Key result
Diabetes duration over 10 years linked to ~4-fold higher odds of cardiovascular autonomic neuropathy.
Why the study?
Cardiovascular autonomic neuropathy is a common complication in diabetes that is often overlooked, and its burden and correlates have not been extensively studied in sub-Saharan Africa.
What is the prevalence and what are the correlates of cardiovascular autonomic neuropathy in adults with diabetes in Uganda?
Cross-Sectional (n=299)
No
What is the prevalence and what are the correlates of cardiovascular autonomic neuropathy in adults with diabetes in Uganda?
This study reveals a high prevalence of cardiovascular autonomic neuropathy among diabetic patients in Uganda, highlighting the need for routine screening in this population.
Answers are grounded in this paper and cite their sources.
High CAN prevalence in Ugandan diabetes outpatients was associated with longer duration; extends sparse regional data but leaves screening utility open.
Background: Cardiovascular autonomic neuropathy (CAN) is a common complication in individuals with diabetes mellitus (DM) but often overlooked in clinical practice. The burden and correlates of CAN have not been extensively studied in low-income countries, particularly in sub-Saharan Africa. Objectives: To determine the prevalence and correlates of CAN among adults in ambulatory diabetes care in southwestern Uganda. Method: We conducted a cross-sectional study among adults with diabetes from November 2018 to April 2019. CAN was assessed using the five autonomic function tests: deep breathing, Valsalva maneuver, postural index on standing, change in blood pressure during standing and diastolic blood pressure response to isometric exercise. We estimated the prevalence of CAN and fit regression models to identify its demographic and clinical correlates. Results: We enrolled 299 individuals. The mean age was 50.1 years (SD ± 9.8), mean HbA1c was 9.7 (SD ± 2.6) and 69.6% were female. CAN was detected in 156/299 (52.2%) of the participants on the basis of one or more abnormal cardiovascular autonomic reflex tests. Out of 299 participants, 88 (29.4%) were classified as early CAN while 61/299 (20.4%) and 7/299 (2.3%) were classified as definite and severe (advanced) CAN respectively. In multivariable regression models, age over 50 years (aOR 3.48, 95%CI 1.35 -8.99, p = 0.010), duration of diabetes over 10 years (aOR 4.09, 95%CI 1.78 -9.38, p = 0.001), and presence of diabetic retinopathy (aOR 2.25, 95%CI 1.16 -4.34, p = 0.016) were correlated with CAN. Conclusions: Our findings reveal a high prevalence of CAN among individuals in routine outpatient care for diabetes mellitus in Uganda. Older age, longer duration of diabetes and coexistence of retinopathy are associated with CAN. Future work should explore the clinical significance and long term outcomes associated with CAN in this region.
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Migisha et al. (2020) conducted a cross-sectional in Diabetes mellitus (n=299). Duration of diabetes > 10 years vs. Duration of diabetes < 5 years was evaluated on Cardiovascular autonomic neuropathy (CAN) (aOR 4.09, 95% CI 1.78-9.38, p=0.001). Cardiovascular autonomic neuropathy was detected in 52.2% of patients, and a diabetes duration over 10 years significantly increased the odds of CAN compared to under 5 years (aOR 4.09).
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