Cardiovascular autonomic neuropathy in patients with type 2 diabetes with and without sensorimotor polyneuropathy

IF 3.9 3区 医学 Q1 CLINICAL NEUROLOGY Journal of the Peripheral Nervous System Pub Date : 2023-07-14 DOI:10.1111/jns.12580
Emil Peters, Mustapha Itani, Alexander G. Kristensen, Astrid Juhl Terkelsen, Thomas Krøigård, Hatice Tankisi, Troels S. Jensen, Nanna B. Finnerup, Sandra Sif Gylfadottir
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Abstract

Background and Aims

Cardiovascular autonomic neuropathy (CAN) in patients with diabetes is associated with poor prognosis. We aimed to assess signs of CAN and autonomic symptoms and to investigate the impact of sensorimotor neuropathy on CAN by examining type 2 diabetes patients with (DPN [distal sensorimotor polyneuropathy]) and without distal sensorimotor polyneuropathy (noDPN) and healthy controls (HC). Secondarily, we aimed to describe the characteristics of patients with CAN.

Methods

A population of 374 subjects from a previously described cohort of the Danish Centre for Strategic Research in Type 2 Diabetes (DD2) were included. Subjects were examined with the Vagus™ device for the diagnosis of CAN, where two or more abnormal cardiovascular autonomic reflex tests indicate definite CAN. Autonomic symptoms were assessed with Composite Autonomic Symptom Score 31 (COMPASS 31) questionnaire. DPN was defined according to the Toronto consensus panel definition.

Results

Definite CAN was present in 22% with DPN, 7% without DPN and 3% of HC, and 91% of patients with definite CAN had DPN. Patients with DPN and definite CAN reported higher COMPASS 31 scores compared to patients with noDPN (20.0 vs. 8.3, p < 0.001) and no CAN (22.1 vs. 12.3, p = 0.01). CAN was associated with HbA1c and age in a multivariate logistic regression analysis but was not associated with IEFND or triglycerides.

Interpretation

One in five patients with DPN have CAN and specific CAN characteristics may help identify patients at risk for developing this severe diabetic complication. Autonomic symptoms were strongly associated with having both DPN and CAN, but too unspecific for diagnosing CAN.

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伴有和不伴有感觉运动多神经病变的2型糖尿病患者的心血管自主神经病变
背景与目的糖尿病患者心血管自主神经病变(CAN)与不良预后相关。我们旨在通过检查伴有远端感觉运动多神经病变(DPN)、无远端感觉运动多神经病变(noDPN)和健康对照(HC)的2型糖尿病患者,评估CAN的体征和自主神经症状,并研究感觉运动神经病变对CAN的影响。其次,我们旨在描述CAN患者的特征。方法从丹麦2型糖尿病战略研究中心(DD2)先前描述的队列中纳入374名受试者。受试者使用Vagus™设备进行检查以诊断CAN,当两项或两项以上的心血管自主反射测试异常表明明确的CAN时。采用自主神经症状综合评分31 (COMPASS 31)问卷评估自主神经症状。DPN是根据多伦多共识小组定义定义的。结果明确的CAN在22%的DPN患者、7%的非DPN患者和3%的HC患者中存在,91%的明确CAN患者患有DPN。DPN和明确CAN患者的COMPASS 31评分高于noDPN患者(20.0比8.3,p < 0.001)和无CAN患者(22.1比12.3,p = 0.01)。在多变量logistic回归分析中,CAN与HbA1c和年龄相关,但与IEFND或甘油三酯无关。五分之一的DPN患者患有CAN,特定的CAN特征可能有助于识别有发生这种严重糖尿病并发症风险的患者。自主神经症状与患有DPN和CAN密切相关,但对于诊断CAN过于特异性。
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来源期刊
CiteScore
6.10
自引率
7.90%
发文量
45
审稿时长
>12 weeks
期刊介绍: The Journal of the Peripheral Nervous System is the official journal of the Peripheral Nerve Society. Founded in 1996, it is the scientific journal of choice for clinicians, clinical scientists and basic neuroscientists interested in all aspects of biology and clinical research of peripheral nervous system disorders. The Journal of the Peripheral Nervous System is a peer-reviewed journal that publishes high quality articles on cell and molecular biology, genomics, neuropathic pain, clinical research, trials, and unique case reports on inherited and acquired peripheral neuropathies. Original articles are organized according to the topic in one of four specific areas: Mechanisms of Disease, Genetics, Clinical Research, and Clinical Trials. The journal also publishes regular review papers on hot topics and Special Issues on basic, clinical, or assembled research in the field of peripheral nervous system disorders. Authors interested in contributing a review-type article or a Special Issue should contact the Editorial Office to discuss the scope of the proposed article with the Editor-in-Chief.
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