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LETTER TO THE EDITOR
Year : 2011  |  Volume : 15  |  Issue : 5  |  Page : 67-68

Diabetic cardiac autonomic neuropathy in well-controlled diabetics within 1 year of diagnosis


Department of Medicine, Jinnah-Allama Iqbal Institute of Diabetes and Endocrinology, Lahore, Pakistan

Date of Web Publication20-Jul-2011

Correspondence Address:
Ali Jawa
Jinnah-Allama Iqbal Institute of Diabetes and Endocrinology, Lahore-54550
Pakistan
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2230-8210.83045

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How to cite this article:
Jawa A, Bokhari R, Jawad A, Akram J. Diabetic cardiac autonomic neuropathy in well-controlled diabetics within 1 year of diagnosis. Indian J Endocr Metab 2011;15, Suppl S1:67-8

How to cite this URL:
Jawa A, Bokhari R, Jawad A, Akram J. Diabetic cardiac autonomic neuropathy in well-controlled diabetics within 1 year of diagnosis. Indian J Endocr Metab [serial online] 2011 [cited 2019 Nov 19];15, Suppl S1:67-8. Available from: http://www.ijem.in/text.asp?2011/15/5/67/83045

Sir,

Diabetic Cardiac Autonomic Neuropathy (DCAN) is associated with high risk of cardiovascular morbidity and mortality. [1] Several methods have been devised to assess cardiac autonomic neuropathy such as measurement of resting heart rate (HR), HR variability, etc. Reduced HR variability has been associated with increased cardiac events in diabetic subjects. [2] Portable ANSiscope is a device that noninvasively measures the parasympathetic/sympathetic nervous system imbalance in an office setting. The ANSiscope computes a percentage of dysautonomia from a recording of 571 RR intervals termed ANS index.

Based on scoring described by Bellavere et al., [3] five risk categories have been identified using the computed ANS Index. Subjects with ANS index <11%, 11-20%, 21-50%, 51-60% and 61-100% were classified into healthy, early, late, advanced, and most-advanced diabetic cardiac autonomic neuropathy (DCAN) groups, respectively. We investigated prevalence of DCAN amongst well-controlled type-2 diabetes mellitus (T2DM) subjects within 1 year of diagnosis.

After obtaining informed consent, all T2DM subjects diagnosed within the past 12-months and hemoglobin A1C (A1C) ≤7 were included in the study. Eighteen of 29 subjects recruited were female, with a mean diabetes duration of 9-months and a mean A1C of 6.3% (5.3-7.0) [Table 1]. 10/29 subjects had no DCAN, whereas 4, 11, 1, and 3 subjects had early, late, advanced, and most-advanced DCAN, respectively.
Table 1: Diabetic cardiac autonomic neuropathy profile of 29 subjects with type 2 diabetes mellitus within one year of diagnosis and an A1C of <7.0

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Our study clearly indicates that despite good glycemic control, almost two-third of recently diagnosed T2DM subjects in Pakistan have some level of DCAN. A similar study conducted in India demonstrated an even higher prevalence of DCAN, albeit using different diagnostic criteria. [4] It is a well-known fact that newly diagnosed T2DM subjects have the disease for at least 5-10 years before they are diagnosed. It is quite possible that if we diagnose diabetes earlier followed by aggressive treatment, we can prevent or reduce the morbidity associated with DCAN.

All our subjects had their diabetes under good control for at-least 3 months as indicated by an A1C<7.0. It seems that short-term good glycemic control does not reverse cardiac dysautonomia. Previous studies have shown that intensive diabetes control in type-1 diabetic subjects is associated with partial reversibility of DCAN. [5] Therefore, it would be interesting to compare the DCAN profile before and after good glycemic control.

American Diabetes Association recommends yearly screening for autonomic neuropathy in T2DM from the time of diagnosis. This cannot be accomplished efficiently unless there is a device available that is accurate and easy to use in a doctor's office setting. Portable ANSiscope seems to be a device that has the potential to meet all these needs of a busy diabetologist.

 
   References Top

1.Maser RE, Lenhard MJ. Cardiovascular autonomic neuropathy due to diabetes mellitus: Clinical manifestations, consequences, and treatment. J Clin Endocrinol Metab 2005;90:5896-903.  Back to cited text no. 1
    
2.Singh JP, Larson MG, O'Donnell CJ, Wilson PF, Tsuji H, Lloyd-Jones DM, et al. Association of hyperglycemia with reduced heart rate variability (The Framingham Heart Study). Am J Cardiol 2000;86:309-12.  Back to cited text no. 2
    
3.Bellavere F, Bosello G, Fedele D, Cardone C, Ferri M. Diagnosis and management of diabetic autonomic neuropathy. Br Med J (Clin Res Ed) 1983;287:61.  Back to cited text no. 3
    
4.Jyotsna VP, Sahoo A, Sreenivas V, Deepak KK. Prevalence and pattern of cardiac autonomic dysfunction in newly detected type 2 diabetes mellitus. Diabetes Res Clin Pract 2009;83:83-8.  Back to cited text no. 4
    
5.Burger AJ, Weinrauch LA, D'Elia JA, Aronson D. Effect of glycemic control on heart rate variability in type I diabetic patients with cardiac autonomic neuropathy. Am J Cardiol 1999;84:687-91.  Back to cited text no. 5
    



 
 
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This article has been cited by
1 Cardiovascular autonomic neuropathy (CAN) in patients of type 2 diabetes mellitus: A tertiary care hospital based study
Zafar A. Arif,Imran Ali Shaikh,Naila Masood
Indian Heart Journal. 2014;
[Pubmed] | [DOI]



 

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