Key result
Cardiovascular autonomic dysfunction affects ~80% of type 2 diabetes patients and strongly correlates with disease duration.
Why the study?
Diabetic autonomic neuropathy is an often-under-recognised complication of diabetes mellitus. This study assessed cardiovascular autonomic responses using the isometric handgrip test and the Valsalva manoeuvre in adults with T2DM and examined their relationship with diabetes duration and HbA1c.
Does bedside assessment using the isometric handgrip test and Valsalva manoeuvre detect cardiovascular autonomic dysfunction and correlate with disease duration and HbA1c in adults with type 2 diabetes mellitus?
Cross-Sectional (n=50)
No
Does bedside assessment using the isometric handgrip test and Valsalva manoeuvre detect cardiovascular autonomic dysfunction and correlate with disease duration and HbA1c in adults with type 2 diabetes mellitus?
Cardiovascular autonomic dysfunction is highly prevalent (80%) among patients with type 2 diabetes in Northeast India and correlates strongly with longer disease duration rather than single HbA1c measurements, supporting routine screening with simple bedside Valsalva and isometric handgrip tests.
Answers are grounded in this paper and cite their sources.
Non-invasive autonomic tests may detect neuropathy in T2DM; leaves open predictive value of duration and HbA1c.
Background: Diabetic autonomic neuropathy is an often-under-recognised complication of diabetes mellitus. Cardiovascular autonomic function can be assessed using non-invasive bedside tests, including the isometric handgrip test and the Valsalva manoeuvre. This study assessed autonomic responses in adults with type 2 diabetes mellitus (T2DM) and examined their relationship with diabetes duration and HbA1c. Materials and Methods: A hospital-based cross-sectional observational study was conducted in the Department of Physiology, Agartala Government Medical College and GBP Hospital, Agartala. Fifty adults with T2DM were included in the reported analysis. The Valsalva ratio and change in diastolic blood pressure (ΔDBP) during handgrip at 30% of maximum voluntary contraction for one minute were assessed. A Valsalva ratio ≥1.20 and a ΔDBP >15 mmHg was considered normal, as specified in the study protocol. Results: The mean age was 53.46 ± 7.91 years and mean BMI was 22.69 ± 2.45 kg/m². Mean diabetes duration was 7.54 ± 2.22 years and mean HbA1c was 7.92 ± 1.06%. Mean Valsalva ratio was 0.972 ± 0.202 and mean ΔDBP was 9.04 ± 4.34 mmHg. An abnormal Valsalva ratio was observed in 37 (74%) participants and an abnormal handgrip DBP response in 28 (56%). At least one test was abnormal in 40 (80%). Mean diabetes duration was 8.33 ± 1.70 years in the group classified as having autonomic dysfunction and 4.40 ± 0.84 years in the group without it (p<0.001). Diabetes duration was inversely correlated with Valsalva ratio (Spearman ρ=−0.823; p<0.001). The association between HbA1c and Valsalva ratio was negative but not statistically significant. Conclusion: Autonomic dysfunction is very common in people with Type 2 diabetes mellitus and longer the duration of diabetes higher the occurrence of autonomic dysfunction. Isometric hand grip test and valsalva menoveour are simple bedside test to assess the autonomic dysfunction which can be used routinely for screening in people with type2 DM.
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Mitra et al. (2026) conducted a cross-sectional in Type 2 Diabetes Mellitus (n=50). Duration of Type 2 Diabetes Mellitus vs. Patients without autonomic neuropathy was evaluated on Autonomic dysfunction (defined as Valsalva ratio <1.20 or diastolic BP rise ≤15 mmHg during isometric handgrip test) and its association with diabetes duration (Spearman ρ -0.823, p=<0.001). Cardiovascular autonomic dysfunction was present in 80% of type 2 diabetes patients and strongly correlated inversely with diabetes duration.
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