Endocrine Abstracts (2006) 11 P197

Early detection of diabetic autonomic neuropathy with a new device

M Fevre-Genoulaz1, MJ Lafitte1, SS Srikanta2, L Punitha2 & S Vidyanand2


1Dyansys Clinical Research Unit, Geneva, Switzerland; 2Samatvam Endocrinology Diabetes Centre, Bangalore, India.


Introduction: Diabetic patients are at high risk of developing diabetic autonomic neuropathy (DAN). The aim of this study was to compare autonomic scoring and measurements from a new device the ANSiscope™ (Dyansys, Inc) of diabetic patients who do not suffer from DAN complications. Method: After approval of the Ethics committee, 18 diabetic patients (mean age 48±7.5) without any complication due to DAN were included in the study. They all underwent 3 standard autonomic tests:Valsalva Manoeuvre, Respiratory sinus arrhythmia, ratio 30:15 and blood pressure fall after tilt test. Classification between healthy (H)/early(E) and advanced(A) DAN was deduced from scoring as described by Bellavere et al. The ANSiscope™ computes a percentage of dysautonomia from a recording of 571 RR intervals recordings for patients at rest in supine position. They are then classified as having healthy(H)/early(E)/late(L)/ advanced(A) or most advanced(MA) DAN. Resting heart rate was used to confirm parasympathetic dysfunction in patients with advanced DAN.

Results:

Patient classification (number of patient – group)
ANSiscopeTM2 H3 E4 L9 A (incl.2 MA)
Aut. scoring2 H3H3 H+1 E5 H+4 E
2 MA patients had a resting heart rate > 100 beats/min.

Discussion: Autonomic scoring was only able to detect 2 groups of patients: 13 H and 5 E whereas the ANSiscope™ detected 5 groups: 2H, 3E, 4L and 9A (including 2 MA cases). The results obtained by the ANSiscope™ were stable and reproducible. The 2 MA cases had a resting heart rate > 100, which confirms parasympathetic dysfunction. These cases were classified as healthy by autonomic scoring.

Conclusion: When no complication indicates a dysfunction of autonomic nervous system and autonomic scoring detects only early stage of DAN, the ANSiscope™ was able to classify the patients in a reproducible manner. This device may be a useful tool to assess DAN in patients without clinical complication and help stratify patients at high risk to develop these symptoms.

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