scholarly journals Intensive Risk Factor Management and Cardiovascular Autonomic Neuropathy in Type 2 Diabetes: The ACCORD Trial

Diabetes Care ◽  
2020 ◽  
Vol 44 (1) ◽  
pp. 164-173
Author(s):  
Yaling Tang ◽  
Hetal Shah ◽  
Carlos Roberto Bueno Junior ◽  
Xiuqin Sun ◽  
Joanna Mitri ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Risk Factor ◽  
Autonomic Neuropathy ◽  
Cardiovascular Autonomic Neuropathy ◽  
Risk Factor Management

130-OR: Effects of Intensive Risk Factor Management on Cardiovascular Autonomic Neuropathy in Type 2 Diabetes: Findings from the ACCORD Trial

Diabetes ◽  
2020 ◽  
Vol 69 (Supplement 1) ◽  
pp. 130-OR
Author(s):  
YALING TANG ◽  
HETAL SHAH ◽  
CARLOS BUENO JUNIOR ◽  
XIUQIN SUN ◽  
JOANNA MITRI ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Risk Factor ◽  
Autonomic Neuropathy ◽  
Cardiovascular Autonomic Neuropathy ◽  
Risk Factor Management

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

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

<b>Objectives: </b>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. <p><b>Research Design and Methods: </b>CAN was defined as heart rate variability indices below the 5<sup>th</sup> 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. </p> <p><b>Results: </b>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). </p> <p><b>Conclusions: </b> 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. </p>

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

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

<b>Objectives: </b>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. <p><b>Research Design and Methods: </b>CAN was defined as heart rate variability indices below the 5<sup>th</sup> 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. </p> <p><b>Results: </b>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). </p> <p><b>Conclusions: </b> 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. </p>

scholarly journals Cardiovascular Autonomic Neuropathy Is an Independent Risk Factor for Left Ventricular Diastolic Dysfunction in Patients with Type 2 Diabetes

2017 ◽  
Vol 2017 ◽  
pp. 1-6
Author(s):  
Jiewen Jin ◽  
Weimin Wang ◽  
Liangying Zhu ◽  
Tianwei Gu ◽  
Qing Niu ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Risk Factor ◽  
Diastolic Dysfunction ◽  
Autonomic Neuropathy ◽  
Independent Risk Factor ◽  
Left Ventricular Diastolic Dysfunction ◽  
Left Ventricular ◽  
Cardiovascular Autonomic Neuropathy ◽  
Ventricular Diastolic Dysfunction

Aim. This study aimed to evaluate the association between cardiovascular autonomic neuropathy (CAN) and left ventricular diastolic dysfunction (LVDD) in type 2 diabetes patients. Methods. 315 type 2 diabetes patients from inpatients of Drum Tower Hospital were included and classified into no CAN (NCAN), possible CAN (PCAN), and definite CAN (DCAN) based on cardiovascular autonomic reflex tests. The left ventricular diastolic function was assessed by tissue Doppler imaging echocardiography. Results. The distribution of NCAN, PCAN, and DCAN was 11.4%, 51.1%, and 37.5%, respectively. The proportion of LVDD increased among the groups of NCAN, PCAN, and DCAN (39.4%, 45.3%, and 68.0%, P=0.001). Patients with DCAN had higher filling pressure (E/e′ ratio) (10.9±2.7 versus 9.4±2.8, P=0.013) and impaired diastolic performance (e′) (6.8±1.7 versus 8.6±2.4, P=0.004) compared with NCAN. CAN was found to be an independent risk factor for LVDD from the multivariate regression analysis (OR = 1.628, P=0.009, 95% CI 1.131–2.344). Conclusions. Our results indicated that CAN was an independent risk marker for the presence of LVDD in patients with diabetes. Early diagnosis and treatment of CAN are advocated for preventing LVDD in type 2 diabetes.

scholarly journals Diabetic Retinopathy Is Strongly Predictive of Cardiovascular Autonomic Neuropathy in Type 2 Diabetes

2016 ◽  
Vol 2016 ◽  
pp. 1-7 ◽  
Author(s):  
Chih-Cheng Huang ◽  
Jong-Jer Lee ◽  
Tsu-Kung Lin ◽  
Nai-Wen Tsai ◽  
Chi-Ren Huang ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Diabetic Retinopathy ◽  
Risk Factor ◽  
Autonomic Neuropathy ◽  
Valsalva Maneuver ◽  
Significant Risk ◽  
Significant Risk Factor ◽  
Cardiovascular Autonomic Neuropathy ◽  
Deep Breathing

A well-established, comprehensive, and simple test battery was used here to re-evaluate risk factors for cardiovascular autonomic neuropathy (CAN) in type 2 diabetes. One hundred and seventy-four patients with type 2 diabetes were evaluated through the methods of deep breathing and Valsalva maneuver for correlation with factors that might influence the presence and severity of CAN. The Composite Autonomic Scoring Scale (CASS) was used to grade the severity of autonomic impairment, and CAN was defined as a CASS score ≥2. Results showed that nephropathy, duration of diabetes, blood pressure, uric acid, and the presence of retinopathy and metabolic syndrome significantly correlated with the CASS score. Age may not be a risk factor for diabetic CAN. However, the effects of diabetes on CAN are more prominent in younger patients than in older ones. Diabetic retinopathy is the most significant risk factor predictive of the presence of CAN in patients with type 2 diabetes.

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

Diabetes ◽  
2019 ◽  
Vol 68 (Supplement 1) ◽  
pp. 321-OR
Author(s):  
YALING TANG ◽  
HETAL SHAH ◽  
XIUQIN SUN ◽  
BRUCE A. PERKINS ◽  
MICHAEL J. WAGNER ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Autonomic Neuropathy ◽  
Genetic Locus ◽  
Cardiovascular Autonomic Neuropathy ◽  
Chromosome 1P36

scholarly journals A study of cardiological autonomic neuropathy in Type 2 Diabetes Mellitus with reference to QT interval for its diagnosis

2019 ◽  
Vol 7 (7) ◽  
pp. 2574
Author(s):  
Lakshmi Priya Inapakolla ◽  
Ramgopal Teja Kotla
Keyword(s):  
Type 2 Diabetes ◽  
Autonomic Neuropathy ◽  
Autonomic Dysfunction ◽  
Cardiovascular Autonomic Neuropathy ◽  
Cardiac Autonomic Neuropathy ◽  
P Value ◽  
Qtc Interval ◽  
Duration Of Diabetes ◽  
Cardiac Autonomic Dysfunction

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.

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

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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