| BackgroundIn recent years, with the prevalence of diabetes doubled,60%-70%of diabetic suffer from diabetic neuropathy problems. Among them, the diabetic cardiovascular autonomic neuropathy (DCAN) is a common complication among which is the most severe life-threatening complications and can be easily overlooked. The latest ADA guidelines recommend routine screening of DCAN five years after diagnosis of T1DM and T2DM, but there was still lack of uniform diagnostic criteria and screening means. Little was known about the relevant predictors.ObjectiveTo explore the relationship between a new noninvasive method-SUDOSCAN diabetic complications detector (eZscan instrument), the autonomic symptoms Survey Scale (SAS), and the traditional evaluation criteria cardiovascular reflex tests, try a non-invasive and easy way to screen Charles DCAN, while observing the related predictors of the occurrence of disease, which will provide new ideas for early screening and prevention of diabetic autonomic neuropathy complications. MethodsIn this study, a cohort of75patients with type2diabetes were randomly enrolled from patients in hospital from November14,2013to March31,2014(40male(53.33%) and35female(46.67%)). The average age of the participants was55.55±14.36years, with minimum23years old and maximum82years old.45cases without diabetes, coronary heart disease and other related diseases were enrolled as non-diabetic group (21male(46.67%) and24female (53.33%)), and the average age was50.80±12.48years, with minimum27years and maximum73years old. Before performing the study, we explained the procedure in detail and obtained informed consent from each participant. All patients took all the tests above by unified doctors. According to the CART diagnostic criteria, all type2diabetes patients were divided into groups of diabetic autonomic neuropathy (DCAN) and non-diabetic autonomic neuropathy group (NDCAN); then the subjects with CART score less than or equal to1were divided into the normal group, the subjects with CART score more than or equal to4were divided into the diagnosis group, others were into the early group. The measures observed include that mean electrochemical skin conductivity of hands and feet, cardiac autonomic neuropathy risk ratio (CAN%), chronic renal disease risk rate (CKD%), insulin resistance risk rate (IR%) detected by SUDOSCAN technology and symptom scores&extent scores detected by the scale of autonomic symptoms (SAS) etc. Statistical were analyzed by the statistical software of SPSS17.0.Results1. Compared with normal control group by CART test, the prevalence of autonomic neuropathy among type2diabetes was significantly higher (40%vs13.3%). SUDOSCAN screening showed significant difference (P=0.046, P=0.025and P<0.001) on hand, foot sweat conductivity (ESC) and autonomic risk ratio (CAN%) between the two groups. Type2diabetes scored significantly higher on both symptom and extent scores of the scale of autonomic symptoms (SAS)(both P <0.001) 2. SUDOSCAN technology could detect difference (P=0.002, P<0.001and P=0.019) on hands, feet ESC mean risk ratio and insulin resistance (IR%) between the diabetic autonomic neuropathy group and non-diabetic autonomic neuropathy group. The both symptom and extent scores of SAS Scale and the numbers of nerve conduction velocity lesions were significantly different between the two groups (P=0.023, P=0.002and P=0.010).3. Comparing the DC AN normal group, the early group and the diagnosis group, SUDOSCAN technology can measure the hands, feet ESC, CAN%, CKD%and IR%differences between the three groups (P=0.010,<0.001,0.021,0.031and0.027). The two scores of the SAS Scale and the numbers of nerve conduction velocity lesions were significantly different between the groups (P<0.001, P<0.001and P=0.006).4. According to the presence of DCAN lesions, the average feet sweat conductivity ([OR=0.930(0.884-0.979), P=0.006]) measured by binary logistic regression analysis, the average hands sweat conductivity ([OR=0.943(0.766-1.147), P=0.033]) and SAS extent score [OR=1.102(1.007-1.207), P=0.036] are good relatively independent predictors of DCAN.5. Regarding the cardiovascular reflex test results as diabetic cardiovascular autonomic neuropathy standards, the SODUSCAN indicators, ROC curve of SAS scores and other indicators, the average of the ESC of the hands and feet, and the effect of test of the Autonomic nervous system lesions scores were statistically significant, AUC area were0.750,0.747and0.707, the corresponding cut-off point was75.76uSi,66.67μSi and16.50points. Among them, the ESC of hands predicts DCAN much better than other indicators, with the sensitivity76.7%, specificity75.6%, Youden index0.522, and when the hand ESC is below75.76μSi, there is a greater risk of DCAN lesions.6. The heart rate autonomic neuropathy (CAN%) measured by eZscan instrument predicted poor test performance, ROC curve area is only0.602and P=0.136>0.05,which is not statistically significant. The instrument does not fully applicable for this crowd. Conclusion1. Compared with that of normal control population, the prevalence of cardiovascular autonomic neuropathy (DCAN) was significantly elevated, hand, feet sweat conductivity decreased significantly, autonomic symptoms were more and severity of symptoms was relatively heavier.2. SUDOSCAN technology is a quantitative, feasible, noninvasive way to screen for diabetic cardiac autonomic neuropathy, which is faster and easier than other diagnostic methods and suitable for large-scale epidemiological or clinical screening surveys. The average sweat conductivity of the hands detected by SUDOSCAN technique is the best and most relatively independent index of DCAN, the cut-off point to diagnose DCAN is75.76μ Si.3. SAS table contains only11questions (Male12). Compared with the previous lengthy, cumbersome questionnaire, it is an effective, simple, time-saving screening method which could be used to help DCAN screening and diagnosis. |
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