| Objective To investigate the prevalence and risk factors of cardiovascular autonomic neuropathy (CAN) in type2diabetes.Methods Two hundred and twenty two type2diabetic (T2DM) patients (all conforms to1999WHO Diabetes Diagnostic Criteria) hospitalized in the endocrinology department of our hospital from March2013to October2013were enrolled. Those who take β receptor blocker in recent two weeks and who have coronary disease, arrhythmia and other cardiovascular diseases and severe liver and kidney diseases were ruled out. Clinical datas (gender, age, BMI, duration of diabetes, hypertension history) were collected. The level of fasting plasma glucose, HbA1c, profile of blood lipid and SDNN were measured. Diabetic retinopathy were evaluated by fundus photography and improve cardiovascular reflex test was used to diagnose CAN:(1) resting heart rate;(2) fist clenching test;(3) blood pressure difference between erect and supine positions;(4) heart rate difference per minute between erect and supine positions. Score1point for each abnormality in (1),(2) and (4), and score2points for abnormality in (3). The patients who get a total score<1were defined as non-CAN; score=2as early CAN; score≥3as CAN. Early CAN and CAN were defined as cardiovascular autonomic nerve damage.Results (1) There were141males and81females in the enrolled T2DM patients with an average age of54.5years old (54.5±11.2years old), a mean diabetic duration of6.1years (6.1±5.5years), a mean BMI of24.8kg/m2(24.8±4.0kg/m2), a mean HbAlc values of9.4%(9.4±3.0%), and a prevalence of hypertension of35.6%(79/222), a prevalence of diabetic retinopathy of33.0%(70/212).(2) In the enrolled T2DM patients, the prevalence of cardiovascular autonomic nerve injury, early CAN and CAN was68%(151/222),52.3%(116/222) and15.8%(35/222) separately.(3) Compared with non-CAN group, the age was older (55.9±10.5vs51.4±12.1years old, t=-2.810, P=0.005), the proportion of diabetic duration>10years was higher (27.8%vs11.3%, x2=4.312, p=0.038), the prevalence of hypertension was higher (40.4%vs26.8%, x2=3.896, P=0.048) and SDNN was smaller (233±13.3vs31.1±14.5, z=-4.403, P=0.000) in cardiovascular autonomic nerve injury group. There was no significant difference in the proportion of HbAlC≤7%(19.9%vs26.8%, x2=0.557, P=0.455) and the proportion of retinopathy (33.6%vs31.9%, x2=0.000683, P=0.979) between non-CAN group and cardiovascular autonomic nerve injury group.(4) Compared with early CAN group, the proportion of diabetic duration>10years was higher (51.4%vs20.7%, x2=5.438, P=0.020), the proportion of diabetic retinopathy was higher (60.0%vs26.5%, x2=4.372, P=0.037) and SDNN was smaller (19.1±12.7vs24.5±13.3, t=2.129, P=0.035) in CAN group. There was no significant difference in age (55.1±11.2vs56.1±10.3, t=0.471, P=0.638), the proportion of HBA1C≤7%(20.0%vs19.8%, x2=0.0477, P=0.827) and the prevalence of hypertension (45.7%vs38.3%, x2=0.109, P=0.741) between early CAN group and CAN group.Conclusion In the present study, the prevalence of cardiovascular autonomic nerve injury, early CAN and CAN was68%,52.3%and15.8%separately in T2DM. CAN may be correlated with the age, diabetic duration, diabetic retinopathy and hypertension in T2DM. Objective To investigate the prevalence and risk factors of nocturnal hypoglycemia in type2diabetes.Methods Two hundred and thirty four type2diabetic (T2DM) patients (all conforms to1999WHO Diabetes Diagnostic Criteria) hospitalized in the endocrinology department of our hospital from March2013to October2013were enrolled. Those who have serious infection, severe hepatic and renal dysfunction, cardiac insufficiency, diabetic acute complication, malignant tumor and dysphrenia and can not take care of themselves were ruled out. Clinical datas (gender, age, BMI, duration of diabetes, hypertension history) were collected. The level of fasting plasma glucose, HbAlc and profile of blood lipid were measured. Diabetic retinopathy were evaluated by fondus photography and Dynamic Glucose Monitoring System (DGMS), which records one glucose value every3minutes was used to evaluate nocturnal hypoglycemia. Glucose value<3.9mmol/L founded for three consecutive times during00:00-08:00period was defined as nocturnal hypoglycemia.Results (1) There were145males and89females in the enrolled T2DM patients with an average age of54.6years old (54.6±11.2years old), a mean diabetic duration of6.1years (6.1±5.6years), a mean BMI of24.8kg/m2(24.8±4.0kg/m2), a mean HbAlc values of9.4%(9.4±3.0%), and a prevalence of hypertension of35.0%(82/234), a prevalence of diabetic retinopathy of32.4%(72/222).(2) In the enrolled T2DM patients, the prevalence of nocturnal hypoglycemia was22.6%(53/234).In the T2DM with nocturnal hypoglycemia, males accounted for62.3%(33/53), females accounted for37.7%(20/53); age<60years old patients accounted for62.3%(33/53), age≥60years old patients accounted for37.7%(20/53), diabetic duration<10years accounted for75.5%(40/53), diabetic duration>10years accounted for24.5%(13/53), HbAlc≤7%accounted for85.0%(45/53), HbAlc>7%accounted for15.0%(8/53).(3) Compared with non-nocturnal hypoglycemia group, the diabetic duration was longer (7.9±7.3vs5.6±5.0, t=2.612, P=0.010), the proportion of HbAlC≤7%was higher (85.0%vs23.8%, x2=23.184, P<0.001) and BMI was smaller (23.9±q4.3vs25.1±3.9, t=-1.981, P=0.049) in nocturnal hypoglycemia group. There was no significant difference in the proportion of age>60years old between non-nocturnal hypoglycemia and nocturnal hypoglycemia in T2DM (37.7%vs34.8%, x2=0.0138, p=0.907).Conclusion In the present study, the prevalence of nocturnal hypoglycemia was22.6%in T2DM. The nocturnal hypoglycemia may be correlated with diabetic duration, the level of HbAlc and BMI in T2DM. Objective To investigate the relationship between cardiovascular autonomic damage and nocturnal hypoglycemia in type2diabetes (T2DM).Methods One hundred and ninety nine T2DM patients (all conforms to1999WHO Diabetes Diagnostic Criteria) hospitalized in the endocrinology department of our hospital from March2013to October2013were enrolled. Those who have serious infection, severe hepatic and renal dysfunction, cardiac insufficiency, diabetic acute complication, malignant tumor and dysphrenia and can not take care of themselves were ruled out. Those who take β receptor blocker in recent two weeks and who have coronary disease, arrhythmia and other cardiovascular diseases and severe liver and kidney diseases were ruled out. Clinical datas (gender, age, BMI, duration of diabetes, hypertension history) were collected. The level of fasting plasma glucose, HbAlc, profile of blood lipid and SDNN were measured. Diabetic retinopathy were evaluated by fundus photography and improve cardiovascular reflex test was used to diagnose CAN:(1) resting heart rate;(2) fist clenching test;(3) blood pressure difference between erect and supine positions;(4) heart rate difference per minute between erect and supine positions. Score1point for each abnormality in (1),(2) and (4), and score2points for abnormality in (3). The patients who get a total score<1were defined as non-CAN and score≥2were defined as cardiovascular autonomic damage. Dynamic Glucose Monitoring System (DGMS), which records one glucose value every3minutes was used to evaluate nocturnal hypoglycemia. Glucose value<3.9mmol/L founded for three consecutive times during00:00-08:00period was defined as nocturnal hypoglycemia.Results (1) In the enrolled T2DM patients, the prevalence of cardiovascular autonomic damage and nocturnal hypoglycemia was64.3%(128/199) and25.1% (50/199).(2) Compared with non-CAN group, the prevalence of nocturnal hypoglycemia was higher in cardiovascular autonomic damage group (30.5%vsl5.5%, x2=5.306, P=0.021).(3) Compared with non-nocturnal hypoglycemia group, the prevalence of cardiovascular autonomic damage was higher in nocturnal hypoglycemia group (78%vs59.7%, x2=5.444, P=0.020)Conclusion There might be a relationship between CAN and nocturnal hypoglycemia in T2DM. T2DM patients complicated with CAN should be monitored blood glucose intensely during night to prevent the occurrence of nocturnal hypoglycemia.
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