In Type 1 diabetic patients, the severity of cardiovascular autonomic neuropathy worsened significantly with increasing degrees of diabetic nephropathy (P<0.05).
Observational (n=70)
Is the severity of cardiovascular autonomic neuropathy associated with the degree of diabetic nephropathy in type 1 diabetic patients?
In type 1 diabetic patients with long disease duration, the severity of cardiovascular autonomic neuropathy is directly related to the degree of diabetic nephropathy.
p-value: p=<0.05
Diabetic cardiovascular autonomic neuropathy increases the risk of deterioration in renal function and is associated with increased mortality in patients with renal failure. Type 1 diabetic patients with long diabetes duration, matched for age (38 +/- 9 years) and diabetes duration (28 +/- 8 years) were studied regarding the association between cardiovascular autonomic nerve function and different degrees of diabetic nephropathy. Eighteen patients were normo- ( 300 mg/l) based on urinary albumin concentrations in three separate morning samples. They were compared with 33 control subjects with similar age. Autonomic nerve function was evaluated by measuring the response of heart rate to deep breathing and active standing. Beat-to-beat finger artery blood pressure (Finapres) was tested during active standing. During deep breathing both change in heart rate (17 +/- 11, 9 +/- 7 and 4 +/- 3 beats/min) and ratio between expiratory and inspiratory R-R intervals (1.32 +/- 0.24, 1.14 +/- 0.15 and 1.05 +/- 0.04) decreased from normo- over micro- to macroalbuminuria (p < 0.05 vs normoalbuminuric and control subjects 17 +/- 5 beats/min and 1.28 +/- 0.10, respectively). Similar results were obtained during active standing with respect to change in systolic arterial blood pressure (3 +/- 8, 2 +/- 13 and -6 +/- 11 mmHg; p < 0.05 vs control subjects 8 +/- 11 mmHg). However, the response of diastolic arterial blood pressure or mean heart rate to standing up did not differ between any of the groups. The ratio of maximum to minimum R-R interval during the dynamic response of heart rate to active standing decreased with the degree of nephropathy (1.27 +/- 0.17, 1.11 +/- 0.11 and 1.05 +/- 0.06) with significantly higher values in patients with normo- compared with patients with macroalbuminuria (p < 0.05). All patients groups had significantly lower values than control subjects (1.46 +/- 0.22, p < 0.05). The overshoot of the blood pressure after an initial fall during active standing decreased with the degree of diabetic nephropathy. In conclusion, type 1 diabetic patients with long duration of diabetes have signs of cardiovascular autonomic neuropathy, the severity of which is related to the degree of nephropathy.
Torffvit et al. (Wed,) conducted a observational in Type 1 diabetes with diabetic nephropathy (n=70). Degree of diabetic nephropathy vs. Normoalbuminuric patients and healthy controls was evaluated on Cardiovascular autonomic nerve function (e.g., change in heart rate during deep breathing) (p=<0.05). In Type 1 diabetic patients, the severity of cardiovascular autonomic neuropathy worsened significantly with increasing degrees of diabetic nephropathy (P<0.05).