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

ABSTRACT

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.