Assessment of Cardiac Autonomic Neuropathy among type 1 & 2 diabetic patients in North India.

Dr. Nitin Gupta; Dr. Vijay Kumar; Dr. Sunita Gupta

Volume : V, Issue : XI, November - 2016

Assessment of Cardiac Autonomic Neuropathy among type 1 & 2 diabetic patients in North India.

Dr. Nitin Gupta, Dr. Vijay Kumar, Dr. Sunita Gupta

Abstract :

Introduction: CAN (Cardiovascular Autonomic Neuropathy) is a least understood complication of diabetes which is often under diagnosed. It causes resting tachycardia, orthostatic hypotension, exercise intolerence and is associated with higher cardiovascular mortality in diabetic patients. ?is stresses the need of early diagnosis of CAN to prevent higher mortality rates. Aim: To study prevalence of cardiac autonomic neuropathy in diabetic patients. Methods: Fifty cases of diabetes mellitus (type 1&2) with no clinical evidence of cardiac disease were subjected to cardiac autonomic function tests according to Ewing�s criteria which were heart rate variability during deep eathing, Valsalva maneuver ratio, heart rate response on standing and BP response to standing and BP response to sustained handgrip to find the prevalence of CAN. Patients were categorized as with no CAN, early, definite and severe type of CAN depending upon abnormality of one or more tests. Results: In this study prevalence of CAN was 54% out of which early, definite and severe involvement was found in 16%,14% and 24% respectively. Cardiac autonomic function tests of heart rate variability during deep eathing, Valsalva maneuver ratio, heart rate response on standing and BP response to standing and BP response to sustained handgrip found abnormal response in 38%,22%,34%,14% and 20% respectively. Diabetic retinopathy and nephropathy were significantly associated with CAN. Conclusion: Prevalence of CAN among diabetics was 54% and parasympathetic cardiac autonomic function tests are more sensitive for the detection of CAN than sympathetic cardiac autonomic function tests. Development of CAN in diabetic patients lead to poor prognosis, increased silent myocardial infarction and sudden cardiac death hence all diabetic patients should be routinely evaluated for CAN using these feasible bedside tests