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.

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.

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.

Clinico-demographic profile of type 2 diabetes patients with cardiac autonomic neuropathy

Background: Patients with diabetes mellitus (DM) are at an increased risk of dying from cardiovascular diseases, the reason for which is not completely understood. Aim: To study the clinico-demographic profile of type 2 diabetes patients with cardiac autonomic neuropathy (CAN). Materials and methods: This was a cross sectional study involving 100 patients attending the diabetic clinic of a tertiary care hospital. Demographic data was collected and autonomic function testing was done with Ewing and Clark’s tests. Results: The prevalence of CAN was 58 %. CAN had statistically significant association with increasing duration of diabetes (p < 0.00001), increasing values of HbA1c (p < 0.00001), and with combined use of insulin and oral medications (p < 0.05). Conclusion: There is a high prevalence of CAN in the diabetic population providing a large pool of patients awaiting effective interventions.

Potential Association of Triglyceride Glucose Index with Cardiac Autonomic Neuropathy in Type 2 Diabetes Mellitus Patients

Cardiac autonomic neuropathy (CAN) is a common and most neglected complication of diabetes, estimated to be roughly 8% in recently diagnosed patients and greater than 50% in patients with chronic disease history. The insulin resistance (IR) itself is bidirectionally associated with increased risk of type 2 diabetes mellitus (T2DM) and CAN is a predisposing factor. The primary objective of the present study was aimed to find a correlation of triglyceride glucose index (TyG index) in CAN patients along with the prevalence of CAN in T2DM patients as a secondary objective. This prevalence study was conducted on 202 patients visiting the diabetic clinic of Hamdard Institute of Medical Sciences and Research, Jamia Hamdard (HIMSR) teaching hospital in New Delhi, India who fulfilled the inclusion criteria. The Ewings autonomic function test was used for diagnosis of CAN. TyG index was calculated for patients based on fasting levels of glucose and triglyceride. The CAN was diagnosed in 62 participants out of 202 T2DM patients (overall prevalence 30.7%). The mean ± standard deviation (SD) for TyG index was 10.3 ± 0.2 and 9.5 ± 0.2 in CAN positive, T2DM patients, respectively. The difference of TyG index, in CAN positive and T2DM patients, was highly significant (P < 0.001). Further correlation analysis was performed to find an association of TyG index, duration, and age with patient groups. TyG index showed a positive correlation with heart rate during deep breathing (HRD), heart rate variation during standing (HRS), blood pressure (BP) response to handgrip and BP response to standing. Our finding highlights the TyG index, low-cost IR index, might be useful as an alternative tool for the early screening of patients at a high risk of diabetic neuropathy.

Effects of High-Dose α-Lipoic Acid on Heart Rate Variability of Type 2 Diabetes Mellitus Patients with Cardiac Autonomic Neuropathy in Korea

BACKGROUND: Diabetic cardiac autonomic neuropathy (CAN) is one of the important complications of diabetes. It is characterized by reduced heart rate variability (HRV). METHODS: In this randomized, double-blind, placebo-controlled, multicenter trial, 75 patients were randomly assigned to one of two groups. One group (n=41) received α-lipoic acid (ALA) at an oral dose of 600 mg/day for the first 12 weeks and then 1,200 mg/day for the next 12 weeks. The other group (n=34) received placebo treatment for 24 weeks. CAN was assessed by measuring HRVs in people with diabetes. RESULTS: Most of the baseline measures for HRVs were similar between the ALA and placebo groups. Although there were no statistically significant HRV changes in the ALA group compared to the placebo group after 24 weeks of trial, we found a positive tendency in some of the HRV parameters of the ALA group. The standard deviations of normal-to-normal RR intervals in the standing position increased by 1.87 ms in the ALA group but decreased by −3.97 ms in the placebo group (P=0.06). The power spectrum of the low frequency (LF) band in the standing position increased by 15.77 ms² in the ALA group, whereas it declined by −15.04 ms² in the placebo group (P=0.08). The high frequency/LF ratio in the upright position increased by 0.35 in the ALA group, whereas it declined by −0.42 in the placebo group (P=0.06). There were no differences between the two groups regarding rates of adverse events. CONCLUSION: Although a slight improvement tendency was seen in HRV in the ALA group, there were no statistically significant HRV changes in the ALA group compared to the placebo group after 24 weeks of trial. However, the high oral dose of ALA was well-tolerated.

Electrocardiographic Abnormalities and Cardiac Autonomic Neuropathy In Type 2 Diabetes Mellitus Patients.

Abstract: Background and Objectives: As Cardiac Autonomic Neuropathy (CAN) in Type 2 Diabetes Mellitus patients is implicated in arrhythmogenesis and sudden cardiac death; we aimed to determine the prevalence of Cardiac Autonomic Neuropathy and to compare the mean CAN scores of those patients with and without electrocardiographic abnormalities. Methodology: After a detailed history and clinical examination, 100 diabetic patients were subjected to Ewing’s and Clark’s cardiac autonomic function tests. CAN scores were computed and their electrocardiograms (ECGs) were studied. Results: 72% had severe CAN (CAN score ≥ 5). 76% had abnormal ECGs with mean CAN scores being higher in those with abnormal ECGs (Mean=7.0 ± 1.7 vs 4.3 ± 1.2, p<0.001). Significant associations were found between CAN scores and age (p=0.013), peripheral neuropathy (p=0.04) and symptoms of dysautonomia (p=0.03). There was a significant difference between the mean CAN scores of those with Coronary Artery Disease (CAD) when compared to those without CAD (Mean 7.26 ± 0.57 vs 6.12 ± 1.93, p=0.012) and between those with longer compared to shorter duration of diabetes(Mean 6.9±1.8 Vs 5.7±1.9, p=0.002). Interpretation and Conclusions: Diabetics with abnormal ECGs, CAD and longer duration of diabetes had higher mean CAN scores. As this complex inter-relationship between Diabetes, CAN & CAD can cause abnormalities in heart rate control, a high index of suspicion for asymptomatic cardiovascular disease is needed in diabetics.

Diabetes y Corazón / Heart and diabetes

En la diabetes mellitus(DM) el corazón es el órgano que se compromete con mayor frecuencia y lo hace a través de la enfermedad coronaria (EC), cardiopatía hipertensiva (CH), miocardiopatía diabética (MCDM) y neuropatía autónoma cardíaca (NAC), entidades de gran morbilidad y mortalidad y que pueden coexistir en el mismo paciente. Las personas diabéticas con enfermedad coronaria establecida son el grupo de mayor riesgo para presentar un infarto cardíaco. La EC en las personas diabéticas adquiere connotaciones propias en relación a su diagnóstico, evolución y tratamiento. En la DM por una parte está ampliamente reconocido el efecto nocivo de la hiperglicemia y de los factores de riesgo cardiovascular (FRCV) para la aparición y progresión de sus complicaciones y por otra, la evidencia de los grandes ensayos clínicos ha demostrado que un enfoque terapéutico global que incluya de manera temprana no sólo un estricto control de la glicemia sino que el resto de los FRCV trae consigo reducción de la morbilidad y mortalidad CV y general. Recientemente se ha estandarizado la manera de investigar y tratar estos factores en presencia de DM. La clave está en la pesquisa y tratamiento precoz de los estados de preDM y DM, y de los otros FRCV asociados como son la elevación del colesterol de LDL, de la presión arterial, eliminar el hábito de fumar y controlar la obesidad. Aunque aparentemente menos frecuentes pero no menos importantes son la MCDM y NAC, exigen una diagnóstico y tratamiento oportuno, al aumentar la morbimortalidad de causa cardiovascular. La insuficiencia cardíaca (IC) es frecuente en las personas con diabetes. La EC es la causa más frecuente de IC, pero la MCDM también contribuye y debe ser investigada ya que expone a mayor morbimortalidad, menor tolerancia al ejercicio y peor calidad de vida. La insuficiencia renal en etapa avanzada es causa frecuente de IC en DM. El objetivo de este artículo presentar una actualización del diagnóstico y manejo del compromiso cardiaco en la diabetes mellitus.

In diabetes mellitus (DM) the heart is the organ most frequently involved, being a major risk factor for developing coronary heart disease (CHD), hypertensive heart disease (HHD), diabetic cardiomyopathy (DCM) and cardiac autonomic neuropathy (CAN), entities with high morbidity and mortality,that can coexist in the same patient. Diabetics with established coronary heart disease have a major risk for acute myocardial infarction. Coronary Heart Disease in diabetics has its own features regarding diagnosis, prognosis and treatment. In DM it is widely recognized the deleterious effect of hyperglycemia as a cardiovascular risk factors (CVRF) for the onset and progression of complications. Moreover, the evidence from clinical trials has shown the importance of a global therapeutic approach, not only an early strict glycemia control, but also in the control at the rest CVRF, making possible to reduce CV morbidity and overall mortality. Recently it has been standardized the way to study and manage these factors, in the presence of DM. The key is, in the early research and treatment of pre-DM and DM states and the other associated cardiovascular risk factors, such as: high LDL cholesterol, blood pressure, smoking and obesity control. Although DCM and CAN are less frequent, they are not less important, requiring prompt diagnosis and treatment, because of its increased morbidity and mortality. Heart failure (HF) is common in people with diabetes. Although the CD is the most common cause of HF, is important to emphasize that DCM also contributes and should be investigated, because it increases morbidity and mortality, reduces exercise tolerance and worsens quality of life. The end-stage renal failure is a frequent cause of heart failure in diabetics. The aim of this article is to present an update of the diagnosis and management of the cardiac disease in diabetes mellitus.

Atypical Cardiac Autonomic Neuropathy Identified with Entropy Measures.

Aims: To identify Cardiac Autonomic Neuropathy (CAN) from a range of measures extracted from Heart Rate Variability (HRV), including higher moments of RR intervals and a spectrum of entropy measures of RR intervals. Study Design: Analysis of HRV measured from participants at a diabetes screening clinic. Groups were compared using t-tests to identify variables that provide separation between groups. Place and Duration of Study: Charles Sturt Diabetes Complications Clinic, Albury, NSW Australia. Methodology: Eleven participants with definite CAN, 67 participants with early CAN, and 71 without CAN had their beat-to-beat fluctuations analyzed using two spectra of HRV: the spectrum of moments of RR intervals and the spectrum of Renyi entropy measures. RR intervals were extracted from ECG recordings and were detrended before analysis. Results: Higher moments of RR intervals identified a previously unnoticed sub-group of patients who are atypical within the definite CAN group. Classification of CAN progression was better with Renyi entropy measures than with moments of RR intervals. Significant differences between early and definite CAN were found with the sixth and eighth moments, (P=.022 and P=.042 respectively), but for entropy measures P values were orders of magnitude smaller. Conclusion: Identification of early CAN provides the opportunity for early intervention and better treatment outcomes, as well as identifying atypical cases. Our findings illustrate the value of exploring a range of different measures when attempting to detect differences in groups of patients with CAN.

Clinical Study on Tiaoxinyin in Treating Diabetic Cardiac Autonomic Neuropathy / 中国中医药信息杂志

Objective To observe the clinical efficacy of Tiaoxinyin treatment for diabetic cardiac autonomic neuropathy (DCAN);To evaluate its efficacy and safety.Methods One hundred patients of DCAN were randomly divided into experimental group (51 cases) and control group (49 cases). Both groups were given basic treatment of diet control and Metformin hydrochloride tablets orally taking. Patients in the experimental group were given Tiaoxinyin, while patients in the control group were treated with Mecobalamin tablets for 8 weeks. Changes and untoward effects in blood glucose, blood fat and heart rate variability were observed before and after treatment so as to compare the efficacy of two groups.Results The total effective rate of the experimental group was 82.35% (42/51) and the control group was 63.27% (31/49), with statistical significance between the two groups (P<0.01). The TCM scores of the two groups decreased after treatment, with statistical significance compared with those before treatment (P<0.01). The difference in TCM scores between the two groups was significance (P<0.05). The level of FBG and 2 h PG in the two groups declined (P<0.05). Heart rate variability had statistical significance compared with that before treatment (P<0.05), with statistical significance between the two groups (P<0.05). No obvious adverse reaction was found.Conclusion Tiaoxinyin is effective and safe in treating DCAN and can improve the heart rate variability indicators in patients.

Assessment of Diabetic Polyneuropathy and Autonomic Neuropathy Using Current Perception Threshold in Korean Patients with Diabetes Mellitus

BACKGROUND: The current perception threshold (CPT) could be quantified by stimulating Abeta and C fibers at 2,000 and 5 Hz, respectively. C fibers play a role in the autonomic nervous system and are involved in temperature and pain sensation. We evaluated the usefulness of CPT for diagnosing distal polyneuropathy (DPN) and cardiovascular autonomic neuropathy (CAN) in diabetic patients. METHODS: The CPT was measured in the index finger (C7 level) and in the third toe (L5 level) in diabetic patients aged 30 to 69 years. We assessed DPN according to the neuropathy total symptom score-6 (NTSS-6) and 10-g monofilament pressure sensation. Subjects with a NTSS-6 >6 or with abnormal 10-g monofilament sensation were defined to have DPN. CAN was evaluated by spectral analysis of heart rate variability and by Ewing's traditional tests. RESULTS: The subjects with DPN had significantly higher CPT at all of the frequencies than the subjects without DPN (P6 could be most precisely predicted by CPT at 2,000 and 5 Hz, respectively. However, only 6.5% and 19.6% of subjects with DPN had an abnormal CPT at 2,000 Hz at the C7 and L5 levels. Although CPT at 5 Hz showed a negative correlation with the power of low and high frequency in the spectral analysis (P<0.05), only 16.7% of subjects with CAN exhibited an abnormal CPT at the same frequency. CONCLUSION: Although the CPT is significantly associated with neuropathic symptoms or signs corresponding to the nerve fiber stimulated, it provides little additional information compared with conventional evaluations.

Association between Cardiac Autonomic Neuropathy, Diabetic Retinopathy and Carotid Atherosclerosis in Patients with Type 2 Diabetes

BACKGROUND: It is not clear whether microangiopathies are associated with subclinical atherosclerosis in type 2 diabetes mellitus (T2DM). We investigated the relation of cardiac autonomic neuropathy (CAN) and other microangiopathies with carotid atherosclerosis in T2DM. METHODS: A total of 131 patients with T2DM were stratified by mean carotid intima-media thickness (CIMT) > or = or or =2. Diabetic microangiopathies were assessed. RESULTS: Patients with CAN comprised 77% of the group with mean CIMT > or =1.0 mm, while they were 29% of the group with CIMT or =1.0 mm, while they were 28% of the group without CIMT thickening (P=0.003). Patients with CAN comprised 51% of the group with > or =2 carotid plaques, while they were 23% of the group with < or =1 carotid plaque (P=0.014). In multivariable adjusted logistic regression analysis, the patients who presented with CAN showed an odds ratio [OR] of 8.6 (95% confidence interval [CI], 1.6 to 44.8) for CIMT thickening and an OR of 2.9 (95% CI, 1.1 to 7.5) for carotid plaques. Furthermore, patients with DR were 3.8 times (95% CI, 1.4 to 10.2) more likely to have CIMT thickening. CONCLUSION: These results suggest that CAN is associated with carotid atherosclerosis, represented as CIMT and plaques, independent of the traditional cardiovascular risk factors in T2DM. CAN or DR may be a determinant of subclinical atherosclerosis in T2DM.

Association between Cardiac Autonomic Neuropathy, Diabetic Retinopathy and Carotid Atherosclerosis in Patients with Type 2 Diabetes

BACKGROUND: It is not clear whether microangiopathies are associated with subclinical atherosclerosis in type 2 diabetes mellitus (T2DM). We investigated the relation of cardiac autonomic neuropathy (CAN) and other microangiopathies with carotid atherosclerosis in T2DM. METHODS: A total of 131 patients with T2DM were stratified by mean carotid intima-media thickness (CIMT) > or = or or =2. Diabetic microangiopathies were assessed. RESULTS: Patients with CAN comprised 77% of the group with mean CIMT > or =1.0 mm, while they were 29% of the group with CIMT or =1.0 mm, while they were 28% of the group without CIMT thickening (P=0.003). Patients with CAN comprised 51% of the group with > or =2 carotid plaques, while they were 23% of the group with < or =1 carotid plaque (P=0.014). In multivariable adjusted logistic regression analysis, the patients who presented with CAN showed an odds ratio [OR] of 8.6 (95% confidence interval [CI], 1.6 to 44.8) for CIMT thickening and an OR of 2.9 (95% CI, 1.1 to 7.5) for carotid plaques. Furthermore, patients with DR were 3.8 times (95% CI, 1.4 to 10.2) more likely to have CIMT thickening. CONCLUSION: These results suggest that CAN is associated with carotid atherosclerosis, represented as CIMT and plaques, independent of the traditional cardiovascular risk factors in T2DM. CAN or DR may be a determinant of subclinical atherosclerosis in T2DM.

Plantar thermography is useful in the early diagnosis of diabetic neuropathy

OBJECTIVES: This study evaluated plantar thermography sensitivity and specificity in diagnosing diabetic polyneuropathy using cardiac tests (heart rate variability) as a reference standard because autonomic small fibers are affected first by this disease. METHODS: Seventy-nine individuals between the ages of 19 and 79 years old (28 males) were evaluated and divided into three groups: control (n = 37), pre-diabetics (n = 13) and type 2 diabetics (n = 29). The plantar images were recorded at baseline and then minutes after a provocative maneuver (Cold Stress Test) using an infrared camera that is appropriate for clinical use. Two thermographic variables were studied: the thermal recovery index and the interdigital anisothermal technique. Heart rate variability was measured in a seven-test battery that included three spectral indexes (in the frequency domain) and four Ewing tests (the Valsalva maneuver, the orthostatic test, a deep breathing test, and the orthostatic hypotension test). Other classically recommended tests were applied, including electromyography (EMG), Michigan inventory, and a clinical interview that included a neurological physical examination. RESULTS: Among the diabetic patients, the interdigital anisothermal technique alone performed better than the thermal recovery index alone, with a better sensitivity (81.3%) and specificity (46.2%). For the pre-diabetic patients, the three tests performed equally well. None of the control subjects displayed abnormal interdigital anisothermal readouts or thermal recovery indices, which precluded the sensitivity estimation in this sample of subjects. However, the specificity (70.6%) was higher in this group. CONCLUSION: In this study, plantar thermography, which predominately considers the small and autonomic fibers that are commonly associated with a sub-clinical condition, proved useful in diagnosing diabetic neuropathy early. The interdigital anisothermal test, when used alone, performed best.

The usefulness of the colour change plaster (NeuroCheck(R)) for the diagnosis of cardiac autonomic neuropathy in type 2 diabetes / 대한내과학회지

BACKGROUND: Recently, the colour change plaster (NeuroCheck(R)) has been introduced, which measures sweat production on the basis of a colour change from blue to pink. This new test was useful to detect of diabetic peripheral neuropathy. The aim of this study was to evaluate the usefulness of the colour change plaster (NeuroCheck(R)) for the diagnosis of cardiac autonomic neuropathy in type 2 diabetic patients. METHODS: This study include 35 type 2 diabetic patients (10 male, 25 female) with a mean age of 55+/-14.9 years and a mean diabetes duration of 11.8+/-8.8 years. Cardiac autonomic neuropathy was diagnosed by means of Ewing's method. Peripheral autonomic neuropathy (Sudomotor function abnormality) was assessed by means of time (more than 600 seconds) until complete colour change in the indicator test. RESULTS: Peripheral autonomic neuropathy was diagnosed in 23 patients (65.7%). Time until starting colour change of plaster in normal and abnormal sudomotor patients were 38.3+/-33.7 sec and 367.1+/-470.3 sec (p<0.05). Time until completing colour change of plaster in normal and abnormal sudomotor patients were 372.5+/-198.8 sec and 1677.4+/-711.9 sec (p<0.05). The autonomic score of two groups were 2.4+/-2.3, 4.6+/-2.2 (p<0.05). Sudomotor abnormal group was older than normal (59.2+/-11.7 yrs, vs 47+/-17.4 yrs). Presence of retinopathy was related with sudomotor abnormality. Peripheral autonomic neuropathy was related with parasympathetic cardiac autonomic neuropathy. Sudomotor function abnormality was related with definite cardiac autonomic neuropathy, but it was not related with early cardiac autonomic neuropathy. The sensitivity, specificity, positive predictive value and negative predictive value of colour change plaster in the diagnosis of definitive cardiovascular autonomic neuropathy was 86.7%, 62.5%, 68.4% and 83.3%, respectively. CONCLUSIONS: The colour change plaster (NeuroCheck(R)) is not useful for the early diagnosis of cardiac autonomic neuropathy in type 2 diabetic neuropathy, but it may be possible for the screening test of definite cardiac autonomic neuropathy.

Analysis of Heart Rate Variability in Preoperative Diabetic Patients by Linear and Nonlinear Dynamics / 대한마취과학회지

BACKGROUND: The aim of this study was to investigate the underlying changes in heart rate variability (HRV) of preoperative diabetic patients using five analytical methods; SDNN (standard deviation of normal to normal intervals), SDANN (standard deviation of the mean of normal RR intervals for each 5 min period of the entire electrocardiographic recording), RMSSD (root mean square successive difference, the squre root of the mean of the sum of the squares of differences between adjacent normal RR intervals over the entire electrocardiographic recording), PNN50 (percent of difference between adjacent normal RR intervals that are greater than 50 ms computed over the entire electrocardiographic recording) for linear time domain analysis and approximate entropy for nonlinear complexity analysis. METHODS: HRV values analyzed by five different measures were compared between a control group of ten nondiabetics without any significant systemic disease and a diabetic group of ten patients from the preoperative ambulatory electrocardiographic recordings. RESULTS: Approximate entropy, SDNN and SDANN values were significantly lower in the diabetic group than those of the control group (P< 0.01). CONCLUSIONS: Significantly decreased approximate entropy, SDNN and SDANN could provide information about decreased cardiovascular complexity and sympathetic output, suggesting the nature of dysfunction of the diabetic cardiovascular system.