Vol 7, No 6 (2006): Practical Diabetology
Research paper
Published online: 2006-10-18
Relationship between glucose control and cardiovascular neuropathy in patients with diabetes type 1 during a two year observational study
Diabetologia Praktyczna 2006;7(6):366-371.
Abstract
INTRODUCTION. The autonomic cardiovascular neuropathy (CVN) in diabetes is associated with an increased
risk of poor clinical prognosis. The aim of the study was to find a relationship between glucose
control during 2 year follow-up and changes of parameters of the autonomic nervous system (ANS).
MATERIAL AND METHODS. 98 patients with diabetes type 1 were enrolled into the study: 53 women and 45 men, mean age at initial examination was 34.0 ± 10.1 years, mean duration of diabetes was 14.4 ± 9.9 years. Autonomic function tests (AFTs) were assessed by the use of the computer device ProSciCard (Linden, Germany). The ATFS measured were time and frequency domain of heart rate variability at 5 minutes rest (HRR, SDRRR, CVR, RMSSDR, VLFR, LFR, HFR, LF/HF), deep breathing test (HRDB, SDRRDB, CVDB, RMSSDDB, RRMAX/MIN DB, RRMAX-MIN DB, MCRDB), Valsalva test (VINDEX), heart rate and blood pressure response to lying to standing test (EINDEX, Pio ∆ SCTK 1’, Pio ∆ SCTK 5’) and sustained handgrip test (Dyn ∆ RCTK 2’, Dyn ∆ RCTK 5’). These examinations were repeated after 24 months. The relative changes in values of the ProSciCard parameters as well as the absolute changes of the values of blood pressure tests were computed. Metabolic compensation of diabetes was assessed by measuring the mean glycated haemoglobin which was taken every 6 months during study. The Spearman’s correlation r test was computed between mean HbA1c and the change of values of ATF’s after 2 years. Separately, the total group of patients along with the subgroup with and without signs of CVN at baseline were analysed.
RESULTS. In the group of all patients and those without CVN at baseline we found a statistically significant positive correlation between mean HbA1c and relative change of HRR r = 0.198 (p = 0.050) and r = 0.284
(p = 0.027) respectively. A statistically significant negative correlation between mean HbA1c and relative change of RRMAX-MIN DB r = –0.218
(p = 0.031) and r = –0.272 (p = 0.034) respectively in the group of all patients and those without CVN at baseline was also found. Moreover we found a negative correlation between mean HbA1c and relative change of RMSSDDB r = –0.285 (p = 0.026) in the group without signs of CVN at baseline.
CONCLUSIONS. Metabolic compensation of diabetes is a very important factor determining the course of CVN. Perfect metabolic control of the disease can improve function of the autonomic nervous system.
MATERIAL AND METHODS. 98 patients with diabetes type 1 were enrolled into the study: 53 women and 45 men, mean age at initial examination was 34.0 ± 10.1 years, mean duration of diabetes was 14.4 ± 9.9 years. Autonomic function tests (AFTs) were assessed by the use of the computer device ProSciCard (Linden, Germany). The ATFS measured were time and frequency domain of heart rate variability at 5 minutes rest (HRR, SDRRR, CVR, RMSSDR, VLFR, LFR, HFR, LF/HF), deep breathing test (HRDB, SDRRDB, CVDB, RMSSDDB, RRMAX/MIN DB, RRMAX-MIN DB, MCRDB), Valsalva test (VINDEX), heart rate and blood pressure response to lying to standing test (EINDEX, Pio ∆ SCTK 1’, Pio ∆ SCTK 5’) and sustained handgrip test (Dyn ∆ RCTK 2’, Dyn ∆ RCTK 5’). These examinations were repeated after 24 months. The relative changes in values of the ProSciCard parameters as well as the absolute changes of the values of blood pressure tests were computed. Metabolic compensation of diabetes was assessed by measuring the mean glycated haemoglobin which was taken every 6 months during study. The Spearman’s correlation r test was computed between mean HbA1c and the change of values of ATF’s after 2 years. Separately, the total group of patients along with the subgroup with and without signs of CVN at baseline were analysed.
RESULTS. In the group of all patients and those without CVN at baseline we found a statistically significant positive correlation between mean HbA1c and relative change of HRR r = 0.198 (p = 0.050) and r = 0.284
(p = 0.027) respectively. A statistically significant negative correlation between mean HbA1c and relative change of RRMAX-MIN DB r = –0.218
(p = 0.031) and r = –0.272 (p = 0.034) respectively in the group of all patients and those without CVN at baseline was also found. Moreover we found a negative correlation between mean HbA1c and relative change of RMSSDDB r = –0.285 (p = 0.026) in the group without signs of CVN at baseline.
CONCLUSIONS. Metabolic compensation of diabetes is a very important factor determining the course of CVN. Perfect metabolic control of the disease can improve function of the autonomic nervous system.
Keywords: cardiovascularneuropathyglycaemic control