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.
|Patient classification (number of patient group)|
|ANSiscopeTM||2 H||3 E||4 L||9 A (incl.2 MA)|
|Aut. scoring||2 H||3H||3 H+1 E||5 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.
01 - 05 Apr 2006
European Society of Endocrinology