Title: Prevalence of Cardiac Autonomic Neuropathy among Type 2 Diabetes Mellitus in a Tertiary Care Centre
Authors: Santhi Thoppappatty Sengottaiyan, Anju Surendran, Suresh Ellappan, Palani Kannan
DOI: https://dx.doi.org/10.18535/jmscr/v5i6.192
Abstract
Background: Cardiac Autonomic Neuropathy (CAN) is one of the chronic complications of diabetes mellitus, with potentially dangerous outcomes. Though very frequent, it is one of the most under diagnosed and often overlooked entity.
Aim: To study the prevalence of cardiac autonomic neuropathy (CAN) among type 2 diabetes patients using non invasive bedside tests.
Materials and Methods: A cross sectional study was conducted among 100 type 2 diabetes patients at our institute, over a period of 6 months. Apart from relevant blood investigations, a detailed history including duration of diabetes, symptoms pertaining to autonomic neuropathy etc. were collected from all patients. A battery of five autonomic function tests using sphygmomanometer, ECG tracings and pulse oxymeter as described by Ewing et al were done in all cases and cardiac autonomic dysfunction score was calculated. IBM.SPSS statistics software was used for statistical analysis. Prevalence of CAN was calculated. Chi-square test was used for categorical variables and p value 0f 0.05 was considered significant.
Results: Among 100 patients in study group 25 had an abnormal CAN score and 43 had borderline values. Prevalence of CAN was 58% in our study group. Chi square tests showed significant relation between duration of diabetes and CAN scores with a p value of 0.000.
Conclusion: Prevalence of CAN among type 2 diabetes is fairly high, which was 58% in our study group. There is a significant relation between prevalence of CAN and duration of diabetes.
Keywords: Diabetes mellitus, Cardiac Autonomic Neuropathy(CAN), Autonomic dysfunction, Autonomic reflex test.
References
1. Spallone V, Ziegler D, Freeman R, et al: on behalf of the Toronto Consensus Panel on Diabetic Neuropathy: Cardiovascular autonomic neuropathy in diabetes: clinical impact, assessment, diagnosis, and management, Diabetes Metab Res Rev 2011 [Epub ahead of print].
2. Vinik, Aaron I., et al. "Diabetic autonomic neuropathy." Diabetes care 26.5 (2003): 1553-1579.
3. Diabetic Cardiovascular Autonomic Neur-opathy Aaron I. Vinik and Dan Ziegler, Circulation. 2007;115:387-397, published online before print January 22, 2007
4. Diabetes in cardiovascular disease :A companion to Braunwald’s heart disease ISBN: 978-1-4557-5418-2 .
5. Ewing, D. J., and Clarke, B. F.: Diagnosis and management of diabetic autonomic neuropathy. Br. Med. J. 1982; 285:916-18.
6. Ewing DJ, Campbell IW, Murray A, Neilson JMM, Clarke BF. Immediate heart-rate response to standing: simple test for autonomic neuropathy in diabetes. BrMedJ1978;i:145-7.
7. Ewing DJ. Cardiovascular reflexes and autonomic neuropathy. Clin Sci Mol Med 1978;55:321-7
8. Ewing DJ, Borsey DQ, Bellavere F, Clarke BF. Cardiac autonomic neuropathy in diabetes-comparison of measures of R-R interval variation. Diabetologia 1981;21: 18-24.
9. Vinik, Aaron I., et al. "Diabetic autonomic neuropathy." Diabetes care 26.5 (2003): 1553-1579.
10. Ewing DJ, Clarke BF. Diagnosis and management of diabetic autonomic neuro-pathy. British Medical Journal (Clinical researched). 1982;285(6346): 916-918.
11. Mohan V et al. Autonomic Neuropathy in NIDDM and fibrocalculus pancreatic diabetes in south India, Diabet
Med 1996; 13: 1038-43
12. DCCT Research Group: The effect of intensive diabetes therapy on measures of autonomic nervous system function in the Diabetes Control and Complications Trial (DCCT). Diabetologia 41:416–423, 1998
13. Vinik AI, Erbas T: Neuropathy. In Handbook of Exercise in Diabetes. Ruderman N, Devlin JT, Schneider SH, Kriska A, Eds. Alexandria, VA, American Diabetes Association, p. 463–496, 2002
Suresh Ellappan
Associate Professor of Diabetology,
Govt.Kilpauk Medical College, Chennai, India
Email: This email address is being protected from spambots. You need JavaScript enabled to view it. Tel: 9444255801