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

TY - JOUR

T1 - Risk Factors for the Presence and Progression of Cardiovascular Autonomic Neuropathy in Type 2 Diabetes

T2 - ADDITION-Denmark

AU - Andersen, Signe T

AU - Witte, Daniel R

AU - Fleischer, Jesper

AU - Andersen, Henning

AU - Lauritzen, Torsten

AU - Jørgensen, Marit E

AU - Jensen, Troels S

AU - Pop-Busui, Rodica

AU - Charles, Morten

N1 - © 2018 by the American Diabetes Association.

PY - 2018/12/1

Y1 - 2018/12/1

N2 - OBJECTIVE: To examine the course of cardiovascular autonomic neuropathy (CAN) and related cardiometabolic risk factors in patients with type 2 diabetes.RESEARCH DESIGN AND METHODS: CAN and cardiometabolic risk factors were assessed in the Danish arm of the Anglo-Danish-Dutch Study of Intensive Treatment in People With Screen Detected Diabetes in Primary Care (ADDITION-Denmark) at 6-year (n = 777) and 13-year (n = 443) follow-up examinations. Cardiovascular autonomic reflex tests (CARTs)-that is, lying to standing, deep breathing, and the Valsalva maneuver-and 2-min resting heart rate variability (HRV) indices were obtained as the main measures of CAN. Risk factors related to CAN status, as determined by CARTs, were studied by using multivariate logistic regressions. The effect of risk factors on continuous CARTs and HRV indices, and their changes over time, were estimated in linear mixed models.RESULTS: A progressive yet heterogeneous course of CAN occurred between the 6- and 13-year follow-ups. Higher HbA1c, weight, BMI, and triglycerides were associated with prevalent CAN. No significant effect of risk factors on CARTs was found when they were analyzed as continuous variables. CART indices decreased over time, and a trend of decreasing HRV indices was seen. Higher HbA1c and BMI were associated with lower HRV index values, but these differences diminished over time.CONCLUSIONS: These data confirm that hyperglycemia, obesity, and hypertriglyceridemia are negatively related to indices of CAN, although these effects diminish over time. The observed heterogeneous course of CAN may challenge the present clinical approach of categorically classifying CARTs to diagnose CAN and the notion of CAN being irreversible.

AB - OBJECTIVE: To examine the course of cardiovascular autonomic neuropathy (CAN) and related cardiometabolic risk factors in patients with type 2 diabetes.RESEARCH DESIGN AND METHODS: CAN and cardiometabolic risk factors were assessed in the Danish arm of the Anglo-Danish-Dutch Study of Intensive Treatment in People With Screen Detected Diabetes in Primary Care (ADDITION-Denmark) at 6-year (n = 777) and 13-year (n = 443) follow-up examinations. Cardiovascular autonomic reflex tests (CARTs)-that is, lying to standing, deep breathing, and the Valsalva maneuver-and 2-min resting heart rate variability (HRV) indices were obtained as the main measures of CAN. Risk factors related to CAN status, as determined by CARTs, were studied by using multivariate logistic regressions. The effect of risk factors on continuous CARTs and HRV indices, and their changes over time, were estimated in linear mixed models.RESULTS: A progressive yet heterogeneous course of CAN occurred between the 6- and 13-year follow-ups. Higher HbA1c, weight, BMI, and triglycerides were associated with prevalent CAN. No significant effect of risk factors on CARTs was found when they were analyzed as continuous variables. CART indices decreased over time, and a trend of decreasing HRV indices was seen. Higher HbA1c and BMI were associated with lower HRV index values, but these differences diminished over time.CONCLUSIONS: These data confirm that hyperglycemia, obesity, and hypertriglyceridemia are negatively related to indices of CAN, although these effects diminish over time. The observed heterogeneous course of CAN may challenge the present clinical approach of categorically classifying CARTs to diagnose CAN and the notion of CAN being irreversible.

KW - Aged

KW - Autonomic Nervous System Diseases/epidemiology

KW - Cardiovascular Diseases/epidemiology

KW - Denmark/epidemiology

KW - Diabetes Mellitus, Type 2/complications

KW - Diabetic Angiopathies/epidemiology

KW - Diabetic Neuropathies/epidemiology

KW - Disease Progression

KW - Female

KW - Follow-Up Studies

KW - Heart Rate/physiology

KW - Humans

KW - Male

KW - Middle Aged

KW - Obesity/complications

KW - Prevalence

KW - Risk Factors

U2 - 10.2337/dc18-1411

DO - 10.2337/dc18-1411

M3 - Journal article

C2 - 30305347

SN - 0149-5992

VL - 41

SP - 2586

EP - 2594

JO - Diabetes Care

JF - Diabetes Care

IS - 12

ER -