scholarly journals Optimization of the method for diagnostics of cardial autonomic neuropathy in diabetes mellitus 2 types

2021 ◽  
pp. 178-183
Author(s):  
L. S. Moshkhoeva ◽  
A. N. Barinov
Keyword(s):  
Diabetes Mellitus ◽  
Type 2 Diabetes ◽  
Nervous System ◽  
Autonomic Neuropathy ◽  
Parasympathetic Nervous System ◽  
Diagnostic Technique ◽  
Pain Syndrome ◽  
Cardiac Autonomic Neuropathy ◽  
Neuropathic Pain Syndrome

Introduction. Early diagnosis of cardiac autonomic neuropathy is the basis for the risk of heart disease and premature death in patients with type 2 diabetes mellitus (type 2 diabetes). All patients with type 2 diabetes and prediabetes should undergo annual screening, including history taking and neurophysiologic evaluation, for early diabetic autonomic neuropathy. This article describes a modern diagnostic technique based on changes in heart rate variability, which allows early detection of damage to the parasympathetic nervous system and timely prescribing disease-modifying treatment in patients with type 2 diabetes.Materials and methods. The study included 50 patients with type 2 diabetes (cf. Age 56.5 ± 13.5 years) and 30 healthy subjects (cf. Age 58 ± 10 years), matched by sex and age. according to the NSC questionnaire, the severity of neurological deficit - according to the NIS-LL scale, neuropathic pain syndrome - according to the TSS scale.Results. In the study group of patients with type 2 diabetes, severe CAN was detected in 13.3%, moderate CAN in 40% of patients, in 46.6% of patients, CAN was not detected. In the group of healthy volunteers, disorders of the autonomic nervous system of moderate were detected in 3.3%, in the remaining 96.7% of autonomic disorders were not accepted.Conclusion. The results of pulse oximetric tests with deep breathing are comparable to the results of the QAT device Case-4 (p < 0.001). The method of pulse oximetric diagnostics is more practical to use in comparison with the hardware QAT.

scholarly journals Type 2 Diabetes Mellitus: Cardiovascular Autonomic Neuropathy and Heart Rate Variability

2021 ◽  
Author(s):  
Sultana Ferdousi ◽  
Phurpa Gyeltshen
Keyword(s):  
Diabetes Mellitus ◽  
Type 2 Diabetes ◽  
Heart Rate ◽  
Heart Rate Variability ◽  
Nervous System ◽  
Type 2 Diabetes Mellitus ◽  
Autonomic Neuropathy ◽  
Parasympathetic Nervous System ◽  
Cardiovascular Autonomic Neuropathy

Type 2 Diabetes Mellitus is associated with both macro- and microvascular complications. One among the latter, is cardiovascular autonomic neuropathy (CAN). CAN is attributed to cardiac arrhythmias and sudden death. Underlying pathogenesis of cardiac autonomic neuropathy is chronic hyperglycemia induced oxidative stress causing neuronal necrosis, apoptosis and death, leading to the sympathetic and parasympathetic nerve dysfunction. The balance between sympathetic and parasympathetic nervous system is reflected by heart rate variability (HRV). HRV describes “the variations of both instantaneous heart rate and R-R intervals which in turn reflects the cardiac autonomic nervous control”. HRV measured at rest is a marker of autonomic nerve function status. Thus, HRV test is recommended to diagnose diabetic CAN. Time domain parameters predominantly reflect overall autonomic activity and parasympathetic nervous system (PNS) modulations. Frequency domain parameters either reflect, sympathetic nervous system (SNS) activity, PNS activity, or the balance between the two activities. Nonlinear HRV indices marks PNS influences, SNS influences and sympatho-vagal balance. Almost all these HRV parameters are remarkably reduced in T2DM due to cardiac autonomic dysfunction. HRV is an important simple and noninvasive diagnostic tool to detect CAN.

Cardiac sympathetic dysinnervation in Type 2 diabetes mellitus with and without ECG-based cardiac autonomic neuropathy

2002 ◽  
Vol 16 (3) ◽  
pp. 220-227 ◽  
Author(s):  
Oliver Schnell ◽  
Katja Hammer ◽  
Daniela Muhr-Becker ◽  
Anette-Gabriele Ziegler ◽  
Mayo Weiss ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Type 2 Diabetes ◽  
Type 2 Diabetes Mellitus ◽  
Autonomic Neuropathy ◽  
Cardiac Autonomic Neuropathy

scholarly journals Diabetic Cardiovascular Autonomic Neuropathy: Effects of Simvastatin and Omega-3 Polyunsaturated Fatty Acids on Insulin Resistance and Lipid Profile Parameters

2021 ◽  
Vol 2-3 (35-36) ◽  
pp. 8-15
Author(s):  
V. Serhiyenko ◽  
◽  
M. Hotsko ◽  
S. Azhmi ◽  
O. Serhiyenko ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Type 2 Diabetes ◽  
Fatty Acids ◽  
Type 2 Diabetes Mellitus ◽  
Polyunsaturated Fatty Acids ◽  
Autonomic Neuropathy ◽  
Density Lipoprotein ◽  
Blood Lipid ◽  
Cardiac Autonomic Neuropathy

Introduction. Currently, there is no unified treatment algorithm of cardiac autonomic neuropathy (CAN) in patients with type 2 diabetes mellitus (T2DM). The aim of the study was to investigate the effects of simvastatin (SIM) and -3 polyunsaturated fatty acids (-3 PUFAs) on blood lipid profile and insulin resistance (IR) in patients with type 2 diabetes mellitus and definite cardiac autonomic neuropathy. Materials and methods. The study involved 72 patients with T2DM and definite CAN. Patients were divided into four groups: 1st - received standard hypoglycemic therapy - control (n = 15); 2nd (n = 22) – in addition simvastatin (SIM) 20.0 mg/q.d.; 3rd (n = 18) - in addition 1 capsule/q.d. of the ω-3 PUFAs; 4th (n = 17) - in addition SIM 10.0 mg/q.d and 1 capsule/q.d of the ω-3 PUFAs for three months. The concentration of glucose, glycated hemoglobin A1c, immunoreactive insulin (IRI), total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), triglycerides (TG) in the blood were determined. Homeostasis model assessment IR (HOMA-IR), atherogenic coefficient (AC), TG/LDL-C, TG/TC, TG/LDL-C and TG and glucose index (TyG) were calculated. Results. Prescription of SIM was accompanied by a statistically significant decrease in TC, LDL-C, TG concentrations. In parallel, SIM induced a decrease of AC, TG/HDL-C, increase in HDL-C, and does not affect the IRI, HOMA-IR, TG/LDL-C, TG/TC, TC/LDL-C/HDL-C, TyG. The use of ω-3 PUFAs has contributed to a significant reduction in TG, AC, TG/LDL-C, TG/TC, TG/HDL-C, TyG index, increase in HDL-C, and was not accompanied by changes in IRI content, HOMA-IR, TC, LDL-C, and TC/LDL-C/HDL-C. The combined prescription of SIM and -3 PUFAs was accompanied by more pronounced, statistically significant changes in the blood lipid spectrum, as well as a decrease in the IRI and HOMA-IR. Conclusions. Obtained results justify the appropriateness of combined simvastatin and -3 polyunsaturated fatty acids prescription to patients with type 2 diabetes mellitus and definite cardiac autonomic neuropathy. Keywords: diabetes mellitus, cardiac autonomic neuropathy, treatment.

scholarly journals DYNAMICS OF CARDIAC AUTONOMIC NEUROPATHY IN PATIENTS WITH ISCHEMIC STROKE DURING VERTICALIZATION

2021 ◽  
pp. 39-49
Author(s):  
V.A. Pavlova ◽  
D.A. Pavlov ◽  
V.V. Mashin
Keyword(s):  
Diabetes Mellitus ◽  
Type 2 Diabetes ◽  
Type 2 Diabetes Mellitus ◽  
Ischemic Stroke ◽  
Autonomic Neuropathy ◽  
Blood Pressure Monitoring ◽  
Cardiac Autonomic Neuropathy ◽  
Rank Test ◽  
Signed Rank Test

Acute cerebrovascular accidents remain an urgent problem in neurology. Heterogeneous pathologies accompanying stroke determine its course and development of complications. Such pathologies require early remodeling during the rehabilitation process. Understaging the symptoms of cardiac autonomic neuropathy (CAN) associated with type 2 diabetes mellitus (DM 2) worsens the patient prognosis after an ischemic stroke. The aim of the paper is to study the manifestations of cardiac autonomic neuropathy in patients with ischemic stroke associated with type 2 diabetes mellitus and to assess their dynamics during verticalization. Materials and Methods. The study involved 60 patients of both sexes (aged 45–75) with acute ischemic stroke (IS). The first group consisted of 30 patients with DM 2, the second group enrolled 30 patients without diabetes. At the beginning of the study, we collected complaints, anamnesis, analyzed risk factors for CAN, examined the patients according to the NIH Stroke Scale and the Rankin Scale, carried out cardiovascular tests (CVT) for CAN detection, electrocardiography, 24-hour blood pressure monitoring, and electroneuromyography. The patients underwent passive verticalization for 12 days, which was followed by neurological examination, CVT and ECG. We used both descriptive (calculating the median, 25th and 75th quartiles) and nonparametric statistics (Mann–Whitney U-test, Wilcoxon signed-rank test, Cochran's Q test) for data processing. Results. Initially, patients with DM 2 demonstrated significant changes in all CVTs, and a predominance of the advanced CAN. Confirmed CAN prevailed in the patients of the second group. After verticalization, some positive changes in neurological scales, CVT, and CAN severity were observed in patients of both groups. However, at the end of the trial, the decrease in CAN manifestation in patients with IS associated with DM 2 was less pronounced as compared with patients without DM. Conclusion. Passive verticalization helps to reduce CAN manifestations in patients with IS, including those with associated DM 2. Keywords: cardiac autonomic neuropathy, verticalization, ischemic stroke, diabetes mellitus. Острые нарушения мозгового кровообращения остаются актуальной проблемой неврологии. Гетерогенные патологии, сопутствующие инсульту, обусловливают особенности его течения, развитие осложнений, что требует своевременной коррекции при составлении реабилитационных программ. Недооценка симптомов кардиальной автономной нейропатии (КАН) на фоне сахарного диабета 2-го типа (СД 2) ухудшает прогноз при ишемическом инсульте. Цель работы – изучить проявления кардиальной автономной нейропатии у пациентов с ишемическим инсультом на фоне СД 2 и оценить их динамику при проведении вертикализации. Материалы и методы. В исследовании участвовали 60 пациентов обоего пола 45–75 лет с ишемическим инсультом (ИИ) в острейшем периоде. Первую группу составили 30 пациентов с СД 2, вторую группу – 30 пациентов без данного заболевания. В начале исследования проводились сбор жалоб, анамнеза, анализ факторов риска КАН, оценка по шкалам NIHSS, Рэнкин, кардиоваскулярные тесты (КВТ) на выявление КАН, электрокардиография, суточное мониторирование артериального давления, электронейромиография. На протяжении 12 дней пациентам осуществлялась пассивная вертикализация. Затем повторно проводились неврологический осмотр, КВТ и ЭКГ. Для статистической обработки данных использовалась описательная (подсчет медианы, 25-го и 75-го квартилей) и непараметрическая статистика (критерии Манна–Уитни, Вилкоксона, Кохрена). Результаты. Исходно у пациентов с СД 2 выявлены выраженные изменения всех КВТ, преобладание прогрессирующей формы КАН. Во второй группе преобладала подтвержденная форма КАН. После курса вертикализации отмечена положительная динамика по неврологическим шкалам, КВТ, степени выраженности КАН в обеих группах при сохранении различий между ними. У пациентов с ИИ на фоне СД 2 уменьшение проявлений КАН в конце исследования было менее выраженным по сравнению с пациентами без СД. Выводы. Пассивная вертикализация способствует уменьшению проявлений КАН у пациентов с ИИ, в т.ч. на фоне СД 2. Ключевые слова: кардиальная автономная нейропатия, вертикализация, ишемический инсульт, сахарный диабет.

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