321-OR: A Genetic Locus on Chromosome 1p36 Associated with Cardiovascular Autonomic Neuropathy in Type 2 Diabetes

Background: Presence of cardiac autonomic neuropathy (CAN) is responsible for silent myocardial infarction and sudden death in diabetics. Hence recognizing cardiac dysautonomia early, which is asymptomatic will help to delay or arrest its progression.Methods: A cross-sectional study to evaluate the Prevalence of Cardiovascular Autonomic Neuropathy in Type 2 diabetes and correlate it with duration of Diabetes and to investigate the relationship between cardiac autonomic dysfunction and corrected QT interval.Results: In the study population, the prevalence of definite CAN was 8%, 24% and 58% in group A, B and C respectively. The prevalence of definite CAN increases with increase in duration of diabetes. P value <0.001 significant.Conclusions: A significant correlation is present between Cardiovascular autonomic dysfunction and QTc prolongation. QTc interval in the ECG can be used to diagnose Cardiovascular autonomic neuropathy with a reasonable sensitivity and specificity.

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The Association Between Continuous Glucose Monitoring-derived Metrics, Including Time in Range, and Cardiovascular Autonomic Neuropathy in Outpatients With Type 2 Diabetes

10.21203/rs.3.rs-101449/v1 ◽

2020 ◽

Author(s):

Min Young Kim ◽

Gyuri Kim ◽

Ji Yun Park ◽

Min Sun Choi ◽

Ji Eun Jun ◽

...

Keyword(s):

Type 2 Diabetes ◽

Autonomic Neuropathy ◽

Autonomic Function ◽

Glucose Monitoring ◽

Glycemic Variability ◽

Cardiovascular Autonomic Neuropathy ◽

Inverse Association ◽

International Consensus ◽

Time In Range

Abstract BackgroundContinuous glucose monitoring (CGM)-derived metrics including time in range (TIR) are attracting attention as new indicators of glycemic control and diabetes complications beyond hemoglobin A1c. This study investigated the association between CGM-derived TIR, hyperglycemia, hypoglycemia metrics, and cardiovascular autonomic neuropathy (CAN) in patients with type 2 diabetes.MethodsA total of 284 patients with type 2 diabetes who underwent CGM for three days and autonomic function tests within three months based on outpatient data were recruited. The definition of CGM-derived metrics was subject to the most recent international consensus. CAN was defined as an abnormal case in two or more parasympathetic and the severity of CAN was estimated as the sum of the scores of the five cardiovascular autonomic function tests.ResultsMultiple logistic regression analysis revealed that the odds ratio of definite CAN was 0.876 [95% confidence interval (CI): 0.79–0.98] per 10% increase in the TIR of 70 to 180 mg/dL, after adjusting for age, sex, diabetes duration, any medications, and glycemic variability. A 10% increase in TIR was significantly inversely associated with the presence of advanced CAN (OR: 0.89, 95% CI: 0.81–0.98). In addition, there was a strong inverse association between a 10% increase in the TIR and the total CAN score (p for trend = 0.001). Among the metrics of hyperglycemia, a time above range (TAR) of greater than 180 mg/dL was also independently correlated with the presence of definite CAN (OR: 1.013, 95% CI: 1.00–1.02) and advanced CAN (OR: 1.01, 95% CI: 1.00–1.02).ConclusionsA TIR value of 70 to 180 mg/dL and a TAR value of greater than 180 mg/dL were significantly associated with cardiovascular autonomic neuropathy in outpatients with type 2 diabetes.

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Intensive risk factor management and cardiovascular autonomic neuropathy in type 2 diabetes: the ACCORD Trial

10.2337/figshare.13020338.v1 ◽

2020 ◽

Author(s):

Yaling Tang ◽

Hetal Shah ◽

Carlos Roberto Bueno Junior ◽

Xiuqin Sun ◽

Joanna Mitri ◽

...

Keyword(s):

Blood Pressure ◽

Type 2 Diabetes ◽

Cardiovascular Risk ◽

Autonomic Neuropathy ◽

Pressure Control ◽

Cardiovascular Autonomic Neuropathy ◽

Risk Factor Management ◽

Traditional Risk Factors ◽

Intensive Blood Pressure

Objectives: The effects of preventive interventions on cardiovascular autonomic neuropathy (CAN) remain unclear. We examined the effect of intensively treating traditional risk factors for CAN, including hyperglycemia, hypertension, and dyslipidemia, in persons with type 2 diabetes (T2D) and high cardiovascular risk participating in the Action to Control Cardiovascular Risk in Diabetes (ACCORD) trial. Research Design and Methods: CAN was defined as heart rate variability indices below the 5th percentile of the normal distribution. Of 10,250 ACCORD participants, 71% (n=7,275) had a CAN evaluation at study entry and at least once after randomization. The effects of intensive interventions on CAN were analyzed among these subjects through generalized linear mixed models. Results: As compared to standard intervention, intensive glucose treatment reduced CAN risk by 16% (OR=0.84, 95%CI 0.75–0.94, p=0.003) – an effect driven by individuals without cardiovascular disease (CVD) at baseline (OR= 0.73, 95%CI 0.63–0.85, p<0.0001) rather than those with CVD (OR=1.10, 95%CI 0.91–1.34, p=0.34) (p for interaction=0.001). Intensive blood pressure intervention decreased CAN risk by 25% (OR=0.75, 95% CI 0.63–0.89, p=0.001), especially in patients ≥65 years old (OR=0.66, 95% CI 0.49–0.88, p=0.005) (p for interaction =0.05). Fenofibrate did not have a significant effect on CAN (OR=0.91, 95%CI 0.78–1.07, p=0.26). Conclusions: These data confirm a beneficial effect of intensive glycemic therapy and demonstrate, for the first time, a similar benefit of intensive blood pressure control on CAN in T2D. A negative CVD history identifies T2D patients who especially benefit from intensive glycemic control for CAN prevention.

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Clinical factors associated with the recovery of cardiovascular autonomic neuropathy in patients with type 2 diabetes mellitus

Cardiovascular Diabetology ◽

10.1186/s12933-019-0830-4 ◽

2019 ◽

Vol 18 (1) ◽

Cited By ~ 4

Author(s):

Ji Eun Jun ◽

Seung-Eun Lee ◽

Min Sun Choi ◽

Sung Woon Park ◽

You-Cheol Hwang ◽

...

Keyword(s):

Diabetes Mellitus ◽

Type 2 Diabetes ◽

Type 2 Diabetes Mellitus ◽

Autonomic Neuropathy ◽

Cardiovascular Autonomic Neuropathy ◽

Clinical Factors ◽

Factors Associated

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Cardiovascular Autonomic Neuropathy Is Associated With Microalbuminuria in Older Patients With Type 2 Diabetes

Diabetes Care ◽

10.2337/diacare.27.4.972 ◽

2004 ◽

Vol 27 (4) ◽

pp. 972-977 ◽

Cited By ~ 32

Author(s):

A. Moran ◽

W. Palmas ◽

L. Field ◽

J. Bhattarai ◽

J. E. Schwartz ◽

...

Keyword(s):

Type 2 Diabetes ◽

Autonomic Neuropathy ◽

Older Patients ◽

Cardiovascular Autonomic Neuropathy

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TCF7L2 gene polymorphisms and type 2 diabetes: association with diabetic retinopathy and cardiovascular autonomic neuropathy

Acta Diabetologica ◽

10.1007/s00592-012-0418-x ◽

2012 ◽

Vol 50 (5) ◽

pp. 789-799 ◽

Cited By ~ 33

Author(s):

Cinzia Ciccacci ◽

Davide Di Fusco ◽

Laura Cacciotti ◽

Roberto Morganti ◽

Cinzia D’Amato ◽

...

Keyword(s):

Type 2 Diabetes ◽

Diabetic Retinopathy ◽

Autonomic Neuropathy ◽

Gene Polymorphisms ◽

Cardiovascular Autonomic Neuropathy ◽

Tcf7l2 Gene

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Risk Factors for the Presence and Progression of Cardiovascular Autonomic Neuropathy in Type 2 Diabetes: ADDITION-Denmark

Diabetes Care ◽

10.2337/dc18-1411 ◽

2018 ◽

Vol 41 (12) ◽

pp. 2586-2594 ◽

Cited By ~ 19

Author(s):

Signe T. Andersen ◽

Daniel R. Witte ◽

Jesper Fleischer ◽

Henning Andersen ◽

Torsten Lauritzen ◽

...

Keyword(s):

Risk Factors ◽

Type 2 Diabetes ◽

Autonomic Neuropathy ◽

Cardiovascular Autonomic Neuropathy

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Intensive risk factor management and cardiovascular autonomic neuropathy in type 2 diabetes: the ACCORD Trial

10.2337/figshare.13020338 ◽

2020 ◽

Author(s):

Yaling Tang ◽

Hetal Shah ◽

Carlos Roberto Bueno Junior ◽

Xiuqin Sun ◽

Joanna Mitri ◽

...

Keyword(s):

Blood Pressure ◽

Type 2 Diabetes ◽

Cardiovascular Risk ◽

Autonomic Neuropathy ◽

Pressure Control ◽

Cardiovascular Autonomic Neuropathy ◽

Risk Factor Management ◽

Traditional Risk Factors ◽

Intensive Blood Pressure

Objectives: The effects of preventive interventions on cardiovascular autonomic neuropathy (CAN) remain unclear. We examined the effect of intensively treating traditional risk factors for CAN, including hyperglycemia, hypertension, and dyslipidemia, in persons with type 2 diabetes (T2D) and high cardiovascular risk participating in the Action to Control Cardiovascular Risk in Diabetes (ACCORD) trial. Research Design and Methods: CAN was defined as heart rate variability indices below the 5th percentile of the normal distribution. Of 10,250 ACCORD participants, 71% (n=7,275) had a CAN evaluation at study entry and at least once after randomization. The effects of intensive interventions on CAN were analyzed among these subjects through generalized linear mixed models. Results: As compared to standard intervention, intensive glucose treatment reduced CAN risk by 16% (OR=0.84, 95%CI 0.75–0.94, p=0.003) – an effect driven by individuals without cardiovascular disease (CVD) at baseline (OR= 0.73, 95%CI 0.63–0.85, p<0.0001) rather than those with CVD (OR=1.10, 95%CI 0.91–1.34, p=0.34) (p for interaction=0.001). Intensive blood pressure intervention decreased CAN risk by 25% (OR=0.75, 95% CI 0.63–0.89, p=0.001), especially in patients ≥65 years old (OR=0.66, 95% CI 0.49–0.88, p=0.005) (p for interaction =0.05). Fenofibrate did not have a significant effect on CAN (OR=0.91, 95%CI 0.78–1.07, p=0.26). Conclusions: These data confirm a beneficial effect of intensive glycemic therapy and demonstrate, for the first time, a similar benefit of intensive blood pressure control on CAN in T2D. A negative CVD history identifies T2D patients who especially benefit from intensive glycemic control for CAN prevention.

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