The cardiovascular form of autonomous neuropathy in the adolescents with type 2 diabetes mellitus

Eremina I.A.; Laptev D.N.; Zil'berman L.I.; Dubinina I.A.; Kuraeva T.L.; Shcheglova O.S.

doi:https://doi.org/10.14341/probl201460515-21

Eremina I.A.

FGBU "Éndokrinologicheskiĭ nauchnyĭ tsentr" Minzdrava RF, Moskva

Laptev D.N.

Éndokrinologicheskiĭ nauchnyĭ tsentr, Moskva

Zil'berman L.I.

FGBU "Éndokrinologicheskiĭ nauchnyĭ tsentr" Minzdrava RF

Dubinina I.A.

FGBU "ndokrinologicheskiĭ nauchnyĭ tsentr" Minzdrava Rossii, Moskva

Kuraeva T.L.

FGU Éndokrinologicheskiĭ nauchnyĭ tsentr Minzdravsotsrazvitiia Rossiĭskoĭ Federatsii, Moskva

Shcheglova O.S.

FGBU "ndokrinologicheskiĭ nauchnyĭ tsentr" Minzdrava Rossii, Moskva

The cardiovascular form of autonomous neuropathy in the adolescents with type 2 diabetes mellitus

Authors:

Eremina I.A., Laptev D.N., Zil'berman L.I., Dubinina I.A., Kuraeva T.L., Shcheglova O.S.

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Journal: Problems of Endocrinology. 2014;60(5): 15‑21

DOI: 10.14341/probl201460515-21

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Eremina IA, Laptev DN, Zil'berman LI, Dubinina IA, Kuraeva TL, Shcheglova OS. The cardiovascular form of autonomous neuropathy in the adolescents with type 2 diabetes mellitus. Problems of Endocrinology. 2014;60(5):15‑21. (In Russ.)
https://doi.org/10.14341/probl201460515-21

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Abstract:

Objective. To estimate the prevalence of the cardiovascular form of autonomous neuropathy (CAN) and the factors associated with this condition in the adolescents suffering from type 2 diabetes mellitus (DM2) in comparison to the adolescents presenting with type 1 diabetes mellitus (DM1). Material and methods. The study included 24 adolescents with DM2 and 30 ones with DM1 matched for the age, duration of the disease, and the quality of its compensation. The control group was comprised of 17 adolescents with exogenous constitutional obesity (ECO). All the patients were examined by means of Holter ECG monitoring with the estimation of the daily cardiac rhythm variability based on the mean weighted variation of rhythmogram (MWVR) and the length of the QTc interval. In addition, standard cardiovascular tests were performed including deep-breath test, the Valsalva maneuver, and the 30:15 intermittent fitness test. Cardiovascular autonomous neuropathy was diagnosed in the patients exhibiting deviation from the normal values in 3 of the five parameters of interest, viz. MWVR, QTc length, and three functional tests. Results. CAN at the subclincal stage was more frequently diagnosed in the adolescents with DM2 than in those suffering DM1 (29.2 and 10% of the cases respectively; p<0.05). This condition was not found in any of the patients presenting with endogenous constitutional obesity. MWVR in the adolescents with DM2 was lower than in the patients with DM1 (p=0.02) or ECO (p=0.04). The QTc duration was greater in the DM2 patients than in the adolescents of the same age presenting with ECO (p=0.02) and comparable with that in the patients suffering DM1 (p=0.3). In the adolescents with DM2, positive correlation between CAN, the duration of diabetes, the quality of its compensation, and the patient's age was documented while the length of the QTc interval negatively correlated with these three variables. Moreover, the occurrence of CAN positively correlated with peripheral neuropathy. No relationship with the severity of insulin resistance was observed.

Keywords:

adolescents

type 2 diabetes mellitus

type 1 diabetes mellitus

obesity

the cardiovascular form of autonomous neuropathy

cardiac rhythm variability

GTc interval

Authors:

Eremina I.A.

FGBU "Éndokrinologicheskiĭ nauchnyĭ tsentr" Minzdrava RF, Moskva

Laptev D.N.

Éndokrinologicheskiĭ nauchnyĭ tsentr, Moskva

Zil'berman L.I.

FGBU "Éndokrinologicheskiĭ nauchnyĭ tsentr" Minzdrava RF

Dubinina I.A.

FGBU "ndokrinologicheskiĭ nauchnyĭ tsentr" Minzdrava Rossii, Moskva

Kuraeva T.L.

FGU Éndokrinologicheskiĭ nauchnyĭ tsentr Minzdravsotsrazvitiia Rossiĭskoĭ Federatsii, Moskva

Shcheglova O.S.

FGBU "ndokrinologicheskiĭ nauchnyĭ tsentr" Minzdrava Rossii, Moskva

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References:

Maser R.E., Mitchell B.D., Vinik A.I., Freeman R. The association between cardiovascular autonomic neuropathy and mortality in individuals with diabetes: a metaanalysis. Diabetes Care 2003; 26: 6: 1895-1901. doi: 10.2337/diacare.26.6.1895.
Dimitropoulos G., Tahrani A.A., Stevens M.J. Cardiac autonomic neuropathy in patients with diabetes mellitus. World J Diabetes 2014; 5: 1: 17-39. doi: 10.4239/wjd.v5.i1.17.
Vinik A.I., Maser R.E., Mitchell B.D., Freeman R. Diabetic autonomic neuropathy. Diabetes Care 2003; 26: 6: 1553-1579. doi:10.2337/diacare.26.6.1895.
Ryabykina G.V., Sobolev A.V. Kholterovskoe i bifunktsional'noe monitorirovanie EKG i arterial'nogo davleniya. Moscow: MEDPRAKTIKA-M; 2010; 319.
Makarov L.M. National russian guidelines on application of the methods of holter monitoring in clinical practice. Rus J Cardiol 2014; 2: 106: 6-71.
O'Brien I.A.D., O'Hare P., Corrall R.J.M. Heart rate variability in healthy subjects: effect of age and the derivation of normal ranges for tests of autonomic function. Br Heart J 1986; 55: 4: 348-354. doi: 10.1136/hrt.55.4.348.
Verrotti A., Loiacono G., Mohn A., Chiarelli F. New insights in diabetic autonomic neuropathy in children and adolescents. Eur J Endocrinol 2009; 161: 6: 811-818. doi: 10.1530/EJE-09-0710.
Agelink M.W., Malessa R., Baumann B., Majewski T., Akila F., Zeit T., Ziegler D. Standardized tests of heart rate variability: normal ranges obtained from 309 healthy humans, and effects of age, gender, and heart rate. Clin Autonom Res 2001; 11: 2: 99-108. doi: 10.1007/bf02322053.
DCCT Research Group. The effect of intensive diabetes therapy on measures of autonomic nervous system function in the Diabetes Control and Complications Trial (DCCT). Diabetologia 1998; 41: 4: 416-423.
Kempler P., Tesfaye S., Chaturvedi N., Stevens L.K., Webb D.J., Eaton S., Kerényi Z., Tamás G., Ward J.D., Fuller J.H. Autonomic neuropathy is associated with increased cardiovascular risk factors: the EURODIAB IDDM Complications Study. Diabet Med 2002; 19: 11: 900-909. doi: 10.1046/j.1464-5491.2002.00821.x.
Ziegler D., Laux G., Dannehl K., Spüler M., Mühlen H., Mayer P., Gries F.A. Assessment of cardiovascular autonomic function: age related normal ranges and reproducibility of spectral analysis, vector analysis and standard test of heart rate variation and blood pressure responses. Diabet Med 1992; 9: 2: 166-175. doi: 10.1111/j.1464-5491.1992.tb01754.x.
O'Brien I.A., McFadden J.P., Corrall R.J.M. The influence of autonomic neuropathy on mortality in insulin-dependent diabetes. Q J Med 1991; 79: 290: 495-502.
Spallone V., Ziegler D., Freeman R., Bernardi L., Frontoni S., Pop-Busui R., Stevens M., Kempler P., Hilsted J., Tesfaye S., Low P., Valensi P. on behalf of the Toronto Consensus Panel on Diabetic Neuropathy. Cardiovascular autonomic neuropathy in diabetes: clinical impact, assessment, diagnosis, and management. Diabetes Metabol Res Rev 2011. doi: 10.1002/dmrr.1239.
Veglio M., Borra M., Stevens L.K., Fuller J.H., Perin P.C. The relation between QTc interval prolongation and diabetic complications. The EURODIAB IDDM Complication Study Group 1999; 42: 1: 68-75. doi: 10.1007/s001250051115.
Schwartz P.J., Stramba-Badiale M., Segantini A., Austoni P., Bosi G., Giorgetti R. Prolongation of the QT interval and the sudden infant death syndrome. New Engl J Med 1998; 338: 4: 1709-1714. doi: 10.1056/NEJM199806113382401.
De Bruyne M.C., Hoes A.W., Kors J.A., Hofman A., Van Bemmel J.H., Grobbee D.E. Prolonged QT interval predicts cardiac and all-cause mortality in the elderly. The Rotterdam Study. Eur Heart J 1999; 20: 4: 278-284. doi: 10.1053/euhj.1998.1276.
Whitsel E.A., Boyko E.J., Siscovick D.S. Reassessing the role of QTc in the diagnosis of autonomic failure among patients with diabetes: a meta-analysis. DiabetesCare 2000; 23: 2: 241-247. doi: 10.2337/diacare.23.2.241.
Ryabykina G.V., Laptev D.N., Sobolev A.V., Seid-Gusseynov A.A., Volkov I.E. Issledovanie intervala QTu detey i podrostkov, bol'nykh sakharnymdiabetom 1 tipa, pri kholterovskommonitorirovanii EKG. Diabetes Mellitus 2007; 2: 19. doi: 10.14341/2072-0351-5791.
Wiggin T.D., Sullivan K.A., Pop-Busui R., Amato A., Sima A.A., Feldman E.L. Elevated triglycerides correlate with progressionof diabetic neuropathy. Diabetes 2009; 58: 7: 1634-1640. doi: 10.2337/db08-1771.
Voulgari C., Psallas M., Kokkinos A., Argiana V., Katsilambros N., Tentolouris N. The association between cardiac autonomic neuropathy with metabolic and other factors in subjects with type 1 and type 2 diabetes.J Diabetes Complications 2011; 25: 3: 159-167. doi: 10.1016/j.jdiacomp.2010.06.001.
Rosenbloom A.L., Silverstein J.H., Amemiya S., Zeitler P., Klingensmith G.J. International Society for Pediatric and Adolescent Diabetes. ISPAD Clinical Practice Consensus Guidelines 2006-2007. Type 2 diabetes mellitus in the child and adolescent. Diabetes 2008; 9: 5: 512-526. doi: 10.1111/j.1399-5448.2008.00429.x.
Mc Grath N.M., Parker G.N., Dawson P. Early presentation of type 2 diabetes mellitus in young New Zealand Maori. Diabet Res Clin Pract 1999; 43: 3: 205-209. doi: 10.1016/S0168-8227(99)00003-0.
Eppens M.C. Prevalence of Diabetes Complications in Adolescents With Type 2 Compared With Type 1 Diabetes. Diabetes Care 2006; 29: 6: 1300-1306. doi: 10.2337/dc05-2470.
Writing Team for the Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications Research Group. Sustained Effect of Intensive Treatment of Type 1 Diabetes Mellitus on Development and Progression of Diabetic Nephropathy. JAMA 2003; 290: 16: 2159. doi: 10.1001/jama.290.16.2159.
Scott A., Toomath R., Bouchier D., Bruce R., Crook N., Carroll D., Cutfield R., Dixon P., Doran J., Dunn P., Hotu C., Khant M., Lonsdale M., Lunt H., Wiltshire E., Wu D. First national audit of the outcomes of care in young people with diabetes in New Zealand: high prevalence of nephropathy in Māori and Pacific Islanders. New Zealand Med J 2006; 119: 1235: U2015.
Yoo E.G., Choi I.K., Kim D.H. Prevalence of microalbuminuria in young patients with type 1 and type 2 diabetes mellitus. J Pediatr Endocrinol Metabol 2004; 17: 10: 1423-1427. doi: 10.1515/jpem.2004.17.10.1423.
Yokoyama H., Okudaira M., Otani T., Watanabe C., Takaike H., Miuira J., Yamada H., Mutou K., Satou A., Uchigata Y., Iwamoto Y. High incidence of diabetic nephropathy in early-onset Japanese NIDDM patients risk analysis. Diabetes Care 1998; 21: 7: 1080-1085. doi: 10.2337/diacare.21.7.1080.
Ettinger L.M., Freeman K., DiMartino-Nardi J.R., Flynn J.T. Microalbuminuria and abnormal ambulatory blood pressure in adolescents with type 2 diabetes mellitus. Journal of Pediatrics. 2005;147(1):67-73. doi:10.1016/j.jpeds.2005.02.003.
Karabouta Z., Barnett S., Shield J.P., Ryan F.J., Crowne E.C. Peripheral neuropathy is an early complication of type 2 diabetes in adolescence. Pediatr Diabetes 2008; 9: 2: 110-114. doi: 10.1111/j.1399-5448.2007.00339.x.
Jaiswal M., Lauer A., Martin C.L., Bell R.A., Divers J., Dabelea D., Pettitt D.J., Saydah S., Pihoker C., Standiford D.A., Rodriguez B.L., Pop-Busui R., Feldman E.L., SEARCH for Diabetes in Youth Study Group. Peripheral neuropathy in adolescents and young adults with type 1 and type 2 diabetes from the SEARCH for Diabetes in Youth follow-up cohort: a pilot study. Diabetes Care 2013; 36: 12: 3903-3908. doi: 10.2337/dc13-1213.
Maser R.E., Lenhard M.J. Cardiovascular autonomic neuropathy due to diabetes mellitus: clinical manifestations, consequences, and treatment. J Clin Endocrinol Metabol 2005; 90: 10: 5896-5903. doi: 10.1210/jc.2005-0754.
Gaede P., Vedel P., Larsen N., Jensen G., Parving H.H., Pedersen O. Multifactorial intervention and cardiovascular disease in patientswith type 2 diabetes. New Engl J Med 2003; 348: 5: 383-393. doi: 10.1056/NEJMoa021778.
Istenes I., Keresztes K., Herm Z., Putz Z., Vargha P., Gandhi R., Tesfaye S., Kempler P. Relationship between autonomic neuropathy and hypertension-are we underestimating the problem? Diabet Med 2008; 25: 7: 863-866. doi: 10.1111/j.1464-5491.2008.02458.x.