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Diabetic Cardiovascular Autonomic Neuropathy

Signe T Andersen, Daniel R Witte, Jesper Fleischer, Henning Andersen, Torsten Lauritzen, Marit E Jørgensen, Troels S Jensen, Rodica Pop-Busui, Morten Charles
OBJECTIVE: To examine the course of cardiovascular autonomic neuropathy (CAN) and related cardiometabolic risk factors in patients with type 2 diabetes. RESEARCH DESIGN AND METHODS: CAN and cardiometabolic risk factors were assessed in the Danish arm of the Anglo-Danish-Dutch Study of Intensive Treatment in People With Screen Detected Diabetes in Primary Care (ADDITION-Denmark) at 6-year ( n = 777) and 13-year ( n = 443) follow-up examinations. Cardiovascular autonomic reflex tests (CARTs)-that is, lying to standing, deep breathing, and the Valsalva maneuver-and 2-min resting heart rate variability (HRV) indices were obtained as the main measures of CAN...
October 10, 2018: Diabetes Care
Yeoree Yang, Eun Young Lee, Jae Hyoung Cho, Yong Moon Park, Seung Hyun Ko, Kun Ho Yoon, Moo Il Kang, Bong Yun Cha, Seung Hwan Lee
BACKGROUND: This study aimed to investigate the association between the presence and severity of cardiovascular autonomic neuropathy (CAN) and development of long-term glucose fluctuation in subjects with type 2 diabetes mellitus. METHODS: In this retrospective cohort study, subjects with type 2 diabetes mellitus who received cardiovascular autonomic reflex tests (CARTs) at baseline and at least 4-year of follow-up with ≥6 measures of glycosylated hemoglobin (HbA1c) were included...
September 28, 2018: Diabetes & Metabolism Journal
Thizá Massaia Londero, Luana Seminotti Giaretta, Luisa Penso Farenzena, Roberto Manfro, Luis Henrique Canani, Daniel Lavinsky, Cristiane Bauermann Leitão, Andrea Carla Bauer
Objective: to assesses microvascular complications in renal transplant recipients with posttransplant diabetes mellitus (PTDM). Research Design and Methods: in this observational study, patients with ≥ 5 years of PTDM were included from a cohort of 895 kidney recipients transplanted in 2000-2011. Diabetic retinopathy was evaluated by fundus photographs and optical coherence tomography (OCT). Diabetes kidney disease was evaluated by protein to creatinine ratio (PCR) and estimated glomerular filtration rate (eGFR)...
October 4, 2018: Journal of Clinical Endocrinology and Metabolism
Tao Yuan, Jiapei Li, Yong Fu, Tao Xu, Juan Li, Xiangqing Wang, Ying Zhou, Yingyue Dong, Weigang Zhao
BACKGROUNDS: Cardiac autonomic neuropathy is a common but always overlooked. More convenient diagnostic methods are needed. HYPOTHESIS: Cardiac autonomic neuropathy risk score evaluated by SUDOSCAN has a fine diagnostic efficacy detecting cardiac autonomic neuropathy. METHODS: This is a cross-sectional study among patients with diabetes mellitus. Subjects undertook SUDOSCAN tests and cardiac autonomic reflex tests, including heart rate variability due to Valsalva maneuver, heart rate response due to deep breathing and heart rate response due to standing up...
2018: PloS One
Aaron I Vinik, Carolina Casellini, Henri K Parson, Sheri R Colberg, Marie-Laure Nevoret
Autonomic nervous system (ANS) imbalance manifesting as cardiac autonomic neuropathy in the diabetic population is an important predictor of cardiovascular events. Symptoms and signs of ANS dysfunction, such as resting heart rate elevations, diminished blood pressure responses to standing, and altered time and frequency domain measures of heart rate variability in response to deep breathing, standing, and the Valsalva maneuver, should be elicited from all patients with diabetes and prediabetes. With the recognition of the presence of ANS imbalance or for its prevention, a rigorous regime should be implemented with lifestyle modification, physical activity, and cautious use of medications that lower blood glucose...
2018: Frontiers in Neuroscience
Srilata Moningi, Sapna Nikhar, Gopinath Ramachandran
Diabetes mellitus is the most common medical condition and with increased awareness of heath and related issues, several patients are getting diagnosed with diabetes. The poor control of sugar and long-standing status of disease affects the autonomic system of body. The autonomic nervous system innervates cardiovascular, gastrointestinal, and genitourinary system, thus affecting important functions of the body. The cardiovascular system involvement can manifest as mild arrhythmias to sudden death. Our search for this review included PubMed, Google Search and End Note X6 version and the key words used for the search were autonomic neuropathy, diabetes, anesthesia, tests and implications...
August 2018: Indian Journal of Anaesthesia
Anca Moţăţăianu, Smaranda Maier, Zoltan Bajko, Septimiu Voidazan, Rodica Bălaşa, Adina Stoian
BACKGROUND: Cardiac autonomic neuropathy (CAN) in diabetes is among the strongest risk markers for future global and cardiovascular mortality. The aim of this study was to analyse CAN prevalence and to compare the associations between CAN, the glycaemic control, cardiovascular risk factors, peripheral neuropathy, retinopathy and macroangiopathy in patients with type 1 (T1DM) and type 2 diabetes mellitus (T2DM). METHODS: One hundred ninety-five diabetic patients were included in this study...
August 27, 2018: BMC Neurology
Lynn Ang, Nathan Cowdin, Kara Mizokami-Stout, Rodica Pop-Busui
IN BRIEF Distal symmetric polyneuropathy (DSPN) and diabetic autonomic neuropathies, particularly cardiovascular autonomic neuropathy (CAN), are prevalent diabetes complications with high morbidity, mortality, and amputation risks. The diagnosis of DSPN is principally a clinical one based on the presence of typical symptoms combined with symmetrical, distal-to-proximal stocking-glove sensory loss. CAN is an independent risk factor for cardiovascular mortality, arrhythmia, silent ischemia, major cardiovascular events, and myocardial dysfunction...
August 2018: Diabetes Spectrum: a Publication of the American Diabetes Association
Mamta Jaiswal, Lynn Ang, Kara Mizokami-Stout, Rodica Pop-Busui
AIM: To assess the relationship between glucose variability (GV) and non-dipping of blood pressure (BP) as a marker of cardiovascular autonomic neuropathy (CAN) among patients with type 1 diabetes (T1D). METHODS: Forty-one subjects with T1D (age 34 ± 13 years, duration 13 ± 6 years, HbA1c 8 ± 1.2%) without cardiovascular disease, dyslipidemia, or hypertension at baseline were enrolled in a 3-year observational cohort study. Subjects were phenotyped for CAN with heart rate variability, cardiovascular autonomic reflex tests, and 24-h BP profiles at baseline and during follow-up...
October 2018: Journal of Diabetes and its Complications
Jingjing Guo, Xuan Sheng, Yu Dan, Yurong Xu, Yuanruohan Zhang, Huihong Ji, Jiayue Wang, Zixi Xu, Hongyu Che, Guodong Li, Shangdong Liang, Guilin Li
Diabetes as a chronic epidemic disease with obvious symptom of hyperglycemia is seriously affecting human health globally due to the diverse diabetic complications. Diabetic cardiovascular autonomic neuropathy (DCAN) is a common complication of both type 1 and type 2 diabetes and incurs high morbidity and mortality. However, the underlying mechanism for DCAN is unclear. It is well known that purinergic signaling is involved in the regulation of cardiovascular function. In this study, we examined whether the P2Y12 receptor could mediate DCAN-induced sympathetic reflexes...
August 6, 2018: Purinergic Signalling
Jae-Seung Yun, Yong-Moon Park, Seon-Ah Cha, Yu-Bae Ahn, Seung-Hyun Ko
BACKGROUND: To examine whether the progression rate of cardiovascular autonomic neuropathy (CAN) stage is an independent predictive factor for cardiovascular disease (CVD) in type 2 diabetes. METHODS: Standardized cardiovascular autonomic reflex tests (CARTs) using traditional Ewing method were performed at baseline. The follow-up CARTs was recommended once every two years. We estimated the primary CVD endpoint, defined as coronary artery disease and ischemic stroke...
August 2, 2018: Cardiovascular Diabetology
Seon-Ah Cha, Yong-Moon Park, Jae-Seung Yun, Seung-Hwan Lee, Yu-Bae Ahn, Sung-Rae Kim, Seung-Hyun Ko
AIMS: To evaluate the association between impaired heart rate variability (HRV) and cardiovascular disease (CVD) in patients with type 2 diabetes (T2DM). METHODS: A total of 655 patients with T2DM who underwent cardiovascular autonomic function testing were consecutively recruited and followed up prospectively. Time- and frequency-domain HRV were assessed for 5 min by beat-to-beat heart rate recording. We estimated the development of CVD events during a follow-up period...
September 2018: Diabetes Research and Clinical Practice
C S Hansen, S Theilade, M Lajer, T W Hansen, P Rossing
AIM: To investigate the association between cardiovascular autonomic neuropathy and bone metabolism in people with Type 1 diabetes. METHODS: We assessed cardiovascular autonomic neuropathy in 329 people with Type 1 diabetes according to heart rate response to deep breathing, to standing and to the Valsalva manoeuvre, and 2-min resting heart rate. More than one pathological non-resting test was defined as cardiovascular autonomic neuropathy. Bone mineral density of the femoral neck (BMDfn) was assessed by dual energy X-ray absorptiometry...
July 12, 2018: Diabetic Medicine: a Journal of the British Diabetic Association
Ogba J Ukpabi, Basden Jc Onwubere
Background: Prolonged corrected QT (QTc) has been identified as a risk factor for malignant arrhythmias and sudden cardiac death. Caucasian studies have shown a definite relationship between QTc prolongation and Cardiac Autonomic Neuropathy (CAN) in diabetic subjects. Objective: To determine the prevalence of prolonged QTc in Black diabetic individuals with CAN and to ascertain how prolonged QTc correlated with the severity of CAN among these patients. Methods: A total of 176 adult diabetic subjects were studied, 87 males and 89 females...
December 2017: African Health Sciences
Shalini Verma, Jamal Ali Moiz, Shahnawaz Anwer, Ahmad H Alghadir, Mohammed Ejaz Hussain
BACKGROUND: Cardiac autonomic neuropathy is a commonly overlooked complication of type 2 diabetes mellitus (T2DM) characterized by an imbalance between sympathetic and parasympathetic supply to the heart, which contributes to cardiovascular morbidity and mortality. T2DM has also been shown to negatively influence oxygen kinetics and increase oxidative stress, which may be linked to the development of various chronic complications. Aerobic training has been reported to improve oxygen uptake, antioxidant defense, and cardiac autonomic function in T2DM; however, the effects of varying doses of exercise on these variables are not known...
May 24, 2018: Trials
O May, C B Graversen, M Ø Johansen, H Arildsen
Cardiovascular autonomic neuropathy (CAN) is a well known prognostic marker in diabetes. A large angle between the QRS- and the T-wave vector (QRS-T angle) in the electrocardiogram (ECG) has recently been introduced as another marker of poor prognosis. AIM: To assess and compare the long-term predictive power of the frontal plane QRS-T angle with CAN in people with diabetes. METHODS: In 1992-93 people with diabetes in the municipality of Horsens, Denmark, were identified by the prescription method andan age and gender stratified sample of 240 individuals with diabetes were randomly selected...
August 2018: Diabetes Research and Clinical Practice
Szabolcs Nyiraty, Fruzsina Pesei, Andrea Orosz, Sara Coluzzi, Orsolya Eszter Vági, Csaba Lengyel, György Ábrahám, Simona Frontoni, Peter Kempler, Tamás Várkonyi
Introduction: The oxidative stress associated with glucose variability might be responsible for neuronal damage while autonomic neuropathy (AN) has a detrimental effect on metabolism. The aim of the study was to find relationship between AN and GV in type 1 diabetic patients and to identify further factors that affect GV. Patients and methods: Twenty type 1 diabetic patients were involved (age: 39.5 ± 3.4 years, duration of diabetes: 17.5 ± 2.5 years; HbA1c: 8...
2018: Frontiers in Endocrinology
M Matta, A Pavy-Le Traon, S Perez-Lloret, C Laporte, I Berdugo, N Nasr, H Hanaire, J M Senard
Aim: The prevalence of cardiovascular autonomic neuropathy (CAN) in diabetes mellitus is well documented. However, the rate and predictors of both the development and progression of CAN have been less studied. Hereby, we assessed the rate and the major risk factors for CAN initiation and progression in a cohort of type 1 diabetic patients followed over a three-year period. Methods: 175 type 1 diabetic patients (mean age: 50 ± 11 years; female/male: 76/99) with positive bedside screening for CAN were included and underwent 2 standardized autonomic testings using 4 standardized tests (deep breathing, Valsalva maneuver, 30/15 ratio, and changes in blood pressure during standing), separated by 3 ± 1 years...
2018: Journal of Diabetes Research
Henrik Ø Hjortkjær, Tonny Jensen, Jannik Hilsted, Helle Corinth, Ulrik M Mogensen, Lars Køber, Andreas Fuchs, Børge G Nordestgaard, Klaus F Kofoed
AIMS: Coronary artery calcium (CAC) is associated with cardiovascular (CV) disease and progression of CAC is an independent predictor of mortality. Type 1 diabetes is associated with increased CV risk, especially in persons with cardiovascular autonomic neuropathy (CAN). This study aimed to examine whether short-term progression of CAC is increased in persons with type 1 diabetes compared to matched controls and if CAN increases risk of CAC progression. METHODS: Fifty-three normoalbuminuric persons with long-term type 1 diabetes (20 with CAN) were matched in a 1:2 ratio with 106 controls without diabetes according to age, sex and baseline CAC...
July 2018: Diabetes Research and Clinical Practice
Eduardo Rivera-Mancilla, Alain H Altamirano-Espinoza, Guadalupe Manrique-Maldonado, Belinda Villanueva-Castillo, Carlos M Villalón
This study compared the cardiac sympatho-inhibitory responses produced by agonists at α2 -adrenergic (B-HT 933), dopamine D2 -like (quinpirole) and histamine H3 /H4 (immepip) receptors between normoglycaemic and streptozotocin-pretreated (diabetic) pithed rats. Intravenous (i.v.) continuous infusions of B-HT 933, quinpirole or immepip were used in normoglycaemic and diabetic pithed rats to analyse their sympatho-inhibitory effects on the electrically-stimulated cardioaccelerator sympathetic outflow. Both in normoglycaemic and diabetic animals, B-HT 933 (until 100 μg/kg per minute) and quinpirole (until 10 μg/kg per minute) inhibited the tachycardic responses to electrical sympathetic stimulation, but not those to i...
August 2018: Clinical and Experimental Pharmacology & Physiology
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