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Cardiac autonomic neuropathy in nonobese young adults with type 1 diabetes

이영아|Hwa Young Kim|Hae Woon Jung|Choong Ho Shin|Sei Won Yang
대한소아내분비학회 (Korean Society Of Pediatric Endocrinology)|2019.09|Annals of Pediatric Endocrinology & Metabolism|제24권 제3호|pp. 180-186|DOI 10.6065/apem.2019.24.3.180

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키워드

KoreaPrevalenceRisk factorsYoung adultType 1 diabetesAutonomic nervous system diseases
주제분류소아과학

초록

Purpose: The aim of this study was to evaluate the prevalence and risk factors for cardiac autonomic neuropathy (CAN) in nonobese nonobese young type 1 diabetes mellitus (T1DM) patients without micro- or macrovascular complications. Methods: CAN was assessed in 95 patients with T1DM, aged 18–29 years, using standard cardiovascular reflex tests – heart rate response to deep breathing, standing, and the Valsalva maneuver and blood pressure response to standing. Furthermore, power spectral analyses of overall heart rate variability (HRV), standard deviation of NN intervals (SDNN), and total power (TP) were tested with DiCAN. CAN was defined as abnormal results for at least 1 of the 4 cardiovascular reflex tests. Results: The prevalence of CAN was 12.6%. The frequency of one and 2 abnormal reflex tests was 10.5% and 2.1%, respectively. No significant differences were observed in age, sex, mean hemoglobin A1c (HbA1c) level, and duration of diabetes with respect to presence of CAN. Patients with CAN exhibited lower overall HRV parameters (SDNN and TP) compared with those without CAN even though there was no statistical significance. In multivariable analyses, higher mean HbA1c level was significantly associated with lower overall HRV (β=-44.42, P=0.002 for SDNN and β=-2.82, P<0.001 for TP). Conclusion: CAN can be detected in 12.6% of young adult T1DM patients even without other micro- or macrovascular complications. Glycemic control is the main determinant to maintain overall HRV and prevent CAN.

Abstract

Purpose: The aim of this study was to evaluate the prevalence and risk factors for cardiac autonomic neuropathy (CAN) in nonobese nonobese young type 1 diabetes mellitus (T1DM) patients without micro- or macrovascular complications. Methods: CAN was assessed in 95 patients with T1DM, aged 18–29 years, using standard cardiovascular reflex tests – heart rate response to deep breathing, standing, and the Valsalva maneuver and blood pressure response to standing. Furthermore, power spectral analyses of overall heart rate variability (HRV), standard deviation of NN intervals (SDNN), and total power (TP) were tested with DiCAN. CAN was defined as abnormal results for at least 1 of the 4 cardiovascular reflex tests. Results: The prevalence of CAN was 12.6%. The frequency of one and 2 abnormal reflex tests was 10.5% and 2.1%, respectively. No significant differences were observed in age, sex, mean hemoglobin A1c (HbA1c) level, and duration of diabetes with respect to presence of CAN. Patients with CAN exhibited lower overall HRV parameters (SDNN and TP) compared with those without CAN even though there was no statistical significance. In multivariable analyses, higher mean HbA1c level was significantly associated with lower overall HRV (β=-44.42, P=0.002 for SDNN and β=-2.82, P<0.001 for TP). Conclusion: CAN can be detected in 12.6% of young adult T1DM patients even without other micro- or macrovascular complications. Glycemic control is the main determinant to maintain overall HRV and prevent CAN.

참고문헌 (38)

  1. Vinik AI, "Diabetic cardiac auto-nomic neuropathy, inflammation and cardiovascular disease", J Diabetes Investig, 4, pp.4~18 (2013)
  2. Maser RE, "The associa-tion between cardiovascular autonomic neuropathy and mortality in individuals with diabetes: a meta-analysis", Diabetes Care, 26, pp.1895~1901 (2003)
  3. Kleiger RE, "Decreased heart rate variability and its association with increased mortality after acute myocardial infarction", Am J Cardiol, 59, pp.256~262 (1987)
  4. Stevens MJ, "Cardiac sympathetic dysinnervation in diabetes: implications for enhanced cardiovascular risk", Circulation, 98, pp.961~968 (1998)
  5. Ewing DJ, "Diagnosis and management of diabetic autonomic neuropathy", Br Med J (Clin Res Ed), 285, pp.916~918 (1982)
  6. Boulton AJ, "Diabetic neuropathies: a statement by the American Diabetes Association", Diabetes Care, 28, pp.956~962 (2005)
  7. "Heart rate variability. Standards of measurement, physio-logical interpretation, and clinical use. Task Force of the European Society of Cardiology and the North American Society of Pacing and Electrophysiology", Eur Heart J, 17, pp.354~381 (1996)
  8. Schönauer M, "Cardiac autonomic diabetic neuropathy", Diab Vasc Dis Res, 5, pp.336~344 (2008)
  9. Tang M, "Autonomic neuropathy in young people with type 1 diabetes: a systematic review", Pediatr Diabetes, 14, pp.239~248 (2013)
  10. Ziegler D, "The epidemi-ology of diabetic neuropathy. Diabetic Cardiovascular Autonomic Neuropathy Multicenter Study Group", J Diabetes Complications, 6, pp.49~57 (1992)
  11. "The effect of intensive diabetes therapy on measures of autonomic nervous system function in the Diabetes Control and Complications Trial (DCCT)", Diabetologia, 41, pp.416~423 (1998)
  12. Kempler P, "Autonomic neuropathy is associated with increased cardiovascular risk factors: the EURODIAB IDDM Complications Study", Diabet Med, 19, pp.900~909 (2002)
  13. Serhiyenko VA, "Cardiac autonomic neuropathy: risk factors, diagnosis and treatment", World J Diabetes, 9, pp.1~24 (2018)
  14. Dafaalla MD, "Risk factors of diabetic cardiac autonomic neuropathy in patients with type 1 diabetes mellitus: a meta-analysis", Open Heart, 3, pp.e000336~ (2016)
  15. Witte DR, "Risk factors for cardiac autonomic neuropathy in type 1 diabetes mellitus", Diabetologia, 48, pp.164~171 (2005)
  16. Stella P, "Cardiovascular autonomic neuropathy (expiration and inspiration ratio)in type 1 diabetes. Incidence and predictors", J Diabetes Complications, 14, pp.1~6 (2000)
  17. Orchard TJ, "Why does diabetic autonomic neuropathy predict IDDM mortality? An analysis from the Pittsburgh Epidemiology of Diabetes Complications Study", Diabetes Res Clin Pract, 34(Suppl), pp.S165~S171 (1996)
  18. American Diabetes Association, "2. Classification and diagnosis of diabetes: standards of medical care in diabetes-2019", Diabetes Care, 42(Suppl 1), pp.S13~S28 (2019)
  19. Herman WH, "Use of the Michigan Neuropathy Screening Instrument as a measure of distal symmetrical peripheral neuropathy in Type 1 diabetes: results from the Diabetes Control and Complications Trial", Epidemiology of Diabetes Interventions and Complications, 2012, pp.29, 937~944
  20. Singh N, "Preventing foot ulcers in patients with diabetes", JAMA, 293, pp.217~228 (2005)
  21. Sletten DM, "COMPASS 31: a refined and abbreviated Composite Autonomic Symptom Score", Mayo Clin Proc, 87, pp.1196~1201 (2012)
  22. Spallone V, "Cardiovascular autonomic neuropathy in diabetes: clinical impact, assessment, diagnosis, and management", Diabetes Metab Res Rev, 27, pp.639~653 (2011)
  23. American Diabetes Association, "10. Microvascular complications and foot care: standards of medical care in diabetes-2018", Diabetes Care, 41(Suppl 1), pp.S105~S118 (2018)
  24. Soedamah-Muthu SS, "Relationship between risk factors and mortality in type 1 diabetic patients in Europe:the EURODIAB Prospective Complications Study (PCS)", Diabetes Care, 31, pp.1360~1366 (2008)
  25. Spallone V, "Recommendations for the use of cardiovascular tests in diagnosing diabetic autonomic neuropathy", Nutr Metab Cardiovasc Dis, 21, pp.69~78 (2011)
  26. Maser RE, "Diabetic autonomic neuropathy and cardiovascular risk. Pittsburgh Epidemiology of Diabetes Complications Study III", Arch Intern Med, 150, pp.1218~1222 (1990)
  27. 김경미, "Determinants for Heart Rate Variability in a Normal Korean Population", Journal of Korean Medical Science, 26(10), pp.1293~1298 (2011), 대한의학회
  28. Jaiswal M, "Reduced heart rate variability among youth with type 1 diabetes: the SEARCH CVD study", Diabetes Care, 36, pp.157~162 (2013)
  29. Rosengård-Bärlund M, "Early autonomic dysfunction in type 1 diabetes: a reversible disorder?", Diabetologia, 52, pp.1164~1172 (2009)
  30. Wawryk AM, "Power spectral analysis of heart rate variability in children and adolescents with IDDM", Diabetes Care, 20, pp.1416~1421 (1997)
  31. Tsuji H, "Reduced heart rate variability and mortality risk in an elderly cohort. The Framingham Heart Study", Circulation, 90, pp.878~883 (1994)
  32. Singh JP, "Association of hyperglycemia with reduced heart rate variability (The Framingham Heart Study)", Am J Cardiol, 86, pp.309~312 (2000)
  33. Ziegler D, "Near-normoglycaemia and development of neuropathy: a 24-year prospective study from diagnosis of type 1 diabetes", BMJ Open, 5, pp.e006559~ (2015)
  34. Pop-Busui R, "Cardiac autonomic neuropathy in diabetes: a clinical perspective", Diabetes Care, 33, pp.434~441 (2010)
  35. Andersen ST, "Risk factors for the presence and progression of cardiovascular autonomic neuropathy in type 2 diabetes: ADDITION-Denmark", Diabetes Care, 41, pp.2586~2594 (2018)
  36. Orlov S, "Cardiac autonomic neuropathy and early progressive renal decline in patients with nonmacroalbuminuric type 1 diabetes", Clin J Am Soc Nephrol, 10, pp.1136~1144 (2015)
  37. Straub RH, "Impact of disease duration on cardiovascular and pupillary autonomic nervous function in IDDM and NIDDM patients", Diabetes Care, 19, pp.960~967 (1996)
  38. Piha SJ, "Effect of disease duration on cardiac autonomic reflexes in young patients with insulin-dependent diabetes mellitus", Diabetes Res Clin Pract, 18, pp.61~67 (1992)

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