Abstract
Diabetic autonomic neuropathy is one of the important complications with increased risk of cardiovascular morbidity and mortality. The present study aimed to investigate diabetic autonomic neuropathy in chronic diabetic patients with tests. It is prospective, observational study was conducted in the Department of General Medicine, Prathima Institute of Medical Sciences, Nagunur, Karimnagar. The following tests were performed to find the autonomic neuropathy in patients. (1) Heart Rate variations during Deep Breathing, (2) Heart Rate variations during Postural Changes, (3) Heart Rate variations during Valsalva maneuver, (4) Diastolic BP variation in response to Sustained Hand Grip Exercise. The laboratory investigations included FBS, Urine Analysis, Kidney & Liver Function Tests, HbA1C, ECG, 2D ECHO were done. The mean age of the patients in the type I DM patients was 37.5 years and mean type II DM patients was 49.5 years. The total number of patients n=55 and out of which n=20 type I DM and Type II DM were n=35. Heart rate variations to postural changes were found to be abnormal in 54.54%, Valsalva ratio was found to be abnormal in 72.72%, Abnormal DBP was found in 21.81% of the patients. Within the limitations of the present study, we conclude that Diabetic Autonomic Neuropathy (DAN) affects a significant of diabetic patients both type I DM and type II DM. The incidence tends to increase as the duration of diabetes mellitus increases. Hence autonomic nervous system tests to determine DAN should be included in the routine examination of chronic diabetics at least once a year to determine its presence and delay its progression.
Keywords: Diabetic Autonomic Neuropathy [DAN], Chronic Diabetes Mellitus, Teaching Hospital.
References
- Vinik AI, Maser RE, Mitchell BD, Freeman R. Diabetic autonomic neuropathy. Diabetes Care 2003;26:1553-79.
- Jaffe RS, Aoki TT, Rohatsch PL, Disbrow EA, Fung DL: Predicting cardiac autonomic neuropathy in type 1 (insulin-dependent) diabetes mellitus. Clin Auton Res 1995; 5:155–58.
- Ziegler D, Gries FA, Spuler M, Lessmann F, Diabetic Cardiovascular Autonomic Neuropathy Multicenter Study Group: The epidemiology of diabetic neuropathy. J Diabetes Complications 1992;6:49–57.
- Vinik AI, Erbas T. Recognizing and treating diabetic autonomic neuropathy. Cleve Clin J Med 2001; Nov; 68(11):928-30.
- Taylor AA, Marcus B. Interaction of the nervous system and the heart. In: The science and practice of pediatric cardiology. Garson A, Bricker JT Jr, Fisher DJ, Neish SR.
Williams and Wilkins 1998; 415-42.
- Pfeifer MA, Weinberg CR, Cook DL, Reenan A, Halter JB, Ensinck JW, Porte D
Autonomic neural dysfunction in recently diagnosed diabetic subjects. Diabetes Care 1984;7:447–53.
- Aggarwal, P.S. Tonpay, S. Trikha, A. Bansal. Prevalence of Autonomic Neuropathy in Diabetes Mellitus. Current Neurobiology 2011; 2 (2):101-05.
- J. Sampson, S. Wilson, P. Karagiannis, M. Edmonds, P. J. Watkins. Progression of Diabetic Autonomic Neuropathy over a Decade in Insulin-Dependent Diabetics QJM: An International Journal of Medicine 1990; 75 (3):635–46.
- OTorffvit, CD Agardh. Day and night variations in ambulatory blood pressure in type I diabetes mellitus with nephropathy and autonomic neuropathy. Journal of Internal Medicine 1993;233(2):131-37.
- Huszno B, Trofimiuk M, Placzkiewicz E, et al; Co-occurrence of diabetic gastropathy and cardiovascular vegetative neuropathy in patients with diabetes type 1. Folia Med Carcov 2001; 42(3):105-11. [Article in Polish]
- Kockar MC, Kayahan IK, Bavbek N. Diabetic gastroparesis in association with autonomic neuropathy and microvasculopathy. Acta Med Okayama 2002; Oct;56(5):237-43.
- AI Vinik, Raelene EM, Braxton DM, Roy Freeman. Diabetic autonomic neuropathy. Diabetes Care 2003 May; 26(5): 1553-79.
Corresponding Author
Dr P Mallesham
Sri Thirumala Hospital, Opp Congress office, Near police station, Peddapalli-505172, Telangana State