Background: Cardiac autonomic neuropathy (CAN) is a common diabetes
complication associated with poor prognosis. This cross-sectional study
aimed to examine for associations between CAN and metabolic and other
parameters in patients with either type 1 (T1DM) or type 2 (T2DM)
diabetes. Patients and Methods: A total of 600 patients (T1DM, n=200;
T2DM, n=400) were recruited. Participants with overt nephropathy,
macrovascular complications, and treated hypertension were excluded. CAN
was diagnosed when two of the four classical autonomic function tests
were abnormal. Results: CAN was diagnosed in 42.0% and in 44.3% of the
participants with T1DM and T2DM, respectively. Multivariate logistic
regression analysis demonstrated that, in T1DM, the odds [OR (95%
confidence intervals)] of CAN increased with higher waist circumference
[1.36 (1.01-2.02)], systolic blood pressure [1.16 (1.03-1.31)],
hypertension [1.19 (1.03-2.67)], smoking [1.10 (1.12-1.40], fasting
glucose [1.01 (1.00-1.01)], HbA(1c) [1.69 (1.07-2.76)], pubertal
diabetes onset [1.08 (1.03-1.24)], LDL cholesterol
[1.01(1.00-1.02)], triglycerides [1.58 (1.24-1.48)], retinopathy
[1.13 (1.04-1.41)], peripheral neuropathy [2.53 (1.07-2.99)],
glomerular filtration rate [0.93 (0.87-0.99)], and microalbuminuria
[1.24 (1.12-1.36)]. The same analysis in T2DM demonstrated that the
odds of CAN increased with higher waist circumference [1.08
(1.00-1.39)], systolic blood pressure [1.06 (1.02-1.12)], hypertension
[1.50 (1.24-2.03)], smoking [1.22 (1.14-1.49)], diabetes duration
[1.20 (1.09-1.34)], fasting glucose [1.21 (1.12-1.31)], HbA(1c)
[1.25 (1.08-1.45)], LDL cholesterol [1.35 (1.04-1.75)],
triglycerides [1.30 (1.00-1.68)], retinopathy [1.24 (1.16-1.35)],
peripheral neuropathy [1.79 (1.07-2.01)], glomerular filtration rate
[0.96 (0.95-0.97)], and microalbuminuria [1.20 (1.14-1.36)].
Conclusions: CAN is common in diabetes and is associated with modifiable
factors including central fat distribution, hypertension, dyslipidemia,
worse diabetes control, and smoking, and with the other microvascular
complications of diabetes. Our findings emphasize the need for a
multifactorial intervention for the prevention of CAN. (C) 2011 Elsevier
Inc. All rights reserved