Frequency and associated risk factors of cardiovascular autonomic neuropathy among patients with type 2 Diabetes

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Background: Cardiovascular autonomic neuropathy (CAN) is a common complication of diabetes and is associated with cardiovascular morbidity and mortality. Despite its prevalence, it is usually underdiagnosed. Objective to assess frequency of CAN in type 2 diabetes, treated at the Diabetology Service...

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Autores principales: Romero, Silvana A., Ortin, Agostina, Mercado, Noelia, Caeiro, Gabriela, Waitman, Jorge
Formato: Artículo revista
Lenguaje:Español
Publicado: Universidad Nacional Cba. Facultad de Ciencias Médicas. Secretaria de Ciencia y Tecnología 2018
Materias:
diabetes mellitus
diabetes complications
diabetic neuropathy
neuropatía diabética
neuropatía autonómica.
Acceso en línea:https://revistas.unc.edu.ar/index.php/med/article/view/17566
Aporte de:
Revistas de la UNC de Universidad Nacional de Córdoba
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institution Universidad Nacional de Córdoba
institution_str I-10
repository_str R-10
container_title_str Revistas de la UNC
language Español
format Artículo revista
topic diabetes mellitus
diabetes complications
diabetic neuropathy
diabetes mellitus
neuropatía diabética
neuropatía autonómica.
spellingShingle diabetes mellitus
diabetes complications
diabetic neuropathy
diabetes mellitus
neuropatía diabética
neuropatía autonómica.
Romero, Silvana A.
Ortin, Agostina
Mercado, Noelia
Caeiro, Gabriela
Waitman, Jorge
Frequency and associated risk factors of cardiovascular autonomic neuropathy among patients with type 2 Diabetes
topic_facet diabetes mellitus
diabetes complications
diabetic neuropathy
diabetes mellitus
neuropatía diabética
neuropatía autonómica.
author Romero, Silvana A.
Ortin, Agostina
Mercado, Noelia
Caeiro, Gabriela
Waitman, Jorge
author_facet Romero, Silvana A.
Ortin, Agostina
Mercado, Noelia
Caeiro, Gabriela
Waitman, Jorge
author_sort Romero, Silvana A.
title Frequency and associated risk factors of cardiovascular autonomic neuropathy among patients with type 2 Diabetes
title_short Frequency and associated risk factors of cardiovascular autonomic neuropathy among patients with type 2 Diabetes
title_full Frequency and associated risk factors of cardiovascular autonomic neuropathy among patients with type 2 Diabetes
title_fullStr Frequency and associated risk factors of cardiovascular autonomic neuropathy among patients with type 2 Diabetes
title_full_unstemmed Frequency and associated risk factors of cardiovascular autonomic neuropathy among patients with type 2 Diabetes
title_sort frequency and associated risk factors of cardiovascular autonomic neuropathy among patients with type 2 diabetes
description Background: Cardiovascular autonomic neuropathy (CAN) is a common complication of diabetes and is associated with cardiovascular morbidity and mortality. Despite its prevalence, it is usually underdiagnosed. Objective to assess frequency of CAN in type 2 diabetes, treated at the Diabetology Service at Cordoba Hospital, Argentina. Methods: Cross-sectional study was conducted from May 2015 to May 2016. Cardiovascular Autonomic Tests (Ewing´s battery) were performed: response to Valsalva maneuver, expiration-to-inspiration ratio (E/I ratio), standing to lying flat and postural hypotension. Results: 100 type 2 diabetes patients, 53% females. The mean age and diabetes duration 52 years old and 8.4 years, respectively. Hemoglobin A1c level of 8.7% and 47% were insulin-requiring type 2 diabetes patients. 29% had early CAN, 54% confirmed CAN (10% severe CAN) and 17% normal cardiovascular tests. Confirmed CAN was higher in those with longer duration of diabetes; longer duration of insulin therapy, older patients and severe hypoglycemia events was higher in those with confirmed CAN versus without CAN or early CAN (p 0.003). The risk factors associated were hypertension OR 2.55 (p 0.02), peripheral neuropathy OR 11.7 (p <0.0001), diabetic retinopathy OR 9.03 (p 0.001), diabetic nephropathy OR 3.12 (p 0.03) and hemoglobin A1c > 7% OR 2.57 (p 0, 03). Conclusions: frequency of CAN was high, was associated with hypertension, microvascular complications, older age, poor metabolic control, longer duration of disease and insulin therapy. Patients with a higher risk of developing CAN should be identified, in order to reduce the impact of this complication.
publisher Universidad Nacional Cba. Facultad de Ciencias Médicas. Secretaria de Ciencia y Tecnología
publishDate 2018
url https://revistas.unc.edu.ar/index.php/med/article/view/17566
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spelling I10-R10-article-175662020-02-27T19:08:24Z Frequency and associated risk factors of cardiovascular autonomic neuropathy among patients with type 2 Diabetes Frecuencia y factores de riesgo asociados de Neuropatía Autonómica Cardíaca en pacientes con Diabetes tipo 2 Romero, Silvana A. Ortin, Agostina Mercado, Noelia Caeiro, Gabriela Waitman, Jorge diabetes mellitus diabetes complications diabetic neuropathy diabetes mellitus neuropatía diabética neuropatía autonómica. Background: Cardiovascular autonomic neuropathy (CAN) is a common complication of diabetes and is associated with cardiovascular morbidity and mortality. Despite its prevalence, it is usually underdiagnosed. Objective to assess frequency of CAN in type 2 diabetes, treated at the Diabetology Service at Cordoba Hospital, Argentina. Methods: Cross-sectional study was conducted from May 2015 to May 2016. Cardiovascular Autonomic Tests (Ewing´s battery) were performed: response to Valsalva maneuver, expiration-to-inspiration ratio (E/I ratio), standing to lying flat and postural hypotension. Results: 100 type 2 diabetes patients, 53% females. The mean age and diabetes duration 52 years old and 8.4 years, respectively. Hemoglobin A1c level of 8.7% and 47% were insulin-requiring type 2 diabetes patients. 29% had early CAN, 54% confirmed CAN (10% severe CAN) and 17% normal cardiovascular tests. Confirmed CAN was higher in those with longer duration of diabetes; longer duration of insulin therapy, older patients and severe hypoglycemia events was higher in those with confirmed CAN versus without CAN or early CAN (p 0.003). The risk factors associated were hypertension OR 2.55 (p 0.02), peripheral neuropathy OR 11.7 (p <0.0001), diabetic retinopathy OR 9.03 (p 0.001), diabetic nephropathy OR 3.12 (p 0.03) and hemoglobin A1c > 7% OR 2.57 (p 0, 03). Conclusions: frequency of CAN was high, was associated with hypertension, microvascular complications, older age, poor metabolic control, longer duration of disease and insulin therapy. Patients with a higher risk of developing CAN should be identified, in order to reduce the impact of this complication. Introducción: La neuropatía autonómica cardíaca (NAC) es una complicación frecuente de la diabetes y aumenta la morbimortalidad cardiovascular. A pesar de su prevalencia e impacto está subdiagnosticada. Objetivo: Determinar la frecuencia de NAC y factores de riesgo asociados en pacientes con diabetes tipo 2(DM2), en el Servicio de Diabetología del Hospital Córdoba. Material y Métodos: estudio transversal, desde Mayo de 2015  a Mayo de 2016. Se realizó Test Autonómicos Cardiovasculares: Maniobra de Valsalva (MV), Respiración  Profunda (RP), Razón 30/15 e Hipotensión ortostática. Resultados: Se reclutaron 100 pacientes con DM2. 53 % sexo femenino. Edad promedio 52 años, IMC 30,9; HbA1c  8,7 % y evolución de la enfermedad 8,4 años. El 17 % presentaron test normales. El 29 % tenía NAC temprana y 54% NAC confirmada (10 % NAC severa). Los pacientes con NAC confirmada tenían mayor tiempo de evolución (11 vs 5 años ), mayor duración de insulinoterapia (5 vs 1,5 años ), mayor edad ( 54 vs 49 años ) y mayor riesgo de hipoglucemias severas comparado con pacientes sin NAC o NAC temprana (p 0,003).Factores de riesgo asociados hipertensión arterial OR 2,55 (p  0,02), neuropatía periférica OR 11,7 (p<0,0001) , retinopatía OR 9,03 (p  0,001), nefropatía OR 3,12 (p 0,03) y HbA1c > 7% OR 2,57(p 0,03). Conclusiones: Hubo una alta frecuencia de NAC, se asoció con hipertensión, complicaciones microvasculares, mayor edad, duración de la enfermedad, de la insulinoterapia y mal control metabólico. Se debería identificar a pacientes con mayor riesgo, para reducir su aparición e impacto. Universidad Nacional Cba. Facultad de Ciencias Médicas. Secretaria de Ciencia y Tecnología 2018-07-27 info:eu-repo/semantics/article info:eu-repo/semantics/publishedVersion application/pdf image/png image/png image/png application/vnd.openxmlformats-officedocument.wordprocessingml.document https://revistas.unc.edu.ar/index.php/med/article/view/17566 Revista de la Facultad de Ciencias Médicas de Córdoba.; Vol. 75 No. 2 (2018); 111-118 Revista de la Facultad de Ciencias Médicas de Córdoba; Vol. 75 Núm. 2 (2018); 111-118 Revista da Faculdade de Ciências Médicas de Córdoba; v. 75 n. 2 (2018); 111-118 1853-0605 0014-6722 10.31053/1853.0605.v75.n2 spa https://revistas.unc.edu.ar/index.php/med/article/view/17566/20617 https://revistas.unc.edu.ar/index.php/med/article/view/17566/26594 https://revistas.unc.edu.ar/index.php/med/article/view/17566/26595 https://revistas.unc.edu.ar/index.php/med/article/view/17566/26596 https://revistas.unc.edu.ar/index.php/med/article/view/17566/26597 Derechos de autor 2018 Universidad Nacional de Córdoba

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