Evaluation of frequency of cardiac autonomic neuropathy in patients with type 1 diabetes mellitus attending a tertiary referral hospital
Keywords:Cardiac Autonomic Neuropathy, Micro vascular complications association, Type 1Diabetes Mellitus, Valsalva manoeuvre, Resting tachycardia
Objective: To determine the frequency of Cardiac Autonomic Neuropathy (CAN) in patients with Type 1 Diabetes Mellitus and its relation to various microvascular complications. Study Design: Descriptive study conducted at Institute of Diabetology, Madras Medical College between May 2015 to July 2015. Methodology: Patients with Type 1 Diabetes Mellitus of at least 1-year duration were selected. CAN was evaluated in terms of parasympathetic and sympathetic involvement by standardized computer software and results were obtained as Normal, Early, Moderate and Definite Cardiac Autonomic Neuropathy involvement. The overall frequency & intersex variation of CAN was assessed. The association between CAN, diabetic control and duration of diabetes were determined. The relative frequency of CAN with various microvascular complications was also studied. Result: The mean age was 28.72 ± 11.19 years with male to female ratio of 1:1. Mean values for duration of diabetes and HbA1c were 11 ± 8.48 years and 7.71 ± 1.96 % respectively. The presence of Normal, Early, Moderate and Definite CAN involvement was 16%, 50%, 10% and 24% respectively in overall study group. The frequency in male patients was 16%, 48%, 16% and 20% and in female patients was 16%, 52%, 4% and 28% respectively. There was no Definite CAN involvement but Moderate CAN involvement was seen in 6% of patients with ≤ 5 years duration of Diabetes (16 patients). 12% and 35% of patients with > 5 years of disease (34 patients) had Moderate and Definite CAN involvement respectively. Moderate & Definite CAN (Severe forms) were significantly related to duration of disease (p < 0.05). Among CAN positive patients 14% patients had retinopathy, 9.5% of patients had nephropathy and nearly 30% patients had neuropathy. Conclusion: CAN is common among long-standing Type 1 diabetes patients. Early CAN involvement was more common than other grades of CAN and there was no statistically significant sex predilection. Severe forms of CAN were significantly related to duration of the disease. Among microvascular complications Peripheral Neuropathy was more commonly associated with Cardiac Autonomic Neuropathy than Retinopathy and Nephropathy (p <0.05).
Singh AK, Gupta R, Ghosh A, Misra A. Diabetes in COVID-19: Prevalence, pathophysiology, prognosis and practical considerations. Diabetes Metab Syndr. 2020; 14:303–310.
Shenoy A, Ismaily M, Bajaj M. Diabetes and covid-19: a global health challenge. BMJ Open Diabetes Research Care.2020;8(1): e001450. doi:10.1136/bmjdrc-2020–001450.
Angelidi AM, Belanger MJ, Mantzoros CS. COVID-19 and diabetes mellitus: what we know, how our patients should be treated now, and what should happen next. Metabolism. 2020; 107:154245. doi: 10.1016/j.metabol.2020.154245.
Gentile S, Strollo F, Ceriello A. COVID-19 infection in Italian people with diabetes: Lessons learned for our future (an experience to be used). Diabetes Res Clin Pract. 2020; 162:108137. doi: 10.1016/j.diabres.2020.108137.
Muniyappa R, Gubbi S. COVID-19 pandemic, coronaviruses, and diabetes mellitus. Am J Physiol Endocrinol Metab. 2020;318: E736–E741.
Centers for Disease Control and Prevention. National Diabetes Statistics Report, 2020. Atlanta, GA: Centers for Disease Control and Prevention, US Department of Health and Human Services, 2020.
Yang JK, Feng Y, Yuan MY, et al. Plasma glucose levels and diabetes are independent predictors for mortality and morbidity in patients with SARS. Diabet Med.2006; 23: 623–628.
WHO, Coronavirus disease (COVID-19) technical guidance. WHO (Accessed on March 4, 2020) Online Version, 2020.
Pearson-Stuttard J, Blundell S, Harris T, Cook DG, Critchley J. Diabetes and infection: assessing the association with glycaemic control in population-based studies. Lancet Diabetes Endocrinol. 2016; 4148–158.
Li S, Wang J, Zhang B, Li X, Liu Y. Diabetes Mellitus and Cause-Specific Mortality: A Population-Based Study. Diabetes Metab J. 2019; 43:319–341.
Hassan DM, Mohammed AM, Bevington J (2019) SMART Population Screening and Management in Qatar. Int J Diabetes Clin Res 6:099. doi.org/10.23937/2377- 3634/1410099.
Guan WJ, Ni ZY, Hu Y, et al. Clinical Characteristics of Coronavirus Disease 2019 in China. N Engl J Med. 2020; 382:1708–1720.
Fadini GP, Morieri ML, Longato E, Avogaro A. Prevalence and impact of diabetes among people infected with SARSCoV-2. J Endocrinol Invest. 2020; 43:867–869.
Tay MZ, Poh CM, Rénia L, MacAry PA, Ng LFP. The trinity of COVID-19: immunity, inflammation and intervention. Nat Rev Immunol. 2020;20(:363–374.
Kohio HP, Adamson AL. Glycolytic control of vacuolartype ATPase activity: a mechanism to regulate influenza viral infection. Virology. 2013; 444:301–309.
Jialin Xiang, Jing Wen, Viaoquing Yuvan. Potential biochemical markers to identify severe cases among COVID-19 patients. BMJ. 2020; 23.
Xu L, Mao Y, Chen G. Risk factors for 2019 novel coronavirus disease (COVID-19) patients progressing to critical illness: a systematic review and metaanalysis. Aging (Albany NY). 2020;12(12):12410–12421. doi:10.18632/aging. 103383
Ji M, Yuan L, Shen W, et al. Characteristics of disease progress in patients with coronavirus disease 2019 in Wuhan, China. Epidemiol Infect. 2020;148: e94. doi:10.1017/S0950268820000977
Chen G, Wu D, Guo W, et al. Clinical and immunological features of severe and moderate coronavirus disease 2019. J Clin Invest. 2020;130(5):2620– 2629. doi:10.1172/JCI137244
Zhang B, Zhou X, Qiu Y, et al. Clinical characteristics of 82 death cases with COVID-19. PLoS One. 2020;15(7): e0235458. doi: 10.1371/journal.pone. 0235458
Hu Y, Zhan C, Chen C, Ai T, Xia L (2020) Chest CT findings related to mortality of patients with COVID-19: A retrospective case-series study. PLoS ONE 15(8): e0237302
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