Journal List > J Korean Diabetes Assoc > v.30(3) > 1062382

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Ko, Kwon, Lee, Kim, Cho, Yoo, Park, Lee, Song, Yoon, Cha, Son, and Ahn: Cardiovascular Autonomic Neuropathy in Patients with Type 2 Diabetes Mellitus
Original Article
The Journal of Korean Diabetes Association

The Journal of Korean Diabetes Association 2006; 30(3): 226-235.

Published online: 31 May 2006

DOI: https://doi.org/10.4093/jkda.2006.30.3.226

Cardiovascular Autonomic Neuropathy in Patients with Type 2 Diabetes Mellitus

Seung-Hyun Ko, Hyuk-Sang Kwon, Jung-Min Lee, Sung-Rae Kim, Jae-Hyung Cho, Ki-Dong Yoo1, Yong-Moon Park2, Won-Chul Lee2, Ki-Ho Song, Kun-Ho Yoon, Bong-Yun Cha, Ho-Young Son, Yu-Bai Ahn

Division of Endocrinology & Metabolism, Department of Internal Medicine, The Catholic University of Korea, Korea.

1Department of Cardiology, The Catholic University of Korea, Korea.

2Department of Preventive Medicine, The Catholic University of Korea, Korea.

Received 1 April 2006       Accepted 24 May 2006

Copyright © 2006 Korean Diabetes Association

Abstract

Background

Diabetic autonomic neuropathy has a significant negative impact on survival and quality of life in type 2 diabetic patients. Especially cardiovascular autonomic neuropathy (CAN) is clinically important, because of its correlation to cardiovascular death. Therefore, we investigated the prevalence of CAN in Korean type 2 diabetic patients.

Methods

1798 type 2 diabetic patients, 727 males and 1071 females, visited Diabetes Clinic at St. Vincent Hospital, Korea, were included from January 2001 to December 2005. Clinical evaluation, laboratory test and assessment of diabetic complication were completed. Standard test for CAN were performed: 1) heart rate variability (HRV) during deep breathing (E/I ratio) 2) Valsalva maneuver 3) 30:15 ratio 4) blood pressure response to standing. CAN score was determined according to the results of the test as following: 0 = normal, 1 = abnormal.

Results

Mean age and diabetic duration of patients were 56.7 ± 10.9, and 9.4 ± 7.5 years. Normal and abnormal CAN were detected in 815 (45.3%) and 983 (54.7%) of the patients, respectively. Abnormal E/I, valsalva, and 30:15 ratio were found in 333 (18.5%), 717 (39.9%), and 546 (30.4%) patients, respectively. Age, diabetic duration, postprandial hyperglycemia, HbA1c, C-reactive protein, and microalbumuria levels were significantly different between normal and abnormal CAN groups. 49 (6.0%) patients of normal and 100 (10.2%) patients of abnormal CAN group showed previous attack of stroke (P = 0.004). In addition, diabetic foot was more frequent in patients with CAN (normal vs. abnormal, 14 (1.7%) vs. 73 (7.4%), P < 0.05).

Conclusion

CAN is frequently found in Korean type 2 diabetic patients. It was associated with diabetic duration, uncontrolled diabetes, increased albumin excretion rate, presence of retinopathy, postprandial hyperglycemia.

Keywords: Autonomic function test, Cardiovascular autonomic neuropathy (CAN), Diabetic complication, Type 2 diabetes mellitus

Figures and Tables

Fig. 1
The prevalence of diabetic complication in type 2 diabetic patients according to total score of cardiovascular autonomic function test. In the patients with proliferative diabetic retinopathy (A) and overt proteinuria (B), total score of autonomic function test was high.
jkda-30-226-g001
Table 1
Clinical Characteristics of Type 2 Diabetic Patients
jkda-30-226-i001

Data are means ± SD and number (%).

*Hypertension defined as a SBP = 140, or a DBP = 90 mmHg, independent of the use of antihypertensive agents or currently treated with antihypertensive agents.

†CVA defined as any events proven by brain imaging or clinically obvious attack of loss of consciousness with neurological deficit.

‡CHD defined as any history of cardiologist-diagnosed ischemic heart disease such as angina, myocardial infarction events detected on a 12-lead ECG or cardiac imaging or coronary angiography.

§Retinopathy classified as followings: No diabetic retinopathy/ mild non-proliferative/ moderate to severe non-proliferative/ proliferative diabetic retinopathy/ undetermined.

∥Nephropathy defined as microalbuminuria > 20 µg/min.

Table 2
Prevalence of Abnormal Cardiovascular Autonomic Function Test Results (more than score 1) in Test Items
jkda-30-226-i002
Table 3
Clinical Characteristics and Laboratory Findings according to Cardiovascular Autonomic Function Test
jkda-30-226-i003
Table 4
Laboratory Parameters according to Cardiovascular Autonomic Neuropathy Results
jkda-30-226-i004

*P < 0.05 vs. group 0

‡P < 0.05 vs. group 1

Table 5
Multiple Regression Analysis
jkda-30-226-i005

*Data are adjusted odds ratio and 95% CI. Adjusted for all other variables.

†Categories are grouped by the median value of each variable.

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