Autonomic neuropathy and QT-interval prolongation in nonalcoholic diabetics, nondiabetic alcoholics and in alcoholic diabetic patients

Tmck 2. Clinical Research & Care

(ABPM) by Takeda TM2430. Systolic and diastolic BP measurements were recorded every 15 mitt (day) and 30 mitt (night), averaged each hour for day (8-22) and night (22-8). The% change from day-to-night (A day-night) in BP was calculated. Type 2 pts showed DB (1.21 f 0.13) significantly (p
P1109 lYeatment of Severe Peripheral and Autonomic Diabetic Neuropathy with a-Lipoic Acid (Controlled, Randomized, Open-Label Trial) T. TANKOVA, D. Koev, L. Dakovska. CZinical Cenrer ofEndocrinology, Medical University Sofur, Bulgaria Aim: To evaluate the effect of a-lipoic acid in severe diabetic neuropathy in a controlled, randomized, open-label study. Material and methods: 39 type 1 diabetic patients with severe neuropathy, of mean age 39.9f10.8 years and mean duration of diabetes 15.1zt6.7 years were treated with a-lipoic acid (Thiogamma) for 10 days 600mg daily iv, thereafter one film tablet of 6OOmg daily for 50 days. 20 type 1 diabetic patients, of mean age 38.2f8.7 years and mean duration of diabetes 17.1f6.5 years served as a control group. We have followed-up patients’ complaints, vibration perception threshold, EMG, Ewing’s tests, laboratory parameters of oxidative stress. Results: On the 10th day we found a decrease of 40% in pain in the treated group and by the end of the 2nd month it fell by 77% (pt0.001). while in the control group pain didn’t change significantly. Vibration perception threshold was reduced in all patients - mean 1.875 1.9 at the great toe, 2.07f1.8 at the 1st metatarsal and 3.22f1.6 at the medial malleolus in the treated group, and 1.68f1.5.2.lf1.4 and 3.7f1.5, respectively, in the control group. By the end of the second month it reached mean 4.21 f 1.7 (pO.8) and 3.93f1.5 (~‘0.6). respectively, in the control group. There was a significant improvement after treatment in the score for severity of cardiovascular autonomic neuropathy - from 6.95f0.9 to 4.33f1.7 (ptO.OOl), while in the control group it changed from 6.7fl.l to 6.95fl.O(pzO.l). We foundimprovement in the Valsalva manoeuvre after treatment from 1.07f0.04 to 1.16f0.05 (p
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PlllO EarlyAutonomic Dysfunction Evidenced by BaroEflex Cardiac Reflex in bpe 2 Diabetic Patients D. VOITA, A. Vitols. L.a&ia Institute of Cardiology, Riga, Latvia The aim of the study was to compare the baroreceptor heart rate and mean blood pressure reactions and heart rate. (HR) variability analyses for an early detection of autonomic dysfunction in non-insulin dependent diabetes mellitus (NlDDM). Methods: 17 pts with NIDDM (men, 58f1.8 yrs aged; HbAt, 9.8f0.9%, ranged from 8.2 to 11.5%. duration of NIDDM 10fl.l yrs; BMI 28f1.5 kg/m2) and 20 healthy gender, age and weight matched control subjects were studied. Analyses of baroreceptor heart rate and mean arterial pressure reactions and heart rate variability test were used. Beat-to-beat HR. finger mean arterial pressure (MAP) were monitored before and during baroreflex activation by neck suction (-60 mmHg, for 5 s) and 512 R-R (ECG) interval files in supine and upright postures were stored, analysing mean R-R interval, its standard deviation (SD), total power spectrum of the low (LF, 0.04-0.15 Hz) and high frequency (HF. 0.15 - 0.4 Hz) bands and LFHF ratio. All medications with tbe exception of bypoglycaemic agents were discontinuated 2 weeks before the study. Values are expressed as meansfstandard error. Results: In NIDDM pts HR (82f1.8 vs 70f3 bpm; PiO.05) and MAP (115f2.5 vs 90f1.4 mm Hg; PcO.05) were increased, but baroreflex bradycardic reaction (2.1f0.3 vs lO!cO.6 bpm; PcO.02) and hypotensive (3f0.5 vs 10.2f0.7 mmHg; Pt0.05) reaction were decreased comparing to controls. In supine position, mean R-R interval (772f25 vs 1017f28 ms; P~O.001) and its standard deviation (27+2.5 vs 54f5.3 ms; P-zO.001) as well as R-R interval decrease in upright position (108f12 vs 254f21 ms; Pt0.001) were less in NIDDM pts than in controls, but LF, HF. and LF:HP ratio (1.07f0.2 vs 1.33?=0.21) values and LF:HF ratio increase failure in upright position (x2 =3.2), did not reveal significant difference. Conclusions: In patients with NIDDM baroreflex bradycardic and hypotensive reactions are superior to HR variability analyses to detect an early impairment of cardiovascular autonomic neuropathy.

Pllll Autonomic Neuropathy and QT-Interval Prcdongation in Nonalcoholic Diabetics, Nondiabetic Alcoholics and in Alcoholic Diabetic Patients I? KEMPLER, K. Keresztes, I. Istenes, 8. K&d& K. Buzhi, Zs. Hermdnyi. 1stDept. of Medicine, Semmelweis University, Buiapest, Hungary Background: Sudden death is not rare in patients with cardiovascular autonomic neuropathy (CAN) and corrected QT-interval (QTcI) prolongation is thought to be important in this respect. Moreover, myocardial infarction is the prime cause of death among Type 2 diabetic patients. The prognostic importance of QTcI at discharge after myocardial infarction has been proved. Aim of our study was to evaluate the relationship between CAN and QTcI in nonalcoholic diabetics, nondiabetic alcoholics and in alcoholic diabetic patients. Methods: Examined were 94 nonalcoholic patients with Type 2 diabetes (mean age: 54,8 years, mean duration of diabetes: 8.9 years), 36 nondiabetic alcoholics (mean age: 42,6 years), 22 alcoholics with Type 2 diabetes (mean age: 47,l years, mean duration of diabetes: 4,9 years) and 82 healthy controls (mean age: 41,7 years). Heart rate responses to deep breathing, standing and Valsalva maneouvre just as blood pressure responses to standing and sustained handgrip were assessed. QTcI was determined with Bar&t’s formula. Results: All controls had normal results in all five tests and a mean QTcI of 397 (SD 21) ms. 70/94 nonalcoholic patients with Type 2 diabetes, 14136 nondiabetic alcoholics and 21/22 alcoholics with Type 2 diabetes had CAN. Significant linear regression was found between severity of CAN - based on the number of abnormal reflex tests on patient - and

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QTcI prolongation (p440 msec) was seen significantly more often in patients with CAN compared to those without CAN (p
P1112 Cause - Effect Relationship between Hyperglycaemia and Pain Perception Threshold ASHOK KUMAR DAS, G.R.K. Sharma, Ramaswamy S.. Medicine, Jipmez Pondicherry, India

(Biomedical Instrument, Newbury, Ohio, U.S.A.) on 50% of the study subjects (n=631). Neuropathy was diagnosed if the vibratory threshold of the great toe exceeded 20. Results: The overall prevalence rate of neuropathy was 7.7% (age standardised-3.9%). The prevalence rates of neuropathy were 5.8%. 14.7% and 17.5% in those with NGT, IGT and diabetes respectively. Univariate regression analysis revealed age and diabetes as strong risk factors for neuropathy (p
P1114 Normal Values of Parameters of Power Spectral Analysis of Heart Rate Variability for Clinical Evaluation of Autonomic Neuropathy J. HOSOVA, A. JirkovskB, P. BouEek, J. SkibovB. Insritutefor Clinical and Experimental Medicine, Prague, Czech Republic

Introduction: Diabetes Mellitus is commonly associated with painful neuropathy. This is effectively managed by achieving good glycaemic control. Aim: To identify a cause - effect relationship between changes in the glycaemic status and pain threshold using clinical and experimental models. Methods: Hyperglycemia was induced chemically in rats using strepotazotocin. Assement of pain threshold was made by thermal (tail flick) and mechanical (tail clip) assay. Clinically, the ischaemic and cold pain threshold and latency for intolerance to pain threshold (IPT) were measured in diabetic patients and healthy volunteers by tourniquet test and visual analog scale). Results: In animal experiments hyperglycemia (from 55.17 to 118.67 mg%) decreased the reaction time from 14.9 to 8.3 seconds indicating hyperalgesia in hyperglycaemic states. This was reversed when blood sugar reduced from 118.67 to 63.7 mg%. The reaction time return almost to normal (8.89 to 17.25 seconds) on achieving glycaemic control (63.75 mg%). In humans an increase in blood glucose postprandially from 80.1 to 153.2 mg% decreased the Ischemic pain threshold (IPT) from 34.5 to 21.3 seconds. Similarly in untreated diabetic patients (323.3 mg% glucose) the IPT latency was 12.37 seconds and it returned to normal (30.87 sec.) on acheieving good glycaemic control (110.93 mg%). Conclusion: An inverse relationship exists between glycaemic status and pain threshold. It is advised to employ ischaemic pain test for constant results in humans. Inclusion of assessment of pain threshold along with other battery of tests will assist early diagnosis of painful diabetic neuropathy.

Background and Aims: Diabetic cardiovascular autonomic neuropatby (CAN) carries an increased risk of mortality. Power spectral analysis (PSA) of heart rate variability (HRV) is more sensitive method for evaluating CAN than standard Ewing’s battery of cardiovascular autonomic function tests. The aim of the study was to select the optimal parameters of PSA of HRV and to establish their normal age-related values. Material and Methods: We tested 123 healthy subjects (aged 20-70 years) with normal Ewing’s tests. Short-term PSA of HRV was performed in modified orthostatic load (3x5 min, in positions supine-standing-supine), using a telemetric system VariaCardio TF4 (Sima Media, Olomouc, Czech Republic). Examination conditions were strictly standardised. Results: Optimal parameters of HRV within PSA were selected by stepwise discriminant analysis between groups with various stages of CAN as assessed by the battery of Ewing’s tests. Cumulative spectral power of the total frequency band (0.05-0.50 Hz) in all three positions (CumPower LFHF 1+2+3) or in positions 2+3 (Cum Power LFHF 2+3) were the most relevant parameters for discrimination between healthy subjects and group with severe CAN. Spectral power of low-frequency band (0.05-0.15 Hz) in all three positions (Power LF 1+2+3) was the most discriminating parameter between healthy subjects and group with early CAN. Group of healthy subjects was divided into 4 age-decades. In each age-decade was expressed the mean f SD for selected optimal parameters of PSA of HRV. The age-related lower limits of normal were defined at the 5” centile for severe CAN and 20” centile for early CAN. A log transformation of the data yielded linear regression between age and the corresponding SD for selected parameters: In CumPowerLFHF 1+2+3 (I= - 0.63, p
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Prevalence of Neuropathy Using Biothesiometry in a Selected South Indian Population - The Chennai Urban Population Study (CUPS) M. RAMU, G. Premalatha, R. Deepa, V. Mohan. Madras Diabetes

Simple Screening Tests for Peripheral Neuropathy in the Diabetes Clinic B.A. PERKINS ‘, D. Olaleye’, B. Zinman3, V. Bri13. ’ HarvardMedical

Research Foundation, Chennai. India

School, Boston, United States of America: ‘SAS, Carey, United States of America; 3 University of Toronto, Toronto, Canada

Objective: The aim of this study was to determine the prevalence and risk factors for neuropathy among South Indians. Methods: The Chennai Urban Population Study (CUPS) is an epidemiological study involving two residential areas in Chennai in South India. Of the total of 1399 eligible subjects (age z 20 years), 1262 (90.2%) participated in the study. All the study subjects underwent a glucose tolerance test (GTT) and were categorized as normal glucose tolerance (NGT) impaired glucose tolerance (IGT) or diabetes. Biothesiometry studies were performed by a single observer using a biothesiometer

Purpose. The utility of rapid and valid sensory tests appropriate for diagnosis of neuropathy in the diabetes clinic, rather than as prognostic tools for the prediction of foot complications, has been unclear due to limitations inherent in previous studies. Although clinical practice guidelines recommend annual screening for neuropathy, they are unable to support specific recommendations for screening maneuvers. The objective of this study is to assess the operating characterisitics of four simple sensory tests in the diagnosis of distal symmetrical polyneuropathy.