Title: Cardiovascular Autonomic Neuropathy (CAN) in Type 2 Diabetes Mellitus Amongst Rural Patients from Central Rural India: A Prospective Hospital Based Study
Authors: Premshanker Singh, Granth Kumar, Dheeraj Kela, Kasim Ali, Pankaj Kashyap, Udit Gupta
DOI: https://dx.doi.org/10.18535/jmscr/v5i4.86
Abstract
Background: Cardiac autonomic neuropathy (CAN) is a frequent chronic complication of diabetes mellitus with potentially life-threatening outcomes. There is very little information available on epidemiology of cardiac autonomic neuropathy (CAN) in diabetic population from rural India. Many studies have concluded that abnormal HbA1c levels, hypertension, distal symmetrical polyneuropathy, retinopathy and exposure to hyperglycemia are risk factors for developing CAN in diabetes.
Aim: To assess the frequency of cardiovascular autonomic neuropathy (CAN) in patients with poorly controlled type 2 diabetes mellitus in rural population of India.
Methods: We studied CAN in 500 poorly controlled type2 diabetic patients of age group above 30 years and HbA1c above 6.5% from Dec 2008 to Dec 2016 at tertiary care rural hospital of UP University of Medical Sciences, Saifai, Etawah(UP), India. All the patients in the study were evaluated for CAN using four different clinical tests- Resting heart rate, test for orthostatic hypotension, hand gripping test and QTc interval on ECG. Patients were labeled as CAN +ve if any two or more than two of the above listed tests were found positive/abnormal.
Results: Our study included 500 diabetic patients .Out of these diabetic patients, 300 (60%) were male and 200(40%) female. Out of 500 diabetic patients, 220(44%) were CAN positive and 280(56%) CAN negative. Out of 220 CAN positive diabetics, 140(46.7%) were male and 80(40.3%) were female showing no significant difference between male and female. However there was significant difference in prevalence of CAN in different age groups eg out of 220 CAN positive diabetics, 54(24.6%) were in age group of 31 to 40 years,76(34.6%) in age group of 41 to 50 years,86(39%) in age group of 51 to 60 years and 4(1.8%) in age group of above 60 years.
Conclusion: The study concluded that CAN is common in poorly controlled diabetics in rural Indian population Clinician must try to identify CAN by simple tests in poorly controlled diabetic patients at earliest possible to prevent its further complication and long term morbidity and mortality
Keywords: Diabetes mellitus, Autonomic neuropathy, Heart rate variability, Cardiovascular reflex tests.
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