Clinical Implications of Simple Parameters for Prediction of Progression of Diabetic Cardiovascular Autonomic Neuropathy
Abstract Number: 2271-PO
Authors: JI HYUN KIM, JUNG MIN LEE, HYUN SHIC SON, SANG AH CHANG
Institutions: Seoul, Korea, Republic of
Results: Cardiovascular autonomic neuropathy (CAN) is closely related to mortality caused by cardiovascular disease in patients with Type 2 diabetes (T2DM). Cardiovascular autonomic dysfunction can be measured by autonomic function test (AFT), but this test is time consuming and expensive. The aim of this study is the evaluation of simple clinical parameters associated with progression of CAN.
Annual cardiovascular autonomic function tests were conducted in 77 patients with T2DM for more than 4 years. Standard tests for CAN measured heart rate variability parameters (expiration-to-inspiration [E/I] ratio, responses to the Valsalva maneuver and standing). Using the American Diabetes Association criteria, the CAN scores were determined from the results of each test as follows: 0 for normal and 1 for abnormal (total maximum score 3). We assessed the increase of total score of CAN together with the changes of blood glucose control status (HbA1c < 8% or ≥ 8%) and urine albumin excretion (overt albuminuria ≥ 30μg/mgCr or not) for detecting trends by using repeated ANOVA measures and χ2 testing.
During the follow-up period, total score of CAN increased in both A1C status, especially showing the highest increase at fourth year in patients with HbA1c ≥ 8% (P= 0.001). But, there was no significant difference between two groups (P=0.179). In patients with overt albuminuria, significant progression of cardiovascular autonomic dysfunction was shown compared with those without, predominantly at fourth year (P=0.000), although these scores also tended to deteriorate with time in both groups (P=0.007).
Progression of cardiovascular autonomic dysfunction was strongly associated with development of overt albuminuria in patients with T2DM. These results demonstrated that the measurement of urine albumin excretion may be useful to predict deterioration of CAN and determine the time to perform AFT more simply in practice. Without the changes of urine albumin excretion, it can be suggested to perform AFT every 4 years.