Key result
Painful diabetic peripheral neuropathy is associated with significantly greater autonomic dysfunction than painless DPN, demonstrated by lower high frequency power (2.67 vs 3.59; P<0.05).
Why the study?
Is painful diabetic peripheral neuropathy associated with greater autonomic dysfunction than painless diabetic peripheral neuropathy?
Cross-Sectional (n=80)
Is painful diabetic peripheral neuropathy associated with greater autonomic dysfunction than painless diabetic peripheral neuropathy?
Absolute Event Rate: 2.67% vs 3.59%
p-value: p=<0.05
Painful diabetic peripheral neuropathy is associated with significantly greater autonomic dysfunction than painless neuropathy, detectable via spectral analysis of heart rate variability.
Painful DPN may indicate greater autonomic involvement warranting targeted screening; leaves open causal links and management implications pending larger studies.
OBJECTIVE: Although a clear link between diabetic peripheral neuropathy (DPN) and autonomic neuropathy is recognized, the relationship of autonomic neuropathy with subtypes of DPN is less clear. This study aimed to investigate the relationship of autonomic neuropathy with painless and painful DPN. RESEARCH DESIGN AND METHODS: Eighty subjects (20 healthy volunteers, 20 with no DPN, 20 with painful DPN, 20 with painless DPN) underwent detailed neurophysiological investigations (including conventional autonomic function tests [AFTs]) and spectral analysis of short-term heart rate variability (HRV), which assesses sympathovagal modulation of the heart rate. Various frequency-domain (including low frequency [LF], high frequency [HF], and total power [TP]) and time-domain (standard deviation of all normal-to-normal R-R intervals [SDNN] and root mean square of successive differences [RMSSD]) parameters were assessed. RESULTS: HRV analysis revealed significant differences across the groups in LF, HF, TP, SDNN, and RMSSD (ANOVA P < 0.001). Subgroup analysis showed that compared with painless DPN, painful DPN had significantly lower HF (3.59 +/- 1.08 [means +/- SD] vs. 2.67 +/- 1.56), TP (5.73 +/- 1.28 vs. 4.79 +/- 1.51), and SDNN (2.91 +/- 0.65 vs. 1.62 +/- 3.5), P < 0.05. No significant differences were seen between painless DPN and painful DPN using an AFT. CONCLUSIONS: This study shows that painful DPN is associated with significantly greater autonomic dysfunction than painless DPN. These changes are only detected using spectral analysis of HRV (a simple test based on a 5-min electrocardiogram recording), suggesting that it is a more sensitive tool to detect autonomic dysfunction, which is still under-detected in people with diabetes. The greater autonomic dysfunction seen in painful DPN may reflect more predominant small fiber involvement and adds to the growing evidence of its role in the pathophysiology of painful DPN.
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Gandhi et al. (2010) conducted a cross-sectional in Diabetic peripheral neuropathy (n=80). Painful diabetic peripheral neuropathy vs. Painless diabetic peripheral neuropathy was evaluated on High frequency (HF) power on heart rate variability analysis (p=<0.05). Painful diabetic peripheral neuropathy is associated with significantly greater autonomic dysfunction than painless DPN, demonstrated by lower high frequency power (2.67 vs 3.59; P<0.05).
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