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Diabetic Cardiovascular Autonomic Neuropathy

Emilie H Zobel, Philip Hasbak, Signe A Winther, Christian Stevns, Jesper Fleischer, Bernt J von Scholten, Lene Holmvang, Andreas Kjaer, Peter Rossing, Tine W Hansen
The link between cardiac autonomic neuropathy and risk of cardiovascular disease is highlighted as an area in which research is needed. This study was undertaken to evaluate the association between measures of cardiac autonomic function and cardiac vascular function in type 1 diabetes using new and sensitive methods.Cross-sectional study in type 1 diabetes, stratified by normoalbuminuria (n=30) and macroalbuminuria (n=30), and in healthy controls (n=30). Cardiac autonomic function was evaluated using heart rate variability (HRV) indices, cardiovascular autonomic reflex tests (CARTs) and cardiac 123 I-metaiodobenzylguanidine (MIBG) imaging...
March 12, 2019: Diabetes
Ji Eun Jun, Seung-Eun Lee, Min Sun Choi, Sung Woon Park, You-Cheol Hwang, Jae Hyeon Kim
BACKGROUND: Cardiovascular autonomic neuropathy (CAN) is a major cause of morbidity and mortality in diabetes patients. Although several risk factors for CAN progression have been established, whether CAN is reversible remains unclear and the clinical factors associated with CAN recovery have not been identified. This study aimed to determine clinical factors related to CAN recovery. METHODS: Type 2 diabetes patients with CAN but free of cardiovascular disease at baseline were enrolled and followed for 2-3 years in this retrospective longitudinal study...
March 11, 2019: Cardiovascular Diabetology
Łukasz Pawliński, Joanna Gastoł, Mateusz Fiema, Bartłomiej Matejko, Beata Kieć-Wilk
INTRODUCTION: Long-term poor metabolic control promotes the occurrence of microvascular complications, such cardiovascular autonomic neuropathy and atherogenic hyperlipidaemia, which translates into increased mortality in patients with type 1 diabetes (T1DM). AIMS: To assess the prevalence of cardiovascular autonomic neuropathy (CAN) in patients with T1DM in relation to treatment method (continuous subcutaneous insulin infusion (CSII) versus multiple daily injections using pens (MDI)) and lipid control...
March 7, 2019: Endokrynologia Polska
Mariana de Oliveira Gois, Alberto Porta, Rodrigo Polaquini Simões, Vandeni Clarice Kunz, Patricia Driusso, Humberto Sadanobu Hirakawa, Beatrice De Maria, Aparecida Maria Catai
Both deterioration of the mechanical vascular properties of barosensitive vessels and autonomic derangement lead to modification of baroreflex sensitivity (BRS) in coronary artery disease (CAD) individuals. Type 2 diabetes (T2D) reduces BRS as well even in absence of cardiac autonomic neuropathy. The aim of the study is to clarify whether, assigned the degree of mechanical vascular impairment and without cardiac autonomic neuropathy, the additional autonomic dysfunction imposed in CAD patients by T2D (CAD-T2D) decreases BRS further...
March 7, 2019: Medical & Biological Engineering & Computing
Masaya Sakamoto, Daisuke Matsutani, Yosuke Kayama
The evaluation of baroreflex sensitivity (BRS), which maintains systemic circulatory homeostasis, is an established tool to assess cardiovascular autonomic neuropathy in type 2 diabetes mellitus (T2DM). As BRS plays an important function in blood pressure regulation, reduced BRS leads to an increase in blood pressure variability, which further leads to reduced BRS. This sequence of events becomes a vicious cycle. The major risk factors for reduced BRS are T2DM and essential hypertension, but many other risk factors have been reported to influence BRS...
February 22, 2019: International Heart Journal
Vincenza Spallone
The burden of diabetic cardiovascular autonomic neuropathy (CAN) is expected to increase due to the diabetes epidemic and its early and widespread appearance. CAN has a definite prognostic role for mortality and cardiovascular morbidity. Putative mechanisms for this are tachycardia, QT interval prolongation, orthostatic hypotension, reverse dipping, and impaired heart rate variability, while emerging mechanisms like inflammation support the pervasiveness of autonomic dysfunction. Efforts to overcome CAN under-diagnosis are on the table: by promoting screening for symptoms and signs; by simplifying cardiovascular reflex tests; and by selecting the candidates for screening...
February 2019: Diabetes & Metabolism Journal
Shruti Agashe, Steven Petak
Cardiovascular autonomic neuropathy (CAN) is a severely debilitating yet underdiagnosed condition in patients with diabetes. The prevalence can range from 2.5% (based on the primary prevention cohort in the Diabetes Control and Complications Trial) to as high as 90% of patients with type 1 diabetes. Clinical manifestations range from orthostasis to myocardial infarction. The diagnosis is made using multiple autonomic function tests to assess both sympathetic and parasympathetic function. The pathophysiology of CAN is complex, likely multifactorial, and not completely understood...
October 2018: Methodist DeBakey Cardiovascular Journal
Lía Nattero-Chávez, Sandra Redondo López, Sara Alonso Díaz, Marta Garnica Ureña, Elena Fernández-Durán, Héctor F Escobar-Morreale, Manuel Luque-Ramírez
CONTEXT: Cardiovascular autonomic (CAN) neuropathy appears to contribute to peripheral arterial stiffness (AS) in type 1 diabetes. If CAN in patients with AS is associated to concomitant asymptomatic atherosclerotic disease (aPAD) remains unclear. OBJECTIVE: To assess the risk of CAN in patients with type 1 diabetes and AS and its potential association to atherosclerosis. DESIGN: Cross-sectional study. SETTING: Type 1 Diabetes clinic from an academic hospital...
February 20, 2019: Journal of Clinical Endocrinology and Metabolism
Shazli Azmi, Maryam Ferdousi, Alise Kalteniece, Hamad Al-Muhannadi, Abdulrahman Al-Mohamedi, Nebras H Hadid, Salah Mahmoud, Harun A Bhat, Hoda Y A Gad, Adnan Khan, Georgios Ponirakis, Ioannis N Petropoulos, Uazman Alam, Rayaz A Malik
The diagnosis and management of diabetic neuropathy can be a major challenge. Late diagnosis contributes to significant morbidity in the form of painful diabetic neuropathy, foot ulceration, amputation, and increased mortality. Both hyperglycaemia and cardiovascular risk factors are implicated in the development of somatic and autonomic neuropathy and an improvement in these risk factors can reduce their rate of development and progression. There are currently no US Food and Drug Administration (FDA)-approved disease-modifying treatments for either somatic or autonomic neuropathy, as a consequence of multiple failed phase III clinical trials...
2019: Therapeutic Advances in Endocrinology and Metabolism
Chuhui Chen, Weimin Wang, Wen Zhou, Jiewen Jin, Wei Chen, Dalong Zhu, Yan Bi
BACKGROUND: Cardiovascular autonomic neuropathy (CAN) is a risk factor for arrhythmias and adverse cardiovascular events, but the relation between the severity of CAN progression and nocturnal arrhythmias needs to be furthermore clarified. The following study aims to evaluate the association between nocturnal arrhythmias and severity of CAN in patients with type 2 diabetes. METHODS: 219 type 2 diabetes patients were recruited from January 2017 to May 2018. Subjects were classified into no CAN (NCAN), early CAN (ECAN), definite CAN (DCAN) or advanced CAN (ACAN) according to cardiovascular autonomic reflex tests (CARTs)...
February 15, 2019: Journal of Diabetes
Ikaro Soares Santos Breder, Andrei C Sposito
Diabetes is one of the most common chronic pathologies around the world, involving treatment with general clinicians, endocrinologists, cardiologists, ophthalmologists, nephrologists and a multidisciplinary team. Patients with type 2 Diabetes Mellitus (T2DM) can be affected by cardiac autonomic neuropathy, leading to increased mortality and morbidity. In this review, we will present current concepts, clinical features, diagnosis, prognosis, and possible treatment. New drugs recently developed to reduce glycemic level presented a pleiotropic effect of reducing sudden death, suggesting a potential use in patients at risk...
January 2019: Revista da Associação Médica Brasileira
Mirinae Kim, Rae-Young Kim, Joo-Young Kim, Young-Hoon Park
This study was conducted to assess whether systemic arterial stiffness, indicated by cardio-ankle vascular index (CAVI), is related to changes in the microvasculature of the retina and choroid in diabetes mellitus (DM). This study included 113 patients with a confirmed diagnosis of type-2 DM. Among them, 18 patients did not have diabetic retinopathy (DR), 71 had non-proliferative DR (NPDR), and 24 had proliferative DR (PDR). The mean CAVI was 7.58 ± 1.41 in no DR, 8.72 ± 1.47 in NPDR, and 8.43 ± 1...
February 4, 2019: Scientific Reports
Anna Shalimova, Beata Graff, Dariusz Gasecki, Jacek Wolf, Agnieszka Sabisz, Edyta Szurowska, Krzysztof Jodzio, Krzysztof Narkiewicz
Context: The review summarizes key studies assessing epidemiology, mechanisms, and consequences of cognitive dysfunction (CD) in type 1 diabetes (DM1). Evidence Synthesis: In a number of studies, the severity of CD in DM1 was affected by the age of onset and diabetes duration, the presence of proliferative retinopathy and autonomic neuropathy. Diabetes-related CD has been observed not only in adults but also in children and adolescents. Most neuroimaging studies in DM1 did not show any differences in whole brain volumes, however, they did reveal selective deficits in grey matter volume or density within the frontal, posterior and temporal cortex, subcortical grey matter...
January 18, 2019: Journal of Clinical Endocrinology and Metabolism
Márta Zsoldos, Attila Pajor, Henriette Pusztafalvi
The prevalence of the metabolic syndrome, type 2 diabetes mellitus, cardiovascular diseases, obesity and depression have increased during the recent years. As the sexual dysfunction is also frequent, we aimed to search for the associations between sexual dysfunction and the metabolic syndrome and its components, respectively, by reviewing the literature. The clinical and biochemical components of the metabolic syndrome included cardiovascular disease, type 2 diabetes mellitus, visceral obesity and depression, furthermore, insulin resistance, atherogenic lipid profile, hypogonadism, chronic systemic inflammation and endothelial dysfunction were all demonstrated to affect adversely the sexual function...
January 2019: Orvosi Hetilap
Sharon Nina Admoni, Daniele Pereira Santos-Bezerra, Ricardo Vesoni Perez, Thiago Andrade Patente, Maria Beatriz Monteiro, Ana Mercedes Cavaleiro, Maria Candida Parisi, Arnaldo Moura Neto, Elizabeth Joao Pavin, Marcia Silva Queiroz, Marcia Nery, Maria Lucia Correa-Giannella
Cardiac autonomic neuropathy is a neglected diabetic chronic complication for which genetic predictors are rarely reported. Oxidative stress is implicated in the pathogenesis of microvascular complications, and glutathione peroxidase 4 is involved in the detoxification of peroxides and of reactive oxygen species. Thus, the association of a functional variant in the gene encoding glutathione peroxidase 4 (rs713041) with this diabetic complication was investigated in 341 individuals with type 1 diabetes evaluated for cardiac autonomic neuropathy status (61...
January 1, 2019: Diabetes & Vascular Disease Research
Michael Böhm, Helmut Schumacher, Koon K Teo, Eva M Lonn, Felix Mahfoud, Christian Ukena, Johannes F E Mann, Giuseppe Mancia, Josep Redon, Roland E Schmieder, Karen Sliwa, Nikolaus Marx, Michael A Weber, Bryan Williams, Salim Yusuf
Aims: Resting heart rate (RHR) has been shown to be associated with cardiovascular outcomes in various conditions. It is unknown whether different levels of RHR and different associations with cardiovascular outcomes occur in patients with or without diabetes, because the impact of autonomic neuropathy on vascular vulnerability might be stronger in diabetes. Methods and results: We examined 30 937 patients aged 55 years or older with a history of or at high risk for cardiovascular disease and after myocardial infarction, stroke, or with proven peripheral vascular disease from the ONTARGET and TRANSCEND trials investigating ramipril, telmisartan, and their combination followed for a median of 56 months...
December 24, 2018: European Heart Journal
Lina A AlOlaiwi, Turki J AlHarbi, Ayla M Tourkmani
INTRODUCTION: Cardiovascular autonomic neuropathy (CAN) and gastroparesis are two types of diabetic autonomic neuropathy which could affect patients' quality of life and carry significant morbidity and mortality outcomes. The aim of this study was to estimate the prevalence and risk factors of both CAN and gastroparesis symptoms among patients with type 2 diabetes mellitus (T2DM) at primary health care level. METHODS: A cross-sectional study was conducted among 400 adults with T2DM from April 1, 2017 to March 20, 2018...
2018: PloS One
Daniele Pereira Santos-Bezerra, Sharon Nina Admoni, Rosana Cristina Mori, Tatiana Souza Pelaes, Ricardo Vesoni Perez, Cleide Guimarães Machado, Maria Beatriz Monteiro, Maria Candida Parisi, Elizabeth Joao Pavin, Marcia Silva Queiroz, Marisa Passarelli, Ubiratan Fabres Machado, Maria Lucia Correa-Giannella
AIMS/INTRODUCTION: Epigenetics participate in the pathogenesis of metabolic memory, a situation in which hyperglycemia exerts prolonged deleterious effects even after its normalization. We tested the hypothesis that genetic variants in an epigenetic gene could predispose to diabetes complications. MATERIAL AND METHODS: We assessed the frequency of 5 single nucleotide polymorphisms (SNPs) in the gene encoding DNA methytransferase 1 (DNMT1; rs8112895, rs7254567, rs11085721, rs17291414, and rs10854076) and their associations with diabetic kidney disease, retinopathy, distal polyneuropathy and autonomic cardiovascular neuropathy (CAN) in 359 long-term Type 1 diabetes individuals...
December 11, 2018: Journal of Diabetes Investigation
Alina Mihaela Leustean, Manuela Ciocoiu, Anca Sava, Claudia Florida Costea, Mariana Floria, Claudia Cristina Tarniceriu, Daniela Maria Tanase
The prevalence of diabetes is steadily rising, and once it occurs, it can cause multiple complications with a negative impact on the whole organism. Complications of diabetes may be macrovascular: such as stroke and ischemic heart disease as well as peripheral vascular and microvascular diseases-retinopathy, nephropathy, and neuropathy. Key factors that cause cardiovascular disease in people with diabetes include hyperglycemia, dyslipidemia, obesity, insulin resistance, inflammation, hypertension, autonomic dysfunction, and decreased vascular response capacity...
2018: Journal of Diabetes Research
Guillaume Bassil, Mengmeng Chang, Audrys Pauza, Jesus Diaz Vera, Athanasios Tsalatsanis, Bruce G Lindsey, Sami F Noujaim
Background Cardiac autonomic neuropathy is thought to cause adverse cardiovascular effects in diabetes mellitus. Pulmonary vein ganglia ( PVG ), which have been implicated in normal and abnormal heart rhythm regulation, have not been fully investigated in type 1 diabetes mellitus (T1D). We examined the functional and anatomical effects of T1D on PVG and studied the details of T1D-induced remodeling on the PVG structure and function. Methods and Results We used a mouse model of T1D (Akita mouse), immunofluorescence, isolated Langendorff-perfused hearts, and mathematical simulations to explore the effects of T1D on PVG ...
December 4, 2018: Journal of the American Heart Association
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