Background and aims: At diagnosis 2030% of patients (pts) with type2 diabetes (T2DM) have neuropathy, that often goes unrecognized. Cardiac autonomic neuropathy (CAN) is associated with 5-fold risk of mortality. As today there is no specific treatment for overt neuropathy, it is important to use prevention and timely revealing. The goal of the work was to evaluate prevalence of peripheral neuropathy and CAN in pts with newly diagnosed T2DM.
Materials and methods: We observed 39 pts with newly diagnosed T2DM without known CV disease, ketoacidosis, alcoholism and/or chronic liver disease and non-diabetic nerve damages, not taking medications affecting CAN reflex tests. Ewings standard reflex tests were performed, severity of CAN was evaluated according to Jermendy, 1995. Standardized evaluation was conducted (Neurometer, Baltimore, MD), that discriminates between neuropathic and non-neuropathic pts and tests different nerve fiber types. Electric current perception threshold was measured at: 5, 250 and 2000 Hz. Measurements were obtained from hallux deep and superficial peroneal nerves. Forced choice method was used to confirm minimum intensity, which was considered as current perception threshold. Clinical data of the study population: males/females-27/12, mean age 49.3±3.6 years; HbA1c 8.3±1.73%; BMI 24.4±2.6 kg/m2.
Results: CAN test scores 0 -1 -18 cases (46.15%), 23 (mild) 17 pts (43.59%) and 46 (moderate) 4 pts (10.26%) CAN. No severe CAN were registered. CPT abnormalities had 14 pts: 8 (20.5%) hyperesthetic and 6 (15.4%) hypoesthetic, 12 of them had CAN. Positive correlation was demonstrated between prevalence of CAN and HbA1c (P<0.001); CAN and peripheral sensory dysfunction (P<0.001).
Conclusion: CAN was observed in 53.85% of the patients; peripheral sensory dysfunction prevalence here was higher (35.9%), than in general population. Undiagnosed hyperglycemia that may be asymptomatic and untreated for years, may explain why at diagnosis CAN and peripheral sensory dysfunction are present in many patients.
03 - 07 May 2008
European Society of Endocrinology