Predictors of Cardiovascular Autonomic Neuropathy Onset and Progression in a Cohort of Type 1 Diabetic Patients

• Published in: Journal of diabetes research Vol. 2018; no. 2018; pp. 1 - 8
• Main Authors: Senard, J. M., Nasr, N., Berdugo, I., Laporte, C., Perez-Lloret, S., Pavy-Le Traon, A., Matta, M., Hanaire, H.
• Format: Journal Article
• Language: English
• Published: Cairo, Egypt Hindawi Publishing Corporation 01-01-2018; Hindawi; Hindawi Limited
• Subjects: Adult; Age; Autonomic Nervous System - physiopathology; Autonomic Nervous System Diseases - diagnosis; Autonomic Nervous System Diseases - etiology; Autonomic Nervous System Diseases - physiopathology; Blood pressure; Body Mass Index; Cardiac stress tests; Cardiovascular Diseases - diagnosis; Cardiovascular Diseases - etiology; Cardiovascular Diseases - physiopathology; Cardiovascular System - innervation; Chi-Square Distribution; Diabetes; Diabetes Mellitus, Type 1 - complications; Diabetes Mellitus, Type 1 - diagnosis; Diabetic Neuropathies - diagnosis; Diabetic Neuropathies - etiology; Diabetic Neuropathies - physiopathology; Diabetic neuropathy; Disease Progression; Erectile dysfunction; Female; Humans; Hypertension; Hypotension; Insulin; Ischemia; Laboratories; Logistic Models; Male; Middle Aged; Multivariate Analysis; Neurologic Examination; Odds Ratio; Peripheral neuropathy; Risk Factors; Serotonin Uptake Inhibitors - adverse effects; Smoking; Statistical analysis; Time Factors; Variables
• ISSN: 2314-6745; 2314-6753
• DOI: 10.1155/2018/5601351

Aim. The prevalence of cardiovascular autonomic neuropathy (CAN) in diabetes mellitus is well documented. However, the rate and predictors of both the development and progression of CAN have been less studied. Hereby, we assessed the rate and the major risk factors for CAN initiation and progression in a cohort of type 1 diabetic patients followed over a three-year period. Methods. 175 type 1 diabetic patients (mean age: 50 ± 11 years; female/male: 76/99) with positive bedside screening for CAN were included and underwent 2 standardized autonomic testings using 4 standardized tests (deep breathing, Valsalva maneuver, 30/15 ratio, and changes in blood pressure during standing), separated by 3 ± 1 years. CAN staging was achieved according to the Toronto Consensus Panel on Diabetic Autonomic Neuropathy into 4 categories: absent, possible, confirmed, or severe CAN. Results. Out of the 175 patients included, 31.4% were free of CAN, 34.2% had possible CAN, 24.6% had confirmed CAN, and 9.7% exhibited severe CAN at the first assessment. Among the 103 patients with nonsevere CAN at inclusion, forty-one (39.8%) had an increase of at least one category when reassessed and 62 (60.2%) remained stable. A bivariate analysis indicated that only BMI and exposure to selective serotonin reuptake inhibitors (SSRIs) were significantly different in both groups. A multivariate analysis indicated that lower BMI (OR: 0.15, CI 95%: 0.05–0.48, p=0.003) and SSRI exposure (OR: 4.18, CI 95%: 1.03–16.97, p=0.04) were the sole predictors of CAN deterioration. In the 55 patients negative for CAN at the first laboratory assessment, 12 became positive at the second assessment. Conclusion. No clear predictive factor for CAN onset was identified. However, once present, CAN progression was related to low BMI and SSRI exposure.