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Frontiers in Neuroscience

Clinical Diabetes

Original Research ARTICLE Provisionally accepted The full-text will be published soon. Notify me

Front. Neurosci. | doi: 10.3389/fnins.2019.01144

Prevalence and Diagnosis of Diabetic Cardiovascular Autonomic Neuropathy in Beijing, China: A Retrospective Multicenter Clinical Study

 Lixin Guo1*, Qi Pan1, Quanmin Li2, Wei Deng3, Dong Zhao4, Lin Qi5, Wei Huang6, Li Ma7, Hongmei Li8, Yufeng Li9, Xiaofeng Lyu10, Aihong Wang11, Hebin Yao12 and Xiaoyan Xing13
  • 1Beijing Hospital, China
  • 2Second Artillery General Hospital of Chinese People's Liberation Army, China
  • 3Beijing Jishuitan Hospital, China
  • 4Beijing Luhe Hospital, Capital Medical University, China
  • 5Beijing Yanhua Hospital, China
  • 6Beijing Haidian Hospital, Peking University, China
  • 7Guang’anmen Hospital, China Academy of Chinese Medical Sciences, China
  • 8China Meitan General Hospital, China
  • 9Beijing Pinggu District Hospital, China
  • 10PLA General Hospital, China
  • 11The 306th Hospital of PLA, China
  • 12Sixth Medical Center of PLA General Hospital, China
  • 13China-Japan Friendship Hospital, China

Cardiovascular autonomic neuropathy (CAN) is a debilitating condition occurring among diabetic patients especially those with long duration of disease. Whereas incidences and treatment of CAN has been well described for Western populations, fewer studies have been conducted among the Chinese. This study, therefore, aimed to assess the prevalence of CAN among sampled Chinese diabetic patients. Accordingly, 2,048 participants with a history of type 1 diabetes mellitus (T1DM, 73) and type 2 diabetes mellitus (T2DM, 1975) were randomly sampled from 13 hospitals. Patients’ biodata were recorded, and autonomic nervous system function tests performed to aid in the preliminary diagnosis of CAN. The final CAN diagnosis was based on the Ewing's test in which heart rate variation (HRV) values were evaluated through deep-breathing (DB), lying-to-standing (LS) and Valsalva (V) tests. Systolic blood pressure (SBP) variation values were also evaluated through LS. In the T1DM group, 61.6% patients were diagnosed with CAN and no differences were observed in the baseline and clinical data between this group and those without CAN (P>0.05). In the T2DM group, 62.6% patients were diagnosed with CAN and statistically significant differences were found between the CAN and non- CAN group with regards to age, duration of diabetes, metformin treatment, retinopathy and hypertension history (P<0.05). The most common manifestations of CAN included weakness (28.6%), dizziness (23.4%), frequent urination (19.6%), upper body sweating (18.3%) and nocturia (15.9%). Additionally, duration of disease and age were independent risk factors for CAN in T1DM and T2DM, respectively. On diagnosis, a combination of the V test + LS test provided the highest sensitivity of detecting CAN among T1DM group (sensitivity=97.6%, AUC=0.887) while for T2DM category, DB test had the highest sensitivity (83.6%), and maximal AUC (0.856) was found with V test + DB test. The overall prevalence of diabetes with CAN in the study was up to 63%.

Keywords: cardiovascular autonomic neuropathy, Diabetes Mellitus, Risk factors, diagnostic method, a Multicenter Clinical Study

Received: 22 Sep 2018; Accepted: 10 Oct 2019.

Copyright: © 2019 Guo, Pan, Li, Deng, Zhao, Qi, Huang, Ma, Li, Li, Lyu, Wang, Yao and Xing. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

* Correspondence: Dr. Lixin Guo, Beijing Hospital, Beijing, China, lixinguo_med@163.com