Predictors of Cardiovascular Autonomic Neuropathy Onset and Progression in a Cohort of Type 1 Diabetic Patients
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...
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| Format: | Article |
| Language: | English |
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Wiley
2018-01-01
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| Series: | Journal of Diabetes Research |
| Online Access: | http://dx.doi.org/10.1155/2018/5601351 |
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| author | M. Matta A. Pavy-Le Traon S. Perez-Lloret C. Laporte I. Berdugo N. Nasr H. Hanaire J. M. Senard |
| author_facet | M. Matta A. Pavy-Le Traon S. Perez-Lloret C. Laporte I. Berdugo N. Nasr H. Hanaire J. M. Senard |
| author_sort | M. Matta |
| collection | DOAJ |
| description | 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. |
| format | Article |
| id | doaj-art-76fc2cfead6a45fa819602cc4d9b9486 |
| institution | Kabale University |
| issn | 2314-6745 2314-6753 |
| language | English |
| publishDate | 2018-01-01 |
| publisher | Wiley |
| record_format | Article |
| series | Journal of Diabetes Research |
| spelling | doaj-art-76fc2cfead6a45fa819602cc4d9b94862025-02-03T07:25:54ZengWileyJournal of Diabetes Research2314-67452314-67532018-01-01201810.1155/2018/56013515601351Predictors of Cardiovascular Autonomic Neuropathy Onset and Progression in a Cohort of Type 1 Diabetic PatientsM. Matta0A. Pavy-Le Traon1S. Perez-Lloret2C. Laporte3I. Berdugo4N. Nasr5H. Hanaire6J. M. Senard7Service de Diabétologie et maladies métaboliques, CHU de Toulouse, 1 avenue Jean Poulhès, 31059 Toulouse Cedex 9, FranceService de Neurologie, Hôpital Pierre-Paul Riquet, Place du Docteur Baylac-TSA 40031, 31059 Toulouse Cedex 9, FranceInstitute of Cardiology Research, University of Buenos Aires, National Research Council (CONICET-ININCA), Buenos Aires, ArgentinaService de Diabétologie et maladies métaboliques, CHU de Toulouse, 1 avenue Jean Poulhès, 31059 Toulouse Cedex 9, FranceService de Diabétologie et maladies métaboliques, CHU de Toulouse, 1 avenue Jean Poulhès, 31059 Toulouse Cedex 9, FranceService de Neurologie, Hôpital Pierre-Paul Riquet, Place du Docteur Baylac-TSA 40031, 31059 Toulouse Cedex 9, FranceService de Diabétologie et maladies métaboliques, CHU de Toulouse, 1 avenue Jean Poulhès, 31059 Toulouse Cedex 9, FranceInstitut des Maladies Métaboliques et Cardiovasculaires, INSERM, Université de Toulouse, 1 avenue Jean Poulhès, BP 84225, 31432 Toulouse Cedex 4, FranceAim. 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.http://dx.doi.org/10.1155/2018/5601351 |
| spellingShingle | M. Matta A. Pavy-Le Traon S. Perez-Lloret C. Laporte I. Berdugo N. Nasr H. Hanaire J. M. Senard Predictors of Cardiovascular Autonomic Neuropathy Onset and Progression in a Cohort of Type 1 Diabetic Patients Journal of Diabetes Research |
| title | Predictors of Cardiovascular Autonomic Neuropathy Onset and Progression in a Cohort of Type 1 Diabetic Patients |
| title_full | Predictors of Cardiovascular Autonomic Neuropathy Onset and Progression in a Cohort of Type 1 Diabetic Patients |
| title_fullStr | Predictors of Cardiovascular Autonomic Neuropathy Onset and Progression in a Cohort of Type 1 Diabetic Patients |
| title_full_unstemmed | Predictors of Cardiovascular Autonomic Neuropathy Onset and Progression in a Cohort of Type 1 Diabetic Patients |
| title_short | Predictors of Cardiovascular Autonomic Neuropathy Onset and Progression in a Cohort of Type 1 Diabetic Patients |
| title_sort | predictors of cardiovascular autonomic neuropathy onset and progression in a cohort of type 1 diabetic patients |
| url | http://dx.doi.org/10.1155/2018/5601351 |
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