{"title":"糖尿病患者心血管自主神经病变治疗方案的评估：一项系统综述。","authors":"Jasmine KaiLi Goh, Leroy Koh","doi":"10.1007/s13340-023-00629-x","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Cardiovascular autonomic neuropathy (CAN) is a debilitating complication of diabetes mellitus. To date, there is no systematic review on all the available drug treatments for CAN in diabetic patients, except for one review focusing on aldose reductase inhibitors.</p><p><strong>Objective: </strong>To evaluate available drug treatment options for CAN in diabetic patients.</p><p><strong>Methods: </strong>A systematic review was conducted with a search of CENTRAL, Embase, PubMed and Scopus from database inception till 14th May 2022. Randomised controlled trials (RCTs) of diabetic patients with CAN that investigated the effect of treatment on blood pressure, heart rate variability, heart rate or QT interval were included.</p><p><strong>Results: </strong>Thirteen RCTs with a total of 724 diabetic patients with CAN were selected. There was a significant improvement in the autonomic indices of diabetic patients with CAN given angiotensin-converting enzyme inhibitor (ACEI) for 24 weeks (<i>p</i><0.05) to two years (<i>p</i><0.001), angiotensin-receptor blocker (ARB) for one year (<i>p</i><0.05), single dose of beta blocker (BB) (<i>p</i><0.05), omega-3 polyunsaturated fatty acids (PUFAs) for three months (<i>p</i><0.05), alpha-lipoic acid (ALA) for four months (<i>p</i> < 0.05) to six months (<i>p</i>=0.048), vitamin B12 in combination with ALA, acetyl L‑carnitine (ALC), superoxide dismutase (SOD) for one year (<i>p</i>=0.001) and near significant improvement in the autonomic indices of diabetic patients with CAN given vitamin E for four months (<i>p</i> = 0.05) compared to the control group. However, there was no significant improvement in the autonomic indices of patients given vitamin B12 monotherapy (<i>p</i> ≥ 0.05).</p><p><strong>Conclusion: </strong>ACEI, ARB, BB, ALA, omega-3 PUFAs, vitamin E, vitamin B12 in combination with ALA, ALC and SOD could be effective treatment options for CAN, while vitamin B12 monotherapy might be unlikely to be recommended for the treatment of CAN due to its lack of efficacy.</p><p><strong>Supplementary information: </strong>The online version contains supplementary material available at 10.1007/s13340-023-00629-x.</p>","PeriodicalId":11340,"journal":{"name":"Diabetology International","volume":null,"pages":null},"PeriodicalIF":1.3000,"publicationDate":"2023-04-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10307756/pdf/","citationCount":"0","resultStr":"{\"title\":\"Evaluating treatment options for cardiovascular autonomic neuropathy in patients with diabetes mellitus: a systematic review.\",\"authors\":\"Jasmine KaiLi Goh, Leroy Koh\",\"doi\":\"10.1007/s13340-023-00629-x\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>Cardiovascular autonomic neuropathy (CAN) is a debilitating complication of diabetes mellitus. To date, there is no systematic review on all the available drug treatments for CAN in diabetic patients, except for one review focusing on aldose reductase inhibitors.</p><p><strong>Objective: </strong>To evaluate available drug treatment options for CAN in diabetic patients.</p><p><strong>Methods: </strong>A systematic review was conducted with a search of CENTRAL, Embase, PubMed and Scopus from database inception till 14th May 2022. Randomised controlled trials (RCTs) of diabetic patients with CAN that investigated the effect of treatment on blood pressure, heart rate variability, heart rate or QT interval were included.</p><p><strong>Results: </strong>Thirteen RCTs with a total of 724 diabetic patients with CAN were selected. There was a significant improvement in the autonomic indices of diabetic patients with CAN given angiotensin-converting enzyme inhibitor (ACEI) for 24 weeks (<i>p</i><0.05) to two years (<i>p</i><0.001), angiotensin-receptor blocker (ARB) for one year (<i>p</i><0.05), single dose of beta blocker (BB) (<i>p</i><0.05), omega-3 polyunsaturated fatty acids (PUFAs) for three months (<i>p</i><0.05), alpha-lipoic acid (ALA) for four months (<i>p</i> < 0.05) to six months (<i>p</i>=0.048), vitamin B12 in combination with ALA, acetyl L‑carnitine (ALC), superoxide dismutase (SOD) for one year (<i>p</i>=0.001) and near significant improvement in the autonomic indices of diabetic patients with CAN given vitamin E for four months (<i>p</i> = 0.05) compared to the control group. However, there was no significant improvement in the autonomic indices of patients given vitamin B12 monotherapy (<i>p</i> ≥ 0.05).</p><p><strong>Conclusion: </strong>ACEI, ARB, BB, ALA, omega-3 PUFAs, vitamin E, vitamin B12 in combination with ALA, ALC and SOD could be effective treatment options for CAN, while vitamin B12 monotherapy might be unlikely to be recommended for the treatment of CAN due to its lack of efficacy.</p><p><strong>Supplementary information: </strong>The online version contains supplementary material available at 10.1007/s13340-023-00629-x.</p>\",\"PeriodicalId\":11340,\"journal\":{\"name\":\"Diabetology International\",\"volume\":null,\"pages\":null},\"PeriodicalIF\":1.3000,\"publicationDate\":\"2023-04-25\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10307756/pdf/\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Diabetology International\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://doi.org/10.1007/s13340-023-00629-x\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"2023/7/1 0:00:00\",\"PubModel\":\"eCollection\",\"JCR\":\"Q4\",\"JCRName\":\"ENDOCRINOLOGY & METABOLISM\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Diabetology International","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.1007/s13340-023-00629-x","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2023/7/1 0:00:00","PubModel":"eCollection","JCR":"Q4","JCRName":"ENDOCRINOLOGY & METABOLISM","Score":null,"Total":0}
Evaluating treatment options for cardiovascular autonomic neuropathy in patients with diabetes mellitus: a systematic review.
Background: Cardiovascular autonomic neuropathy (CAN) is a debilitating complication of diabetes mellitus. To date, there is no systematic review on all the available drug treatments for CAN in diabetic patients, except for one review focusing on aldose reductase inhibitors.
Objective: To evaluate available drug treatment options for CAN in diabetic patients.
Methods: A systematic review was conducted with a search of CENTRAL, Embase, PubMed and Scopus from database inception till 14th May 2022. Randomised controlled trials (RCTs) of diabetic patients with CAN that investigated the effect of treatment on blood pressure, heart rate variability, heart rate or QT interval were included.
Results: Thirteen RCTs with a total of 724 diabetic patients with CAN were selected. There was a significant improvement in the autonomic indices of diabetic patients with CAN given angiotensin-converting enzyme inhibitor (ACEI) for 24 weeks (p<0.05) to two years (p<0.001), angiotensin-receptor blocker (ARB) for one year (p<0.05), single dose of beta blocker (BB) (p<0.05), omega-3 polyunsaturated fatty acids (PUFAs) for three months (p<0.05), alpha-lipoic acid (ALA) for four months (p < 0.05) to six months (p=0.048), vitamin B12 in combination with ALA, acetyl L‑carnitine (ALC), superoxide dismutase (SOD) for one year (p=0.001) and near significant improvement in the autonomic indices of diabetic patients with CAN given vitamin E for four months (p = 0.05) compared to the control group. However, there was no significant improvement in the autonomic indices of patients given vitamin B12 monotherapy (p ≥ 0.05).
Conclusion: ACEI, ARB, BB, ALA, omega-3 PUFAs, vitamin E, vitamin B12 in combination with ALA, ALC and SOD could be effective treatment options for CAN, while vitamin B12 monotherapy might be unlikely to be recommended for the treatment of CAN due to its lack of efficacy.
Supplementary information: The online version contains supplementary material available at 10.1007/s13340-023-00629-x.
期刊介绍：
Diabetology International, the official journal of the Japan Diabetes Society, publishes original research articles about experimental research and clinical studies in diabetes and related areas. The journal also presents editorials, reviews, commentaries, reports of expert committees, and case reports on any aspect of diabetes. Diabetology International welcomes submissions from researchers, clinicians, and health professionals throughout the world who are interested in research, treatment, and care of patients with diabetes. All manuscripts are peer-reviewed to assure that high-quality information in the field of diabetes is made available to readers. Manuscripts are reviewed with due respect for the author''s confidentiality. At the same time, reviewers also have rights to confidentiality, which are respected by the editors. The journal follows a single-blind review procedure, where the reviewers are aware of the names and affiliations of the authors, but the reviewer reports provided to authors are anonymous. Single-blind peer review is the traditional model of peer review that many reviewers are comfortable with, and it facilitates a dispassionate critique of a manuscript.
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