Determinants of Cardiac Autonomic Neuropathy among Patients with Diabetic Peripheral Neuropathy:

Introduction. Cardiac autonomic neuropathy (CAN) is a frequently underdiagnosed consequence of diabetes mellitus (DM), increasing the risk of cardiac arrhythmia, silent myocardial ischemia, and sudden cardiac death. Diabetic peripheral neuropathy (DPN) is a common consequence of diabetes. We aimed to study the proportion of CAN among patients with DPN and identify the predictors of CAN in these patients. Methodology. This was a hospital-based cross-sectional study conducted over a six-month period. A total of 60 DM patients with nerve conduction study–proven DPN, who fulfilled the inclusion and exclusion criteria, were enrolled in the study. CAN was assessed using both parasympathetic and sympathetic tests. A p-value of <0.05 was considered significant. Results. The study included a total of 60 patients with diabetic peripheral neuropathy, out of whom 19 (32%) had CAN. Of the 19 patients with CAN, 11 had severe CAN. There was no statistically significant association between the severity of DPN and CAN (p = 0.162). Logistic regression analysis (Model 3) showed that when adjusted for symptoms, risk factors, hypertension, and a specific ECG finding (left atrial enlargement), the determinants of CAN were the presence of motor symptoms, being overweight or obese, and the presence of left atrial enlargement. Conclusion. Among this cohort of persons with DM who all had DPN, CAN was found in one-third (32%) of the sample. Patients with DPN who are overweight or obese, have motor neuropathy, or have left atrial enlargement have the most significant risk for developing CAN and may be recommended for its screening. Given that CAN is a frequently overlooked condition, each early diagnosis of CAN may potentially prevent its debilitating complications and even fatal outcomes.