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Autonomic neuropathy in diabetic subjects
Track 2. Clinical Research
S261
& Care
PllOl
P1103
Cardiovascular Autonomic Neuropathy in Diabetic Patients ROALD E. GOMEZ P ’ , Lilia R. Uzcategui 0. ’ , Yajaira E. Zerpa ’ , Olga Yrala*, Victor H. Perez*. ’ Unidadde Endocrinologia. Universidad
Autonomic Neuropathy in Diabetic Subjects H.S. FERDOUS’, M.F. Pathan’, Z.A. Liatif’, J.L. Taft’, PG. Colmanz.
de LAS Andes, Merida, Merida, Venezuela: 2 Medicina Interna, Hosp. Regulo Pa&no Aiiez, Maracaibo, Zulia, Venezuela
Between the chronic complications of the diabetes, the cardiovascular autonomic neuropathy (CAN) can play an important role because this represents a great risk of morbidity and mortality. The sub-clinic presence of CAN is often asinthomatic and this explains why its incidence is underestimated. Objective: To evaluate the incidence of CAN in a group of diabetic patients and to correlate it with the course of the disease. Methods: 30 diabetic patients (group A) with ages between 32 and 70 years were evaluated, the RINES VALCARDI INDEX (RVI) was applied to theses patients. This index consists in the registration of the cardiac frequency in the electro cardiographic with different stimulus (resting, inspiration, expiration, valsalva and carotid massage), then a subtraction was made between the longest RR and the shortest RR in each phase and then the summatory of all the points. 30 healthy subjects (group B) were taken as the control. Results: there were not significant differences between the ages, the average of the duration of the disease was 7.67 f 3.17 years. Related to the RVI, the group A had an average of 17.57 f 6.94 points; the group B 35.57 f 5.78, p < 0.001. there was important correlation between the ages and RVI in both group, (group A r = - 0.73 and group B = -0.9 (p < 0.001). There was a significant negative relation between the RVI and the duration of the disease, r =-0.71 (p
P1102 No Strict Relationship between Peripheral Sensory Neuropathy and Autonomic Cardiovascular Neuropathy in Long-Lasting Qpe 1 Diabetes FEDERICO R. ESTRELLA ‘, Monique M. Marchand ’ , Philippe P. Ernest ’ , Pierre J. Lefebre ’ , Andre J. Scheen ’ The relationships between markers of peripheral sensory neuropathy (PSN) and cardiovascular autonomic neuropathy (CAN) were studied in 26 patients with long-lasting (~10 years) type 1 diabetes and no other neurologic disease. PSN was assessed by the measurement of foot vibratory detection threshold (VDT using a CASE IV” System). CAN was assessed using RR-interval E/I ratio during deep breathing and continuous measurement of heart rate and mean arterial blood pressure (MAP using a Finapres@ device) during both a Valsalva maneuver and an active postural test (squatting test). Two groups were defined according to VDT: group 1 (n = 13): VDT z 97ti percentile of normal values (98.8 f 0.4) and group 2 (n = 13): VDT < 97” percentile (84.2 f 17.4; mean f SD). The two groups had similar age, BMI, diabetes duration (24 f 9 vs 25 f 9 years) and HbAt, levels (8.8 f 1.0 vs 8.3 f 0.8%). Positive microalbmninuria (2 20 mg/L) was found in 50% of patients of group 1 and in 25% of group 2. R-R En ratio (1.22 f 0.15 vs 1.21 f 0.16, NS) was similar in the two groups while RR Valsava ratio was lower in group 1 than in group 2 (1.31 f 0.14 vs 1.75 f 0.56, p = 0.02). Postural hypotension(- 44 f 14 vs 44 f 9 mm Hg), delay of recovery of baseline MAF’ levels (28 f 19 vs 32 f 20 set), reflex tachycardia (+ 24 f 13 vs + 23 f 13 beats/mm) and baroreflex gain (2.26 f 1.58 vs 1.86 f 1.52 msec/mm Hg) were similar (all NS) in the two groups. In conclusion, PSN and CAN indices may progress in an independent manner in patients with long-lasting typ 1 diabetes.
‘Research Division, Birdem, Dhoka, Bangladesh: Hospital, Melbourne, Australia
2 Royal Melbourne
Autonomic Neuropathy (AN) is a common complication along with other macro and microvascular dysfunction in both type 1 and type 2 diabetic patients with long duration. Sometimes it produces very disconceming clinical problem affecting many diverse visceral functions, cardiovascular involvement is well described and is a leading cause of sudden death. Simple clinic tests detecting cardiovascular dysfunction is well established. We have conducted autonomic function tests on 50 unselected (type l-16;type2-34) diabetic subjects and 16 nondiabetic unmatched controls according to Ewing’s protocol. Type 1 with average age 39 years, duration 27 years had uncontrolled DM (HbAlc 9.0%) developed Retinopathy, Nephropathy, Neuropathy and Cardiovascular diseases in 448, 19%. 25% andl9% cases respectively. Type 2 with average age 63 years with duration13 years had uncontrolled DM(HbAic 8.3%) developed Retinopathy, Nephropathy, Neuropathy and Cardiovascular diseases in 68%,56%,44% and 50% cases respectively. Among the parasympathetic tests, heart rate response to Valsalva (Vals ratio), rate variation during deep inspiration (HRV breath) and on standing (HRV stand) were done. Vals ratio, HRV breath and HRV stand were significantly (P
P1104 Is CeasedVibration Sense of the Foot a Term of Macrovascular Complications in Patients with Diabetes? JETTE VIBE-PETERSEN ’ , Michael Lohmann’, Torben Jorgensen3, Hans Perrild ’ . ’ Dept. of Internal Medicine I, Bispebjerg Hospital, Copenhagen, Denmark; 2 Copenhagen Wound Healing Centre, Bispebjerg Hospital, Copenhagen, Denmark; 3 Centre of Preventive Medicine, Glostrup Hospital, Glostrup, Denmark
Background and Aims: Prophylactic foot-care programs often include a test of the patient’s peripheral sensation of the foot. Does the measurement of vibration sense by biothesiometry reflect peripheral neuropathy or is it rather a manifestation of peripheral macrovascular disease? Materials and Methods: A cohort of 468 consecutive diabetics (Type 1: 169(112M/57F), mean age 46.4(+16.8), median diabetes duration 10 years (IQR 5-19) and Type 2: 299 (165M034F) mean age 63.2(&12.5), median duration 8 years (IQR 2-12)) answered a questionnaire incl. smoking and peripheral vascular symptoms/signs (decreased perfusion and/or claudicatio and/or peripheral bypass). Other data: HbAlc, Blood Pressure, total-cholesterol, HDL-cholesterol, triglycerides, biothesiometry of three different points (the big toe, head of 1st metatarsal and head of 5th metatarsal), urinary albumin excretion (albuminuria >30 mg/24 h) and ztretinopathy. Results: in Type 1 and Type 2 diabetic patients HbAlc (%) was 8.6(f1.4) v 8.7(+1.9), syst.BP(mmHg) 137(+20) v. 151(f23), cholesterol(mmol/l) 5.0(f1.2) v. 5.8(f1.3) and triglycerides(mmol/l) l.l(f0.9) v. 2.7(+3.1). Logistic regression, after stepwise exclusion, revealed the following independent risk factors (OR (95%CI)) for ceased versus decreased and normal vibration sense in patients with Type 1 diabetes: Diabetes duration 1.06(1.01-1.11). peripheral vascular symptoms/signs 12.57 (3.71-42.60) and albuminuria 8.53 (2.51-28.91). In patients with Type 2 diabetes the
S261
& Care
PllOl
P1103
Cardiovascular Autonomic Neuropathy in Diabetic Patients ROALD E. GOMEZ P ’ , Lilia R. Uzcategui 0. ’ , Yajaira E. Zerpa ’ , Olga Yrala*, Victor H. Perez*. ’ Unidadde Endocrinologia. Universidad
Autonomic Neuropathy in Diabetic Subjects H.S. FERDOUS’, M.F. Pathan’, Z.A. Liatif’, J.L. Taft’, PG. Colmanz.
de LAS Andes, Merida, Merida, Venezuela: 2 Medicina Interna, Hosp. Regulo Pa&no Aiiez, Maracaibo, Zulia, Venezuela
Between the chronic complications of the diabetes, the cardiovascular autonomic neuropathy (CAN) can play an important role because this represents a great risk of morbidity and mortality. The sub-clinic presence of CAN is often asinthomatic and this explains why its incidence is underestimated. Objective: To evaluate the incidence of CAN in a group of diabetic patients and to correlate it with the course of the disease. Methods: 30 diabetic patients (group A) with ages between 32 and 70 years were evaluated, the RINES VALCARDI INDEX (RVI) was applied to theses patients. This index consists in the registration of the cardiac frequency in the electro cardiographic with different stimulus (resting, inspiration, expiration, valsalva and carotid massage), then a subtraction was made between the longest RR and the shortest RR in each phase and then the summatory of all the points. 30 healthy subjects (group B) were taken as the control. Results: there were not significant differences between the ages, the average of the duration of the disease was 7.67 f 3.17 years. Related to the RVI, the group A had an average of 17.57 f 6.94 points; the group B 35.57 f 5.78, p < 0.001. there was important correlation between the ages and RVI in both group, (group A r = - 0.73 and group B = -0.9 (p < 0.001). There was a significant negative relation between the RVI and the duration of the disease, r =-0.71 (p
P1102 No Strict Relationship between Peripheral Sensory Neuropathy and Autonomic Cardiovascular Neuropathy in Long-Lasting Qpe 1 Diabetes FEDERICO R. ESTRELLA ‘, Monique M. Marchand ’ , Philippe P. Ernest ’ , Pierre J. Lefebre ’ , Andre J. Scheen ’ The relationships between markers of peripheral sensory neuropathy (PSN) and cardiovascular autonomic neuropathy (CAN) were studied in 26 patients with long-lasting (~10 years) type 1 diabetes and no other neurologic disease. PSN was assessed by the measurement of foot vibratory detection threshold (VDT using a CASE IV” System). CAN was assessed using RR-interval E/I ratio during deep breathing and continuous measurement of heart rate and mean arterial blood pressure (MAP using a Finapres@ device) during both a Valsalva maneuver and an active postural test (squatting test). Two groups were defined according to VDT: group 1 (n = 13): VDT z 97ti percentile of normal values (98.8 f 0.4) and group 2 (n = 13): VDT < 97” percentile (84.2 f 17.4; mean f SD). The two groups had similar age, BMI, diabetes duration (24 f 9 vs 25 f 9 years) and HbAt, levels (8.8 f 1.0 vs 8.3 f 0.8%). Positive microalbmninuria (2 20 mg/L) was found in 50% of patients of group 1 and in 25% of group 2. R-R En ratio (1.22 f 0.15 vs 1.21 f 0.16, NS) was similar in the two groups while RR Valsava ratio was lower in group 1 than in group 2 (1.31 f 0.14 vs 1.75 f 0.56, p = 0.02). Postural hypotension(- 44 f 14 vs 44 f 9 mm Hg), delay of recovery of baseline MAF’ levels (28 f 19 vs 32 f 20 set), reflex tachycardia (+ 24 f 13 vs + 23 f 13 beats/mm) and baroreflex gain (2.26 f 1.58 vs 1.86 f 1.52 msec/mm Hg) were similar (all NS) in the two groups. In conclusion, PSN and CAN indices may progress in an independent manner in patients with long-lasting typ 1 diabetes.
‘Research Division, Birdem, Dhoka, Bangladesh: Hospital, Melbourne, Australia
2 Royal Melbourne
Autonomic Neuropathy (AN) is a common complication along with other macro and microvascular dysfunction in both type 1 and type 2 diabetic patients with long duration. Sometimes it produces very disconceming clinical problem affecting many diverse visceral functions, cardiovascular involvement is well described and is a leading cause of sudden death. Simple clinic tests detecting cardiovascular dysfunction is well established. We have conducted autonomic function tests on 50 unselected (type l-16;type2-34) diabetic subjects and 16 nondiabetic unmatched controls according to Ewing’s protocol. Type 1 with average age 39 years, duration 27 years had uncontrolled DM (HbAlc 9.0%) developed Retinopathy, Nephropathy, Neuropathy and Cardiovascular diseases in 448, 19%. 25% andl9% cases respectively. Type 2 with average age 63 years with duration13 years had uncontrolled DM(HbAic 8.3%) developed Retinopathy, Nephropathy, Neuropathy and Cardiovascular diseases in 68%,56%,44% and 50% cases respectively. Among the parasympathetic tests, heart rate response to Valsalva (Vals ratio), rate variation during deep inspiration (HRV breath) and on standing (HRV stand) were done. Vals ratio, HRV breath and HRV stand were significantly (P
P1104 Is CeasedVibration Sense of the Foot a Term of Macrovascular Complications in Patients with Diabetes? JETTE VIBE-PETERSEN ’ , Michael Lohmann’, Torben Jorgensen3, Hans Perrild ’ . ’ Dept. of Internal Medicine I, Bispebjerg Hospital, Copenhagen, Denmark; 2 Copenhagen Wound Healing Centre, Bispebjerg Hospital, Copenhagen, Denmark; 3 Centre of Preventive Medicine, Glostrup Hospital, Glostrup, Denmark
Background and Aims: Prophylactic foot-care programs often include a test of the patient’s peripheral sensation of the foot. Does the measurement of vibration sense by biothesiometry reflect peripheral neuropathy or is it rather a manifestation of peripheral macrovascular disease? Materials and Methods: A cohort of 468 consecutive diabetics (Type 1: 169(112M/57F), mean age 46.4(+16.8), median diabetes duration 10 years (IQR 5-19) and Type 2: 299 (165M034F) mean age 63.2(&12.5), median duration 8 years (IQR 2-12)) answered a questionnaire incl. smoking and peripheral vascular symptoms/signs (decreased perfusion and/or claudicatio and/or peripheral bypass). Other data: HbAlc, Blood Pressure, total-cholesterol, HDL-cholesterol, triglycerides, biothesiometry of three different points (the big toe, head of 1st metatarsal and head of 5th metatarsal), urinary albumin excretion (albuminuria >30 mg/24 h) and ztretinopathy. Results: in Type 1 and Type 2 diabetic patients HbAlc (%) was 8.6(f1.4) v 8.7(+1.9), syst.BP(mmHg) 137(+20) v. 151(f23), cholesterol(mmol/l) 5.0(f1.2) v. 5.8(f1.3) and triglycerides(mmol/l) l.l(f0.9) v. 2.7(+3.1). Logistic regression, after stepwise exclusion, revealed the following independent risk factors (OR (95%CI)) for ceased versus decreased and normal vibration sense in patients with Type 1 diabetes: Diabetes duration 1.06(1.01-1.11). peripheral vascular symptoms/signs 12.57 (3.71-42.60) and albuminuria 8.53 (2.51-28.91). In patients with Type 2 diabetes the