Risk Factors For Cardiovascular Autonomic Neuropathy In Type 2 Diabetes Mellitus

Objective1.To analyze the prevalence,clinical characteristics and risk factors for diabetic cardiovascular autonomic neuropathy(DCAN)in patients with type 2 diabetes mellitus(T2DM).2.To investigate the predictive value of DCAN related independent risk factors on DCAN.Subjects and MethodsThe present study enrolled a total of 134 patients with T2DM in the Department of Endocrinology and Department of neurology in Nanfang Hospital,Southern Medical University during September 2017 and May 2018.All participants were required to offer detailed medical history and accept the physical examination,biochemical tests,Ewing test to diagnose diabetic cardio,vascular autonomic neuropathy,diabetic peripheral neuropathy examinations,and fundus examination.Patients were divided into DCAN+group and DCAN-group according to Ewing’s score,and divided into non-lesion,early or suspicious lesions,lesions,and severe lesion group according to the staging of Ewing test.All the analyses were performed with the statistical soft-wares SPSS Statistics,EmpowerStats and R.ResultsIn the current study,the prevalence of DCAN was 38.8%,of which 22.4%and 16.4%were for lesions group and severe lesion group,respectively.The clinical data DCAN+group and DCAN-group were compared.There were significant differences(P<0.05)in age,diabetic duration,systolic blood pressure,insulin resistance including HOMA2-IR and fasting C-peptide(FCP),renal function including creatinine,Cystatin C(Cys C),uric acid(UA)and eGFR,albuminuria including urinary albumin excretion rates(UAER),urinary protein quantity(UTP)and urinary albumin-to-creatinine ratio(UACR),and the prevalence of diabetic kidney disease(DKD)and diabetic retinopathy(DR)between these two groups,all worsened with the degree of DCAN.Univariate logistic regression analysis showed that the indexes above were all correlated with DCAN(P<0.05).Subsequently,four independent risk factors,age(OR 1.08,95%CI 1.02,1.15,P=0.008),FCP(OR 3.02,95%CI 1.61,5.65,P<0.001),HOMA2-IR(OR 27.24,95%CI 5.84,127.03,P<0.001),and UAER(OR 1.00,95%CI 1.00,1.00,P=0.043),were screened out by multivariate logistic correlation analysis.Verified by stratified analysis and interaction test,the four independent risk factors were not significantly influenced by other confounding factors.Receiver operating characteristic(ROC)analysis showed that area under curve(AUC)of HOMA2-IR model was the largest with significant differences compared to the models of age,FCP,UAER alone,while AUC of the models combining HOMA2-IR with single or multiple indicators among age,FCP,UAER,were larger than that of HOMA2-IR alone,but with no statistically significance.For HOMA2-IR,the AUC was 0.878(95%CI 0.810,0.946)with the optimal cut-off value of 1.735,corresponding to a specificity of 81.9%and a sensitivity of 81.1%.Conclusions1.The prevalence of DCAN is quite high in patients with T2DM,in which nearly half of the confirmed DCAN cases are diagnosed as severe lesions,indicating significant syndrome concealment in the early stage of DCAN.2.Age,diabetic duration,systolic blood pressure,insulin resistance(HOMA2-IR,FCP),renal function(creatinine,Cys C,UA,eGFR),albuminuria(UAER,UTP,UACR)and diabetic complications including DKD and DR are risk factors for DCAN,in which age,FCP,HOMA2-IR,and UAER are the independent ones.3.HOMA2-IR has the highest predictive value of DCAN in patients with T2DM,which could accurately predict the occurrence of DCAN with satisfied clinical value.4.The patients whose HOMA2-IR is more than1.735 are at a high risk of DCAN;thus,DCAN screening should be carried out in time to intervene as early as possible.