A study of cardiovascular autonomic neuropathy in the diabetic patients at tertiary health care center

 

 

Abstract              Background: Cardiac autonomic neuropathy (CAN) is one of the major complications of diabetes mellitus. It is also the most under diagnosed and least understood diabetic complications. It generally manifests as exercise intolerance, resting tachycardia and orthostatic hypotension. Diabetic neuropathy progresses from asymptomatic (subclinical) stage to the symptomatic stage with the progression of disease. Factors that may facilitate the process include poor glycemic control coupled with duration of disease and patient’s age. Present study was planned to study cardiovascular autonomic neuropathy in type 2 diabetic patients at a tertiary health care center. Material and Methods: The present study was observational, prospective type conducted in the department of medicine, in patients of diabetes mellitus attending the outpatient department and patients admitted in medicine wards. Results: In present study, total 130 patients were included. 47 % patients were from above 50 years age group. Most common age group was 51-60 years (28 %) followed by > 60 years (19 %). Male to female ratio was 1.4:1. Most patients had diabetes duration less than 2 years (51 %). In present study, heart rate variation during deep breathing (E: I ratio) was normal in 68% patients, while 32 % patients had abnormal findings. Immediate heart rate response to standing (30:75 ratio) was normal in 59% patients, while 41 % patients had abnormal findings. Valsalva ratio (Normal ≥1.21) was normal in 70% patients, while 30 % patients had abnormal findings. Postural hypotension test (Normal ≤20 mm of Hg fall in systolic BP) was normal in 88% patients, while 12 % patients had abnormal findings. Blood pressure response to sustained handgrip was normal in 87% patients, while 13% patients had abnormal findings. We noted normal findings in 69 % patients. Abnormal findings such as early parasympathetic disturbance in 31%, definite parasympathetic disturbance in 19% and combined parasympathetic and sympathetic disturbance in 11 %. Conclusion: In the present study, the overall prevalence of autonomic neuropathy in type 2 diabetes mellitus was 47%. Cardiac autonomic neuropathy is a preventable condition, requires early diagnosis of diabetes melites, good glycemic control , regular screening and good patient counselling to prevent further morbidity.

Keywords: diabetes mellitus, cardiovascular, complication, Cardiac autonomic neuropathy.