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Cardiovascular autonomic neuropathy in patients with type 1 diabetes mellitus: consequences and preventive measurements.

Session Poster Session 1

Speaker Paul Dendale

Event : ESC Preventive Cardiology (Formerly EuroPrevent) 2018

  • Topic : preventive cardiology
  • Sub-topic : Diabetes and the Heart
  • Session type : Poster Session

Authors : R De Busser (Hasselt,BE), A Nys (Hasselt,BE), A Janssen (Hasselt,BE), P Bertrand (Hasselt,BE), T Al Hatawe (Hasselt,BE), G Claessen (Hasselt,BE), K Bonne (Hasselt,BE), P Dendale (Hasselt,BE)

R De Busser1 , A Nys1 , A Janssen1 , P Bertrand1 , T Al Hatawe1 , G Claessen1 , K Bonne1 , P Dendale1 , 1Virga Jesse Hospital - Hasselt - Belgium ,

European Journal of Preventive Cardiology ( May 2018 ) 25 ( Supplement 1 ), 37

Background Diabetic autonomic neuropathy affects the cardiovascular nerves which causes symptoms such as orthostatic hypotension, reduced heart rate variability, increased resting heart rate and reduced exercise capacity. This has an impact on the patient’s prognosis and quality of life. Purpose This monocentric study investigated the influence of type 1 diabetes mellitus (T1D) on autonomic cardiovascular responses, and the potential correlations between the severity of diabetic cardiovascular autonomic neuropathy (DCAN) and both quality of life and exercise capacity. As a secondary aim, the influences of gender, age, number of years since diagnosis of T1D, relative VO2max, maximal heart rate, minimal heart rate, maximal RER and relevant interaction terms were studied. Methods 52 T1D subjects and 27 matched control subjects were selected. The autonomic function analysis measured beat to beat variation of blood pressure and heart rate caused by Valsalva manoeuvre, isometric handgrip, deep breathing, cold pressor and short head-up tilt test. Moreover, a maximal ergospirometry was performed and three questionnaires about quality of life (EQ-5D-3L), physical capacity (IPAQ) and experience of symptoms of autonomic dysfunction in daily life (SCOPA-AUT) were completed. The results of the autonomic function tests were presented by a severity score of DCAN (the higher, the more severe). Descriptive statistics, comparative statistics and regression analyses were used to represent the data. Results The severity score of DCAN was not significantly different between the two test groups (p = 0,29). Further, resting heart rate (p < 0,01), heart rate reserve (p = 0,01), maximal RER (p = 0,03), quality of life (p < 0,01; p = 0,02) and symptoms of autonomic dysfunction (p = 0,01) were significantly different. Negative correlations were found between the severity of DCAN and quality of life (p = 0,02; p = 0,04), absolute VO2max (p = 0,01), maximal heart rate (p < 0,01) and heart rate reserve (p < 0,01). After backward elimination, the regression model indicated a significant correlation between the severity of DCAN and age (p = 0,01), relative VO2max (p = 0,02), minimal heart rate during rest (p = 0,02), maximal RER (p = 0,03) and the interaction term ‘age*minimal heart rate during rest’ (p = 0,01). Conclusions The study did not show a significantly higher severity score of DCAN in the group of test subjects with T1D. Despite of that, several parameters involved with the autonomic nervous system were significantly different in the presence of T1D. Subjects with T1D experienced more symptoms of DCAN and a poorer quality of life. The presence of DCAN reduces the quality of life and has an impact on the parameters of the ergospirometry. Thus, the autonomic function tests and/or the ergospirometry can be used for early detection of DCAN to prevent its negative effects on quality of life, physical capacity and experience of symptoms of DCAN.

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