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Could we predict asymptomatic cardiovascular autonomic neuropathy in type 1 diabetic patients attending out-patients clinics?

Lässt sich die kardiovaskuläre autonome Neuropathie bei symptomlosen Patienten mit Typ 1 Diabetes mellitus vorhersagen?

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Zusammenfassung

HINTERGRUND UND ZIELE: Die kardiovaskuläre autonome Neuropathie (KAN) ist bei Patienten mit Typ 1 Diabetes mellitus (DM1) mit einer erhöhten Morbidität und Mortalität verbunden. Diese Komplikation kann über lange Zeit ohne Symptome einhergehen. Ziel dieser Studie war es die Prävalenz, den Schweregrad und mögliche Vorhersageparameter der asymptomatischen KAN zu erfassen. PATIENTEN UND METHODEN: 107 Patienten mit DM1 (52 Männer, 55 Frauen, Alter 39,8 ± 12,4 Jahre [18–72]; Dauer des DM1: 16,6 ± 9,5 Jahre [0,5–43], Alter bei Manifestation 23,5 ± 12,8 Jahre [1–54], BMI 25,1 ± 3,2 [1,9–33,91]) wurden untersucht. Das Vorliegen einer KAN wurde mit Hilfe von Standard-Reflex-Testen (Ewing Batterie) erhoben und die Patienten wurden entsprechend den Ergebnissen in drei Gruppen eingeteilt: Gruppe 0 ohne KAN, Gruppe I mit erstgradiger KAN und Gruppe 2 mit zweitgradiger KAN. Wir erhoben außerdem die mit KAN am häufigsten einhergehenden chronischen Komplikationen des DM1, Episoden schwerer Hypoglykämie, zeitliche Parameter des DM1 (Patientenalter, Dauer des DM1, Alter bei Manifestation) und außerdem DM1-spezifische Parameter wie glykosyliertes Hb, BMI, kardiovaskuläre Erkrankungen und Blutdruck. Die Vorhersagbarkeit einer KAN wurde entsprechend den erhobenen Korrelationen beurteilt. ERGEBNISSE: Nur 50 der 107 der Patienten (46%) zeigten keine KAN. Bei 38 Patienten (36%) fanden wir eine erstgradige , bei 19 (18%) eine zweitgradige KAN. KAN korrelierte mehr mit der Dauer des DM1 (p < 0,001), als mit dem Alter der Patienten (p < 0,05). Es bestand eine grenzwertig signifikante Korrelation (p = 0,053) mit dem glykosylierten Hb. Weiters haben wir eine signifikant positive Korrelation zwischen KAN und dem Auftreten von chronischen Komplikationen (periphere Neuropathie: p < 0,001), Retinopathie: p < 0,001, Nephropathie: erhöhtes Kreatinin: p < 0,03, Albuminurie: p < 0,01) gefunden. Obwohl der Blutdruck bei allen Patienten im Normalbreich (124,2/74,5 ± 11,5/7,8 mmHg) lag, wurde eine positive Korrelation mit der KAN (p < 0,05) bestätigt. Zu den akuten Komplikationen des DM1 bestand keine Korrelation. SCHLUSSFOLGERUNGEN: Unsere Studie zeigt, dass die asymptomatische KAN bei Patienten mit DM1 sehr häufig ist. Mit Hilfe von multifaktorieller logistischer Regression konnten wir zeigen, dass bei gleichzeitigem Vorliegen von Albuminurie, peripherer Neuopathie und erhöhtem systolischem Blutdruck eine hohe Wahrscheinlichkeit für das zusätzliche Vorhandensein einer KAN besteht.

Summary

BACKGROUND AND AIMS: Diabetic cardiovascular autonomic neuropathy (CAN) is associated with increased morbidity and mortality. This complication may be asymptomatic for a long time. The aim of this study was to assess the prevalence, severity and predictors of asymptomatic CAN in patients with type 1 diabetes mellitus (DM1). PATIENTS AND METHODS: 107 patients with DM1 were enrolled: 52 men and 55 women aged 39.8 ± 12.4 years (18–72), duration of DM 16.6 ± 9.5 years (0.5–43), age at DM manifestation 23.5 ± 12.8 years (1–54) and BMI 25.1 ± 3.2 (18.9–33.91). CAN was assessed using standard cardiovascular reflex tests (Ewing battery) and the patients were divided into three groups according to the results: Group 0, without CAN; Group I, 1st degree CAN; Group II, 2nd degree CAN. We assessed the most frequent relationships between CAN and chronic complications, episodes of severe hypoglycemia, time-related parameters (age of patients, duration of diabetes, age at manifestation), glycosylated hemoglobin (HbA1c), BMI, cardiovascular diseases and blood pressure, and determined the predictability of CAN on the basis of these relationships. RESULTS: Only 50 of the 107 patients (46%) showed no CAN. We found 1st degree CAN in 38 patients (36%) and 2nd degree CAN in 19 (18%). CAN correlated more significantly with the duration of diabetes (p < 0.001) than with age (p < 0.05). The relationship between CAN and HbA1c was on the borderline of statistical significance (p = 0.053). We found a positive correlation between CAN and the presence of chronic complications [peripheral neuropathy (p < 0.001), retinopathy (p < 0.001), and some markers of nephropathy: creatinine (p < 0.03), albuminuria (p < 0.01)]. Although blood pressure was within the physiological range (124.2/74.5 ± 11.5/7.8 mmHg) in all patients, a positive correlation with CAN was confirmed (p < 0.05). No relationship with occurrence of severe hypoglycemia was found. CONCLUSIONS: According to our results, asymptomatic CAN is very frequent in patients with DM1. By using multifactorial logistic regression (step-wise) analysis we demonstrated that if albuminuria, peripheral neuropathy and elevated systolic BP are present simultaneously, there is a high probability that the patient also has CAN (84.9% of initial group correctly predicted, p < 0.001).

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Authors and Affiliations

  1. Medical Department I, Diabetology Center, Charles University, Pilsen, Czech Republic

    Silvie Lacigová, Petr Šafránek, Daniela Čechurová, Michal Krčma, Jakub Víšek, Zdeněk Jankovec, Michal Žourek, Iva Haladová & Zdeněk Rušavý

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  1. Silvie Lacigová
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  2. Petr Šafránek
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  3. Daniela Čechurová
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  8. Iva Haladová
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  9. Zdeněk Rušavý
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Correspondence to Silvie Lacigová.

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Lacigová, S., Šafránek, P., Čechurová, D. et al. Could we predict asymptomatic cardiovascular autonomic neuropathy in type 1 diabetic patients attending out-patients clinics?. Wien Klin Wochenschr 119, 303–308 (2007). https://doi.org/10.1007/s00508-007-0789-0

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