College, Chennai, Tamil Nadu were included. All the selected patients underwent laboratory investigations, biothesiometry, fundus examination, and CAN assessment by CANS analyser.Results: A slight female preponderance was noted in the study, though it was statistically insignificant. Out of 102 patients, prevalence of CAN dysfunction was found in 82 (80.39%) of T2DM patients. No significant association of CAN was noted with duration of diabetes (p=0.772), HbA1c (p=0.827) and nephropathy (p=0.524). However, peripheral neuropathy (p=0.006) and retinopathy (p=0.03) were found to be significantly associated with CAN in T2DM patients.Conclusions: Prevalence of CAN in asymptomatic South Indian T2DM population was found to be 80.39%, with equal sex distribution and was most common in the 51- 60 years age group. Diabetic neuropathy and retinopathy were the most significant microvascular complications predictive of the incidence of CAN in T2DM patients.

A study on diastolic dysfunction in asymptomatic type 2 diabetes mellitus with normal systolic function

Background: Diastolic heart failure, otherwise called as heart failure with preserved ejection fraction, is common finding of hypertensive heart disease, but various studies report a high incidence of diastolic heart failure in patients with type 2 diabetes mellitus in spite of the absence of coronary artery heart disease and hypertension. The objectives of the study were to determine the prevalence of dysfunction of left ventricle in diastole in type 2 diabetes mellitus patients and to compare with the non-diabetic individuals with that of asymptomatic type II diabetes patients. To assess the correlation of diastolic dysfunction in diabetes with age of patients, HbA1c levels, duration of diabetes, retinopathy, autonomic neuropathy.Methods: A prospective cross sectional among them 50 patients were diabetics and 50 were non-diabetic controls. Diastolic dysfunction was measured with standard echocardiographic parameters and the results were computed with corresponding variables of the patients. All the variables and their data were analysed for percentage, mean, standard deviation ‘t’ test and chi square test. The ‘t’-test was used to study the quantitative data while chi square test was used to study the qualitative data.Results: Among the study population 60% had diastolic dysfunction and 14% had diastolic dysfunction among cases and control group respectively. Diastolic dysfunction was present among 23.3% and the 76.7% of the age group groups of less than 45 and more than 45 years of age respectively. In this study poor glycaemic status was significantly associated with diastolic dysfunction, whereas duration of diabetes, retinopathy and autonomic neuropathy were not statistically significant.Conclusions: Present study reveals moderately high incidence of diastolic dysfunction in asymptomatic diabetic; subjects and, this finding was correlated with the HBA1C levels but not with retinopathy and autonomic neuropathy.