Endocrine Abstracts

JOINT3793

Introduction: Cardiovascular autonomic neuropathy (CAN) is significant cause of mortality and morbidity in diabetic individuals. Postprandial hypotension (PPH) is one of the clinical manifestation of CAN. The aim of study was to explore the frequency of CAN and spesifically PPH in different glucose tolerance abnormality states meeting prediabetes criteria, besides the relationship between CAN, PPH, and diabetic microvascular complications.

Methods: A total of 82 patients who met the criteria for prediabetes according to fasting, random blood glucose or HbA1c levels included in the study. During OGTT, blood pressure and heart rate were evaluated in 0, 10, 20, 30, 45, 60, 75, 90, 105 ve 120. minutes. Resting heart rate and heart rate after inspiration, orthostatic hypotension assessment, ECG recording following Valsalva maneuver, handgrip test were performed for evaluating CAN. One test positivity was accepted possible CAN, while 2 or more test positivity were considered confirmed CAN according to Toronto Consensus Criteria. Microvascular complications were evaluated in all patients.

Results: At least one positive test result was found in all 70 patients performed CAN tests. Of these patients, 8 (11.4%) were diagnosed with possible CAN, while 62 (88.6%) were detected confirmed CAN. Confirmed CAN were detected in 14 (87%) patients with IFG, 25 (96%) patients with IGT, 29 (91 %) patients had both IFG and IGT. Possibly CAN were detected in 2 (13 %) patients with IFG, 1 (4%) patients with IGT, 1 (9 %) patients had both IFG and IGT. The remaining patients were diagnosed with prediabetes based on HbA1c levels. PPH was detected in 27 patients (33.3%) during one or more measurement points of OGTT. This rate was 30%(n =21) among patients who underwent CAN testing. Of patients with PPH, 19 (27%) had confirmed CAN, and 2 (0.2%) had possible CAN. No cases of orthostatic hypotension were observed. Rates of microalbuminuria and peripheral neuropathy were 7.5% and 68.1% in prediabetic patients. The rates were 12.5% and 57% in possible CAN patients, while they were 6.7% and 71% in patients with confirmed CAN. No cases of diabetic retinopathy were observed.

Conclusions: Microvascular complications can develop in prediabetic state. CAN and PPH can be frequently observed in different glucose tolerance abnormalities. As part of routine evaluation in prediabetic patients, screening for CAN, PPH, and microvascular complications should be implemented.