The relationship between daytime, nighttime and total heart rate with albumin and protein excretion in newly diagnosed type 2 diabetic patients
Introduction: Autonomic nervous system dysfunction has been widely observed in patients with type 2 diabetes. Twenty-four hour ambulatory heart rate measurements (AHRM) have been found to associate with autonomic dysfunction in patient with type 2 diabetes. Since albumin excretion is also related with autonomic dysfunction; in the current study, we analyzed whether 24-h AHRM were related with 24 h urinary albumin excretion (UAE) and urinary protein excretion (UPE) in newly diagnosed patients with type 2 diabetes.
Methods: All patients underwent following procedures: history taking, physical examination, blood pressure measurement, 12 lead electocardiographic evaluation, routine urine analysis, biochemical analysis, 24-h urine collection to measure urinary sodium and protein excretion and creatinine clearance calculation. Twenty-four hour ambulatory blood pressure and heart rate monitoring were performed for all patients. Diagnosis of diabetes was based on at least two fasting blood glucose.
Results: In total 80 patients (34 male, 46 female aged 50.4±9.2 years) with newly diagnosed type 2 diabetic patients were included. Stepwise linear regression of factors including age, gender, body mass index, smoking status, presence of coronary artery disease, dipping status, averaged fasting blood glucose, 24-h creatinine clearance, 24-h average ambulatory systolic blood pressure (AASBP), 24-h average ambulatory diastolic blood pressure (AADBP), daytime AHRM, nighttime AHRM and 24-h AHRM revealed that logarithmically converted 24-h UAE were independently related with 24-h AASBP (b: 0.02, CI: 0.090.031, P: 0.001) and nighttime AHRM (b: 0.05, CI: 0.030.069, P<0.0001). Using the same independent variables logarithmically converted 24-h UPE were independently related with age (b: −0.014, CI: −0.027 (to) −0.001, P: 0.032), with averaged fasting blood glucose (b: 0.011, CI: 0.0020.021, P 0.023), 24-h AASBP (b: 0.013, CI: 0.0050.020, P 0.002), nighttime AHRM (b 0.021, CI: 0.0090.033, P 0.001).
Conclusion: Nighttime AHRM but not daytime and 24-h AHRM were related with both 24-h UAE and UPE in patients with type 2 diabetes. Whether augmentation of autonomic dysfunction specifically during nighttime should be evaluated in patients with type 2 diabetes.
Declaration of interest: The authors declare that there is no conflict of interest that could be perceived as prejudicing the impartiality of the research project.
Funding: This research did not receive any specific grant from any funding agency in the public, commercial or not-for-profit sector.