Title : Cardiac Autonomic Neuropathy (CAN) in diabetics
Abstract:
Introduction: Cardiac autonomic neuropathy (CAN) is a common condition, the prevalence of which is underestimated in diabetic patients. Cardiovascular dysautonomia in diabetic patients has major complications, notably orthostatic hypotension, which can sometimes be disabling, and silent myocardial infarction.
Patients and Methods: CAN was investigated in a population of 300 patients (172 with type 2 diabetes, 128 with type 1 diabetes) by analyzing heart rate variations during three standard tests (deep breathing, active standing, Valsalva maneuver), primarily assessing parasympathetic activity. These patients had a mean age of 42.5 ± 12.8 years, a mean duration of diabetes of 8.3 ± 5.8 years, and 52 had hypertension. CAN was present in 110 patients (62 with type 2 diabetes, 48 with type 1 diabetes).
Results: Among the 300 patients, 66.2% had no significant abnormalities, 20.6% had moderate abnormalities, primarily parasympathetic, and 12.6% had confirmed dysautonomia. The severity of NAC was correlated with the presence of other dysautonomia symptoms (bladder problems, erectile dysfunction), peripheral neuropathy, hypertension, as well as nephropathy and retinopathy. The association of NAC with microangiopathic complications has been found in other studies.
Conclusion: Several studies have demonstrated the value of early diagnosis and screening for NAC.Current American and European guidelines recommend screening for NAC at the time of diagnosis in patients with type 2 diabetes, and within 5 years of diagnosis in patients with type 1 diabetes (or earlier if warning signs are present).
