What is the clinical evidence from this study?

Study design: Observational. Population: Long-standing diabetes mellitus (n=884). Intervention: Long-standing diabetes mellitus. Primary outcome: Prevalence of Cardiovascular Autonomic Neuropathy (CAN).

January 1, 2025Open Access

Clinical Characteristics and Epidemiology of Cardiovascular Autonomic Neuropathy in Peoples With Long-Standing Diabetes

Key Result

Among patients with diabetes for 10 or more years, the prevalence of cardiovascular autonomic neuropathy was 88%, with older age, higher systolic blood pressure, and QTc prolongation identified as significant risk factors.

Study Design

Type

Observational (n=884)

Multicenter

Yes

Structured PICO

Population

884 patients with type 1 or type 2 diabetes for 10 or more years, assessed for cardiovascular autonomic neuropathy across eight hospitals in South Korea.

Outcome

Epidemiology, clinical characteristics, and risk factors associated with cardiovascular autonomic neuropathy (CAN)surrogate

In patients with diabetes for over 10 years, cardiovascular autonomic neuropathy is highly prevalent (88%) and is significantly associated with advanced age, higher systolic blood pressure, and QTc prolongation.

Limitations

Retrospective design
Enrolled only individuals with long-duration DM who were tested for CAN, introducing potential selection bias
Included both T1DM and T2DM, which have different prevalences and pathogeneses for CAN, with T1DM comprising a very small proportion
Variable data collection defects, such as lack of data on the duration and amount of alcohol consumption
Enrolled patients had poor blood sugar control

Abstract

BACKGROUND: Cardiovascular autonomic neuropathy (CAN) is a frequently underdiagnosed complication of diabetes mellitus that contributes to increased mortality and morbidity rates. This multicenter study investigated the epidemiology and clinical characteristics of CAN in patients with long-term diabetes. METHODS: Retrospective data were collected from 884 individuals with diabetes who were assessed for CAN across eight hospitals in Korea. CAN was diagnosed using electrocardiography and cardiovascular autonomic function tests, including the heart rate-corrected QT interval and Ewing's method. This study evaluated the clinical characteristics, cardiovascular autonomic nerve function test results, and risk factors associated with CAN. RESULTS: Among the 884 patients, 778 (88%) were diagnosed with CAN (DCAN), while 106 (12%) were not (non-DCAN). Individuals with DCAN were older, had a longer duration of diabetes, and had higher creatinine levels. The DCAN group showed decreased time and frequency parameters of heart rate variability (HRV). A multiple logistic regression analysis revealed that a longer diabetes duration, older age, and higher creatinine level were significant risk factors for CAN. CONCLUSION: CAN was associated with advanced age, a longer duration of diabetes, higher creatinine levels, and lower time and frequency HRV parameters.

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